Transcript Document 7132719

Understanding the Social and
Emotional Development of
Young Children in Foster Care
Vanessa R. Lapointe
Megan Tardif
May 11, 2006
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
Early Development – Key Points
• Interrelatedness of domains
• Establishment of internal working models of
attachment (first 2 years)
• Resilience (Schofield & Beek, 2005)
• Matthews’ Principle
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
Time
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
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
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)
Issues predating placement in care
• Abuse and/or Neglect
– Maltreated children have poorer skills in:
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Initiating interactions with peers
Responsibility
Maintaining self-control
Internalizing behaviors
Hyperactivity
Reduced quality of play
(Veloz & Fordham, 2005)
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
children’s challenges (Buehler et al., 2000)
– Children birth to 3 highest victimization rate of
child maltreatment (US Department of Health and
Human Services)
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 (59x)– this instability exacerbates existing behavioral
difficulties (Holland & Gorey, 2004)
Issues predating placement in care
• Experience of poor parental strategies
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Deficient family management skills
Harsh and inconsistent discipline
Low levels of supervision and involvement in child’s life
Lack of appropriate prosocial reinforcement
• Leads to increased risk for mental health problems
(Leslie et al., 2005)
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)
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)
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)
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)
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
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)
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)
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)
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)
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)
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
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 rescreening over-time
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).
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
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)
Developmental Screening and
Surveillance Program
Screening
Tool
Target
Ages
Time to
Complete
Domains Covered
Languages available
Publisher
ASQ – 2nd
Edition
4-60
months
10-15
minutes
language, personalsocial
fine motor
gross motor
cognition
ASQ SE
6-60
months
10-15
minutes
social and emotional
Child
Development
Inventory
0-78
months
(6 ½
years)
“Very
quick”
social, self help, motor,
language; General
Development Scale and
30 items to identify
parent's other concerns
English
Ellsworth & Vandermeer Press, Ltd.,
PEDS –
Parents
Evaluation of
Development
al Status
Birth – 8
years
2 minutes
a wide range of
developmental issues
including behavioural
and mental health
problems
English, Spanish and
Vietnamese, additional
translations including
Hmung, Somali, Chinese,
and Malaysian can be
licensed by emailing the
publisher
Ellsworth & Vandermeer Press, Ltd.,
English, Spanish, French
and Korean
Paul H. Brookes Publishing Co.,
Paul H. Brookes Publishing Co.,
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
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
(Wolverton, 2002)
6. Attention to cultural
issues
7. Monitoring and
evaluation
8. Training and Education
9. Funding
10. Designing managed
care to fit needs of
children
Broader Program
• Embedded in a more holistic approach to
foster care that recognizes the systemic
influences on young children’s 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)
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)
Developmental Screening and
Surveillance Program
• Challenges
– Resources
• Administrative
• Tools (minor)
• Early Interventionists
– Shortage!
– Defining “delay”
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
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)
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)
Questions/Comments