Sunday, July 12, 2009

Guidelines for Trauma-Informed Behavior Management in Foster Care

I am working on training and materials to adapt the Restorative Approach for foster parents. As one piece of it, I am developing Behavior Management guidelines for foster families. The guideline will be meaningless unless embedded in a training program that teaches how to understand trauma, how to help children heal, understanding symptoms as adaptations, the use of the relationship, and taking care of ourselves. However, I do think it will be useful to give parents specific ideas about what we expect them to do. Here is what I have so far, and I would greatly appreciate feed back. Just click the word "comment" below. Thank you.

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. (Daniel Hughes)

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

5. Behavioral difficulty should be handled through re-direction and persuasion. Consequences should not be threatened or imposed except as a last resort.

6. 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.

7. Points Levels and behavior charts are not used.

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

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

10. 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.

11. 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.

12. 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.

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

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

15. Restrictions can be used (car, pool, etc). These are used when a child abuses the rules around activities to the point where safety is compromised. They should be for short times such as a day or two and constantly reevaluated.

16. Children can be asked to leave the family area 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.

17. 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.

18. 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.

19. 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?

Thanks again for any ideas or suggestions you may have.


Arthur Becker-Weidman, PhD said...

A good resource for parents, and therapists too, is Creating Capacity for Attachment, edited by Arthur Becker-Weidman & Deborah Shell. It has several chapters in it about and for parents of children who have Complex Trauma and disorders of attachment. The text is based on Dyadic Developmental Psychotherapy, which is an evidence-based, effective, and empirically validated treatment for such families.

another good resource is The association for the treatment and training in the attachment of children

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