Transcript A Proposal of a Multiple Family Group Weekend Visitation

Visitation and Strengthening the
Parent-Child Relationship in
Foster Care
Joanne Cannavo, MSSA, CSW
CDHS
University at Buffalo
School of Social Work
© 2004 CDHS College Relations Group Buffalo State
College/SUNY at Buffalo Research Foundation
Background Information
Estimates of children in foster care
have increased over the years.
 Although estimates vary, there are over
542,000 children in foster care in the
United States.

Child Welfare League of America, 2004
Upstate Foster Care: 1998-2002
In Care, Admissions, and Discharges
1998
1999
2000
2001
2002
13,281
12,936
12,470
12,233
12,045
Admission 7,704
7,480
7,297
7,257
6,832
7,765
7,927
7,865
7,466
7,119
In Care
Discharge
Reasons for Foster Care Placements

(1) Child Maltreatment, Physical Emotional
& Sexual Abuse
Denby & Curtis, 2003
–
–
–
In 1999, 87.3% of abuse and neglect
perpetrators were parents. Huebner, 2002
In 2002, 81% of abuse and neglect
perpetrators were parents
U.S. Department of Health and Human Services, administration on Children, Youth and
Families. (2004). Child Maltreatment 2002. Washington, DC: US Government Printing
Office, p xviii.
Reasons for Foster Care Placements
 (2)
Substance Abusing Parents
McNichol & Tash, 2001
Reasons for Foster Care Placements
 (3)
Parent’s psychological
instability and therefore inability to
care for children. Denby & Curtis, 2003
Reasons for Foster Care Placements
 (4)
Damaged attachment and
relationships between parent and
child due to various family
problems
Haight, Black, Mangelsdorf, Giorgio, Tata, Schoppe, & Szewczyk,
2002; Haight et al., 2003
Reasons for Foster Care Placements
 (5)
Failed reunifications resulting in
return to foster care placements.
Davis, Landsverk, Newton, & Ganger, 1996
Duration of Foster Care and Factors
Associated with it


Children average a duration of 33 months in
foster care
Most frequent duration intervals in foster care
are those lasting:
–
–
–
–
–
1-5 months
6-11 months
12-17 months
3-4 years
5 or more years
US Deartment of Health and Human Services, Administration on Children, Youth and Families, 2004
Duration of Foster Care and Factors
Associated with it

The younger a child is when he or she
enters foster care, the greater the
likelihood that child will spend a large
portion of their childhood in the foster
care system.
George & Wulczyn, 1998
Duration of Foster Care and Factors
Associated with it
Multiple placements are an issue
 Several multiple placements take place,
whether in traditional foster homes or
residential treatment facilities

Rubin, Alessandrini, Feudtner, Mandell, Localio, & Hadley, 2004
Duration of Foster Care and Factors
Associated with it


Once children are in the system as
adolescents, they tend to age out of the
system rather than find a permanent home
About 20,000 youths mature out of foster
care at age 18 and face independent living
with little supports or resources
Reilly, 2003
Duration of Foster Care and Factors
Associated with it

As a result, they struggle with employment
issues, homelessness, lack of education and
problems with living arrangements.
Reilly, 2003
Duration of Foster Care and Factors
Associated with it
Reunification is not a viable option for
every child
 For some youth, reunification is not
likely to occur

Yancey, 1998
Duration of Foster Care and Factors
Associated with it


The effectiveness of some independent living
centers implemented over the last 15 years
is questionable.
As a result, inadequate psychosocial abilities
to function are note focused upon or
resolved.
Reilly, 2003
Duration of Foster Care and Factors
Associated with it

Parents who have a diagnosis of a serious
emotional disorder have a greater likelihood
than other less disturbed parents to have
their children permanently removed from
their homes
Taylor, Norman, Murphy, Jellinek, Quinn, Poitrast, & Goshko, 1991
Duration of Foster Care and Factors
Associated with it




The foster care system’s response to the mental health
needs of such children has lacked.
Thirty five to 85% of adolescents in foster care have
emotional disturbances
Thirty percent of children in early and middle childhood
have severe emotional, behavioral and developmental
problems.
These children have higher rates of depression, lower
social skills, poorer adaptive functioning, and more
externalizing behaviors, such as aggression and
impulsivity. Yancey, 1998
Factors Associated with Foster Care



The juvenile court system must make decisions
about the well-being of children daily, and such
children in the child welfare system are
becoming younger over time Osofsky, 2003
Approximately 120,000 children enter the
foster care system prior to their first birthday
U.S. Children’s Bureau, 2001
Given the increase in such a young population
entering the child welfare system, the courts
must address the needs of this young, at-risk
group of children, who in essence have largely
been ignored by the courts.
Existing Permanency Plans







Reunification with parent(s) or principal
caretakers (44%)
Adoption (22%)
Emancipation (6%)
Living with other relatives (5%)
Guardianship (3%)
Long term foster care for children who are
institutionalized (8%)
Not yet established (11%) U.S. Children’s Bureau, 2001
Status of Reunification Plans

Reunification of children from foster care with
their biological parents after having been in
foster care has been criticized due to:
 declines in reunification rates
 the instability of some reunifications Jones, 1998
 Many families who are expected to be
reunified are not or the children
subsequently reenter foster care Downs, Costin, &
Mcfadden, 1996
Public Policy Information yielding such
Reunification goals

Adoption Assistance and Child Welfare
Act of 1980 (P.L. 96-272) requires
regular visitation to take place between
parents and their children when they
are in foster care.
Public Policy Information yielding such
Reunification goals

Adoption and Safe Families Act of 1997
(AFSA; P.L. 105-89) purports that family
reunification remains the goal for the
majority for foster children.
Public Policy Information yielding such
Reunification goals

The AFSA policy objective to reunifying
foster children with their parents has
been criticized due to declines in
reunification rates and instability of
some reunifications.
Haight, Kagel, & Black, 2003
Background Information

Between 50% and 75% of children placed in
out of home care eventually reunify.

Between 20% and 40% of those reunified
subsequently reenter foster care
Taussig, 2002
Child Factors Associated with
Decreased Rates of Reunification
Being an infant
 Being African American
 Having been removed for neglect

Taussig, 2002
Family of Origin Factors associated
with Decreased Reunification Rates:

(1) Lack of Parental Visitation while
children are in foster care

(2) Family Poverty
Child Welfare Variables Associated
with Decreased Rates of Reunification

Longer time spent in out of home care

Having been placed with a relative
Taussig, 2002
Risks of Being in Foster Care
Long-term research indicates increased
risks for:
Not finishing high school (37%)
 Incarceration (27% M; 10% F)
 Unemployment (50%)

Taussig, 2002
Risks of Being in Foster Care

Youth who were reunified with their
biological families after placement in
foster care were more likely to have
more negative outcomes and
problematic lives than those who were
not reunified.
Taussig, Clyman, Landsverk, 2001
Risks of Being in Foster Care

Reunified youth, compared to youth who are
not reunified, are more likely to:
 get a ticket or be arrested (49.2%
versus 30.2%)
 have more behavior problems (59.5%
versus 55.7%) have lower overall
competence (41.1% versus 45.0%)
Taussig,
Clyman, Landsverk, 2001
Risks of Maltreated Youth in Foster Care
Longitudinal research, 1991, CA study:
Self-destructive behavior
 Substance abuse
 Total risk behaviors
 Likelihood of getting a ticket/arrested

Risks of Maltreated Youth in Foster Care
Dropping out of school
 Receiving lower grades
 Increasing problems in internalizing
behaviors
 Increasing total behavioral problems
 Decreased total competence

Focus Group Issues
Visitation programs are untapped
resources for families
 Visitation is a critical piece of permanency
planning
 Increased therapeutic perspective and
therapeutic sites are needed

Focus Group Issues
Visitation is the key to whether or not a
child will return home
 Home-visits are necessary
 Visits should not be held in foster
parents’ homes
 Children should see their parents
immediately upon removal from homes

Barriers to more Successful Foster
Care Placements, Visitation &
Reunification








poor / little space for visits
Too few agencies offer visitation
No uniform visitation process
Foster care workers have varied roles
(active vs. passive)
Transportation of children
Frequency of visitation not sufficient
Poor retention of parents
Varied visitation supervisors
Attachment

There is a rising importance of
strengthening the parent-child relationship
during visitation as the factor that will
determine reunification. Haight et al., 2002, 2003
Attachment

Many factors strengthen this
relationship, such as the emotional
bond of Attachment. Haight et al., 2003
Factors Associated with Attachment

Some believe that the differences in
security of attachment are a direct
result of the care given by the person
whom one is attached to, and not a
result of any child factors. American Academy of
Pediatrics, 2002
Factors Associated with Attachment

Exceptional parenting has reliably been
found to yield secure attachment in
children from various backgrounds.
Clements & Barnett, 2002
Factors Associated with Attachment

Emotionally healthy personality characteristics
of parents and child play a role in predicting
positive quality of attachment Kendler, Sham, MacLean, 1997;
Small, 1998
Factors Associated with Attachment

Parents who had a loving relationship with
their own mothers were two times more likely
to have a loving attachment relationship with
their children Brook, Richter, & Whiteman, 2000
Factors Associated with Attachment

Secure infants are more apt to resolve
subsequent developmental struggles more
functionally when compared to insecurely
attached infants Eiden, Edwards, & Leonard, 2002
Factors Associated with Attachment

Regular contact between parent and
foster child yield greater closeness and
identification to the family as the child
ages. Browne & Maloney, 2002
Effects of Poor Attachment on Children



There are many factors that can prevent a
healthy emotional attachment, particularly during
infancy.
Various occurrences and situations may be
considered that may either prevent or damage
attachment.
Disruptions in attachment may take place when
the attachment figure is not available or
responding to the child, such as what may take
place during separation or some disruption in the
care provided to the child Bowlby, 1973
Effects of Poor Attachment on Children

Infants who are insecurely attached are more
inclined to have difficulties negotiating
significant developmental issues later in life,
ranging from autonomy and ego resilience to
social proficiency and emotional wellbeing.
This insecure attachment may be an early
indicator for maladaptive behavior later in life
Eiden, Edwards, & Leonard, 2002
Effects of Poor Attachment on Children

Maltreatment is another aspect that may
yield attachment problems.

Maltreated infants are at higher risk for
forming disorganized attachments to those
who take care of them. Carlson, Cicchetti, Barnett, & Braunwald, 1989
Effects of Poor Attachment on Children


Maltreated preschoolers develop a distorted
concept of themselves and those taking care
of them Toth, Cicchetti, Macfie, Maughan, & Vanmeenen, 2000
Maltreated children may have inaccurate
conceptions of themselves and those taking
care of them, as well as peers when at
school age Dodge, Petit, & Bates, 1994
Effects of Poor Attachment on Children

Longitudinal studies show that neglect
is correlated with avoidance of
attachment figures in infancy,
dysfunctional social skills, behavior
control, self-esteem, and preschool
problem-solving ability. Huebner, 2002
Effects of Poor Attachment on Children

Parents with personal turmoil (ie.)
anxiety, post-partum depression) have
poorer attachments with their children.
Kendler et al., 1997
Improving Attachment and the ParentChild Relationship: Types of
Intervention Studies






Formalized Psychological Treatments
Educational Home Visitation
Multiple Family Group Therapy Intervention
Change of Residence
Play Therapy
Combination of Interventions
Implications: Foster Care & Visitation
An increase in attachment between parents and
children will likely have the following effects:
 Decreased length of stay in foster care
 Increase in successful reunifications
 Decreased frequency of returns to foster care
 Increased family happiness and child mental
health
 Decreased incidence of abuse or neglect
Haight et al., 2002; Haight et al., 2003
Visitation


Reunification is the primary permanency goal
for most of the children in foster care Haight et al., 2003
“Parent visitation, the scheduled face-to-face
contact between parents and their children in
foster care, is considered the primary
intervention for maintaining and enhancing the
development of parent child-relationships
necessary for successful family reunification”
Haight et al, 2003, p. 195
Visitation


The emphasis of reunifying children in foster
care with birth parents requires that birth
parents have supervised visits with their
children.
There is evidence that the more active the
parents are in visitation, the more likely
reunification will occur. Davis et al., 1996
Visitation

Visitation needs to improve while
incorporating the perspectives of parents and
foster parents, as well as child welfare
workers. Haight, et al., 2002
Visitation: Parents

Haight et al. (2002) described the grief and
strife suffered by mothers after enduring
separation from their children when they
enter foster care, and emphasized the
importance of expression of emotions and
verbal interaction during visits.
Visitation: Foster Parents

Foster mothers also have a struggle to get
children emotionally ready for visits, as well
as assist them emotionally afterwards.
Haight, et al., 2002
Visitation: Child Welfare Workers

Child welfare workers struggle with
encouraging emotional closeness between
the parents and children while being
supervised, as well as have the task of
evaluating the behavior of parents during
visitation sessions.
Visitation


Another struggle hurting the process was the
varied degree of understanding of
appropriate social work practice during visits.
The adults involved bring very valuable but
different practice experience to the process
of visitation that should be better understood
by the parties involved.
Haight et al., 2002
Visitation
Example given by one study:
 What foster care workers supervising the
parent-child interactions thought was
positively reinforcing, was actually perceived
as demeaning by the biological parents who
visit their children in foster care.
Haight et al., 2002
Improving the Visitation Process

Understanding the struggles of those actually involved
in the process can address the avoided interpersonal
and psychological aspects that may affect visitation.

Understanding such complexities of visits
interpersonally and emotionally acknowledges the
struggle for those involved, particularly the children, and
can therefore offer suggestions of how to improve the
visitation between parents and children towards the
decision and goal for successful reunification Haight et al., 2002
Comprehensive Plans for the
Intervention to Increase Uniformity of
Visitation & Strengthen Relationships
(1) A Review of the Literature
(2) Introduction to Key Issues in Foster Care
(3) An Active Role in Visitation
(4) Parent-Child Interaction
(5) Safety
(6) Preventive Planning Towards Successful
Reunification
(7) Education and Other Relevant Areas of Focus
Increased Uniformity of Visitation
featuring an Active Role of Supervision


Many area professionals have conveyed that
there is little to no uniformity of the Foster Care
Visitation process.
This particularly includes the degree of
involvement in the visitation session by the
Foster Care Worker, as well as visitation
supervisors in general, visit settings, and
frequency of visits.
Increased Uniformity of Visitation
featuring an Active Role of Supervision



Towards the goal of increasing the uniformity of
visitation, this curriculum will primarily focus on:
(a) an educational intervention that will likely impact the
parents and foster care workers, and…
(b) an Active Role of the Foster Care Workers during
visitation sessions where they are interactive and
modeling emotionally healthy, appropriate behaviors
for the parents. Both of these are considered
educational impacts for the parents, as well as
interventions that will ac to increase the parent-child
relationship during foster care visitation.
Forms

Several easy-to-complete forms have been
developed towards the uniformity of the
visitation process, as well as enabling the
more comprehensive collection of
information
Forms







Guidelines to Setting Up Visitation Plan
The Importance of Visitation
Visitation Intake Form
Parent-Child Relationship Assessment Form
Visitation Contract
Supervised Visitation Program Observation
Form
Parent Impression of Supervised Visitation
Program
UNIT A – Literature Review
UNIT B: Introduction & Background


Outline of Initial Assessments, Activities and
Information
Factors placing children in foster care




Reasons caused by children
Reasons caused by parents
The True & False About Foster Care
Statistics
UNIT C : Parent-Child Assessment
UNIT D: An Active Role in Visitation
UNIT E: Parent-Child Interaction
UNIT F: SAFETY
UNIT G: Preventive Planning Towards
Successful Reunification
UNIT H: Education and Other Relevant
Areas of Focus
Intensive Educational and Assessment
Methodology for Foster Care Worker
and Parents






Basic Conflict and Resolution and Mediation
Skills
Communication and Relationship Builders
Basic Parenting Tips: 101
Three Parenting Patterns of Discipline
Child Development Guide
Scenarios: Parenting related to Child
Development
Intensive Educational and Assessment
Methodology for Foster Care Worker
and Parents






Interventions to Ensure an Active Role in
Supervising Visitation
Scenarios: Foster Care Workers Modeled
Response to Scenarios for Parents
Key Factors for Emotional Intelligence
Erikson’s Theory on Psychosocial Development
Grief and Loss
Stages of Grief and Loss: Kubler-Ross
Intensive Educational and
Assessment Methodology for Foster
Care Worker and Parents




Bill of Rights for Grieving Children
Danger Signals for Depression and Suicide
Burnout
Stress and Self-Rating Scale
Intensive Educational and
Assessment Methodology for Foster
Care Worker and Parents




Maternal Behavior Rating Scale
Reunification Planning Checklist
Follow-Up
Scenarios and Solutions for Adjustment
During Follow-Up
UNIT I: Appendix: Handouts
References
American Academy of Pediatrics, (2000). Developmental Issues for young children in foster care. Pediatrics, 106 (5),
1145-1150.
Boyd-Franklin, N. (1993). Black families. In F. Walsh, (Ed.), Normal family processes. (2nd Ed.). New York: The
Guilford Press.
Browne, D., & Maloney, A. (2002). ‘Contact Irregular’: A qualitative analysis of the impact of visiting patterns of natural
parents on foster placements. Child and Family Social Work, 7, 35-45.
Clements, M., & Barnett, D. (2002). Parenting and attachment among toddlers with congenital anomalies: Examining the
strange situation and attachment Q-sort. Infant Mental Health Journal, 23 (6), 625-642.
Camp, J., & Finkelstein, N. (1997). Parenting training for women in residential substance abuse treatment: Results of a
demonstration project. Journal of Substance Abuse Treatment, 14 (5), 411-422.
Cohen, N., Muir, E., Lojkasek, M., Muir, R., Parker, C., Barwick, M., & Brown, M.(1999). Wait, watch and wonder: Testing
the effectiveness of a new approach to mother-infant psychotherapy. Infant Mental Health Journal, 20 (4), 429-451.
References
Cosden, M., & Cortez-Ison, E. (1999). Sexual abuse, parental bonding, social support, and program retention for
women in substance abuse treatment. Journal of Substance Abuse Treatment, 16 (2), 149-155.
Dare, C. & Eisler, I. (2000). A multi-family group day treatment program for adolescent eating disorders. European
Eating Disorders Review, 8, 4-18.
Davey, T. & Abell, M. (in press). A community-based multiple family group intervention for sheltered families: Impact
of the weekend retreat.
Davis, I., Landsverk, J., Newton, R., & Ganger, W. (1996). Parental visiting and foster care reunification. Children
and Youth Services Review, 18 (4/5), 363-382.
Denby, R., & Curtis, C. (2003). Why special populations are not the target of family preservation services: A case
for program reform. Journal of Sociology & Social Welfare, 30 (2), 149-173.
Haight, W., Black, J., Mangelsdorf, S., Giorgio, G., Tata, L., Schoppe, S., & Szewczyk, M. (2002). Making visits
better. Child Welfare, 81 (2), 173-202.
References
Haight, W., Kagel, J., & Black, J. (2003). Understanding and supporting parent-child relationships during foster care
visits: Attachment theory and research. Social Work, 48 (2), 195-207.
Huebner, C. (2002). Evaluation of a clinic-based parent education program to reduce the risk of infant and toddler
maltreatment. Public Health Nursing, 19 (5), 377-389.
McKay, M., Gonzales, J., Stone, S., Ryland, D. & Kohner, K. (1995). Multiple family therapy groups: A responsive
intervention model for inner city families. Social Work with Groups, 18 (4), 41-56.
McNichol, T., & Tash, C. (2001). Parental substance abuse and the development of children in family foster care.
Child Welfare, 80 (2), 239-256.
Taussig, H., Clyman, R., & Landsverk, J. (2001). Children who return home from foster care: A 6-year perspective
study of behavioral health outcomes in adolescence. Pediatrics, 108 (1), 1-7.
References
Waters, E., & Deane, K. (1985). Defining and assessing individual differences in attachment relationships: Qmethodology and the organization of behavior in infancy and early childhood. In I. Bretherton & E. Waters
(eds.), Growing points of attachment theory and research. Monographs of the Society for Research in
Child Development, 50 (1-2, Serial No. 209).