by Edie De Vilbiss
She sat in my office over tea and we talked about the things she could do to become more spiritually centered. The conversation drifted to the reasons that she is challenged to trust anyone. A child of a woman addicted to drugs, she was removed by DCFS at three years old. She had the same foster family until she was in fifth grade. With a roof over her head and a deep fear of the unknown, she didn’t say anything about the daily beatings or the verbal abuse for many years. Once she did tell someone, she was removed from that placement. The next several years saw multiple placements. She is not sure how many, more than twelve, she can name them. But, she knows there are more.
“Is there anything you would like to see change about how DCFS (Department of Child and Family Services) handles young people?”
A brief pause, “I want them to be on the kid’s side. I got treated like I was bad or wrong every time I had to be moved. Why couldn’t they understand what was going on with me?”
Indeed. Why is it so hard for adults to understand that outrageous behavior always has a reason? Why is it that when we go into a field to help people, we end up hurting them too? What she’s seeking is called trauma-informed care. Research is that when a child has been traumatized there are specific behaviors that are difficult to engage with which result. Rage or self-harm, outrageous language, and other unusual behaviors are common. When caring adults are trained to respond appropriately to these behaviors, the child can learn to respond to life more appropriately. When our reaction to the outrageous and unacceptable behavior is rejecting and condemning it increases the child’s negative self-image. The behaviors not only continue, they get worse. This is how we, who care for children, make their lives even more difficult.
Data on how often multiple placements are occurring in Louisiana is not readily available. However, the anecdotal reports of the youth we serve indicate that this is an ongoing issue. We are not the first state to need to address this issue.
In an article on the HHS public access website, Rubin et al. found the following:
The current study provides the most compelling evidence to date that placement stability, independent of a child’s problems at entry into care, can influence well-being for children in out-of-home care. Regardless of a child’s baseline risk for instability in this study, those children who failed to achieve placement stability were estimated to have a 36%−63% increased risk of behavioral problems compared with children who achieved any stability in foster care. The impact of placement stability on behavioral problems was not trivial, as even among the children who carried a low risk for placement instability, 1 in 5 children (20%) failed to achieve any stability in the first 18 months of foster care.
When a child experiences multiple failed placements his or her ability to adapt behavior is not properly developed. Repeated removal likely increases the child’s self-identity as a person who is unworthy of love and nurture. When a caseworker is overwhelmed and dismayed when removing a child, the child does not perceive it is the caseworker’s issue. The child internalizes a negative self-image.
The merry go round of removing a child and placing them elsewhere has a negative impact on the caseworker, the foster family and the budget as well.
The caseworker is likely to experience the sudden removal of a child for unacceptable behavior as a failure on his or her part. Sometimes the caseworker who responds is an on-call worker with no history with the child. Being new to the child and the case, they might harbor a sense that the previous worker failed in their work. In addition, resources are limited and take time to find. The pressure to keep up with the work load and locate non-existent resource taxes the ability to attend to the well-being of the child’s self image.
Foster-parenting a child is challenging. Other people’s children come to a foster family with a history, unique behavior patterns, and a personality in development. Attending to the physical needs of a child is demanding in itself. Adapting to established behavior requires close observation and adaptation. A “failed” placement does not rest only on the child and the case worker, the foster parent has a sense of inadequacy also.
From a budgetary stance, child removal and seeking a new placement is an expensive endeavor. Immediate costs are high.
- Often an emergency removal occurs after hours, and there is the expense of overtime.
- Locating and training foster care families is expensive.
- Emergency lodging in a hotel room has costs associated with it.
The long term costs of multiple foster care placements may be incalculable.
- The lost production of the child as an employee when he or she reaches adulthood. .
- Increased risk of long term incarceration because of unmanaged anger and violence.
- The medical costs over a lifetime for children with multiple Adverse Childhood Experiences are born by our society.
The issue of multiple foster care placements must be addressed. New Jersey is tackling this issue. The “key strategies” they identified are:
- Placing children with relatives or family members when possible
- Placement matching to make optimal first placements for children
- Improving services to children in care
- Programs that support foster caregivers to better address children’s needs
- Caseworker retention
- Staff training
The first strategy is addressed in the Louisiana DCFS Policy 4-807. The first consideration is to find a relative who is an appropriate placement.
Louisiana also has placement specialists who are trained to match a young person with a foster family.
Staff retention is often an issue when people are working with troubled children. Empowering the worker may prove to be a positive avenue for addressing this.
Training in trauma-informed care across the systems, from administrators in the Department of Child and Family Services to Child Placement Specialists, Case workers, and most assuredly to foster parents is a positive step in alleviating the harm from our current system.
Improving services to children in care; programs that support foster caregivers to better address children’s needs, and staff training could all be addressed by rolling out a program of TBRI® (Trust Based Relational Intervention) training for both case workers and foster parents.
TBRI® is an attachment-based, trauma-informed intervention that is designed to meet the complex needs of vulnerable children. TBRI® uses Empowering Principles to address physical needs, Connecting Principles for attachment needs, and Correcting Principles to disarm fear-based behaviors. While the intervention is based on years of attachment, sensory processing, and neuroscience research, the heartbeat of TBRI® is connection.
The principles of TBRI® are practical and simple. Addressing the basic human needs of the young people in our care makes sense. For caseworkers and foster parents to be trained in trauma informed care principles, with information about how to address the issues will empower positive outcomes. Training together will help form relationships between the caseworkers and foster parents. Common training will engender a common language based on the understanding of life challenges for the young people in our care.
expensive and time-consuming. However, the expenditure to train people
appropriately will alleviate much of the long term costs of the foster care
merry go round. We have a moral and
legal responsibility to offer the best we can for the youth we serve. When the
state removes a child, the state must provide better than the child had.
Multiple placements fail this endeavor.
 The study referenced below identified a stable placement as one established within 45 days of removal, and instability as not meeting that mark. Her first placement was stable; she was there for years. Once she was removed from that placement, she was unable to re-establish stability with a different caregiver.
 Rubin, David M., MD MSCE, O’Reilly, Amanda, MPH, Luan, Xianqun, MS, Localio, A. Russell, JD MS. The Impact of Placement Stability on Behavioral Well-Being for Children in Foster Care. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2693406/ accessed 07/24/2019.
 How can we improve placement stability for children in foster care? Casey Family Programs. 10/03/2018. https://www.casey.org/strategies-improve-placement-stability/ accessed 07/25/2019.