‘Family Time’ and young children: An examination of the family visitation experiences of young children in foster care

by Jill Barbre, MSEd, LCSW, Erikson Institute DCFS Early Childhood Project
Student, Erikson Institute/Loyola Applied Child Development Doctoral Program

When people think and talk about Family Time, or visitation between children in care and their birth parents, the horror stories they have heard or even witnessed often come to mind, but even when visits are not horrible, they are often very unsatisfying for all involved. This article will address what we all mean when we talk about Family Time, and will look at what young children in care might experience in Family Time. I will look at what the research says about young children’s experiences of relationships and trauma, and use that for further thought and discussion about what that means for their experience of Family Time/foster care visitation.

What is family time and what is Family Time?

I use the term family time in two ways: small f and t family time, and capital F and T Family Time, to make the point that there is a difference between the two, but there are aspects that both can share, and that it can be helpful and instructive to look at both. Small “ft” family time is what anyone has with their family, and in the context of this discussion, any family time spent with young children. We can look at capital “FT” Family Time in terms of the role one holds within child welfare. The following questions can help to spur one’s thinking about what meaningful and quality family time looks like and how it might inform how we think about Family Time:

• What does family time look like for you in your own life? 
• How does any child experience family time?
• How do you see Family Time from the perspective of your role in child welfare? 

What is Family Time like for children in care? A story

To help reflect on what Family Time can be like for young children in care, I will share a brief story, from a baby’s perspective, created from a variety of actual stories which are not uncommon, but do not represent any one particular identifiable child.

A baby’s story: I’m a 6-month old baby girl. My foster mother is putting me in my snowsuit, I know something is going to happen. She’s smiling at me and talking and I’m saying a lot back to her, in my baby way. She puts me in my car seat and now I really know that something is going to happen. I’m feeling warm and I fall asleep while I wait to find out. When I wake up, I’m in a strange car seat and a strange person is taking me out. I don’t recognize their face or voice, I startle and start to feel uneasy. The strange person carries me in my car seat to a room where there is another person I’m not sure about. She smells familiar, her voice sounds really familiar, I look her all over and study her face. I love how familiar she feels but also I start to feel terrified and don’t know why. She takes me out of my car seat but she leaves me in my snowsuit for a while and I start to get hot and fussy. She finally takes me out of my snowsuit but I’m really scared too and I start to cry really hard. She jiggles me and walks me around but I’m too far gone. Lots of grownups start to come by and talk to her. Her face is sad and angry and scared. I’m so scared I can’t stop screaming. She starts to shout with the strange person who brought me there. She puts me back in my snowsuit but she’s not gentle like I’m used to, and her face is upset. She puts me in the car seat and gives me back to the strange person. I’m screaming and screaming, and then I pass out. When I wake up I see my foster mother’s face. She looks worried and talks with me softly and I start to settle a little, but later on at night I have a really hard time getting to sleep like I’m used to and I wake up crying a lot. The next time my foster mother tries to put my snowsuit on I get scared and cry and struggle to make her stop, and she looks like that makes her confused.

This story illustrates many common aspects of the visitation experience for young children. For the child, the visit isn’t just the visit; it’s before, during, and after. It is what is happening in the child’s mind in between visits, either implicitly or explicitly depending on the child’s developmental capacity for memory. The child has a sense of both connection and disconnection from all of the adults who are part of this experience. The child’s sense of safety or unsafety in the visit is dependent on predictability and the attachment relationship they have come to rely on.

We don’t always know what triggers a trauma response in a young child, but we can see something has done that when we observe them in a state of being overwhelmed and dysregulated. Each child at their different age and stages has different developmental capacities for coping—the kind of memories the child has, how the child uses memory to predict their experience and to cope, how the child is able to make bids for attention and support, how the child experiences time (what is a long time, a sense of before/after or a fuzzy sense of that), and how the child shows their attachment needs, which can be either clear or confusing to adults.

Young children have different ways to cue that they aren’t coping and their capacities for coping have become overwhelmed, but these cues can be confusing, or the adults around them don’t always know how to read or interpret these cues, and that affects how the adults help or don’t help children to cope. Adults can help young children by providing predictability, helping to co-regulate, etc., and they can hinder or even retraumatize young children by misunderstanding and being misattuned or even getting mad at them for what is understandable behavior given the circumstances, as well as the child’s age and experience.

What does research have to say to us about what young children in care need?

Visitation is pointed to in research studies as one of the biggest predictors of reunification, but what does this mean? The story I’ve told here, not such an unusual story, illustrates how important it is to look a little closer, and think about what visitation is actually like for children. Often, visitation is already happening, no matter what the outcome will ultimately be in terms of reunification, what a child and parent have been through together, and regardless of a parent’s capacities for a good visitation experience. 

What is attachment and why is it important?

Attachment is a word that is widely used, but often without clarity. So, what are some of the things researchers in the early childhood field say about attachment?

“Thus, just as animals of many species, including man, are disposed to respond with fear to sudden movement or a marked change in level of sound or light because to do so has a survival value, so are many species, including man, disposed to respond to separation from a potentially caregiving figure and for the same reasons” (Bowlby, 1988).

Attachment is an evolutionary and biologically-based strategy for infants and young children to ensure their basic needs are met and they are safe. Infants signal their needs for attachment to the adults who care for them, and those adults are primed to respond. Proximity is a big part of the biological basis of attachment, so that young children and the adults who care for them have a sense of everything being all right when they are close, and a fear of potential danger when they are separated. Starting from birth and developing over the next year of life (and refining over the rest of their lives), children are developing a sense of what their attachment base is like—is it secure and safe, is it unreliable, is it unavailable, is it frightening? Children learn this through the style of response they get from their caregivers. When we talk about attachment, it should be more nuanced, include more of these kinds of details, not just “is the child attached or not?” Any kind of attachment relationship helps to form development in some way, but stable, caring relationships and attachments are essential for healthy development.

Developing an internal working model of relationships

What we know about infants and toddlers is that they are developing their “internal working models of attachment” (Bowlby, 1979). That is, the images they have in their mind about what to expect in relationships with others. Their internal working models of attachment and relationship inform how children learn to predict what will happen with their parents and caregivers, themselves, and in their worlds. They are developing their cognitive capacity for memory about what usually happens and they use this to think about what is supposed to happen with other people. They can use their internal working model to build a capacity to hold their caregiver in mind when their needs are not met right away, or when they are separated from them. The development of these self-regulatory capacities are all dependent on the child’s relationships and experiences, and take time to develop and internalize. So as an example, the baby who is fed when they signal their hunger by crying starts to learn that this will happen, and that helps them to trust that they can wait a little before crying—that baby is developing a model in their mind that people will help them. When the baby is not fed when they’re hungry, their internal working model develops differently—that baby develops the idea that people are not there to help, and that baby learns that their signals don’t have the same meaning as for the baby who is responded to.

Here is another way of saying what attachment is from Stephen Seligman, the infant mental health clinician and theorist: “In developmental terms, we want the child to experience and learn co-regulation of emotion, of attention, of information exchange, of cooperation, and to internalize a strong sense of security.” (Bretherton et al., 2011, p. 541)

This is where relationships cannot be separated from a child’s developmental skills—it’s not that they have or haven’t learned words to say what they feel, that they have or haven’t learned to behave, or that they have or haven’t learned to cope with difficulty. It’s that someone, or more typically people important to the child, have guided them in how all of this happens, have been there with them (or not) when they struggle to help them through. Healthy, supportive relationships provide the buffer for all of us in dealing with stress, and the process of learning about how this works starts in our earliest moments, months and years. Relationships that are not as healthy and supportive, especially when they are toxic, can influence children’s development and how they manage stress in ways that are not beneficial to the child.

The question about attachment becomes, again according to Seligman (Bretherton, 2011, p. 541): “what kinds of situations will support those co-regulative processes [which are how the parent and the environment helps the child to regulate] that we now know are the sources of self-regulatory processes in all of those areas.” Notice that he’s saying it’s not just “is the child securely attached or not.” It’s about how is this child responded to when they need something? How does this child show what they need? What is the adult’s response to the child teaching that child about what to expect from other people, and what to expect in terms of their safety in the world? How is the child showing what they have learned to expect from others – are they avoidant because they don’t expect a response? Are they attention seeking because they might get a response but they aren’t sure? Or do they expect that their signals for help will be responded to the way they need? Those are the kinds of behaviors and expectations that an Internal Working Model starts to develop in a child, and the kinds of co-regulation that adults do in the ways that Seligman is talking about are all part of that development. We can think about the baby’s story again, and about how important co-regulation would be in that kind of scenario —co-regulation of emotion, of attention, of information exchange (or you can call it communication), of interaction and cooperation.

Why is it important to think about transitions for young children?

Transitions, especially between caregivers, are a kind of flashpoint for attachment and co-regulation experiences for an infant or young child. In transitioning from one place or person to another, the infant and young child are looking for what tells them that they are safe, and they are exquisitely attuned to what feels unsafe. As an example of this, the researcher Ed Tronick conducted a study called the “Still Face Experiment” in which he video recorded what happened if a mother who had just been playing with her baby suddenly stopped and gave no emotional cues or feedback at all – if she just had a “still face.” (Tronick et al., 1978) In the iconic video example, the baby starts to fuss and then slowly to fuss and then become emotionally and physically dysregulated when the mom doesn’t respond to his bids for attention and connection. The “still face” was something unexpected and unusual for that baby, who expected his mom to continue to talk and smile at him. When disturbances happen that interrupt what a child expects, a child looks to their attachment figure to help right themselves, and when that caregiver isn’t available, the child has to figure out something else or they can fall apart. This happens for securely attached children as much as for anyone.

When we think about transitions for young children, we often think about “transitional objects”—that is a fancy clinical term for blankie, or lovie, or teddy bear, or whatever a child has chosen as an object that helps them cope with stress and especially the stress of separation. They are called transitional objects because they are a stand-in for the caregiver—not the person themselves, but something in between—and the child is able to use them to calm themselves rather than always needing the caregiver to help them. A child’s ability to use a transitional object is like an outward sign of the Internal Working Model the child is building.

Think about any infant or young child transitioning between one person and another, what do we look for? Whether they are comfortable yet or not, what will help them feel comfortable, do they “like” the person we are handing them off to, or like us if we are that person? What if they don’t? Think about children in a new child care or school experience. Think about children with family members they haven’t seen in a long time. What helps them get used to the new place or new person and start to feel safe? A strong Internal Working Model of security and expectation of safety is one way that children cope, but a young child can’t just rely on that to deal with new or different places or people—they need time, they need their familiar attachment person or help to call their familiar attachment person to mind, and they need their familiar person to behave in ways they expect. It can help us to think about what these normative attachment experiences can tell us about what children in care go through, and what they need.

Here is a table that sums up how attuned attachment relationships not only support a variety of emotional and regulatory processes in the child, but also have an impact on a deep level, building the brain and neurological system in ways that help children to cope with future stress—like building emotional muscles.

Adapted from Zilberstein (2014, p. 295)

As described by the Center for the Developing Child at Harvard University (2007):

Studies show that toddlers who have secure, trusting relationships with parents or non-parent caregivers experience minimal stress hormone activation when frightened by a strange event, and those who have insecure relationships experience a significant activation of the stress response system. Numerous scientific studies support these conclusions: providing supportive, responsive relationships as early in life as possible can prevent or reverse the damaging effects of toxic stress.

When we think about the relationship experience of children in foster care, it can look very different. Children in care have by definition experienced at least one trauma—separation from the caregiver they had known as their base (unless they have been with family all along and those family become their placement caregivers)—and they often have experienced a lot more trauma as well. They also experience misattunement and a lack of supportive co-regulation in their experience of being cared for. Children in care often have not fully recovered from the toxic and traumatic stress they may have experienced before their placement and from their experience of separation, so they can still become easily triggered by what other children would perceive as normative stress, like being separated for a short time from their caregiver, having to wait for something they want, being exposed to others’ negative feelings. These experiences are hard for the adults around them to recognize as triggers. They have often developed a different kind of internal working model, which does not them to cope. They need extra buffering in the relationships around them to begin to heal their trauma and their traumatic expectations of relationships.

What happens without an attuned caregiver and a secure attachment?

• Children have difficulties coping with disturbing thoughts, feelings and experiences.
• Children can show biological markers of fear and apprehension (increased cortisol levels) even when they are outwardly showing that they want care and comforting (securely attached children do not show increased cortisol levels when crying to get their caregivers’ attention).
• Children have trouble recognizing, regulating, and integrating various cognitive and emotional cues.
• Self-regulation and problem solving remain less developed as the child’s attempts to cope with dysregulation leave little space for concentrating on, using, and developing higher-order cortical regions and skills—this leaves them especially vulnerable to trauma and stress.

Adapted from Zilberstein (2014, p. 296)

The above table describes the things that can happen when a child who has experienced trauma doesn’t have access to attuned attachment relationships, or when their parents or caregivers are the source of their trauma. Without relationships that begin to help them to recognize feelings of safety in relationship, children in care often cannot tell the difference between who is safe and who is not. As illustrated in the story above, until these children heal, they can be easily triggered back into a traumatized state. When children are in that state, they can often feel like no one is safe for them. What we hope is that children can begin to develop these kinds of relationships with their foster caregivers, but we also know that young children are often in flux in terms of their placements, and often haven’t had enough time with a caregiver to provide a secure base. This is often their context for visits, too – such as going from one relationship that feels too new not to be shaky, to see their parent for a brief time, and then going back to that new relationship where they may not feel quite safe yet.

Alicia Lieberman shares what can happen to the internal working models of young children in care when they don’t have a secure base: they can develop “traumatic expectations”:

• Shattering of developmental expectation of protection from the attachment figure
• The protector becomes the source of danger
• “Unresolvable fear”: Nowhere to turn for help
• Contradictory feelings toward each parent
• Life-long fears of intimacy
• Fear of feeling leads to acting out

(Adapted from Babies and Parents Can't Wait)

What we know about young children is that their brains and nervous systems are still capable of healing from toxic stress when they are provided with supportive, responsive relationships. Foster caregivers are supposed to be those people for children in care until the child’s parents are able to do so. What we don’t want to happen is for children in care to have more trauma experiences at the same time as they are trying to heal from them.

It’s important to note that children in care can develop positive attachment relationships with their caregivers, and to think about what that does and doesn’t mean for their Family Time visits and for their relationships with their parents:

• Seeing their placement caregivers as their attachment figures doesn’t mean children don’t deeply want to be connected to their parents, too—they do want that.
• It might mean they have been able to develop a secure base with the person who is most responsible for their daily needs and safety, and have come to rely on and expect that from that person.
• It isn’t appropriate to make judgments about the quality of attachment between parent and child on the basis of Family Time visits, because that experience  already places stress on the child’s attachment system -  by separating them from their foster caregivers, by leaving them in the care and transportation with people they may not know to get to a visit, and by bringing up feelings of uncertainty about whether the parent they had been separated from is going to disappear again from their lives.
• We need to support the quality of all of the relationships and interactions that surround young children, during Family Time and at all times.

How can the relationships around a child in care buffer their experience in visitation? We can’t avoid all of the problematic moments, because visitation inherently brings up stress and sometimes trauma. We’ve talked about attachment relationships and how important they are to a child in care, but I’d like to offer another idea—the power of simple interactions and developmental relationships in the interactions that surround children’s Family Time experience.

Nadine Burke-Harris, a pediatrician who has worked on helping recognize how adverse childhood experiences show up in children’s health outcomes, points to relationships as the most healing factor for trauma in children’s lives. (Burke-Harris, 2018) She is also now the surgeon general of the state of California, and is very keen to provide children with trauma-informed, buffering relationships in the different contexts that children find themselves in, like schools. As part of this, she advocates that teachers and school personnel also need to become co-regulators and buffers for children (Merrill, 2020), not just the child’s family, and we can extend this idea to the child welfare context.

The idea of developmental relationships comes out of work done by Junlei Li, who is now with Harvard, but was the head of the Fred Rogers Center in Pittsburgh for several years beforehand. He identified the four “active ingredients” that are needed to provide supportive “developmental relationships” for children. (Li & Julian, 2012) And he and his group of researchers were not just looking at parental or caregiver relationships, but teachers, afterschool workers, and even crossing guards—any adult that has an interaction with a child can make it a high-quality interaction by including these ingredients. These four ingredients are: a feeling of positive connection between the child and adult; a sense of back and forth interaction so that the child feels like an equal participant; that within the interaction the child is given opportunities to explore and grow; and that the child feels fully included in what is going on (Li & Julian, 2012).

So a case manager, a case aide who supervises visits, people who are involved in transport, the receptionist at an agency, family court personnel, can all engage in these high quality interactions with young children, help to buffer their stress, and help parents to focus on these four ingredients during their visits - and in those ways help to make Family Time transitions and interactions less stressful or toxic.

Summary

A focus on these issues in the context of Family Time/foster care visitation for young children can bring up many thoughts and ideas about how this experience might go better. It is important to listen to the “voices” of children, and also the voices of child welfare professionals “on the ground.” One idea from my conversations with child welfare professionals is that parents could be helped to understand trauma before visits, so they know what to expect with their children and in their own feelings and experience. Another is that planning for Family Time should not just be about the schedule, or about compliance with visits. Others say that presenting more detail in court about how visits are going for children, parents, and in the parent-child relationship can help with better decision-making and planning about Family Time. Children’s developmental capacities need to be considered in planning Family Time—for example, a two or four-year-old isn’t really able to sit in front of Zoom for one hour a week, or even make sense of an in person visit one hour a week, so it is important to look at what would work for them that can make Family Time more meaningful and not a waste of time.

It’s important to look at children’s behavior around Family Time, and especially to note whether they appear to be feeling safe or not, and looking at their behavior as communicating meaning and not just as something to manage. Transitions and changes in return home goals are important to think about in terms of the child’s experience—for example, by not just changing the frequency of visits without considering how that can impact the child. Policy does not always state a specific amount of time for visits, so that there is leeway for young children’s needs to be taken into account by the court and included in Family Time decisions and planning.

Finally, a Family Time visit is a whole experience for a child, it’s not just their interactions with their parents—all of the adults involved are important. It’s important to build in a sense of support, safety and predictability for a child’s experience of Family Time, however this looks for that child and where they are in their particular developmental phase and life experience. We need to be attuned to the fact that Family Time visits can bring up trauma reminders for children (and for parents) but we don’t want to further traumatize them, if we can help it. We want to be aware of children’s trauma reactions and help figure out what can help them to regroup and feel safer, and help them to really connect with their parents and make it a better experience for all.

Resources for further information about young children and foster care visitation:

• Family Time
• Child Welfare Parent Visits
• Child Welfare Services for Infants and Toddlers
• ZerotoThree Developmental Approach to Child Welfare Services for Infants and Toddlers
• ZerotoThree Core Components of the Safe Babies Court Team Approach

References

Bowlby, J. (1979). The making and breaking of affectional bonds. London: Tavistock.

Bowlby, J.  (1988)  A  secure  base: Clinical  applications  of  attachment theory. London: Routledge.

Bretherton, I., Seligman, S., Solomon, J., Crowell, J. and McIntosh, J. (2011), “If I could tell the judge something about attachment…”: Perspectives on attachment theory in the family law courtroom. Family Court Review, 49: 539-548. https://doi.org/10.1111/j.1744-1617.2011.01391.x

Burke-Harris, N. (2018) The deepest well: Healing the long-term effects of childhood adversity Boston: Houghton Mifflin Harcourt.

Center on the Developing Child (2007). The Impact of Early Adversity on Child Development (InBrief). Retrieved from www.developingchild.harvard.edu.

Li, J. & Julian, M. (2012) Developmental relationships as the active ingredient: A unifying working hypothesis of ‘‘What Works’’ across intervention settings. American Journal of Orthopsychiatry, 82:2, 157–166.

Lieberman, A. Babies and parents can’t wait: Addressing the impact of parental trauma and substance abuse on the parent-child relationship. Presentation retrieved from: https://calswec.berkeley.edu/sites/default/files/babiesandparentscantwait.pdf

Merrill, S. (2020) Trauma is “written into our bodies”—but educators can help: Dr. Nadine Burke Harris, California’s first surgeon general, on the impact of multigenerational adversity, SEL in the classroom, and the transformational powers of meditation. Retrieved from: https://www.edutopia.org/article/trauma-written-our-bodies-educators-can-help

Tronick E, Als H, Adamson L, Wise S, Brazelton TB (1978). The infant's response to entrapment between contradictory messages in face-to-face interaction. J Am Acad Child Psychiatry. Winter;17(1):1-13.

Zilberstein, K. (2014) Trauma’s neurobiological toll: Implications for clinical work with children. Smith College Studies in Social Work, 84, 292–309.