Sunday, July 29, 2012

My Book is Available!

Order from Choose bookstore and then put my name, Wilcox, in the search engine.

I am so delighted to report that my book came out this week. It is entitled: Trauma-Informed Care: The Restorative Approach. This book is a practical guide to implementing trauma-informed care in all sorts of settings. The focus is on making our every day actions in treatment settings match what we know from brain science helps children heal.
Chapter One introduces the trauma framework, a useful road map to understanding both the effects of trauma and how people can heal. Although we have considerable new information about what helps people heal from trauma, many programs serving the children who have experienced the most trauma have not yet incorporated this information into their treatment or their programs’ milieus.

In the following chapters I provide a specific treatment design using this new brain science as the blueprint for treatment programs for children. Chapter Two is an overview of the method, including its theoretical underpinnings, day-to-day operations, how it addresses shame, and answers to common questions and concerns.
Chapters Three, Four, and Five use case examples to convey the specifics of the approach. Chapter Three focuses on demonstrating the daily workings of a trauma-informed treatment program. Chapter Four illustrates the power of how staff define and talk about the children and their behaviors. Chapter Five contains examples of the challenges of caring for traumatized children, and how the method works during hard times.

Chapter Six examines one of the most difficult decisions in implementing trauma-informed care: how to respond when the children hurt others. This chapter asks providers to consider their theory of change, and to operate from a theory of what will actually help the child be less likely to repeat this behavior. It introduces the restorative task, a response that incorporates opportunities for healing and for making amends, and gives examples of such tasks. Suggestions for improving tasks and how to respond if the child refuses the task are included.
Chapter Seven focuses on the role of the clinician in trauma-informed care, the characteristics of a clinician who will succeed in this system, and necessary training. In the Restorative Approach, the clinician and the child-care team work closely together providing individual, group and family therapy as essential parts of the treatment program. Treatment planning reflects the therapist’s theories of what steps help a child heal. As in all best-practice programs, the therapist will need support and supervision in order to lead the team in a clinical approach to behavior.

Chapter Eight covers the importance of providing trauma-informed care for the families. Most of the parents of children in treatment are themselves trauma survivors, which presents unique challenges in parenting. The program helps them by being attentive to their need to feel safe and to build trust. A key component is to recognize and honor their strengths, and to provide opportunities for the family to have fun and joy together. The families can be educated in the restorative approach and experiment with using it themselves when the client is at home.
Chapter Nine extends the restorative approach to foster care, describing how training in understanding trauma can help foster parents not to take behaviors personally and to keep the child despite behavioral problems. Formal training is important, and the support workers use of the theory to understand actual events will solidify the family’s understanding.

Chapter Ten looks at characteristics of the agency-as-a-whole that support trauma-informed care. The role of agency leadership is crucial in implementing this approach. The agency structure makes a big difference in the success of the Restorative Approach. Developing the necessary culture of connection takes time, but enables the approach to endure. The physical plant affects the experiences of both the clients and the staff.

Chapter Eleven, “Cultivating a Trauma-Sensitive Staff,” describes the processes that are essential to develop and maintain a good staff. Many agencies find that staff turnover decreases after the implementation of trauma-informed care. Hiring, training, supervision and promotion are all crucial tools. Certain skills that support a trauma-informed approach can be deliberately taught. Most crucial is attention to vicarious traumatization, the way the work affects staff and how they can take care of themselves and each other to stay alive and hopeful in the work.
Chapter Twelve covers the actual change process, and what steps an agency can take to facilitate the change. A transformation committee is a good mechanism to lead the change. Later steps include changing policies and procedures to solidify the changes. John Kotter’s Stages of Change (1996) form a helpful guide to examine the process.

Chapter Thirteen concentrates on sustaining the change. Unfortunately there are many forces pushing the system back towards a punitive approach. Certain challenges can be predicted and addressed.
Chapter Fourteen emphasizes measuring and celebrating progress. The chapter presents various factors to measure and scales to utilize in measuring them. Results garnered from these data can be shared with funders, the Board of Directors, consumers and other stakeholders. Celebrating success will help sustain the transformation.

The Appendices contain useful tools for agencies to employ.
The books can be ordered from Choose bookstore and then put my name, Wilcox, in the search engine.
If you do read the book, PLEASE email me ( ) and let me know what you think of it. I hope you will find it to be a valuable resource to you in implementing and sustaining trauma-informed care.

Sunday, July 15, 2012

Two Conference Presentations Next Week

I am presenting at two national conferences next week. If you are attending either, please come up and introduce yourself. I would love to meet you!

The first is the annual NASW conference, Restoring Hope. The conference is in Washington, DC at the Wardman Park Marriott Hotel. My workshop is:

Using the New Brain Science to Create Hope and Healing for Child Survivors of Trauma
Date: Tuesday, July 24
Time: 3:15 pm - 4:15 pm
Room : Wilson B

The second presentation is at the Foster Family Treatment Association 26th Annual Conference on Treatment Foster Care. The conference will be held July 22-25, in Atlanta, GA. at the Sheraton,Atlanta hotel.

My workshop there is:

Workshop D17 - Using a Trauma Framework to Strengthen Foster Placements.
Wednesday, July 25th
10:30 a.m. - 12:00 p.m.

Seriously I would love to meet you if you will be attending either of these conferences. Please say hello!

Thursday, July 05, 2012

Supporting Kinship Care Foster Placements

I have recently become interested in the process of supporting relative foster parents and helping the placements to endure.

In the REPORT TO THE CONGRESS ON KINSHIP FOSTER CARE U.S. Department of Health and Human Services, completed by the Administration on Children, Youth and Families Children’s Bureau, it is stated  that “Because States' data are scarce, it is difficult to estimate how fast public kinship care has increased-but available evidence suggests that it increased substantially during the late 1980s and early 1990s. In the 25 States that do have data, the proportion of children in public kinship care increased from 18 to 31 percent between 1986 and 1990."

I was struck when a foster care leader in our state system described relative foster parents as “the most under-resourced families in the system.” It seems as though there is an un-examined assumption that because relative foster parents are well, relatives, love will carry the day and they will not need help. Foster parenting is a hard job for anyone who does it. And there are some aspects of kinship care that make it uniquely difficult.

Ambiguity of choice presents a significant stressor. Unrelated foster parents choose to be foster parents, decide that this is a good time in their lives, and have to go through an elaborate screening before even hearing the name of a child. Relative foster parents are presented with a child who is a member of their family and who is in distress. They may or may not know this child, and this may or may not be a good time in their lives. But they have to choose between taking the child or having the child go into the child welfare system. Even those who feel deeply that this is more than they can handle also feel a moral obligation to care for the child. The Report to Congress further states that: “Unlike non-kin foster parents, kinship caregivers usually receive little, if any, advance preparation for their role. In all States, non-kin foster parents are required to complete a rigorous training program before the State will license them. Such training helps future foster parents understand the needs of abused or neglected children and emphasizes strategies for meeting these needs effectively. Non-kin foster parents also have time to prepare mentally for their new roles and to adjust their living space to make it appropriate for children of a particular age. In sharp contrast, kinship caregivers often become involved in a crisis situation with little or no notice.”

Accompanying family history and dynamics are always present in the placement. The related child comes with an entire history and many attached feelings. This aspect of relative foster care seems to be rarely discussed in the literature, but is a powerful factor in the outcome of the placement. For example, if a grandmother is caring for a grandchild, that child inevitably connects to a history of pain and distress with this mother’s own child. Perhaps the child’s mother is addicted to drugs. Inevitably her mother, the child’s grandmother, has suffered a lot of pain around this. She may have taken her daughter to treatment progress without success. She has often been deeply hurt by her daughter’s betrayal, such as if her daughter has stolen from her. She has experienced many episodes of hope when her daughter was in rehab or appeared to be turning her life around, followed by despair when the drugs took control again. Furthermore, she may have had experiences with the child’s father, perhaps bad ones. Maybe the child’s father was abusive to her daughter. All of this hurts a mother’s heart and leaves deep impressions. And in fact her daughter is often still in the area, drifting in and out of the family’s life.

How does this all effect the grandmother’s relationship with the child? She loves the child. She wants to do the best for him and raise him right. She wants to protect him from all harm. Yet who does the child look like? How hopeful does she feel towards the child’s future? How resentful does she feel about having this added responsibility in her life at this time?

All these factors are also influenced by the relative caregiver’s health, his/her financial and social situation, and many other aspects of their life.

Often the caregiver has no one to talk to about this, no one to validate their complex feelings and to help them separate the present with the child from the past with the child’s parents. So, the child and the caregiver are both being profoundly influenced by the unexamined past.

Then,  to continue to quote the report, “Unlike trained non-kin foster parents, kinship caregivers often receive little formal training and may have a limited understanding of the child welfare system, what is expected of them, and the resources available to assist them. Kinship caregivers, however, generally have greater knowledge of the family history and dynamics that have created the need for a child to be placed outside the home. Not only are public kinship caregivers less likely than non-kin foster parents to receive services, their needs are more often overlooked. Public kinship caregivers are referred for, offered, and actually receive fewer services for themselves and for the children in their care public kinship caregivers are less likely to request or receive educational or mental health assessments, individual or group counseling, or tutoring for the children in their care.”

Specifically, the kinship care providers often receive little training about trauma, how it affects children, and how they can heal. The main advantage of having such knowledge is that it enables parents to define the child’s behavior differently. When the child won’t eat with them, or refuses to talk, or questions their directives, or has a meltdown in a store, or is aggressive with other children in the home, or won’t go to sleep at night, the parent sees this as rejection, defiance, and a behavior to be eliminated. If the parent is given training that really helps them understand behavior differently, they instead can define the behavior as fear, emotional over load, and problems with trust. This change of definition leads to a complete change of reaction. The kinship care parent is less likely to take the behavior personally, less likely to respond with punishment and more likely to respond with support. This training is essential for kinship care parents. And it must be available in many flexible delivery modes, including a trained person who can offer the parent training in their home individually. Support groups can be both helpful and powerful, but for some parents the thought of having to schedule attendance at a group is such a stressor that any benefit is undermined. A flexible delivery system allows each parent to utilize the help that fits where they are at the moment.

Another essential component of supporting kinship care is to pay attention to the experience of the parent themselves. How is being a kinship caregiver affecting the parent themselves? At a recent training one foster mother stated that she had been a foster mother for sixteen years and no one had ever asked her how the work was affecting her. Caring for children with trauma histories produces vicarious traumatization in foster and kinship care parents as it does in treatment workers. Foster and kinship parents have the additional stress of being largely alone when crisis occur; of possible getting pressure from extended family; of losing friends and family because of being unable to leave the child; of worrying about the effect of the foster child on their biological children; and other issues. For kinship foster parents managing the relationship with the child’s biological parents may be another source of stress.

The kinship care parents need a safe place to discuss all this and to receive validation. This can be individual or in a group. A group, when it is possible for a parent, has the strong benefit of helping the parent that they are not alone. But the parent needs to be educated on the inevitability of vicarious traumatization, how to care for oneself to combat it, and how to maximize the transformative power of providing foster care.

The limited information we have about relative foster care does show that despite the lack of education and support services, relative placements tend to last longer than non-relative placements. We desperately need to create stability for these children that have been hurt through no fault of their own. All the other healing they need and deserve can only take place when they feel safe, cared for and that they belong somewhere. It seems that one way that we could increase that safety would be to provide more and earlier support for kinship care families.

What are your thoughts on this? Have you done any work in this area? Do you know of anything written about supporting kinship care families? Please click on “comment” and let me know. Thank you.