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Does the brain play a role in preventing Placement disruptions?

By Debi A. Grebenik, Ph.D., LCSW

The phone rings. It’s a familiar conversation. The agitated voice on the other end states that the child must be moved. With a sigh of exasperation, the listener responds. If this conversation caught you by surprise, your opportunity to intervene may have passed. How did we not see this coming? What can we do differently? What is the desired outcome? How can we prevent these calls?

Most of us will agree that the optimal fostering experience includes an emphasis on staying the course, going the distance and maintaining the placement so that children grow and improve. The question is, how do we get there?

Stay tuned. First, we need to start with an understanding of how placements develop which will guide us in our understanding of how and why they disrupt. Foster parents begin the process with training, information, and optimism. Then they get their first placement and experience many emotions, thoughts, and fears. Both new and experienced foster parents can cycle through a medley of emotions and cognitions. Our job is to support their process and guide them in their journey. Incumbent to their process is knowledge of child development, their own emotional health, ability to work with others, and the ability to implement appropriate interventions.

Disruptions generally do not consist of a one time event; however, there are exceptions where significant events occur, causing immediate removals. In the majority of placement disruptions the stages can be identified. First, the foster parents begin to view the negatives with more weight than the positives of the placement. This is when they begin to complain and express discontent; often their negativity may be projected toward others or situations. It is imperative that foster care workers tune into this progression and hear what the foster parents are saying as well as what they aren’t saying. Workers can make the most positive impact if we catch them at this initial stage.

Next, the child is seen as the cause for all problems and an increase in acting out behaviors becomes apparent. This discontent progresses to the foster parent going public and talking to others about the problems. Significant to note is the decreased focus on the relationship with the child(ren) and more emphasis on their behaviors.

The turning point occurs when parents find themselves giving threats; setting timeframes for improvement that aren’t met; or telling the child that they gave their notice on them. The final part in this process is when the child fails to meet the expectations and violates the conditions resulting in the decision to disrupt. Then the dreaded phone call is made to you out of despair, discouragement, and defeat.

Ideally, all of us would be able to prevent these steps; however, early interventions coupled with an understanding of child development and the role of the brain can derail this runaway train.
Most of the focus is directed toward a child’s behavior which can leave foster parents and workers frustrated and feeling ineffective. Most children are not able to verbally express their feelings and fears; thus they act out. If behavior is a child’s language, then why would we want to shut down their behavior? Can we uncover the purpose of their behaviors and respond appropriately so that the child’s needs are met in a nurturing and loving response. To do this, we need to understand their brains which will lead to an understanding of their behaviors.

Brains are changed due to abuse, neglect, and trauma. The mere removal of any child from their home creates a trauma response. When the brain experiences abuse or neglect, even when in utero, the brain is changed. The amygdale, known as the threat center which drives the fight, flight or freeze responses, becomes hyper-vigilant. The child’s ability to distinguish between real and perceived threats is diminished which may result in behavioral outbursts. For example, a foster parent asks a child to take the trash outside. The child begins yelling and will not comply. The foster parent may begin to talk about consequences for the child’s choices if the child does not comply. The child, in a hyper-vigilant state, can not respond logically or rationally to the directive and instead, escalates even further. The foster parent then matches the tone of the interaction and the child, feeling very threatened and dysregulated, becomes aggressive or shuts down. This is the beginning of a pattern of interaction that will eventually lead to placement disruption. What is missing here? It was just a simple request to empty the trash. What’s a foster parent to do? This is not an easy pattern to interrupt and change.

Foster parents and workers must start with an understanding of themselves and what triggers them. Do they get triggered when a child raises their voice, when they aren’t compliant, when they engage in control battles, or use disrespectful language? Foster parents and workers together must come to an understanding that their roles require responsibility over reactivity; awareness of their own fears; reframing of children’s behaviors; and a commitment to the healing journey where mistakes are embraced and learned from. When foster parents and workers become stressed due to the overwhelming demands put on them, they can become constricted and unable to open up to a child’s emotional state and needs. Stress causes confused and distorted thinking which is why interventions based on logic or behavior modification are ineffective with foster children due to their trauma histories.

Trauma’s impact on the unconscious mind becomes apparent as children react from their past, obsess about their future, which takes them out of the present. Due to this response, children are more apt to become dysregulated and distorted in their feeling and thinking processes. In addition, during times of stress, children will regress to an earlier developmental stage. Foster parents and workers must be aware of the age that the child becomes during moments of stress and respond in an age appropriate manner. While the child may look fourteen, developmentally at the moment of the stress, he or she may in actuality respond as a two year old. Knowing this, the foster parents or workers can respond with compassion and understanding for the child.

Answers lie in the ability to be mindful of ourselves, possess an understanding of trauma, be aware of a child’s needs, use time-in to build relationship, utilize containment to create safety, and maintain a spirit of regulation. Being mindful of ourselves requires self- awareness and an ability to manage our own stress. An understanding of children’s developmental needs and how they are expressed is also paramount to success in the fostering journey. Use time in instead of time out; one of the key concepts to working with children with trauma histories because it builds relationship rather than enforcing consequences. Ask your child to join you in the kitchen while you cook dinner rather than require them to sit in time out as discipline. Have the child sit by you while you read in an effort to let your calm soothe them. Children act out because they need attention; give them what they need and their behaviors will diminish. Children heal through positive repetitions in their environment. Create predictability and safety through relationship. Containment is achieved through monitoring the chaos in the home, the noise levels, the number of transitions, and the stimulation of the environment. Maintain a spirit of regulation by building a calm and soothing environment in your home and in yourself. Remember that we make poor word choices when our pulse rises over 100.

Other methods that promote healing for the child include the use of narratives to capture the child’s story whether words or pictures are used. Art is a powerful medium in its ability to provide emotional expression opportunities. Music soothes and can aid in times of transition. Drumming or rhythmic movements create healing pathways in the brain. Deep breaths for all involved temper the heightened responses of the amygdale. The smell of oranges helps to reduce anxiety; use this scent in the home to create a calming home environment.

Above all else, remember that children who are acting out are seeking regulation; if foster parents and workers understand and embrace that concept; they are free to respond with what the child needs. When the child receives what they need, their fear decreases, their brain calms, and their behaviors improve. Armed with an understanding of trauma, the brain, development, and their roles, foster parents and workers can prevent placement disruptions. Oh, for a world without placement disruptions!