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Reducing Separation Trauma Kathleen I. W. Brundage University at Buffalo, SUNY © 2005 - Reducing Separation Trauma Kathleen I. W. Brundage University at Buffalo, SUNY © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

“Attachment and separation are the heart of child welfare work” – Fahlberg (1991) © “Attachment and separation are the heart of child welfare work” – Fahlberg (1991) © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Overview • Attachment Review • Separation: Emotional & Psychological Effects • Promoting Attachment in Overview • Attachment Review • Separation: Emotional & Psychological Effects • Promoting Attachment in the Foster Home • Current Research Study © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Attachment © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Attachment © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

What is Attachment? • The emotional bond that forms between a child and his What is Attachment? • The emotional bond that forms between a child and his or her first primary caregiver and sets the stage for all of the child’s future relationships and the ways in which the child interacts with the world (Bowlby, 1988) • The capacity for emotional security, closeness, and autonomy which develops in response to a predictable pattern of warmth, sensitivity, responsiveness, and dependability from a significant caregiver (Karen, 1994) © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

The Attachment Cycle • The child has a need • The child expresses the The Attachment Cycle • The child has a need • The child expresses the need by fussing, crying, or otherwise raging • The need is gratified by a caregiver, who provides movement, eye contact, speech, warmth, and/or feeding • This gratification leads to the development of the child’s trust in others NEED AROUSAL TRUST (Rage/Fussing) GRATIFICATION © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Secure Attachment throughout the Lifespan • Greater curiosity and persistence as a toddler • Secure Attachment throughout the Lifespan • Greater curiosity and persistence as a toddler • Positive peer relationships in preschoolers • Advanced cognitive functioning during middle childhood • Development of a social conscience and positive self-concept in adolescence • Healthy, reciprocal relationships in adulthood – Webster (1999); Allen & Ladd (1999); Feeney (2000) © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Secure Attachment • • • Emotional Resilience Adaptability to new situations Self-reliance and feelings Secure Attachment • • • Emotional Resilience Adaptability to new situations Self-reliance and feelings of self-worth Ability to cope with stress and frustration Flexible thinking Ability to modulate emotion Attain full intellectual potential Able to sort out perceptions and think logically Development of social emotions and able to trust others • Conscience development © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation – Kagan (2004)

Attachment Styles • Secure • Insecure – Insecure-Avoidant – Insecure-Ambivalent – Insecure-Disorganized © 2005 Attachment Styles • Secure • Insecure – Insecure-Avoidant – Insecure-Ambivalent – Insecure-Disorganized © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Insecure Attachment • Avoidant – Act distant • Ambivalent – Constantly clamor for attention Insecure Attachment • Avoidant – Act distant • Ambivalent – Constantly clamor for attention and nurturance, never comforted • Disorganized – Contradictory behavior with the caretaker © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

School-Age and Adolescence • Avoidant – Affective disorder (depression) – Obsessive Compulsive Disorder – School-Age and Adolescence • Avoidant – Affective disorder (depression) – Obsessive Compulsive Disorder – Histrionic, borderline, and schizotypal personality disorders • Ambivalent – Conduct disorder – Substance abuse – Narcissistic or antisocial personality disorder • Disorganized – Aggression – Oppositional Defiant Disorder - Lyons-Ruth (1996); Rosenstein & Horowitz (1996) © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Attachment Problems Can Cause: • • Problems with Emotional development Problems with Psychosocial development Attachment Problems Can Cause: • • Problems with Emotional development Problems with Psychosocial development Problems with Cognitive development, esp. Language delays Motor delays Physical health problems Neurological problems Growth delays Problems with Behavioral regulation (see Handout 1) – Carlson et al. (2003); Fahlberg (1991); Feeney (2000); Leslie et al. (2002); Moss (2205); Schore (2001); Seigel (2001) © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Attachment Disorder • A constellation of aberrant attachment behaviors and other social behavioral abnormalities Attachment Disorder • A constellation of aberrant attachment behaviors and other social behavioral abnormalities resulting from “pathogenic care” (APA, 2000, p 130) • Affects children who have been – – Traumatized Neglected Parents suffering from depression, mental illness, addictions Experienced physical, sexual, and/or emotional abuse – APA (2000); Keck & Kupecky (2002) © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

…AD • Two clinical patterns: 1) Emotionally withdrawn/inhibited 2) Indiscriminately social/disinhibitied • Have learned …AD • Two clinical patterns: 1) Emotionally withdrawn/inhibited 2) Indiscriminately social/disinhibitied • Have learned that the world is unsafe and have trouble trusting others • Characteristics (see Handout 2) – APA (2000); Cline (1990); Keck & Kupecky (2002); Levy & Orlans (1998) © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

AD in Adolescence • • • Oppositional Defiant Disorder Attention Deficit Hyperactivity Disorder Affective AD in Adolescence • • • Oppositional Defiant Disorder Attention Deficit Hyperactivity Disorder Affective Disorders (Depression) Serious criminal behavior Hard drug use Psychiatric disturbances in adulthood – Greenberg (1999); Ladnier & Massanari (2000); Dozier et al. (1999) © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Attachment and Foster Children • • • Loss of primary caregiver Often experience multiple Attachment and Foster Children • • • Loss of primary caregiver Often experience multiple placements 70%+ are removed due to abuse and/or neglect About half have disordered attachments Expectations & adaptive strategies learned in original attachment relationship are maladaptive in context of new relationships – CWLA (2002); Finzi et al. (2001); Newton et al. (2000) © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Separation © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Separation © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

What do Foster Children lose? • Parents/caregivers • Siblings (in some situations) • Grandparents, What do Foster Children lose? • Parents/caregivers • Siblings (in some situations) • Grandparents, other relatives • Friends • Pets • Home • Neighborhood & community • Belongings • Image of themselves and their families © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Emotional Response to Separation • Fear • Helplessness • • Horror Sense of loss Emotional Response to Separation • Fear • Helplessness • • Horror Sense of loss Anger Sadness Guilt Confusion Loneliness Trauma Grief • See Handout 3 - Chapman et al. (2004); Hughes (1997); Johnson et al. (1995); Kagan (2004); Kobak (1999); Mauk & Sharpnack, (1999); Waddell & Thomas (1998) © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Behavioral Responses to Separation • • • Bullying and hostile behavior Lying Stealing Aggression Behavioral Responses to Separation • • • Bullying and hostile behavior Lying Stealing Aggression toward peers Thoughts of suicide Substance abuse –Delaney (1991); Hughes (1997); Newton et al. (2000); Penzerro & Lein (1995); Rosenstein & Horowitz (1996) Sroufe et al. (2003) © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

When Separation Trauma Remains Unresolved: • Disproportionately high involvement in mental health, juvenile justice, When Separation Trauma Remains Unresolved: • Disproportionately high involvement in mental health, juvenile justice, and adult criminal justice systems • Difficulty in future relationships – Delaney (1991); Hughes (1997); Newton et al. (2000); Penzerro & Lein (1995); Rosenstein & Horowitz (1996) Sroufe et al. (2003) © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Factors Affecting the Severity of a Child’s Reaction to Separation • • Child’s age Factors Affecting the Severity of a Child’s Reaction to Separation • • Child’s age and stage of development Significance of the lost person(s) Past experiences with separation Child's perceptions of the reason for separation • Length of the separation © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Factors Affecting the Severity of a Child’s Reaction to Separation • • • Child’s Factors Affecting the Severity of a Child’s Reaction to Separation • • • Child’s behavior and temperament Preparation for the move Post-separation environment, including caregiver state of mind – Barber (2001); Barber & Delfabbro (2003); Bernier & Dozier (2003); Chapman et al. (2004); Cournos (2002); Fahlberg (1991); Heinicke & Westheimer (1966); Mauk & Sharpnack (1999); Mc. Fadden (1992); Newton et al. (2000); Penzerro & Lein (1995); Redding et al. (2000); Rycus & Hughes (1998). © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Promoting Attachment in the Foster Home © 2005 - 2006 CDHS College Relations Group Promoting Attachment in the Foster Home © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Child Barriers to Attachment • Prior relationship disruptions give a sense of relationships as Child Barriers to Attachment • Prior relationship disruptions give a sense of relationships as inconsistent and undependable • Disturbed expectations about relationships • Disturbances in interpersonal relatedness • Developmental delays (esp. speech and language) • Behavior problems • Disturbances in sense of self • Emotion regulation problems – Zeanah & Smyke (2005) © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Foster Parent Barriers to Attachment • Trained in previous era when foster parents were Foster Parent Barriers to Attachment • Trained in previous era when foster parents were told not to “get too attached” • The child is not raised by the foster parent from birth • Misrepresentation of child’s needs and experience – Viewing child as “damaged goods” – Believe the child “merely” needs structure and affection © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

…Foster Parent Barriers • Stepping around/covering up the child’s traumatic history and painful feelings …Foster Parent Barriers • Stepping around/covering up the child’s traumatic history and painful feelings • Foster parent’s unresolved losses • Insecure attachment style of foster parent – Bernier & Dozier (2003); Dozier et al. (2001); Zeanah & Smyke (2005) © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

 • Adults who care for needy children are often those who have experienced • Adults who care for needy children are often those who have experienced childhood trauma themselves – Cournos (2002); Redding et al. (2000) © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Foster Parent Attachment Styles Foster Parent Population Adult Population at large Secure 32% 70% Foster Parent Attachment Styles Foster Parent Population Adult Population at large Secure 32% 70% Insecure 68% 30% © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation – Steele et al. (2003)

The Issue of Foster Parent Attachment • Foster parent state of mind with regard The Issue of Foster Parent Attachment • Foster parent state of mind with regard to attachment is a stronger predictor of infant attachment than age at placement, and may mediate the effects of abuse/neglect history. – Children under 2 y/o, 3 months after placement: • Secure foster parent – 79% secure foster children • Insecure foster parent – 37% secure foster children © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation – Dozier et al. (2001)

Insecure Attachment • Caregivers with insecure attachment styles tend to step around the child’s Insecure Attachment • Caregivers with insecure attachment styles tend to step around the child’s trauma • They tend to distance themselves from troubling emotions – Steele, Kaniuk, Hodges, Haworth, & Huss (2003) © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Secure Foster Parent Attachment • More accurate interpretation of child’s behavior (recognize anger and Secure Foster Parent Attachment • More accurate interpretation of child’s behavior (recognize anger and despair underlying acting out behavior) • Accurate understanding of child’s developmental level (important for attunement to child’s needs) • Better foster parent-foster child bonding – Bernier & Dozier (2003) © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Training is Key • Foster parents need to understand: – The developmental status of Training is Key • Foster parents need to understand: – The developmental status of the child (Handout 4) – The child’s particular background • Personality • Attachment history • Thoughts & feelings about the family – Bernier & Dozier (2003); Mennen & O’Keefe (2004); Rycus & Hughes (1998) © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

…Training & Support • Foster parents benefit from training in recognizing what young foster …Training & Support • Foster parents benefit from training in recognizing what young foster children actually need, not necessarily what they signal that they need – Children placed later than 12 months old typically display behaviors of insecure attachment styles – Foster mothers tend to respond “in kind” – “Powerfully self-perpetuating cycle” – Dozier et al (2002); Stovall & Dozier (2000); Mennen & O’Keefe (2005); © 2005 - 2006 CDHS College Relations Zeanah & Smyke (2005) Group Buffalo State College/SUNY at Buffalo Research Foundation

…Training & Support • Assessments of foster child attachment • Regular phone contact with …Training & Support • Assessments of foster child attachment • Regular phone contact with support teams (Child Welfare Workers) • Support Groups • Regularly scheduled foster parent training sessions (child development, attachment, behavior modification) ØSignificant decrease in child behavior problems (even for children with AD) – Mennan & O’keefe (2005); Zeanah & Smyke (2005) © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

…Training and Support • Supporting collaborative relationships between foster parents and social workers promotes …Training and Support • Supporting collaborative relationships between foster parents and social workers promotes foster parent selfefficacy and removes barriers to attachment – Foster parents should be valued for their ability to provide input regarding child development • Social workers should be encouraged to provide foster parents with needed info but also to be open to foster parent input – Mennan & O’Keefe (2005); Zeanah & Smyke (2005) © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Current Study Needs Assessment for Reducing Separation Trauma: Foster Child & Foster Parent Attachment Current Study Needs Assessment for Reducing Separation Trauma: Foster Child & Foster Parent Attachment and Preparation for Placement © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

– Medical needs – History of abuse or Preparation for Placementskills neglect – Interests – Medical needs – History of abuse or Preparation for Placementskills neglect – Interests and – Developmental level – Behavior problems (especially – Fears and anxieties and communication level) how the child typically – Habits and preferences expresses those and is for things like eating, accustomed to being sleeping, and bathing comforted ØDo foster parent and social worker reports agree? ØDo foster parents need more preparatory support? © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Child’s Behavior & Temperament • Attachment Disorder Checklist (Becker-Weidman, 2001) – 50% of foster Child’s Behavior & Temperament • Attachment Disorder Checklist (Becker-Weidman, 2001) – 50% of foster children nation-wide present clinically significant symptoms of AD – Many foster parents are under-trained to recognize possible signs of AD Ø Foster Parent and Child Welfare Staff reports of child behavior to i. d. whether symptoms of AD are recognized at the rate specified in the research literature Ø Implications for future research: may add to limited body of knowledge on school-age and adolescent foster child attachment © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Foster Parent State of Mind with Regard to Attachment • • Foster Parent self-report Foster Parent State of Mind with Regard to Attachment • • Foster Parent self-report assessment of attachment style Child Welfare Worker observations of foster parent attachment behaviors Ø Does self-reported attachment style agree with social worker reports of attachment behavior? Ø Need for education about attachment-promoting attachment behaviors? © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Research Questions ØOverall, do foster parent and child welfare worker reports agree? ØAre there Research Questions ØOverall, do foster parent and child welfare worker reports agree? ØAre there relationships between preparation for placement and foster child behavior/foster parent attachment? ØIs there a relationship between foster child attachment behavior and foster parent attachment style? © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Thank you. Questions? © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY Thank you. Questions? © 2005 - 2006 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

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