Before I talk to you about healing divisions in foster families through family therapies, I want to share with you a journey, my journey, of parenting through the foster care system…
Imagine for a moment that you and your spouse had a birthing and post-partum experience filled with trauma. While the experience gave you a beautiful daughter, your dreams of continuing to expand your family have not faded; nor has your fear of another traumatic birthing experience. You and your spouse decide to pursue adoption. Your agency assures you that becoming licensed foster parents is the best route for achieving your goals, so, you become licensed.
You finally receive the call that you have been anticipating. “We have a placement for you – an 11-month-old girl and 3-year-old boy.” You ask all the right questions. “Do they have other siblings?” “What is the permanency plan?” “Will there be parenting visits?” They provide all the right answers. “There’s an 8-year-old older brother placed with another family. Reunification is very unlikely. Mother is refusing to cooperate and did not appear in court. There are no parenting visits. This case will lead to adoption.” You accept placement.
The children arrive reeking of mildew, marijuana, and feces, and have nothing but the clothes on their backs. You run to the store while your partner and 5-year-old daughter attempt to make the children feel at home. You grab the essentials – clothes, shoes, diapers, wipes, car seats. You return home and give the children baths. Your new son has bruises, abrasions, cigarette burns, and a bite mark on his back and arms – some healed, some fresh. Your new daughter has severe diaper rash – skin missing from her butt and vagina. You take the children to their new bedrooms. Your daughter falls right to sleep. Your son is excited to see a Spiderman filled room. He is more excited to see that he has a bed. They both sleep until about noon the next day.
The following day is just as long as the previous. You begin getting acclimated to your new life with three children. Your daughter has hemangiomas, tachycardia, and strabismus, all of which have never been treated. Your son has a developmental speech delay and is exhibiting trauma responses including fear of loud noises, wanting all doors to be closed, and fear of being touched. You schedule doctor, dentist, and therapy appointments, find a school, begin the IEP process, and complete required applications for state assistance. You purchase a new vehicle because your current one is too small for three car seats. You learn that your daughter’s first birthday is tomorrow, so you put together an impromptu party for her with the grandparents.
A week later, you receive a call from CPS informing you that Birth Mother has decided to work to get her children back. Parenting visits get scheduled. Your application for childcare payments is denied. The state does not cover childcare expenses for educational purposes.
Parenting visits begin. After each visit, your son becomes violent and aggressive. He slaps your 5-year-old in the face, pushes her from on top of your play structure, slams her head against the wall. He yanks at his baby sisters’ limbs and throws toys at her head. As time progresses, he begins exhibiting sexually inappropriate behaviors including attempting to grind on your 5-year-old, grope your breasts, and fondle his baby sister’s nipples. You plead for assistance from your foster care worker. You beg them to suspend parenting visits and provide support for your son. You craft a 30 page letter for the court documenting the negative effects of parenting visits, including Birth Mother physically abusing your son during a visit in front of foster care workers, her missing visits, her missing doctor appointments, her showing up to your infants surgery late and leaving prior to discharge, and videos of the drug exposure, neglect, and abuse that the children experienced in her care–details that were omitted in the petition for removal.
It’s review hearing day. You are optimistic that parenting visits will be suspended based on the foster care worker telling you that would be her recommendation. Your son had been begging to see his older brother, so you had been asking the foster care worker for sibling visits. Your faith in the system becomes shattered when the foster care worker lies on the stand. The referee asks about sibling visits and the foster care worker says they have been occurring weekly. He asks about parenting visits, and she says they have been going well. He asks about the children’s needs, and she says they have none. Icing on the cake? She recommends parenting visits continue and the referee refuses to read or admit my letter. Your son is moved to a new placement without young children due to his risk to your daughters. You attempt to maintain a relationship with him, though it has proven difficult due to conflicting schedules.
Today, a hole remains in our family where our son used to reside. Our daughter gets diarrhea every week following parenting visits. Her sleep schedule becomes disrupted from missed naps. We plan family vacations but become thwarted by obstacles. We attend weekly physical therapy, Early-on, dermatology, ophthalmology, and cardiology appointments while Birth Mother never shows up and does not follow through on her services. However, the goal remains reunification while we are in limbo, hoping and praying that our little one will forever be ours. These are the divisions that often occur between foster children and their foster families due to a system that does not truly care about the best interests of the children.
Divisions between foster children and their families
For the past few decades, the foster care system has seen record numbers of children in care (Lindsey, 2001). The children entrusted to the child welfare system often experience division within their family of origins and within their foster families, and need specific social, medical, behavioral health, and mental health services (Collado & Levine, 2007). Most children who enter the foster care system have experienced a traumatic event related to neglect, abuse, or maltreatment (Fisher et al., 2023). Experiences of child neglect and abuse and being placed in the foster care system each pose unique implications for the health and well-being of children and families (Ocampo-Chih et al., 2023). The research indicates that 47.9% of children in foster care have significant behavioral or emotional problems, and 40-80% of children have mental health disorders (Collado & Levine, 2007). Despite these numbers, only 3% of mental healthcare professionals provide services to children in foster care or their families (Collado & Levine, 2007), creating a deficit in mental health accessibility. Some evidence suggests that this is, in part, due to mental health providers being unsure of how to intervene effectively and efficiently (Crenshaw, 2004). These obstacles can be addressed through quality training for child welfare workers and foster parents, and therapists intervening within the family system using family-focused interventions to promote healing of divisions (Lindsey, 2001).
Intervening within the family system
Children in foster care and their foster families are often faced with a host of difficulties and challenges (Collado & Levine, 2007; Findley & Praetorius, 2023). Children within the foster care system frequently demonstrate disrupted attachment, behavioral problems, and psychological distress (Fisher et al., 2023), and the responsibility of healing the divisions, mending the attachment wounds, and ensuring that the foster children receive the support and services that they need falls to the foster parents (Findley & Praetorius, 2023). Other challenges such as religious and cultural differences between foster children and foster parents, or differences in their core values can also pose barriers and influence division between foster parents and the children in their care (van Bergen et al., 2023). Mental health professionals are uniquely positioned to assist children in foster care and their foster families with adjusting to their freshly formed family or healing the divisions (Graff et al., 2022), while providing them with tools to develop healthy attachments and adaptive coping skills (Graff et al., 2022; Lindsey, 2001; Reid et al., 2022). The use of family-focused interventions has shown positive health outcomes related to the children’s increased emotional regulation, improved behavior and psychological functioning, and increased attachment between children and their foster families (Fisher et al., 2023). More specifically, using attachment as a tool through interventions such as parent-child interaction therapy (PCIT), filial therapy, parent co-therapy, and emotionally focused family therapy (EFFT) can improve outcomes and heal divisions within in foster family systems (Capps, 2012; Gardenhire et al., 2019; Hart & Thomas, 2000; McWey, 2004; Mersky et al., 2016; Timmer et al., 2006; Winters et al., 2022; Wittenborn et al., 2006).
Parent-child interaction therapy
Parent-child interaction therapy was developed for children between the ages of two and seven years old to address disruptive, oppositional, and aggressive behaviors (Osofsky et al., 2017). PCIT is particularly suitable for healing divisions between foster children and their foster parents due to its approach of teaching behavior management skills to caregivers and improving attachment between caregivers and children (Osofsky et al., 2017). Using a combination of nondirective play therapy and in vivo coaching to parents, significant conduct problems, internalizing problems, and externalizing problems in children become reduced (Osofsky et al., 2017). Research suggests that PCIT, when used as an intervention with foster children and their foster parents, enhances parental attitude, mitigates parental stress (Mersky et al., 2015), and heals divisions (Mersky et al., 2016; Timmer et al., 2006). Furthermore, research indicates that PCIT is especially efficacious in improving health outcomes for children who have had adverse childhood experiences or been exposed to physical abuse, sexual abuse, physical neglect, emotional neglect, or other forms of maltreatment (Mersky et al., 2015; Mersky et al., 2016; Osofsky et al., 2017; Timmer et al., 2006).
Filial therapy
Filial therapy focuses on building and strengthening relationships between children and their parents or caregivers (Vanfleet et al., 2005). During filial therapy, therapists train parents in parenting attitudes and skills, and teach them to engage with their children in nondirective play therapy (Vanfleet et al., 2005). Filial therapy uses patience and humility to develop and enhance attachment between children and their caregivers (Vanfleet et al., 2005), which facilitates the healing of divisions. In addition to being used as an intervention, filial therapy is an effective preventative measure and promotes healthy psychosocial development (Vanfleet et al., 2005). Foster parents have reported noticing significant reduction of their foster children’s conduct and behavioral problems, emotional dysregulation, and psychological symptoms after engaging in filial therapy (Capps, 2012). Foster children often experience significant instability and unpredictability in their lives (Capps, 2012) and find it difficult to trust that their new foster families and environments are safe and stable (Capps, 2012). Filial therapy addresses these challenges by applying approaches that enhance and strengthen the foster parent – foster child relationship, providing the child with a sense of stability and consistency (Capps, 2012).
Parent co-therapy
Parent co-therapy also uses parents and caregivers as agents of change for their children (Hart & Thomas, 2000). In parent co-therapy, traditional family hierarchies are challenged to heal divisions and promote safety, security, and attachment between children and their parents or caregivers (Hart & Thomas, 2000). Parent co-therapy indirectly treats children through their parents who serve as “co-therapists” (Hart & Thomas, 2000, p. 306). Parents or caregivers work with the therapist to learn skills to advocate for their children, and the therapist serves as a mediator between the parents and other professionals, such as case workers or court professionals, and mirrors a parenting role that the parents can integrate with their children (Hart & Thomas, 2000). Foster parents learn to expand their own developmental capacities and recognize and interpret their foster children’s emotional and behavioral responses in a way that helps the children develop alternative responses (Hart & Thomas, 2000). Research suggests that once foster parents develop these skills, the attachment between them and their foster children develops and strengthens, the children’s functioning improves, and the divisions between them begin to heal (Hart & Thomas, 2000).
Emotionally focused family therapy
Emotionally focused family therapy approaches the family system from an attachment lens and implements techniques that teach the parent or caregiver how to understand their child’s needs and meet them with the appropriate comfort and affection (Wittenborn et al., 2006). This model integrates experiential techniques to identify patterns of negative interaction between family members that arise from anger and fear or facilitate division (Wittenborn et al., 2006). EFFT is then used to reprocess and reorganize encounters and promote secure attachments between family members (Wittenborn et al., 2006). This process teaches family members to communicate, regulate their emotions, and problem solve, while optimizing familial bonds and connections (Wittenborn et al., 2006). EFFT can be used to bring forth insight into the child’s foster care experience, as well as how their relationships and attachment with their biological parents may be influencing how they are relating to their foster parents (McWey et al., 2004). Additionally, EFFT can be used to heal divisions and develop attachment between each foster family member, and strengthen those attachments (McWey et al., 2004).
Summary
My experience parenting foster children, unfortunately, is a regular occurrence in the foster care system. I have heard my story echo through foster parents who have had similar experiences. Between 30% and 80% of children who enter the child welfare system have a reported mental health, physical health, emotional health, conduct, or chronic health condition (Gardenhire et al., 2019), and their foster families rarely receive the knowledge or support needed to ensure their foster children receive adequate care (Collado & Levine, 2007), causing undue stress and division between foster children and their foster parents (Crenshaw, 2004). Although nearly 50% of foster children experience significant mental health difficulties, few mental health professionals work with children and families (Collado & Levine, 2007), and fewer receive training or education on working with foster children and families (Gardenhire et al., 2019). To address the lack of sufficient training for professionals and accessibility for foster children and families, and promote healing of the divisions, mental health professionals need formal training in working with foster families and require support in learning to implement family focused interventions into their work.