Thursday, July 16, 2009

Foster Care Behavioral Guidelines

Healing Parents: Helping Wounded Children Learn to Trust & Love by Michael Orlans, Terry M. Levy
CWLA Press (Child Welfare League of America) (December 30, 2006)

Creating Capacity for Attachment: Dyadic Developmental Psychotherapy in the Treatment of Trauma-Attachment Disorders by Deborah Shell; Art Becker-Weidman Wood N Barnes (July 20, 2005)

I have improved my foster care guidelines, partly through consultation with these two books.
Again, this is only meaningful when imbedded in a context of training, supervision and support. I am currently working on developing a series of six training modules to deliver to our foster care program through out the up coming year.

All comments and suggestions would be most welcome.

Guidelines for Trauma-Informed Behavior Management in Foster Care

1. This approach to behavior management is based on the understanding that problem behaviors are the child’s attempt to manage intolerable emotions such as fear, despair and hopelessness. Because the child does not trust relationships and thus has trouble asking for and accepting help; because he or she has an overly activated nervous system; and because he or she has not learned emotion management skills, the child reacts to set backs with behaviors that help in the moment but have long term negative consequences.

2. The most powerful way to change behavior will be through forming strong relationships, creating attuned communication, creating a sense of self worth, and modeling and teaching emotion management skills.

3. Interactions with the children should be consistent with the Restorative Approach. They should display the qualities of playfulness, love, acceptance, curiosity, and empathy.

4. Whenever possible parents should promote attunement with their children. When there is a break in attunement, the parent should address it and reconnect.

5. Parents must understand that they need to help the child regulate his emotions, by remaining calm them selves, using soothing words, and naming and validating feelings.

6. Many children are shame based and do not feel worthy of life. Parents should be aware of the pervasiveness of shame, be careful not to shame the child, and understand the paralyzing effect of shame.

7. As the child begins to feel safe, her need for problem behaviors will decrease.

8. Building the relationship is more important than changing the behavior. In fact it is necessary before the behavior can change. Prioritize alliance, not compliance.

9. Behavioral difficulty should be handled through re-direction and persuasion. Consequences should not be threatened or imposed except as a last resort. Children can be kept closer in (i.e. kept to house, in sight of parents) when they have acted out, but should constantly be re-evaluated as to whether this is still necessary.

10. Points Levels and behavior charts are not used.

11. As soon as the child is back on track after any incident, they should resume normal activities.

12. Children who are having difficulty should be kept closer to parents. They should not go on trips or off on their own.

13. When a child is agitated, escalated or out of control, all parent efforts should be directed towards helping them calm down. This can be done through listening, validating, taking a walk, quiet, adult closeness and calmness. There should be no discussion at this time of consequences or better ways to handle things. These can be discussed later when the child is calm.

14. If a child has a major problem, they should be given a restorative task consistent with the problem they had. The task should include the elements of learning, making amends and reconnecting. In other words, they should be given opportunities to repair damage done, make amends to people hurt, restore damaged relationships, and do something nice for the family.

15. Until the child has completed their restorative tasks, they should not participate in extra or just-for-fun activities. They should be part of all regular activities. This means all regular therapy and school unless parents determine it’s unsafe for the child to be in these activities. They could go to bed earlier to get energy for their restorative work.

16. When the child has completed their restorative task, they should return to all normal activity.

17. Isolation to any room should not be used. Children become regulated in the presence of regulated adults.

18. Restrictions can be used (car, pool, etc). These are used when a child is not safe while doing these activities. They should be for short times such as a day or two and constantly reevaluated.

19. Children can be asked to leave the family area (if possible, with an adult) to calm down or re focus, and then return in a short time (5-15 minutes), but this should be done only rarely- children are most likely to calm down when close to calm adults, not when sent off by themselves.

20. Structure is extremely important and the children need a highly structured day with planned activities, and they are helped by knowing what will happen next. Families maintain order throughout the day by such mechanisms as plans, describing what will happen next, taking turns, quiet time, and game playing. Alternating quiet activities with more energetic activities helps the kids contain their emotions. When kids are unsafe, keeping them to a small circle of activities and people is helpful; taking them to events like large family picnics may be a set up for difficult behavior. Choices should be limited. Free time, alone time, and going to bed are particularly difficult and should be supported by the adult. Events in which there is a lot of noise, confusion and stimulation (such as shopping) can also be difficult for some children. The adults should try to structure the child’s day so he experiences success, not put him in situations for which he is not prepared. Routines, rituals and ceremonies are very helpful in establishing a safe structure in the home.

21. Bedtime and hygiene are particularly sensitive times for children who have experienced trauma. Problems in these areas should not be addressed through punishments or rewards. The children should be supported through parent closeness and creative interventions such as music, night lights, bubble baths, etc.

22. When a child’s behavior begins to deteriorate, the first question to ask is: is she feeling safe? The second question is: is she over stimulated?

1 comment:

Arthur Becker-Weidman, PhD said...

I'm glad you liked my book. Orleans and Levy are nearly done revising their book with a number of important changes and deletions.

I have a DVD on attachment facilitating parenting that many parents and professionals find helpful as well.