Overview of Foster Care Through the Literature Review

Visitation and Strengthening the Parent-Child Relationship in Foster Care

Curriculum Manual

Joanne Cannavo, MSSA, CSW, PhD Student School of Social Work University at Buffalo

Funding for this research project was provided by NYS Office of Children and Family Services, Contract year 2003: Project 1029071, Award: 27229; Contract year 2004: Project 10371221, Award 31183, through the Center for Development of Human Services, College Relations Group, Research Foundation of SUNY, Buffalo State College.

Unit A: Literature Review Overview of Foster Care through the Literature Review……………………….… Outline of Power Point Slides to accompany discussion of the Literature Review...

Unit B: Introduction Introduction…………………………………………………………………………

Unit C: Parent-Child Assessment Assessment Forms and other modalities that function to assess the parent and child…………………………………………………………………………………………

Unit D: An Active Role in Visitation Increase in an active role by both parents and foster care workers to enhance the Parent-Child Relationships through Visitation ………………………………………….

Unit E: Parent-Child Interaction The Quality of Interactions between Parent and Child……………………………

Unit F: Safety Modalities that address any of the 18 New York State Safety and Risk factors…………………………………………………………………………………….. Safety Factors 5 & 10 encompass the consideration of mental health status of the parent, resulting in a need the parent’s increased education to be preventive regarding care for their children ……………………………………………………………………..

Unit G: Preventive Planning Towards Successful Reunification Planning for Reunification starts at Day One………………………………………

Unit H: Education and Other Relevant Areas of Focus Educational modalities in sum………….…………………………………………..

Unit I: Appendix Complete Appendix of Handouts…………...………………………………………

Unit J: References References

UNIT A The Literature Review

 Overview of Foster Care through the Literature Review……..…  Outline of Power Point Slides to accompany discussion of the Literature Review......

UNIT B Introduction and Background

 Factors placing children in foster care  Reasons caused by children  Reasons caused by parents  The True & False About Foster Care  Statistics

UNIT C Parent-Child Assessment

 Guidelines to Setting Up Visitation Plan  The Importance of Visitation  Visitation Intake Form  Parent-Child Relationship Assessment Form  Visitation Contract  Supervised Visitation Program Observation Form  Parent Impression of Supervised Visitation Program  Child Development Guide  Scenarios: Suggested Behaviors for Effective Parenting  Interventions to Ensure an Active Role in Supervising Visitation  Scenarios: Foster Care Workers Modeled Response to Scenarios for Parents  Erikson’s Theory on Psychosocial Development  Grief and Loss  Stages of Grief and Loss: Kubler-Ross  Danger Signals for Depression and Suicide  Burnout  Stress and Self-Rating Scale  Maternal Behavior Rating Scale  Reunification Planning Checklist  Follow-Up  Scenarios and Solutions for Adjustment During Follow-Up

 Guidelines to Setting Up Visitation Plan  The Importance of Visitation  Visitation Intake Form  Parent-Child Relationship Assessment Form  Visitation Contract  Supervised Visitation Program Observation Form  Parent Impression of Supervised Visitation Program  Basic Conflict and Resolution and Mediation Skills  Communication and Relationship Builders  Basic Parenting Tips: 101  Three Parenting Patterns of Discipline  Child Development Guide  Scenarios: Suggested Behaviors for Effective Parenting  Interventions to Ensure an Active Role in Supervising Visitation  Scenarios: Foster Care Workers Modeled Response to Scenarios for Parents  Key Factors for Emotional Intelligence  Erikson’s Theory on Psychosocial Development  Grief and Loss  Stages of Grief and Loss: Kubler-Ross  Bill of Rights for Grieving Children  Danger Signals for Depression and Suicide  Maternal Behavior Rating Scale  Reunification Planning Checklist  Follow-Up  Scenarios and Solutions for Adjustment During Follow-Up

 Guidelines to Setting Up Visitation Plan  Parent-Child Relationship Assessment Form  Supervised Visitation Program Observation Form  Parent Impression of Supervised Visitation Program  Basic Conflict and Resolution and Mediation Skills  Communication and Relationship Builders  Basic Parenting Tips: 101  Three Parenting Patterns of Discipline  Child Development Guide  Scenarios: Suggested Behaviors for Effective Parenting  Interventions to Ensure an Active Role in Supervising Visitation  Scenarios: Foster Care Workers Modeled Response to Scenarios for Parents  Key Factors for Emotional Intelligence  Grief and Loss  Stages of Grief and Loss: Kubler-Ross  Bill of Rights for Grieving Children  Danger Signals for Depression and Suicide  Stress and Self-Rating Scale  Maternal Behavior Rating Scale  Reunification Planning Checklist  Scenarios and Solutions for Adjustment During Follow-Up

 Guidelines to Setting Up Visitation Plan  The Importance of Visitation  Visitation Intake Form  Parent-Child Relationship Assessment Form  Visitation Contract  Supervised Visitation Program Observation Form  Parent Impression of Supervised Visitation Program  Basic Conflict and Resolution and Mediation Skills  Communication and Relationship Builders  Basic Parenting Tips: 101  Three Parenting Patterns of Discipline  Child Development Guide  Scenarios: Suggested Behaviors for Effective Parenting  Interventions to Ensure an Active Role in Supervising Visitation  Scenarios: Foster Care Workers Modeled Response to Scenarios for Parents  Key Factors for Emotional Intelligence  Grief and Loss  Bill of Rights for Grieving Children  Danger Signals for Depression and Suicide  Burnout  Stress and Self-Rating Scale  Maternal Behavior Rating Scale  Reunification Planning Checklist  Follow-Up

 Guidelines to Setting Up Visitation Plan  The Importance of Visitation  Visitation Intake Form  Parent-Child Relationship Assessment Form  Visitation Contract  Supervised Visitation Program Observation Form  Parent Impression of Supervised Visitation Program  Basic Conflict and Resolution and Mediation Skills  Communication and Relationship Builders  Basic Parenting Tips: 101  Three Parenting Patterns of Discipline  Child Development Guide  Scenarios: Suggested Behaviors for Effective Parenting  Interventions to Ensure an Active Role in Supervising Visitation  Scenarios: Foster Care Workers Modeled Response to Scenarios for Parents  Key Factors for Emotional Intelligence  Erikson’s Theory on Psychosocial Development  Grief and Loss  Stages of Grief and Loss: Kubler-Ross  Bill of Rights for Grieving Children  Danger Signals for Depression and Suicide  Burnout  Stress and Self-Rating Scale  Maternal Behavior Rating Scale  Reunification Planning Checklist  Follow-Up  Scenarios and Solutions for Adjustment During Follow-Up

 Basic Conflict and Resolution and Mediation Skills  Communication and Relationship Builders  Basic Parenting Tips: 101  Three Parenting Patterns of Discipline  Child Development Guide  Scenarios: Suggested Behaviors for Effective Parenting  Interventions to Ensure an Active Role in Supervising Visitation  Scenarios: Foster Care Workers Modeled Response to Scenarios for Parents  Key Factors for Emotional Intelligence  Erikson’s Theory on Psychosocial Development  Grief and Loss  Stages of Grief and Loss: Kubler-Ross  Bill of Rights for Grieving Children  Danger Signals for Depression and Suicide  Burnout  Stress and Self-Rating Scale  Scenarios and Solutions for Adjustment During Follow-Up

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Purpose: To provide participants with current information about (a) the foster care system (b) factors that influence successful foster care placements, (c) education on child development, grief and loss, emotional intelligence, and parenting skills, (d) effective interventions that will increase success in visitation, improve parenting skills, and educate about different methods that can be used to improve the parent-child relationship, and (e) how to evaluate and assess the quality of interaction between parent-child in preparation for discharge and reunification. In essence, this serves as an intervention to increase the overall uniformity of the foster care visitation process lead by foster care workers.

Rationale: The reality of foster care is that it is governed by the Federal and State laws. Changes in child welfare policies, such as the Adoption and Safe Families Act of 1997 (AFSA; P.L. 105-89) purports that family reunifications remains the goal for the majority of foster children. Furthermore, the Adoption Assistance and Child Welfare Act of 1980 (P.L. 96-272) requires regular visitations to take place between parents and their children when they are in foster care. Given these policies and identified issues focusing on a primary goal, the visit is the primary child welfare intervention for maintaining and supporting adequate parent/child relationship and ensuring a successful reunification.

Target Population: caseworker, supervisor, child care staff

Objectives and Enabling Abilities: The participants will be able to : Cognitive: - Understand the obstacles and barriers prevent reunification in families - Strengthen participants ability to encourage family interactions among child and foster parents and child and biological parent

Operative: - demonstrate methods of intervention to reduce obstacles and barriers for reunification - model parenting skills to enhance and strengthen parent/child relationship

Affective: - value the practice of visitation and how it impacts family reunification

Materials: - Handouts - Power point slides

Time: - Two Days

Method: - Lecture - Brainstorming - Handouts - Role playing - Large group activities - Small group activities

The Increased Uniformity of Visitation, featuring an ‘Active Role’ of Supervision

Many area professionals have conveyed that there is little to no uniformity of the Foster Care Visitation process. This particularly includes the degree of involvement in the visitation session by the Foster Care Worker, the parents of the foster children, as well as visitation supervisors in general, visit settings, and frequency of visits. Towards the goal of increasing the uniformity of visitation, this curriculum will primarily focus on (a) an educational intervention that will likely impact the parents and foster care workers, and (b) an active role of the Foster Care Workers during visitation sessions where they are interactive and modeling emotionally healthy, appropriate behaviors for the parents. Both of these are considered educational impacts for the parents, as well as interventions that will act to increase the parent-child relationship during foster care visitation.

Overview of Foster Care Through the Literature Review

Joanne M. Cannavo, MSSA, CSW, Ph.D. Student New York State University at Buffalo School of Social Work August 31, 2004

This article addresses problems related to foster care visitation, especially the role of visitation in improving attachment between parents and at risk children. Several obstacles of the visitation process are identified, which contribute to the longer duration of time in foster care for children, as well as poorer parent-child relationship and attachment, and less successful reunifications.

Recommendations for biological parents, foster parents and the child welfare personnel are made to improve the process overall. Since parent-child attachment and visitation are central to successful reunifications of foster care, interventions to improve attachment and relationships are examined as methods of improving such during visitation.

Key Words

Key words used in the search for intervention studies as well as professional articles to provide relevant information included: intervention, foster care, visitation, reunification, attachment, relations*, family relations*, mother-child, parent-child, substance abuse, treatment, communication, feeling*, day treatment, residential. Several were selected to attempt to search or any possible intervention studies that existed involving foster care, particularly regarding visitation. Such key words were also selected to attempt to acquire as many intervention studies as possible that assessed attachment or sought to change attachment. The latter was done since there have been virtually no published intervention studies on foster care interventions, according to Victor Groza, Ph.D. Professor at Case Western Reserve University in Cleveland, Ohio, and an authority on foster care and adoption

(V. Groza, personal communication, January 26, 2004). Intervention studies that were used with other populations were selected in the hope that the type of interventions may be successful if used with the

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation foster care setting. Moderately sufficient literature was found that discussed the issues related to foster care visitation.

Visitation and Strengthening the Parent-Child Relationship in Foster Care

Problem Overview

This article addresses the problems related to foster care visitation, especially the role of visitation in improving attachment between parents and at risk children. It is assumed that attachment is central to successful reunifications of foster children and understanding how visitation can promote successful reunification will be explored.

Placement of children out of home is not a new phenomenon. Since the beginning of recorded history there have been examples of children being cared for and raised by both kin and non-kin. More recently, according to data from 2001, there were approximately 542,000 children in the United States foster care system (Child Welfare League of America, 2004). As in the past, many factors bring children into the foster care system. Many forms of child maltreatment - physical, emotional and sexual abuse as well as neglect – have long been the most cited reasons for children being removed from parental care (Denby & Curtis, 2003). In 1999, 87.3% of abuse and neglect perpetrators were parents (Huebner, 2002), while in 2002 the federal government estimated that 81% of perpetrators were parents (U.S. Department of Health and Human Services, Administration on Children, Youth and

Families, 2004). In recent years, there have been increasing numbers of children coming into the system because of the consequences of parental substance related problems that place children at risk or because of significant mental health problems that limit the ability of parents to care for or protect their children (Denby & Curtis, 2003; McNichol & Tash, 2001). Some have argued that a key factor associated with children becoming dependent is that their parents do not adequately bond to their children and the consequent problems between parent and child become a reflection of various family

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation problems (Haight, Black, Mangelsdorf, Giorgio, Tata, Schoppe, & Szewczyk, 2002). Finally, despite best efforts to reunite children with their parents, some come back into foster care because the family is unable to ensure the wellbeing and safety of these children (Davis, Landsverk, Newton & Ganger,

1996).

Duration of Foster Care and Factors Associated with it Length of stay in foster care is concerning. Children average a duration of 33 months in foster care. Modes for duration in foster care included 1-5 months, 6-11 months, 12-17 months, 3-4 years, and 5 or more years (U.S. Department of Health and Human Services, Administration on Children,

Youth and Families, 2004). A secure and nurturing home is central to all child welfare decisions. The less time children are placed in foster care the better especially considering that the average age of a child in foster care is about ten years old (U.S. Department of Health and Human Services,

Administration on Children, Youth and Families, 2004). Further, younger the child is when he or she enters foster care, the greater likelihood that child will spend a large portion of their childhood in the foster care system (Goerge & Wulczyn, 1998). The child welfare system appears to have some important issues of concern with the process of the system. For example, the literature raises the concern of multiple placements experienced by foster children, whether traditional foster care homes or residential treatment facilities (Rubin, Alessandrini, Fuedtner, Mandell, Localio, & Hadley, 2004).

Further, once children are in the system as adolescents, they tend to age out of the system rather than find a permanent home. It has been estimated that yearly as many as twenty thousand youths mature out of foster care at the age of eighteen and facing independent living with little in the way of resources or support. As a result, they struggle with employment, homelessness, and lack of education, and problems with living arrangements (Reilly, 2003).

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation There are various impediments to the release of children from the foster care system. It is unrealistic that reunification is a viable option for every child. There is growing recognition that for some youths, reunification is not likely to occur (Yancey, 1998). Although nationwide various independent living programs have been implemented over the last fifteen years for youth who are aging out of the foster care system, the effectiveness of these is questionable (Reilly, 2003), and therefore the inadequate psychosocial abilities to function are not focused upon or resolved. In addition, parents who have a diagnosis of a serious emotional disorder have a greater likelihood than other less disturbed parents to have their children permanently removed from their homes (Taylor,

Norman, Murphy, Jellinek, Quinn, Poitrast, & Goshko, 1991). Furthermore, the foster care system’s response to the mental health needs of such children has lacked. Thirty five to 85% of adolescents in foster care have emotional disturbances (Yancey, 1998). Thirty percent of children in early and middle childhood have severe emotional, behavioral and developmental problems. These children have higher rates of depression, lower social skills, poorer adaptive functioning, and more externalizing behaviors, such as aggression and impulsivity.

The juvenile court system must make decisions about the well-being of children daily, and such children in the child welfare system are becoming younger over time (Osofsky, 2003). Approximately

120,000 children enter the foster care system prior to their first birthday (U.S. Children’s Bureau,

2001). Given the increase in such a young population entering the child welfare system, the courts must address the needs of this young, at-risk group of children, who in essence have largely been ignored by the courts. The court could benefit from the professional insight and guidance from experts in child development and mental health expertise related to infants particularly (Osofsky, 2003).

There are various options and permanency plans that exist to potentially resolve placements in foster care. They include, as well as the percentage breakdown of those children with such plans:

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation reunification with parent(s) or principal caretakers (44%), adoption (22%), emancipation (6%), living with other relatives (5%), guardianship (3%). In addition, there is the option of long term foster care experienced by children who are institutionalized (8%). Some foster children (11%) have case plan goals that are not yet established (U.S. Children’s Bureau, 2001).

Reunification of children from foster care with their biological parents after having been in foster care has been criticized because some criticism focuses on declines in reunification rates while others on the instability of some reunifications (Jones, 1998). Analysis of national data indicate that many families who are expected to be reunified are not or that the children subsequently reenter foster care (Downs, Costin, & Mcfadden, 1996). This may be the impetus for some to argue for expanding permanency planning options other than keeping children with their families of origin (Schuerman,

1991; Wells & Biegel, 1992). What is clear is that failure to understand the factors that are present in successful reunification of foster children with their families of origin is only beginning to be explored

(Barth, Courtney, Berrick & Albert, 1994; Cantos & Gries, 1997; Davis, Landsverk, Newton, &

Ganger, 1996; Haight, 2002, 2003; Leathers, 2002, 2003). As Jones (1998) so eloquently stated,

“reunified families are often single-parent households who have children with multiple problems” (p.

306). Therefore, it is important that solutions address the complex challenges families face accomplishing the task of reunification.

The reality of foster care is that it is governed by Federal and State law. Changes in child welfare policies, such as the Adoption and Safe Families Act of 1997 (AFSA; P.L. 105-89) purports that family reunification remains the goal for the majority of foster children. Furthermore, the

Adoption Assistance and Child Welfare Act of 1980 (P.L. 96-272) requires regular visitation to take place between parents and their children when they are in foster care. In essence, there has been a policy shift from placement outside of the family until the 1980s, to quick adoptions (P.L. 96-272) to

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Family Preservation Acts (P.L. 98-257 and P.L. 105-89). Given these policies and identified issues focusing on a primary goal, it is important to better examine the factors to be addressed which will meet such goals.

Clearly, understanding which factor(s) would yield the most successful outcome for the reunification is important to foster care providers. Additionally, it is imperative that those factors address the reality of many families entering the child welfare system. Children in foster care today are more likely to have multiple placements (Rubin, et al., 2004). Youth who were reunified with their biological families after placement in foster care were more likely to have more negative outcomes and problematic lives than those who were not reunified. One study suggests that reunified youth, compared to youth who are not reunified, are more likely to get a ticket or be arrested (49.2% versus 30.2%), to drop out of school (20.6% versus 9.4%), and have more behavior problems (59.5% versus 55.7%), as well as lower overall competence (41.1% versus 45.0%) (Taussig, Clyman,

Landsverk, 2001). This raises a question of the explanation for such problems, including the foster care experience, multiple placements or reunification.

Visitation

The role of visitation and its effects on children are addressed in the literature (Cantos and

Gries, 1997; Davis, Landsverk, Newton and Ganger, 1996; Haight, Black, Mangelsdorf, Giorgio, Tata,

Schoppe and Szewczyk, 2002; Leathers, 2002). At the core of visitation is the reinforcement of the parent-child relationship (Haight, Kagle, and Black, 2003; Jones, 1998). In addition, visitation is used to influence and evaluate the extent of attachment between parent and child, possibility for permanence, and potential for kinship placement options. (Hegar, 1993). Further research has also explored social, environmental and family correlates that predict reunification (Jones, 1998) that

Developmental Factors

The American Academy of Pediatrics (2002) focuses on several developmental issues as a whole that affect children’s experiences in foster care and must be considered. The number of young children with complex, severe physical and mental health problems as well as developmental problems are entering foster care during the first few years of life when brain growth is most active (American

Academy of Pediatrics, 2000). Many of these children have suffered extreme abuse or neglect

(American Academy of Pediatrics, 2000; Britner & Mossler, 2002), do not get their medical or emotional needs met, and have not had the experience of being in a stable, nurturing environment particularly while in those first few years of life. Some literature fortunately focuses on such individual aspects as abuse, and its impact on decision making regarding out-of-home placements that authorities and clinical professionals make based on the type and extensiveness of abuse (Britner &

Mossler, 2002). Such an emphasis must exist to continually consider this and other developmental concerns of children in foster care. Foster care experiences should be as positive as possible for the children involved. A focus therefore exists to examine threats to a child’s development ranging from abuse to stress in the family and on the child specifically. Therefore, various developmental issues and considerations are reviewed to stress the importance of improving the foster care experience, and to incorporate the factors into preventive measures for at-risk families and planning decisions for children in foster care. Stress within the family contributes to the inability for the child to cope and effectively express oneself, attachment history and an awareness of time should dictate the pace of decision- making, and multiple placements are detrimental to the foster child (American Academy of Pediatrics,

2000). The emotional stress on the families involved may contribute to their struggle to function well

2003). “Developmental aspects point to the need for tailoring visits to the children and parents’ changing developmental needs. Regular and frequent visits are especially important during infancy and early childhood” (Haight, 2003, p. 204). Although the literature offers varied factors contributing to the decision-making process in foster care reunification, the more recent literature suggests the rising importance of strengthening the parent-child relationship during visitation as the factor that will determine reunification (Haight et al, 2003; Haight et al, 2002; Davis et al, 1996; Leathers, 2002;

Cantos & Gries, 1997).

Attachment

Attachment is defined as “an emotional bond between individuals, based on attraction and dependence, which develops during critical periods of life and may disappear when one individual has no further opportunity to relate to the other” (Barker, 1995, p. 28). Ainsworth’s Attachment Theory, which she developed in the 1970’s, states that behaviorally, as a result of attachment, an infant will predictably seek to be near one or a few significant other people. These significant people are most likely the primary caregiver and perhaps a few other caregivers. It is a natural occurrence and is based on necessity to survive, such as through the protection that is enabled by maintaining such proximity to the caregivers. By approximately six months of age, such attachments are enabled to the primary caregiver and the select few others (Ainsworth, 1989). Although Mary Ainsworth did not do any interventions, she is famous for her Attachment Theory, as well as her classification of the patterns of attachment that resulted primarily from her examination of the “Strange Situation” (Ainsworth &

Bowlby, 1991, p. 338). Ainsworth examined the patterns of behavior and attachment as she observed how 12 month-old infants responded to being separated from and then reunited with their mothers.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation The infant reactions were used to indicate the quality of attachment, deriving classifications of both secure and insecure types of attachment from her observations (Ainsworth & Bowlby, 1991).

Factors Associated with Attachment

The development of a secure attachment relationship with a primary care giving adult is one critical facet of social and emotional development during infancy (Eiden, Edwards, & Leonard, 2002).

Although different factors from genetics to parenting quality may affect attachment, both positively and negatively, there is evidence that secure attachment is a direct result of the care given by the person of whom one is attached to, and not a result of any child factors (American Academy of

Pediatrics, 2002). Development of secure attachments are associated with good parenting skills regardless of other social factors (Clements & Barnett, 2002). However, it is simplistic to think that the relationship between parenting skills and attachment is linear. The research on the parent-child attachment relationships supports the idea that emotionally healthy personality characteristics of parents and child play a role in predicting positive quality of attachment (Kendler, Sham, MacLean,

1997; Small, 1998). Parents who had a loving relationship with their own mothers were two times more likely to have a loving attachment relationship with their children (Brook, Richter, & Whiteman,

2000). Secure infants are more apt to resolve subsequent developmental struggles more functionally when compared to insecurely attached infants (Eiden, Edwards, & Leonard, 2002).

There are many factors that can prevent a healthy emotional attachment, particularly during infancy. Various occurrences and situations may be considered that may either prevent or damage attachment. Disruptions in attachment may take place when the attachment figure is not available or responding to the child, such as what may take place during separation or some disruption in the care provided to the child (Bowlby, 1973). Infants who are insecurely attached are more inclined to have difficulties negotiating significant developmental issues later in life, ranging from autonomy and ego

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation resilience to social proficiency and emotional wellbeing. Such insecure attachment may be an early indicator for maladaptive behavior later in life (Eiden, Edwards, & Leonard, 2002). In addition, maltreatment is another aspect that may yield attachment problems. Maltreated infants are at higher risk for forming disorganized attachments to those who take care of them. (Carlson, Cicchetti, Barnett,

& Braunwald, 1989). These children therefore are at a higher risk for numerous other struggles in the future on a long-term basis (Carlson, 1998; Lyons-Ruth, 1996). Regarding the manner in which children relate and attach, maltreated preschoolers develop a distorted concept of themselves and those taking care of them (Toth, Cicchetti, Macfie, Maughan, & Vanmeenen, 2000). Another study found that they may have inaccurate conceptions of themselves and those taking care of them, as well as peers when at school age (Dodge, Petit, & Bates, 1994). In addition, longitudinal studies show that neglect is correlated with avoidance of attachment figures in infancy, dysfunctional social skills, behavior control, self-esteem, and preschool problem-solving ability (Huebner, 2002). Furthermore, parents whose mothers were controlling and rigid were much more likely to be rigid with their own children (Brook, Richter, & Whiteman, 2000). Interestingly, a study by Kendler et al (1997) suggests that parents who struggle with personal turmoil and dysfunction, such as anxiety, have a greater chance of having poorer attachments to their children. Furthermore, some women who have post partum depression have also been found to have a questionable attachment due to the compromised ability to meet the attentive and emotional needs of infants (Murray, Cooper, Wilson, & Romaniuk, 2003).

Parents who struggle with substance use and abuse also dealt with attachment problems with their children (Kandel, 1990). Gallant, Gorey, Gallant, Perry, & Ryan (1998) found that there is a decreased attachment and bond produced in alcoholic parents versus non-alcoholic parents when specific attitudes and behaviors were monitored in parents.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation As was mentioned, there is an increasing importance of strengthening the parent-child relationship during visitation as the factor that will determine reunification (Haight et al., 2002, 2003.

The emotional bond of attachment can strengthen the relationship (Haight et al., 2003). Regular contact between parent and child yields greater closeness and identification to the family as the child ages (Browne & Maloney, 2002). Considering this core developmental aspect as well as improving visitation may contribute to improving the foster care experience.

Relationship and Visitation

Reunification is the primary permanency goal for most of the children in foster care (Haight et al., 2003). “Parent visitation, the scheduled face-to-face contact between parents and their children in foster care, is considered the primary intervention for maintaining and enhancing the development of parent child-relationships necessary for successful family reunification” (Haight et al, 2003, p. 195).

The emphasis of reunifying children in foster care with birth parents requires that birth parents have supervised visits with their children (Davis et al., 1996). There is evidence that the more active the parents are in visitation, the more likely reunification will occur. This was demonstrated by Davis et al

(1996) in a study conducted in San Diego that found a strong correlation between frequent parental visitation and reunification outcomes for children. The study focused on children 12 years of age or younger. The majority (66%) of the 922 children in the study who experienced maternal and paternal visitation frequencies consistent with court orders were reunified within the first 18 months in foster care. It is important to note that visitation is not synonymous with ensuring safety of children reunified. Maternal visitation at the recommended levels was such a strong predictor that a child had ten times more of likelihood to be reunified (Davis et al., 1996). In fact, Davis et al found there was no association detected between parental visiting and reoccurrence of maltreatment of reunified children at follow-up. The study had some important limitations. First, it was not clear what the

However, this study as a whole provided support overall that visitations are essential to the goal of reunification.

Leathers (2002) examined the issue of visitation and family reunification as well in her study of

230 twelve and thirteen year olds placed in traditional family foster care. She found that mothers who visited their children, were involved in their activities, and had involvement in case reviews were those that had more frequent visitation of their children than mothers who visited in non-agency settings and did not have any other kinds of involvement. Like Davis et al. (1996), Leathers found that frequent visitation was “highly predictive of reunification” (2002, p. 595). Leathers (2002) did not report frequencies so comparison between the studies is difficult. Inherent in any discussion about reunification is the issue of what services may contribute to an increased chance of a parent’s reunification with their child. She therefore stresses visitation as an effective reunification method that may help with decisions to reunify more quickly (Leathers, 2002). Leathers (2003) also discusses another conflict contributing to the outcomes in foster care visitation. In her next study involving almost 200 adolescent foster children, she found that frequent visitation is potentially difficult for the foster children because of conflicts regarding loyalty between foster parents and their own parents.

Children with emotional or behavioral disturbances were most likely to struggle with such a loyalty conflict, and therefore caution must be exercised because of conflicts regarding loyalty between foster parents and their own parents. Children with emotional or behavioral disturbances were most likely to struggle with such a loyalty conflict, and therefore treatment interventions designed to address the this conflict might improve the matter (Leathers, 2003).

As the literature continues to emphasize the importance of visitation in reunification, Haight et al, (2002, 2003) discussed the importance of visitation and relationships respectively. She lends

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation support to the significance of visitation and parent-child relationships, and she stresses the importance of and necessity of them for successful reunification. “Organized visits are considered so critical to the effort to reunite families” (Haight et al., 2002, p. 174), however, the existing literature suggests the problems with visitation that contribute to the lack of success of the overall process (Haight et al.,

2002). Visitation needs to improve while incorporating the perspectives of parents and foster parents, as well as child welfare workers. Haight et al. (2002) described the grief and strife suffered by mothers after enduring separation from their children when they enter foster care, and emphasized the importance of expression of emotions and verbal interaction during visits. Child welfare workers struggle with encouraging emotional closeness between the parents and children while being supervised, as well as have the task of evaluating the behavior of parents during visitation sessions.

Foster mothers also have a struggle to get children emotionally ready for visits, as well as assist them emotionally afterwards. Another struggle hurting the process was the varied degree of understanding of appropriate social work practice during visits. The adults involved bring very valuable but different practice experience to the process of visitation that should be better understood by the parties involved.

For example, what foster care workers supervising the parent-child interactions thought was positively reinforcing, was actually perceived as demeaning by the biological parents who visit their children in foster care. Understanding the struggles of those actually involved in the process can address the avoided interpersonal and psychological aspects that may affect visitation. Understanding such complexities of visits interpersonally and emotionally acknowledges the struggle for those involved, particularly the children, and can therefore offer suggestions of how to improve the visitation between parents and children towards the decision and goal for successful reunification (Haight et al., 2002).

Haight et al. (2002) therefore makes suggestions as to how to accomplish this and heightens awareness of the concerns on the matter. The history and context of each individual case may affect

The unresolved and conflictual feelings of mothers and children must be considered, and consequently, how they may struggle to function well given their struggle with the separation from each other. This particularly applies to mothers who struggle with improving parenting abilities, as well as struggle with affecting the child welfare workers and foster parents with potential emotional reactions. The other adults involved in the process can help support such mothers and their grief. Mothers, foster parents and the children all could benefit from assistance with mentally and emotionally preparing for visits beyond its content and structure, as well as to assist with dealing with the complex nature of the visit process as a whole. An example of this is the stressful role of the foster parent who has the task of supporting the parent-child relationship as well as preparing children for visits and at times supervising the visits. In addition, visit settings often lack “adequate physical context” (Haight et al,

2002, p. 194) in which to hold the session which would lend to more of a private, child-friendly setting. The literature suggests that considering and addressing these issues collectively may improve the relationship and visitation that takes place toward the additional goal of reunification (Haight et al.,

2002).

Haight et al (2003) furthers the focus on how to improve the relationship in this process, as she finds and highly emphasizes that the quality of attachment between the parent and child is a very important factor in contributing to the quality of visits. “Universal aspects of attachment relationships suggest that when reunification is the permanency goal, regular visits should be encouraged; that families should be supported before, during, and after visits; and that secure attachment relationships should be supported between children and their foster and biological parents” (Haight et al., 2003, p.

204). The aspects related to attachment relationships recommend more homelike environments for visits, and the importance of comprehending and supporting the parent-child relationships both socially

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation and culturally. During instances where the quality of attachment is problematic, visit sessions should be organized with other therapeutic services who can maintain a higher degree of involvement to professionally monitor the situation and provide intervention that may be needed. It is also important for policy makers and practitioners to validate the attachment aspects of the parent-child relationship so that service plans adequately reflect the family’s needs through visitation (Haight et al., 2003).

Although this specific work of Haight et al. (2003) as well as Cantos and Gries (1997) do not focus on the decision or result of reunification, their efforts in providing literature to emphasize visitation is consistent with the findings of others mentioned previously who purport that this issue is significant in yielding successful results with the decision to reunify (Davis et al., 1996; Leathers, 2002).

Lastly regarding the issue of importance of visitation, Cantos and Gries (1997) continue to suggest support for the importance of parental visitation. However they state that although parental visiting has been heavily cited as beneficial to children in foster care, after examining their own findings they seem to lend support to the complication of the role of visitation, as Leathers (2003) does. Cantos and Gries (1997) examined the emotional and behavioral states of children who were visited versus not visited. They found that “visiting may minimize the amount of externalizing behaviors exhibited by these children, but the extent of internalizing behaviors may depend on the degree of adjustment the children have made to placement” (p. 316). Therefore, when making decisions about reunification, the literature that supports visitation seems to also support a need to address emotional and behavioral issues to qualitatively improve visitation and the parent-child relationship towards a likelihood of successful reunification.

A weakness of the literature in the area of relationship and visitation overall is the lack of information on quantities and frequency of visitation that would bring about such indicated results.

This acts to prevent creation of any standards or guidelines whether statewide or nationally to produce

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation results to either reduce the length of stay in foster care or increase the likelihood of reunification. It would seem that understanding and perceiving some standard for frequency and quantity of visitation may help people in position of making decisions about permanency planning and reunification, particularly involving goals to reduce the amount of time spent in foster care.

Social and Environmental Factors

It seems that many social and environmental factors determining reunification become weighted differently depending on focus of importance at the time of assessment. Of such factors as attachment, permanence, and kinship, Hegar states that “one is often traded off for another” (Hegar, 1993, p. 367) when deciding on placement options if reunification possibly may not take place. Hegar (1993) discusses the importance of children’s attachment bonds to parents and surrogates as a goal in foster care placement. She indicates that permanence, which included relationships that continue throughout time, whether in a biological family, kinship, through adoption, in stable guardianship or an extended family foster care arrangement is the primary focus of child placement practice. Kinship, or the perception of family, is viewed a very old concept in the placement of children but is the most recent of these three factors to attract a respectable degree of professional attention. Hegar summarizes in her review that these factors are weighted towards making decisions are made about placement for foster children, and are presented in such a manner as to examine all options for placement of children

(Hegar, 1993) particularly if reunification may not be an option.

Gammon (2001) examines racial and socioeconomic bias in social workers’ decision making about family reunification. She administered a questionnaire to 1,200 randomly selected social workers from the NASW registry and received a 48.6% response rate, and proceeded to examine race and socioeconomic status independently on the decision to reunify a family using foster children who had been in care for 17 months. Findings indicated no statistical significance and differences, lending

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation to the conclusion that child protective service social workers in the position of reunifying families are not influenced by the race of socioeconomic status of the client during this decision-making process.

In addition, the study found that social workers who were male more often felt that children should remain in foster care. Furthermore, the greater the length of time working in the social work field, the greater the likelihood that they would act to reunify the family (Gammon, 2001).

Jones (1998) also focuses on the social and family correlates of positive reunification. Jones encompasses a broad gamut of such factors that are important in influencing reunification but does not isolate the impact of relationship or visitation with such significance as the other literature discusses

(Jones, 1998). However, Jones’ focus examines how social and environmental factors affect reunification by causing more stress in the parents with a weak social and environmental structure

(Jones, 1998). Increased stress can be correlated with a questionable ability to function towards having a positive relationship with one’s child, an ability which the this paper discusses as important in being a deciding factor for reunification (Haight et al., 2003; American Academy of Pediatrics, 2000).

Negative social and environmental factors are likely to increase stress experienced by families. Stress can create conflict within families and reduce the effectiveness of parenting abilities. In addition, if a family lacks a strong social support system, it may not be able to manage stress well due to such lack of assistive tangible resources as well as emotionally. Lastly, financial stress may reduce the ability of purchasing necessary supportive services and therefore continues to add to stress (Jones 1998).

The broad social and environmental factors include “income, economic, housing, social support, and family structure variables” (Jones, 1998, p.305). Specifically, such variables were examined including type of abuse experienced, stressful life events, family events such as change in family constellation, caretaker health, economic events, characteristics of the in-home caretaker, and child’s environment including aspects such as evaluating the safety of the environment or existence of

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation inadequate housing. It was hypothesized that these variables would show significant correlations with reunification results, and that a model of social and family characteristics could be created to predict success or failure of reunification of children who went home after foster care. Information for the study was derived from review of case records and computer files from the Department of Social

Services. An extensive database was used to obtain information children who were utilized, including children birth through twelve years of age who were withdrawn from their homes for more than three days by the Department of Social Services from April 1990 through October 1991. When examining factors that were correlated with reunification failure, poverty and inadequate housing are very large risks to prevent successful reunification in the social environment. Also worth noting is the presence of the assistance of Aid to Families with Dependent Children (AFDC) as well as having been removed from a residence with inadequate housing. Interestingly, the number of parents living in a home did not apparently have predictive qualities in this study. Other factors yielding unsuccessful reunification were being a child with medical or behavioral problems, as well as a non-white child (Jones, 1998).

Thus, it is hoped that this may reveal some of the important aspects that may contribute to higher stress within families and therefore impact the relationship viewed necessary for successful reunification, as was posited earlier.

Decision-Making

Despite that decision-making is crucial regarding placements and visitation for children in out- of-home care, little published empirical research exists to address the topic. As was mentioned previously, visitation is viewed as an effective reunification method that may help with decisions to reunify more quickly (Leathers, 2002). Exploring unsuccessful decisions was examined by Rossi,

Schuerman, and Budde (1999), who found that foster care workers made two types of mistakes in decision making. They failed “to remove children from their families when it is called for and …

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation (removed) children when it is unnecessary” (Rossi, Schuerman, & Budde, p. 579). In addition, foster care workers are responsible for making placement decisions for foster children, but may not actually be the most knowledgeable to assess the children and their behaviors. Treatment foster care homes have increased over time as placement options in addition to the usual foster care homes or kinship foster homes. Therefore, foster parents or residential treatment counselors may be better able to assess foster children and the appropriateness of placement decisions but such information is not sought (Courtney, 1998). Furthermore, when making such placement decisions, Courtney (1998) found that certain characteristics such as child age, behavior problems, and placement history, had a strong correlation with the increased likelihood that a child welfare worker would seek to find a treatment foster care or group care placement for a child as opposed to a regular foster care home or kinship foster care home. Glisson (1996) found that child age, gender, frequency of times in custody and problem behaviors as assessed by the child’s caregiver were associated with the degree of restrictiveness of the child’s placement setting in out-of-home care. This addresses the concern of ensuring an appropriate placement which would only then enable successful visitation with such a good fit. Interestingly, Brittner and Mossler (2002) found that professional group membership, as opposed to aspects such as age or ethnicity of the foster child or the persistence of abuse, explains the varied patterns of prioritizing and utilizing information when making decisions for community-based training and intervention efforts are considered. For example, when making decisions about foster care placements, mental health providers and social workers reportedly depend on data about the seriousness of and pattern of abuse, on information about services offered historically, and the parents’ reaction to such services. Judges and guardians ad litem depend more closely on information about the likelihood of reoccurrence of maltreatment and the child’s capability to give an account of the abuse.

CASA volunteers in this study relied on data about the stability of the family (Brittner & Mossler,

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation 2002). Overall, there is a need for research that explores differences between successful and unsuccessful decision-making in placements, visitation, and reunification.

Interventions

There are virtually no known published interventions studies that have taken place to address the issue of attachment and relationship of children in foster care with their primary caregivers.

Therefore, this paper will look at the interventions that have acted to develop better attachments regardless of the setting in which the children reside, in an effort to assess what interventions may potentially be successful with the foster care visitation setting. Therefore, an examination of the professional literature and intervention studies produces a variety of suggestions as to answer the question: what interventions are best to help children develop better attachments? It is hoped that the examination of the interventions that may potentially best help children develop better attachments may yield proposals for future interventions in an attempt to strengthen the attachment and relationship between primary caregivers and their foster children.

A Review of the Intervention Research on Attachment

The literature discusses various interventions that have been done and raises the issue that no one intervention may be more successful or better than others at improving attachment (Bakermans-

Kranenburg, 2003). Regardless of whether or not this dodo verdict (Luborsky et al., 2002) is true, the challenge remains of examining as well as performing more interventions that will produce a positive effect on attachment. The literature discusses the importance in performing more intervention studies that aim at altering parental behavior or the development of children, which both involve improving attachment. Research designs that are not experimental in nature are largely saturating the parenting and child development field, and experiments may be vital in determining whether parenting, genetics or other influences are affecting the development of children. In addition, experimental interventions

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation are a method of producing the most ideal manner of altering the attitudes, behaviors and mental perspectives of humans (Bakermans-Kranenburg, 2003). There are many professional manuscripts and descriptions of treatment interventions and models (Nichols, Gergely, & Fonagy, 2001; Watts &

Broaddus, 2002). However, there were relatively few experimental and quasi-experimental intervention studies found. In addition, although interventions have taken place regarding attachment with several different age cohorts (Davey & Abell, 2003; Toth, Maughan, Manly, Spagnola &

Cicchetti, 2002, Zeanah, 2003), much of the intervention research that has been done involves solely infants (Bakermans-Kranenburg, Juffer, & van Ijzendoorn, 1998; Camp & Finkelstein, 1997; Cohen et al., 1999; Cosden & Cortez-Ison, 1999; Culp, Culp, Blankemeyer, & Passmark, 1998; Heinicke,

Fineman, Ruth, Recchia, Guthrie, Rodning, 1999; Heinicke et al., 2000; Dolev, Sher, Etzion-Carasso,

2002; Leitch, 1999; Murray et al., 2003).

Formalized Psychological Treatments as Interventions

Two other studies take a different approach at developing attachment as they utilize various forms of psychological treatments towards enhancing attachment (Cohen et al., 1999; Murray et al.,

2003). Murray et al. (2003) examined the effects of three psychological treatments that were delivered in the homes by trained therapists on 193 mothers with post-partum depression, and how it impacted the relationship between child and mother, as well as the outcome on the child. The mothers were randomly assigned to either routine primary care, or one of three interventions, including non-directive counseling, cognitive behavioral therapy or psychodynamic therapy. They were measured at 4.5, 18 and 60 months following the birth of their babies by assessors who were unaware of the treatment interventions that they were given. Mothers completed a checklist that was created specifically for this study that allowed them to reflect on the level of difficulty in managing their infant’s behavior as well as problems in the mother-infant relationship. Videotapes of mother and child interacting during

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation brief play sessions were also assessed. This study, assessing maternal mood, the mother-child relationship, and aspects of the child’s developmental status, found that regarding attachment, there were no significant differences between the treatment groups and the control group. The treatment effects still lacked significance upon controlling for social adversity.

This study showed some minor benefits regarding the mother-child relationship and child outcome, such as during play, regarding separation issues or meeting their needs for attention.

However, the study found that most of the outcomes did not show any positive effect of the interventions (Murray et al., 2003). The study’s focus on three different treatment modalities as well as usage of a community control group was viewed as a strength, to be able to analyze across various methods of treatment, as well as the brief benefits that were described. However, this study demonstrated these treatment interventions to be weak on a long term basis, which presents as a limitation. This study exemplifies a positive contribution regardless, as it may indicate that other modalities may be necessary to propose given that interventions delivered when women are already depressed begin with a disadvantage and unlikelihood of working more effectively (Murray et al.,

2003). Considering this, it seems questionable of how well this type of treatment intervention may be able to enhance the attachment, in this instance, the mother’s ability to enhance the attachment between the infants and themselves. The efficacy of the design, however, is respectable. The large sample size of 193 subjects, coupled with the researchers being blind to which interventions the subjects were receiving, the use of control group, and the measures of pre and post test contributed to the strengths.

In addition, this study indicated that it controlled for pre-treatment measures, yielding no specialist therapist effects on the constructs of problematic behavior, problematic relationships or maternal sensitivity (Murray et al., 2002). The treatment matching on the diagnosis of Major Depressive

Disorder is also viewed as a strength. Lastly, an adequate statistical test was used that generally is able

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation to show a fair statistical power. This study used the Kruskal-Wallis one way analysis statistical methodology. Despite the simplicity of this test, it has been shown to be very reliable (K. Levy, personal communication, May 3, 2004). However, the study demonstrated significance, but could only do so with an alpha level of P=.85. This clearly lessens confidence in the findings, but not the rigor in which the design was conducted except for the standard that the investigators accepted for significance.

The other study of focus that examined the effectiveness of psychological treatment was done by Cohen et al. (1999) and examined two different psychotherapy interventions. Sixty seven infants and their mothers were randomly assigned to either the infant-led psychotherapy group through the program called Wait, Watch, and Wonder (WWW), or the mother-infant psychotherapy group (PPT)

(Cohen et al., 1999). The PPT treatment intervention involved communication between the mother and therapist during the entire session while the mother played with the infant; they were instructed to talk and play simultaneously. This was different from the WWW treatment program, where mother was directed to get on the floor with the infant, monitor the infant and allow it to lead while the therapist assessed the interchanges between mother and infant, and later interviewed mothers about their observations. This study, like Murray et al.’s study (2003) had random assignment but took place in a clinic setting with self or organization referrals as opposed to the home setting conducted in

Murray et al.’s study where subjects were acquired after having been approached. The use of a control group was not viewed to be practical, since making infants and their mothers wait such extended periods of time for treatment may be unethical, as well as that mothers may be dissuaded from getting help (Cohen et al., 1999).

Findings of Cohen et al.’s intervention study were much more positive than those of Murray.

Cohen et al. (1999) found that the WWW group showed a larger change toward a secure attachment relationship, as well as an increased development cognitively and emotional regulation when compared

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation to the PPT group infants. Furthermore, WWW group mothers demonstrated a great increase in satisfaction with parenting and competence, as well as a decrease in depression versus the PPT mothers. Both treatment interventions showed positive effects in reducing the problematic behavior of the infants, as well as lowering the parental stress, maternal intrusiveness and conflict between the mothers and infants (Cohen et al., 1999).

The intense focus by mothers on increasing the awareness in the actions of their children supports interest in intervention to develop better attachments. The comparison of the two different psychotherapy approaches between mother-infant dyads conceptually was valuable in providing qualitatively different modalities of which to compare, particularly having one intervention play a role in tuning into the infants’ lead of actions and interests. The lack of a control group, which Murray et al. included (2003), is viewed as a limitation. In addition, the infants were already attached upon entry into the study; therefore it may have been more beneficial to have done the study with the infants at an earlier stage prior to formative attachments to examine if the potential effects on attachment were actually due to the treatment interventions. This aspect, coupled with the fact that this was not an experimental design with a control group, does not allow the reader to conclude that the findings were in fact a result of the interventions. Furthermore, this study did use random assignment but did not have a control group. However the efficacy of the study otherwise is impressive. The investigator stated that this study “goes beyond the current infant psychotherapy literature by including standardized measures of cognitive development and ratings of affect regulation” Cohen et al., 1999).

Lastly, the use of the Strange Situation (Ainsworth, 1989) as the attachment measure was viewed as reliable and valid given the rigorous testing that it has undergone starting years ago by Mary

Ainsworth.

Educational Home Visitation Methods as Interventions

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Five studies employed various educational interventions within the homes of mothers and their infants as a method of attempting to impact some aspect of attachment. Leitch (1999) carried out an intervention of infant communication education through a 45 minute videotape providing information on infant states, behaviors, communication cues, as well as social and cognitive behaviors that were meant to enhance growth. The intervention was provided in the homes of first-time mothers done prenatally to examine the scope of the infant-mother interaction within the first 24 hours after birth.

The treatment group received the infant communication two weeks before their delivery date, where the control group solely attended the routine teaching sessions. The study, which used the Nursing

Child Assessment Teaching Scale (NCAST) measuring the dependent variable on six sub-categories, found significance for the overall total scores as well as for the contingency sensitivity to cues and contingency social-emotional growth-fostering behavior. Given that little emphasis has been on infant communication prenatally to increase the quality of the interchanges between mother and child, more clinics and service providers may seek to intervene in this manner towards ultimately enhancing the mother-child relationship (Leitch, 1999). Clearly the significance on these constructs reflects support as an intervention to enhance attachment. The additional educational focus through this intervention on developmental aspects is a strength in that it goes beyond the routine education to mothers of basic routine care and maintenance of an infant. In addition, the major weakness is the question of whether or not assessing attachment can be done within the first 24 hours after birth during such as short period of time, which in essence questions ideas of validity as to whether the intervention is measuring what it is intended to measure. Lastly, there was a low statistical power shown, .80, and a high attrition rate.

The sample began with 70 subjects and resulted in 29.

Bakermans-Kranenburg et al. (1998) utilized varied treatment interventions as opposed to the single educational video, however continued to implement them in the homes of subjects as did Leitch

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation et al. (1999). Although this study intervened from the subject’s home, the intervention that was implemented was more extensive and had the similar goal of enhancing attachment in infants, however

Leitch, et al. (1999) focused on increasing the mother-infant interaction. Bakermans-Kranenburg et al. (1998) began with mothers who had insecure attachments, and looked at the dependent variables of attachment as well as maternal sensitivity. Mothers’ types of insecure attachment were classified as being either dismissing or preoccupied. Bakermans-Kranrnburg et al. (1998) sought to examine the effects of two different interventions. Thirty subjects were distributed randomly among three groups: a control group; a group who was provided written literature about sensitive parenting coupled with personal video feedback; and a group who received the personal video feedback accompanied with discussions about early attachment experiences. The findings supported the generally accepted concept that short-term behavioral interventions, focused on parental sensitivity, produce only temporary effects, while the parents’ status of attachment is not affected. However, this study did find that short term interventions had a positive effect on improving parents’ sensitive responsiveness.

Regardless of type of security of maternal attachment or type of intervention used in this study, maternal sensitiveness responsiveness significantly improved. In addition, findings further indicated that parents with specifically identified insecure attachments may be more likely to have success with interventions. Mothers with dismissing attachment styles benefited more from the informational literature and video feedback, where mothers who were preoccupied benefited more from the intervention with the supplemental attachment focused discussions. (Bakermans-Kranenburg et al.,

1998).

The Bakermans-Kranenburg et al. (1998) study yielded some positive findings that lend support to the value of the impacts of attachment of infants, which therefore may lend some clinical significance. The small sample size of 30 subjects divided among the three groups was viewed as a

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation limitation. Despite the control group that would normally increase control in the experiment, the small sample size lacks the ability to generalize findings to the large population. Despite the positive findings that this study reported, the short-term intervention as well as the small sample size gives less value to this study’s usefulness. In addition, the study did not include any type of assessment of the level of attachment of the mothers who participated in the study with their own parents. This could have had an impact on the relationships if such data was gathered. Furthermore, this study did appear concerned with treatment matching issues, as assessments were done initial to group the mothers by type of attachment, which is viewed positively.

The findings from the UCLA Family Development Project Intervention by Heinicke, et al.

(1999) are the basis for his later study (Heinicke et al., 2000). This foundation is also based on the assumption that various aspects of familial functioning must be focused upon, particularly in families that are at-risk, if supported changes may be accomplished (Heinicke et al., 1999). Heinicke et al.

(1999) showed that the intervention of a home-visiting relationship-based treatment with at-risk mothers had a positive effect on specific aspects of functioning in the first year of an infant’s life. The study consisted of two samples of mothers who were in the third trimester of pregnancy with their first child and were viewed to be at –risk due to poverty and lack of support. Thirty-one mothers received the ‘home-visiting’ intervention; 33 mothers did not and instead received the ‘pediatric follow-up’ which consisted of developmental assessments and feedback, as well as referrals if deemed necessary.

The one hour per week home-visiting relationship-based treatment consisted of the opportunity for mothers to have a positive, functional relationship based on trust with a home-visitor that visited weekly. The home-visiting took place for one hour weekly towards the end of the women’s pregnancy and during the first year, followed by alternating weeks during the second year, and telephone contacts in the third and fourth years during follow-up. In addition to the home-visitor, the intervention also

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation included participation in a mother-infant group, the latter of which was optional. The number of sessions attended ranged from 0 – 43, and the average number of sessions attended was 17. This was viewed to be a limitation given that the subjects therefore would receive unequal amounts of the intervention due to the option of attending the group. This study also used a small sample size which is also viewed to be a limitation. Findings reported that children in the intervention group were noted to be more secure and their mothers were found to be more attentive to the needs of her children. In addition, children who received the intervention were found to be more independent, had an increased task-awareness, and received support for such by their mothers (Heinicke et al., 1999).

Heinicke et al. (2000) continued the scope of the earlier study of the UCLA Family

Development Project Intervention as they now limit examination to the intervention group. This phase of the study involved 46 families, all of whom participated in the home-visiting intervention. Thirty- one of them were examined as part of the clinical trial and 15 families were examined independently of that trial. This study now “asks whether variations in the earlier status and/or variations in the mother’s involvement in the intervention predict variations in the 12-month parent responsiveness and child security (Heinicke et al., 2000, p. 135).” This is a classic example of analysis of process and outcome of an intervention (Orlinsky, Ronnestad, & Willutzki, 2004). Heinicki et al. (2000) focused on the process variable of the mother’s involvement in the intervention, and believed that mother’s personality and her partner and family degree of support could influence outcome. They hypothesized that mother responsiveness interacting with an infant characteristic such as infant soothability could possibly have an effect on the development of the child’s security of attachment later in life (Heinicke et al., 2000). This study measured the child’s reaction to separation, and their belief that they would be taken care of, as well as the mother’s attentiveness to the child’s needs. More specifically, maternal involvement and ability to relate to the home-visitor, partner support, personality dimensions and

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation mother-infant interactions composed the intervention. Findings indicated that parents who met the needs of babies who were able to be soothed by the age of one month had a greater likelihood of having secure children at the age of one year. The positive effects were not largely robust. In addition, there was no control or comparison group during this phase. Both of these aspects are considered limitations (Heinicke et al., 2000).

Aside from the limitations discussed throughout, both Heinicke et al.’s studies (1999, 2000) demonstrated strengths such as the ongoing duration of the study to track the long-term effects over time. It stipulates very specific and detailed criteria to operationally define subjects, thus adding control to the study. In addition, Heinicke et al.’s more recent intervention study innovatively sought to examine process variables in its study (2000), a focus that in the opinion of many is not prevalent in the literature, relatively speaking. The use of treatment manuals on both of the studies by Heinicke et al. (1999, 2000) contributes to strength of the measurement of the process variables in the study as well as to the control and internal validity. Specific examples of how the manual was used were while sharing in the enjoyment of the infant, describing the basic ideas and purpose of the project, and discussing positive feelings. The manualized process will also act to reduce negative therapist effects.

The Heinicke et al. studies (1999, 2000) may be viewed as able to have a more positive effect when compared to the other home-visitation programs in the sense that the duration of the program itself seems to raise a question of whether more of a lasting effect and ability to have an impact on attachment may take place. However, that is speculation since this study did not measure specifically for parental sensitivity as was of focus previously. As Bakermans-Kranenburg et al. (1998) conveyed, short-term interventions on a behavioral realm, focused on parental sensitivity, largely produce only temporary effects, while the parents’ status of attachment is not affected.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Lastly, Culp et al. (1998) offers a final look at an intervention that primarily takes place through home visitation. Intervening with mothers in their third trimester of gestation as Leitch (1999) did, Culp et al. implemented a much more involved education program than the prenatal education video treatment program by Leitch (1999). Differently from the other interventions discussed, however, Culp et al compared 38 adolescent first-time mothers versus 22 nonadolescent first-time mothers after six months of weekly child development paraprofessionals trained in this area. There was no control group, which could be perceived as a limitation. Through the in-home education program, mothers received the training one hour weekly that was manually based yet still individualized. The mothers were given training in the area of child development, parenting abilities, and were given referrals for services in the community. The intervention program’s goal was to enhance the development of the parent and child, and encourage a secure relationship between parent and child. All mothers improved significantly in their intelligence of infant development, empathic attentiveness, and knowledge of child and parent roles in the family. The condition of the safety of their residences improved, as well as their degree of involvement with organizations in the community.

Interestingly, “the adolescent mothers scored significantly lower than the nonadolescent mothers at baseline on only two measures: knowledge of infant development and understanding of child and parent roles; however, after 6 months of intervention, their scores were not significantly different from the nonadolescent mothers (Culp et al., 1998, p. 111).”

The treatment intervention program serves as an unexpected strength to benefit both adolescent mothers and nonadolescent mothers, particularly when adolescent mothers start the program with less knowledge than the nonadolescent mothers. (Culp et al., 1998). However, the status of the sample size not being fairly evenly split could be perceived as a limitation, and particularly applies in this instance where there were no significant differences on the measures of comprehension of infant

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation development and knowledge of parenting roles between the two groups after intervention. This raises the question of whether there would have been a significant difference if the sample sizes were equal.

The study overall serves as a symbol of awareness of the need for more educational intervention for mothers in general. Finally, although this was a quasi-experimental design, it did employ a control group and baseline and post tests to show comparisons for change, adding strength to the design.

Attempts at efficacy are also demonstrated through the employment of “the manualized, yet individualized, curriculum on parenting skills, child development, home safety, and information on available community resources” (Culp et al. 1999, p. 115).

Combination of Interventions

One final study employed various treatment groups as it compared several different interventions previously of focus. Since children who endure abusive treatment or caregiving that lacks sensitivity have a greater likelihood of developing negative representations of their parents or caregivers and therefore poor representations of themselves, maltreated children also have the risk of having insecure attachments (Toth et al., 2002). On the basis of this, the concept of mental representations of self and others are examined here to reflect the attachment in children. Toth et al.

(2002) utilized different interventions including a Preschooler-Parent Psychotherapy (PPP, n=23) group, Psychoeducational Home Visitation (PHV, n=34), and a Community Standard (CS, n=30)

Intervention group. One hundred twenty-two mothers and their preschool age children, 87 maltreated,

35 nonmaltreated, participated in the study, the latter of whom comprised a comparison group.

Maltreated subjects were randomly assigned at baseline to one of the following groups in this preventive intervention “designed to modify children’s internal representations of self and of self in relation to other (Toth et al., 2002, p. 877).” The children were administered a series of eleven narrative story stems presenting conflicts and moral struggles related to parent-child and family

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation relationships, and children were asked to complete the stories of what occurs next. The PPP intervention group consisted of dyadic sessions spent with a clinical therapist for one hour weekly, which most often took place in a clinic setting as opposed to home, where the therapist made efforts to alter the relationship between mother and child. An integral aspect of the PPP group was concept that

“PPP is designed to provide the mother with a corrective emotional experience in the context of the relationship with the therapist….Through empathy, respect, concern, and unfailing positive regard, therapists help maltreating mothers to overcome…negative expectations and provide a holding environment for the mother and preschooler in which new experiences of self in relationship to others and to the preschooler may be internalized (Toth et al., 2002, p. 891).” During one hour sessions weekly, the PHV model focused with the clinical therapist on accomplishing a thorough assessment of the risks as well as safety aspects taking place in families to potentially explain the events around which the maltreatment took place. Mothers were also taught cognitive behavioral techniques created to change the mother-child manners in which they interacted and teach healthier parenting skills. The

PHV sessions generally took place at home, however modifications took place to meet at the organization’s center at times due to client need. The CS comparison group receiving standard services through the Department of Social Services was used to examine the effects of standard services, as well as the incorporation of the comparison group of 35 non-maltreated preschoolers (NC). Findings reported that the PPP intervention model with the foundation of attachment theory was more competent at improving representation of self and of caregivers than is the didactic model of intervention aimed at changing parenting abilities. The children in the PPP group exhibited more of a decrease in maladaptive maternal representations across time when compared to PHV and CS. The

PPP group showed a greater decline in negative representations of themselves when compared to CS,

PHV and NC children. In addition, the relationship expectations between the mothers and children in

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation the PPP group became increasingly positive throughout the treatment intervention program (Toth et al., 2002). The variability of location that took place at times for the PPP and PHV groups can be seen as a limitation given that it eliminates the consistency that is beneficial with administering the intervention. Aside from this, this study has been an intensive, treatment intervention aimed at a focus in relationships as well as prevention, the latter of which has not been seen in any of the literature reviewed in this paper, and is therefore viewed as a strength.

All assessments during this ongoing longitudinal study were facilitated by female research assistants who had no knowledge of the maltreatment status of the families, the intervention status, or the hypotheses of the study (Toth et al., 2002). This acts to remove the bias of the principle investigator collecting the data. However, there is no discussion of the level of education or degree of training that the research assistants experienced to reduce therapist effects as well as to gain interrater reliability. Yet the study does indicate that it took steps to ensure that the experimenter asked the child the same scripted questions, as well as that the story stems were told with the same level of drams and voice inflection (Toth et al, 2002). However the reliability of this is still questioned. Furthermore, the experimental design employed in this study is viewed to be strong given its use of a control group, randomization, as well as pre and post test measure. Furthermore, statistical power was evident in this study. In addition to performing ANOVAs, it also performed Tukey post hoc pairwise comparisons with a respectable alpha level of .05.

Multiple Family Group Intervention

Multiple Family Group (MFG) intervention was used in an attempt to reduce stress level, decease parent stress, increase family functioning and cohesiveness and relationship. The MFG intervention offers an enjoyable, safe and supportive environment in which families can interact freely and without distractions or struggles such as the need for child care (Davey & Abell, in press). The

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation proposal and use of MFG’s was as a responsive intervention methodology for low economic status, minority children and families (Aponte, Zarski, Bixenstene, & Cibik, 1991; Boyd- Franklin, 1993;

McKay, Gonzales, Stone, Ryland, & Kohner, 1995).They usually group four to seven families and typically last approximately 90 minutes (Tolan & McKay, 1995). However, some intervention programs have altered the format and shown success with this. Such is the case with Davey and

Abell’s (in press) study where and MFG was utilized with families residing in shelters. Their MFG design consisted of providing a therapeutic environment in which to have discussions among the similar families of issues on their lives, create supportive friendships, as well as provide family mental health services (McKay et al., 1995). The series of their weekly groups was lacking cohesiveness due to the attrition of the families who did not reside in the shelters as long as the average usually indicates.

The researchers thus restructured the format to consist of one intensive family session over two days on one weekend lacking an over-night stay, and found success with this. Parents who participated indicated that they wished that the retreat were longer; investigators took this as support for a longer term intervention (Davey & Abell, in press).

The fidelity of the MFG intervention itself unfortunately may be questionable only because

MFG interventions have not been widely utilized or rigorously tested empirically (particularly with attachment and families) with any thoroughness that would lend to the greater fidelity. Of the few studies that utilized the MFG intervention, positive results were obtained (Dare & Eisler, 1995; Davey

& Abell, in press, Rhodes & Zelman, 1986). MFG has been tried with varied populations. However, some such studies are still awaiting results (Dare & Eisler, 2000), or have not yet had extensive use with certain populations such as the homeless population (Davey & Abell, in press). Success with

MFG interventions have been found though with African Americans (Boyd-Franklin, 1993), multiple problem families (Aponte et al., 1991), and abused women and their children (Rhodes & Zelman,

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation 1986). Aside from this, since the MFG has a Family Systems foundation (Davey & Abell, in press), it lends greater support for increasing fidelity of this modality. In regards to the retreat staff, they were described as consisting of “a clinically trained social worker, a social worker from a metropolitan public school homeless education program, and trained student volunteers from the local school of social work graduate program” (Davey & Abell, in press, p.8). No mention is made of efforts to train the staff or of the use of any treatment manuals for such an innovate intervention, thus lessening the control and internal validity, and in essence, the efficacy of the study. In addition, although there is no control group, this quasi-experimental study did employ a pre and post test design. However, only 19 of the 34 families were present to complete the post-test assessments at the conclusion of the study

(Davey & Abell, in press). This also lessens the control of this study. This is an innovative intervention that could have employed an experimental design to achieve efficacy if such other measures were taken into consideration. Since it was non-experimental in design, the clinical significance is worthy, and lays the foundation for continued research with such types of interventions that may employ an experimental design with efficacy as a goal so that better validity may be achieved.

Change of Residence as an Intervention

Some of the intervention studies utilized a residential facility as part of the design. Cosden &

Cortez-Ison (1999) studied 84 pregnant or parenting women with children under age 3 who were entering residential care for substance abuse treatment. The concept was based on the idea that residential treatment with children in the mothers’ care would increase the attractiveness of entering treatment. The investigators based their predictions on attachment theory, as they proposed that the early history and attachment of subjects will determine the how effective they can use social supports such as the comprehensive services provided by the residential program. The investigators concluded

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation that bonding experiences were correlated with social satisfaction experienced. They also stated that having a history of sexual abuse was correlated negatively with the time spent in the program as well as graduating from the program (Cosden & Cortez-Ison, 1999).

This intensive, quasi-experimental design measured various constructs (one encompassing attachment) with three existing instruments. However, despite such, the study still relied on two forms of measurement that likely resulted in weakening this study. They include self-reports and use of retrospective data, which are known to have questionable reliability. Operationalizing and measuring constructs in more than one manner would have strengthened the support for this study. In addition, this study had a high attrition rate, where less than half of the 84 women graduated from the program, leaving for various reasons. Based on concepts of therapist effects, the question is raised as to what measures were taken to establish a therapeutic bond which would have a greater likelihood of producing success in treatment, as one of the components was psychotherapy services. This concern is raised since upon starting the program at intake, the resident-subjects were administered the three test instruments, as well as interviewed, possibly communicating sensitive material as history with sexual abuse. In addition, discussion of the training or competency of therapists or intervention staff is not included except to state that “All assessments were conducted by program staff trained to administer the instruments” (Cosden & Cortez-Ison, 1999, p. 152). No mention of manualized treatments with fidelity monitors takes place, which may be expected given the quasi-experimental design, yet is unacceptable given the comprehensive and intensive nature of this residential treatment program.

Another study used a residential facility for substance abuse treatment with the goal of impacting attachment. The residential treatment program for mothers and infants had a respectable sample size of 170 pregnant and parenting women and measured on parenting skills, self-esteem and interaction between mother and child. They received individual psychotherapy and group training ad

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation support, the latter of which was lead by Coalition on Addiction, Pregnancy and Parenting (CAPP) specialists. The study indicated that the CAPP professionals were certified to administer one of the three standardized instruments used, and that two instruments (for intake and evaluation) were designed by evaluation staff. The findings indicated that the mothers showed improvement on all measures (Camp & Finkelstein, 1997).

The initial sample was viewed as a respectable quantity, and treatment matching components were satisfactory given the grouping of mothers requiring residential care for their substance abuse problems. However, this study had limitations such as the high attrition rate, with approximately 131 subjects completing the majority of the treatment program. In addition, the timing of assessments may weaken the results of the measurements on some of these variables. The investigators indicated that the subjects took assessments after having been exposed to parenting education or after having resided for many months in a facility that encouraged mother-child relationship and interaction (Camp &

Finkelstein, 1997). Furthermore, aspects related to potential fidelity, manualized treatment of any issues related to therapist effects regarding the individual psychotherapy services were not discussed.

Lastly, there was no mention or indication of the reliability or particularly the validity of the intake and final evaluation measurement instruments that CAPP created for the purpose of this study. In sum, the investigators indicate the “need to use caution in interpreting the results of these data” (Camp &

Finkelstein, 1997, p. 419).

Use of the residential facility as part of the design to bring about change is not uncommon.

However there were not a significant number of studies that did such in an effort to examine attachment among other variables. Metsch, Wolfe, Fewell, McCoy, Elwood, Wohler-Torres, Petersen-

Baston, and Haskins (2001) completed an intervention in a public housing setting. However, their aim through use of the Key West Housing Authority in Florida through the SafePort Program was to

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation examine subjects’ drug-free status comparing women who were in residence with their children versus those who were not. Preliminary findings indicated thus far that women had greater success when in residential treatment with their children than without. Although this study did not measure attachment, it is worth mentioning in support for further research and exploration into interventions that may be effective due to the planned participation in treatment with participants’ children (Metsch et al., 2001).

There is clinical significance in mentioning the following study, although it is not to be considered in the assessment as an intervention study whose purpose is to improve attachment since it does not have any published findings. This intervention format by Zeanah et al. (2003) may be shown to be successful in the future if it is viewed to be applicable to the foster care visitation setting, and it may likely be clinically significant. The initial focus of this paper described the need for greater attachment and the proposal to attain such by strengthening the attachment and relationship between parent and foster children during foster care visitation. However, Zeanah et al. (2003) actually utilized foster care placement as the intervention as a proposed solution to the problem of over-utilized and extensive care in institutionalization settings in Bucharest, Romania. Among the core constructs for measurement, the construct of attachment as an aspect of development was of focus as the study hypothesized that foster care would improve the development of formerly institutionalized children.

Currently approximately 40,000 children have such extended stays in institutions, they may possibly reach adulthood as residents, and the conditions in which they lived were horrid and inhumane. Foster care did not have a great presence in Romania during the 1990’s. Thus, the concept of foster care as a solution and viable research option is viewed favorably, particularly since there have been no such other interventions of its kind. This was a longitudinal study involving 136 participant children from six area institutions in Bucharest and began in April 2001. It “comprises a randomized, control trial of foster care as an intervention for institutionalized young children” (Zeanah et al., 2003, p. 894).

(Zeanah et al., 2003). It is hoped that the findings once released will lend support for this type of intervention, particularly when assessing aspects related to the foster care setting. This study will also hopefully continue a trend supporting the philosophy that “young children develop more favorably in families than in large group settings with rotating staff” (Zeanah et al., 2003, p. 902). It will be interesting and of value to practitioners to learn of the degree of uniformity of the foster care process, if recorded and included. It will also be interesting to learn as to how other countries such as this one ensured uniformity.

Play Therapy Interventions

It is important to make mention of the intervention of play therapy as a possibly modality for consideration here. It has been used in many settings demonstrating various types with the purpose of impacting a range of variables from parenting skills to parent-child relationship and attachment with a range of involvement in the playsessions, for example directive and non-directive play therapy (Ryan,

2004) . Play therapy and specifically Filial play therapy have been used as procedure for comprehension and helping children in their process of growth. Training sessions on such therapy modalities usually extend over months, however Garry Landreth adapted historical play therapy models to an abridged version over several weeks. He describes Filial therapy as a “unique approach used by counseling professionals trained in play therapy to train parents to be therapeutic agents with their own children through a format of didactic instruction, demonstration play sessions, and supervision. Parents are taught basic child centered play therapy skills including responsive listening; recognizing children’s emotional needs; therapeutic limit-setting; building children’s self-esteem; and structured required weekly play sessions with their children using a special kit of selected toys. Parents learn how to create a nonjudgemental, understanding, and accepting environment, which enhances the

& Broaddus, 2002, p. 372). Although the various studies and case studies are too numerous to methodologically review here, several play therapy and filial therapy intervention modalities have been met with fair success at minimum with varied populations from grandparents to incarcerated fathers, and on variables from attachment, parent skills and self-efficacy (Bratton, Ray & Moffit, 1998; Fall,

1999; Landreth & Lobaugh, 1998; Mulhern, 2001; Ryan, 2004; Watts & Broaddus, 2002; Wilson &

Ryan, 2001).

Summary of the Studies’ Treatment and Methodological Variables

The intervention studies reviewed can be synthesized in terms of treatment variables and rigor of the methodology. Various theoretical approaches were utilized. There was quite a varied breakdown of theoretical approaches found in these studies. They ranged from those involving psychotherapeutic interventions (Cohen et al., 1999; Murray et al., 2003, Toth et al., 2002), educational training (Culp et al., 1999;), interventions specifically done through home visitation (Heinicke et al.,

1999; Heinicke et al., 2000; Leitch, 1999), interventions utilizing subjects’ placement in a residential facility (Camp & Finkelstein, 1997; Cosden & Cortez-Ison, 1999), to one that utilized an intensive multiple family group intervention (Davey & Abell, in press). Cognitive Behavioral therapy was used once in comparison to Psychodynamic therapy and non-directive counseling with women with major depressive disorder post partum (Murray et al., 2003).

The duration of the interventions varied as well. One study was short-term in duration with one contact to the subject as the intervention (Leitch, 1999). Davey and Abell (in press) can be viewed as short-term as well since after its modifications due to attrition, they held one intensive weekend multiple family group. As was mentioned, subjects reportedly stated that they wished that the retreat was longer. Two studies had interventions lastly about two-three months (Bakermans-Kranenburg et

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation al., 1998; Murray et al., 2003). Four studies had interventions that lasted approximately six months in duration (Cohen et al., 1999; Cosden & Cortez-Ison, 1999; Culp et al., 1999; & Toth et al., 2002).

Three studies had interventions lasting one year (Camp & Finkelstein, 1997; Heinicke et al., 1999;

Heinicke et al., 2000). As indicated in the discussion of the study by Bakermans-Kranenburg et al.,

(1998), the findings supported the generally accepted concept that short-term behavioral interventions, focused on parental sensitivity, produce only temporary effects, while the parents’ status of attachment is not affected (Bakermans-Kranenburg et al., 1998). Studies that measured quite extensively across time or were longitudinal in nature seemed to have the benefit of more comprehensive data as well as likelihood of having a greater impact due to prolonged exposure to the subjects to the intervention

(Camp & Finkelstein, 1997; Cohen et al., 1999; Cosden & Cortez-Ison, 1999; Heinicke et a., 1999;

Heinicke et al., 2000; Toth, et al., 2002), as well as those that offered an intensive exposure to the intervention, such as through weekly psychotherapy (Cohen, et al., 2002; Cosden & Cortez-Ison, 1999;

Toth, et al., 2002).

Most of the studies consisted of interventions that predominantly involved mother and their infants, or pregnant mothers (Bakermans-Kranenburg et al., 1998; Camp & Finkelstein, 1997; Cohen et al., 1999; Cosden & Cortez-Ison, 1999; Culp et al., 1999; Hienicke et al., 1999; Heinicke et al.,

2000; Leitch, 1999; Murray et al., 2003). Few interventions measuring attachment existed that did not examine infants. However, Toth et al. studies mothers and their preschoolers (2002). In addition, the mean age for children in Davey & Abell’s MFG intervention study was nine-years-old (in press). As a result, the samples were composed largely of mothers and infants. Although assessing for attachment between parents and children, mothers were the primary parents assessed in the studies. Regarding the

MFG intervention by Davey and Abell (in press), although their study sought to assess families, most of the parents who participated were unmarried mothers.

 Davey & Abell, in press: 50% Caucasian versus 50% African American participants; one

American Indian family

 Cosden & Cortez-Ison, 1999: Ethnicity of the sample was approximately 57% European

American, 25% Latina, 13% African American, 4% Native American

 Camp & Finkelstien, 1997: 79% were women of color; 122 Blacks, 6 Hispanics, 3 Native

Americans

 Culp et al., 1998: Mothers were 77% Caucasian, 12 % African American, 8 % Native

American, 3% multi-racial.

In regards to methodology, only four of the eleven studies conducted an experimental design

(Bakermans-Kranenburg et al., 1998; Heinicke et al., 1999; Murray et al., 2003; Toth et al., 2002).

Davey and Abell (in press) used a non-experimental design with no control or comparison group. The remaining six intervention studies used a quasi-experimental design, where in essence there was no control group, and in some instances no comparison group as well (Camp & Finkelstein, 1997; Cohen et al., 1999; Cosden & Cortez-Ison, 1999; Culp et al., 1999; Heinicke et al., 2000; & Leitch, 1999).

Discussion and Implications for Practice and Research

There was a respectable amount of literature available for review of factors and reasons to seek out-of-home care, factors yielding a return to foster care after reunification, as well as various other factors that may add to the lack of successful reunification. However, regarding the issue of primary focus in this paper, there was very little literature, and particularly little empirical research, available on the matter regarding decision-making and factors that lead to reunification particularly enhanced by visitation and strengthening the relationship between the parent and child. In order to provide a broad

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation perspective, such literature particularly regarding various factors contributing to reunification was examined. This added a perspective of the clinical importance of the impact that such dynamics have on the foster children, the developmental effects in the child and family, as well as the many other social and environmental factors that can play an important role in impacting the family. Such social, environmental and developmental factors, for example, as prevalent as the stress (American Academy of Pediatrics, 2000) factor, can have a negative impact on the quality of the parent-child relationship

(Haight et al., 2003). Thus, it conveys the importance in exploring the various other social and environmental factors accompanied by the emphasis on the key pivotal points of relationship and visitation that may be enhanced to have a better effect on lasting, sound reunification decisions.

The literature that does exist on the matter of focus strongly supports strengthening the relationship and enhancing the quality of visitation, and therefore this paper has focused on prioritizing that need as well. Much more exploration is necessary in that area, due in part to the little literature, as well as due to the fact that the existing literature needs to be expanded upon as to how to improve in these areas. Research must be done to examine the effects of certain methodologies that may have a positive effect on improving the relationship between parent and child in foster care. In addition, literature is needed to give guidance and instruction to foster care workers, parents and foster parents as to more specifically how to enhance the relationships and therefore yield faster and more confident reunification decisions. Furthermore, as was mentioned, the research did not define the lengths or specific durations of the visitation process, no matter what effect the visitation had on the reunification process and decision to reunify. More research must be done to comparatively examine the duration and frequency of visitation sessions with the outcome of reunification. Lastly, more importance is added to these recommendations that are made if the lasting effects are monitored as well.

Interventions that may produce more reunification decisions by strengthening the parent-child

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation relationship and increasing the quality and frequency of visitation should be followed by the research that follows the periodic monitoring of the family in an assistive and preventive manner to ensure continued success and hopefully reduce the decreasing reunification and return to foster care rates that were mentioned previously. Thus, many questions and necessities for research exist that invite both professional works to suggest the treatment interventions needed, as well as empirical research to examine the effectiveness of such models and methodologies toward the goal of making better decisions about reunification through improving visitation and strengthening the parent-child relationship.

The studies reviewed in this paper examine the impacts on the basic foundation of attachment theory in one respect or another, and show support for the likely success of some interventions over others.

Given that much of the intervention research today appears to be predominantly focused on infants (Bakermans-Kranenburg et al., 1998; Cohen, Muir, Lojkasek, Muir, Parker, Barwick, &

Brown, 1999; Culp, Culp, Blankemeyer, & Passmark, 1998; Heinicke et al., 1999; Heinicke et al.,

2000; Koren-Karie, Oppenheim, Dolev, Sher, Etzion-Carasso, 2002; Leitch, 1999; Meins,

Fernyhough, Fradley, & Tuckey, 2001; Murray et al., 2003), the common theme of early intervention as a mechanism of improving various aspects of attachment seems supported and logical (Blair, Peters,

& Lawrence, 2003).

A specific focus for future intervention could continue to build on specific ideas of attachment theory of Ainsworth, who indicated that the mother’s ability to respond to their child’s needs in a sensitive and attentive manner is necessary for development of secure infant-mother attachments

(Ainsworth, 1989). Others have even focused on preventive measures, as was discussed (Toth et al.,

2002). The importance of mothers increasing their insight and intuitiveness in their children seems to

Kranenburg, et al., 1998; Cohen, et al., 1998). As was mentioned previously, studies that measured quite extensively across time or were longitudinal in nature seemed to have the benefit of more comprehensive data as well as likelihood of having a greater impact due to prolonged exposure to the subjects to the intervention (Camp & Finkelstein, 1997; Cohen et al., 1999; Cosden & Cortez-Ison,

1999; Heinicke et a., 1999; Heinicke et al., 2000; Toth, et al., 2002), as well as those that offered an intensive exposure to the intervention, such as through weekly psychotherapy (Cohen, et al., 2002;

Cosden & Cortez-Ison, 1999; Toth, et al., 2002) and Multiple Family Group intervention (Davey &

Abell, in press), versus minimal exposures to the intervention (Leitch, 1999).

Social work practice and research should continue to build on the premise to seek interventions that seem more diagnostic, such as through the assessments of the narrative story-stems by Toth, et al.,

(2002) to assess where our youth are at developmentally and bring about greater changes through the increased awareness derived by intervention research. The benefits of and information derived from intensive, treatment interventions aimed at focusing on relationships as well as prevention seem evident. Given the examination of these interventions, further research should continue the focus of remedying maladaptive traits while focusing on aspects of attachment and maintaining an underlying focus of prevention.

As was mentioned previously, there is a lack of published intervention studies that exist to offer methods of increasing attachment during foster care visitation. However, support for such other attachment interventions discussed here can be applied to the aim of improving the relationship between parents and their children who are in foster care. The success with other populations examined here suggests that it may be worth exploring with the visitation setting between parents and their children in foster care. Such applications include intervention possibilities such as involvement

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation in joint psychotherapy sessions on an ongoing basis due to the success reflected here. In addition, the intensive approach suggested by residential settings where both parent and child are present seem to have good potential as well given the results in others settings. In regards to the SafePort program in

Key West, Florida, their goal is keeping families together whenever possible. Metsch et al. (2001) indicates that when mothers complete such residential treatment they are significantly more likely to have their children placed in their care when having been removed by CPS from their mothers.

Although this study is still in the process of determining further findings, “it may indicate that CPS monitors and tries to keep families together and recognizes the important influence of family reunification on successful completion of treatment” (Metsch et al., 2001, p. 216). However, foster care visitation taking place in a residential setting may hold more liability for some populations versus others. For example, some children may have been removed from the care of their parents due to sexual abuse issues, and a residential setting therefore may not likely be recommended for visitation.

However, the a day treatment approach held on consecutive days on the weekend, similar to the weekend retreats described (Davie et al, 2001, 2003) may provide the intensity of the weekend retreat yet eliminate the liability issues of overnight monitoring. Such consecutive day treatment visitation interventions could take place in a group residential setting, as opposed to the hospital setting that day treatment is commonly associated with. Selection of the group residential setting could therefore be flexible enough to create a homelike, recreational and therapeutic atmosphere that may be conductive to facilitating family togetherness. In addition, as was described in many of the intervention studies, clinical professionals are largely in the position of implementing the treatment intervention due to the therapeutic nature. It is recommended that clinicians, such as social workers, continue this role

Aside from employing interventions that would assist with improving the parent-child relationship during foster care visitation, other factors are also important to address and resolve. Many

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation struggles exist in the visitation process as it currently exists, ranging from environment to role confusion of significant parties involved. There often are no consistent meeting rooms or settings in which visitation may take place, as well as poor and unclean toys for the families to use. There are issues of who will transport foster children to their visits with their parents, and who will supervise these visits. Finally, the degree of how active the supervisor, usually the county foster care worker or the foster parent, will be in their involvement as they supervise the parent and foster child varies

(Haight et al., 2002). Regardless of the intervention selected, uniformity must be installed at least across counties as to how the process will be facilitated with roles and supervision. Lack of uniformity also adds to the lack of valid measurability should such interventions be employed in the foster care setting. In addition, it is a disservice to families when adequate supplies and surroundings are not provided for visitation. This is one instance when the issues of funding should be addressed, as various the political powers could possibly recognize the needs that exist and provide services where needed. This goes beyond the basic needs of supplies, as programs can direct funding towards such intervention programs that would ultimately likely act to reduce spending later on other reactive programs. This may be the case if foster care visitation intervention programs that increase parent- child attachment could possibly show a decrease in problematic behavior in the children and an increase in the stability and functioning of the parents. Further intervention research should therefore be done to implement such studies with the parents and their children in foster care.

Implementation of successful interventions with the foster care visitation setting where attachment and relationship between parent and children in foster care were strengthened would hopefully and ideally decrease length of stay in foster care, decrease of frequency of returns to foster care placements, increase the overall happiness and mental health status of those involved, and decrease abuse and neglect incidents. Although such hopeful outcomes are the ideal, they should be

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation goals for outcomes from such interventions. In addition, follow-up should be incorporated after the provision of such treatment interventions, since adjustment during reunification may be potentially difficult and may require additional support. Ideally, the successes selected from these intervention studies may potentially contribute to the future success of social work research and practice particularly related to foster care visitation in the future.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation © 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation © 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation References

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 Estimates of children in foster care have increased over the years.  Although estimates vary, there are over 542,000 children in foster care in the United States. Child Welfare League of America, 2004

Upstate Foster Care: 1998-2002 In Care, Admissions, and Discharges

SEE CHART

Reasons for Foster Care Placements  (1) Child Maltreatment, Physical Emotional & Sexual Abuse Denby & Curtis, 2003 – In 1999, 87.3% of abuse and neglect perpetrators were parents. Huebner, 2002 – In 2002, 81% of abuse and neglect perpetrators were parents – U.S. Department of Health and Human Services, administration on Children, Youth and Families. (2004). Child Maltreatment 2002. Washington, DC: US Government Printing Office, p xviii.

Reasons for Foster Care Placements

 (2) Substance Abusing Parents McNichol & Tash, 2001

 (3) Parent’s psychological instability and therefore inability to care for children. Denby & Curtis, 2003

 (4) Damaged attachment and relationships between parent and child due to various family problems Haight, Black, Mangelsdorf, Giorgio, Tata, Schoppe, & Szewczyk, 2002; Haight et al., 2003

 (5) Failed reunifications resulting in return to foster care placements. Davis, Landsverk, Newton, & Ganger, 1996

Duration of Foster Care and Factors Associated with it  Children average a duration of 33 months in foster care  Most frequent duration intervals in foster care are those lasting: – 1-5 months – 6-11 months – 12-17 months – 3-4 years – 5 or more years US Department of Health and Human Services, Administration on Children, Youth and Families, 2004 Duration of Foster Care and Factors Associated with it  The younger a child is when he or she enters foster care, the greater the likelihood that child will spend a large portion of their childhood in the foster care system.

George & Wulczyn, 1998

Duration of Foster Care and Factors Associated with it  Multiple placements are an issue  Several multiple placements take place, whether in traditional foster homes or residential treatment facilities

Rubin, Alessandrini, Feudtner, Mandell, Localio, & Hadley, 2004 Duration of Foster Care and Factors Associated with it  Once children are in the system as adolescents, they tend to age out of the system rather than find a permanent home  About 20,000 youths mature out of foster care at age 18 and face independent living with little supports or resources

Reilly, 2003 Duration of Foster Care and Factors Associated with it  As a result, they struggle with employment issues, homelessness, lack of education and problems with living arrangements.

Reilly, 2003 Duration of Foster Care and Factors Associated with it  Reunification is not a viable option for every child  For some youth, reunification is not likely to occur Yancey, 1998

Duration of Foster Care and Factors Associated with it

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation  The effectiveness of some independent living centers implemented over the last 15 years is questionable.  As a result, inadequate psychosocial abilities to function are note focused upon or resolved.

Reilly, 2003 Duration of Foster Care and Factors Associated with it  Parents who have a diagnosis of a serious emotional disorder have a greater likelihood than other less disturbed parents to have their children permanently removed from their homes

Taylor, Norman, Murphy, Jellinek, Quinn, Poitrast, & Goshko, 1991 Duration of Foster Care and Factors Associated with it  The foster care system’s response to the mental health needs of such children has lacked.  Thirty five to 85% of adolescents in foster care have emotional disturbances  Thirty percent of children in early and middle childhood have severe emotional, behavioral and developmental problems.  These children have higher rates of depression, lower social skills, poorer adaptive functioning, and more externalizing behaviors, such as aggression and impulsivity. Yancey, 1998 Factors Associated with Foster Care  The juvenile court system must make decisions about the well-being of children daily, and such children in the child welfare system are becoming younger over time Osofsky, 2003  Approximately 120,000 children enter the foster care system prior to their first birthday U.S. Children’s Bureau, 2001  Given the increase in such a young population entering the child welfare system, the courts must address the needs of this young, at-risk group of children, who in essence have largely been ignored by the courts. Existing Permanency Plans  Reunification with parent(s) or principal caretakers (44%)  Adoption (22%)  Emancipation (6%)  Living with other relatives (5%)  Guardianship (3%)  Long term foster care for children who are institutionalized (8%)  Not yet established (11%) U.S. Children’s Bureau, 2001 Status of Reunification Plans  Reunification of children from foster care with their biological parents after having been in foster care has been criticized due to:  declines in reunification rates  the instability of some reunifications Jones, 1998  Many families who are expected to be reunified are not or the children subsequently reenter foster care Downs, Costin, & Mcfadden, 1996 Public Policy Information yielding such Reunification goals

 Adoption Assistance and Child Welfare Act of 1980 (P.L. 96-272) requires regular visitation to take place between parents and their children when they are in foster care. Public Policy Information yielding such Reunification goals

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation  Adoption and Safe Families Act of 1997 (AFSA; P.L. 105-89) purports that family reunification remains the goal for the majority for foster children. Public Policy Information yielding such Reunification goals

 The AFSA policy objective to reunifying foster children with their parents has been criticized due to declines in reunification rates and instability of some reunifications. Haight, Kagel, & Black, 2003

Background Information

 Between 50% and 75% of children placed in out of home care eventually reunify.

 Between 20% and 40% of those reunified subsequently reenter foster care

Taussig, 2002 Child Factors Associated with Decreased Rates of Reunification

 Being an infant  Being African American  Having been removed for neglect

Taussig, 2002 Family of Origin Factors associated with Decreased Reunification Rates:

 (1) Lack of Parental Visitation while children are in foster care

 (2) Family Poverty

Child Welfare Variables Associated with Decreased Rates of Reunification

 Longer time spent in out of home care

 Having been placed with a relative

Taussig, 2002 Risks of Being in Foster Care Long-term research indicates increased risks for:

 Not finishing high school (37%)  Incarceration (27% M; 10% F)  Unemployment (50%) Taussig, 2002

Risks of Being in Foster Care

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation  Youth who were reunified with their biological families after placement in foster care were more likely to have more negative outcomes and problematic lives than those who were not reunified. Taussig, Clyman, Landsverk, 2001 Risks of Being in Foster Care  Reunified youth, compared to youth who are not reunified, are more likely to:  get a ticket or be arrested (49.2% versus 30.2%)  have more behavior problems (59.5% versus 55.7%) have lower overall competence (41.1% versus 45.0%) Taussig, Clyman, Landsverk, 2001 Risks of Maltreated Youth in Foster Care Longitudinal research, 1991, CA study:

 Self-destructive behavior  Substance abuse  Total risk behaviors  Likelihood of getting a ticket/arrested Risks of Maltreated Youth in Foster Care  Dropping out of school  Receiving lower grades  Increasing problems in internalizing behaviors  Increasing total behavioral problems  Decreased total competence

Focus Group Issues  Visitation programs are untapped resources for families  Visitation is a critical piece of permanency planning  Increased therapeutic perspective and therapeutic sites are needed

Focus Group Issues  Visitation is the key to whether or not a child will return home  Home-visits are necessary  Visits should not be held in foster parents’ homes  Children should see their parents immediately upon removal from homes Barriers to more Successful Foster Care Placements, Visitation & Reunification  poor / little space for visits  Too few agencies offer visitation  No uniform visitation process  Foster care workers have varied roles (active vs. passive)  Transportation of children  Frequency of visitation not sufficient  Poor retention of parents  Varied visitation supervisors

Attachment

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation  There is a rising importance of strengthening the parent-child relationship during visitation as the factor that will determine reunification. Haight et al., 2002, 2003

Attachment

 Many factors strengthen this relationship, such as the emotional bond of Attachment. Haight et al., 2003

RELATIONSHIPS:

State:

 ATTACHMENT - is the most important form of social development that occurs during infancy; forming a bond that provides safety and security to the child; having a strong, firm attachment provides a safe base from which the child can gain independence and knows that he/she will have its needs met.

 Mary Ainsworth’s Strange Situation – Mary Ainsworth, famous for her Attachment Theory, facilitated a study where she created 8 staged episodes that illustrated the strength of attachment between a child and (typically) his or her mother. The manner in which the individual 12 months old infants responded to the strangers and their mothers would categorize them into one of the four attachment styles which will be discussed shortly (see section after the list of staged episodes)

 State / Review:

Episode #………Description………………….Questions? / Behaviors Observed: # 1: Mother, baby and observer enter experimental room. Observer leaves. Many attractive toys are scattered around………..

# 2: Mother sits and watches while baby is free to explore the room…….(Q?) Does baby use mother as a secure base?

# 3: Stranger enters. Stranger is silent for 1 minute. Stranger talks to mother for one minute. Stranger approaches baby. Mother leaves room unobstrusively…….. …(Q?) What are baby’s reactions to stranger?

# 4: Baby is alone with stranger……………(Q?) Is there separation anxiety?

# 5: Mother comes back into room and greets and comforts baby. Baby is encouraged to play again………… (Q?) How did baby react to mother’s return?

# 6: Mother leaves room, says, “Bye-bye.” Baby is alone…….(Q?) Is there separation anxiety?

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation # 7: Stranger enters room and interacts with baby…………(Q?) Does the baby have the ability to be comforted by the stranger?

# 8: Mother enters room. Greets baby and picks up baby. Stranger leaves…….(Q?) How does baby react to reunion with mother?

State: Ainsworth tested babies at 12 months of age. All episodes lasted 3 minutes. Although Ainsworth used mothers, this test can be used with other caretakers such as fathers or regular babysitters. State / Review: Types of attachment in children: (1) SECURELY ATTACHED CHILDREN (2/3 of children) – use mother as a safe base, are at ease as long as she is present, exploring when they can see her, upset when she leaves, and go to her when she returns

(2) AVOIDANT CHILDREN – ( 20 %) do not seek proximity to the mother; after she leaves they seem to avoid her when she returns as if they are angered by her behavior

(3) AMBIVALENT CHILDREN – (12%) display a combination of positive and negative reactions to their mothers; they show great distress when she leaves, but upon her return they may simultaneously seek close contact but also hit and kick her

(4) DISORGANIZED-DISORIENTED CHILDREN - (2%) may be the least securely attached at all; show inconsistent, often contradictory behavior, such as approaching the mother when she returns but not looking at her.

State:

 Infant attachment ,may have significant consequences for relationships at later stages in life (Erikson/Freud)  Not all children who are not securely attached as infants experience difficulties later in life; some research suggests that those who had avoidant and ambivalent attachment do quite well later in life  Infants can attach to several caregivers; mothers are most often the attachment figure: (1) They are sensitive to their infant’s needs (2) They are aware of their infant’s moods (3) They provide appropriate responses

 Some believe that the differences in security of attachment are a direct result of the care given by the person whom one is attached to, and not a result of any child factors. American Academy of Pediatrics, 2002

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation  Exceptional parenting has reliably been found to yield secure attachment in children from various backgrounds. Clements & Barnett, 2002

 Emotionally healthy personality characteristics of parents and child play a role in predicting positive quality of attachment Kendler, Sham, MacLean, 1997; Small, 1998

 Parents who had a loving relationship with their own mothers were two times more likely to have a loving attachment relationship with their children Brook, Richter, & Whiteman, 2000

 Secure infants are more apt to resolve subsequent developmental struggles more functionally when compared to insecurely attached infants Eiden, Edwards, & Leonard, 2002

 Regular contact between parent and foster child yield greater closeness and identification to the family as the child ages. Browne & Maloney, 2002

Effects of Poor Attachment on Children  There are many factors that can prevent a healthy emotional attachment, particularly during infancy.  Various occurrences and situations may be considered that may either prevent or damage attachment.  Disruptions in attachment may take place when the attachment figure is not available or responding to the child, such as what may take place during separation or some disruption in the care provided to the child Bowlby, 1973 Effects of Poor Attachment on Children  Infants who are insecurely attached are more inclined to have difficulties negotiating significant developmental issues later in life, ranging from autonomy and ego resilience to social proficiency and emotional wellbeing. This insecure attachment may be an early indicator for maladaptive behavior later in life Eiden, Edwards, & Leonard, 2002

Effects of Poor Attachment on Children

 Maltreatment is another aspect that may yield attachment problems.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation  Maltreated infants are at higher risk for forming disorganized attachments to those who take care of them. Carlson, Cicchetti, Barnett, & Braunwald, 1989

Effects of Poor Attachment on Children  Maltreated preschoolers develop a distorted concept of themselves and those taking care of them Toth, Cicchetti, Macfie, Maughan, & Vanmeenen, 2000  Maltreated children may have inaccurate conceptions of themselves and those taking care of them, as well as peers when at school age Dodge, Petit, & Bates, 1994

 Longitudinal studies show that neglect is correlated with avoidance of attachment figures in infancy, dysfunctional social skills, behavior control, self-esteem, and preschool problem-solving ability. Huebner, 2002

 Parents with personal turmoil (ie.) anxiety, post-partum depression) have poorer attachments with their children. Kendler et al., 1997

Improving Attachment and the Parent-Child Relationship: Types of Intervention Studies  Formalized Psychological Treatments  Educational Home Visitation  Multiple Family Group Therapy Intervention  Change of Residence  Play Therapy  Combination of Interventions

Implications: Foster Care & Visitation An increase in attachment between parents and children will likely have the following effects:  Decreased length of stay in foster care  Increase in successful reunifications  Decreased frequency of returns to foster care  Increased family happiness and child mental health  Decreased incidence of abuse or neglect Haight et al., 2002; Haight et al., 2003 Visitation  Reunification is the primary permanency goal for most of the children in foster care Haight et al., 2003  “Parent visitation, the scheduled face-to-face contact between parents and their children in foster care, is considered the primary intervention for maintaining and enhancing the development of parent child-relationships necessary for successful family reunification” Haight et al, 2003, p. 195 Visitation

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation  The emphasis of reunifying children in foster care with birth parents requires that birth parents have supervised visits with their children.  There is evidence that the more active the parents are in visitation, the more likely reunification will occur. Davis et al., 1996 Visitation

 Visitation needs to improve while incorporating the perspectives of parents and foster parents, as well as child welfare workers. Haight, et al., 2002

Visitation: Parents

 Haight et al. (2002) described the grief and strife suffered by mothers after enduring separation from their children when they enter foster care, and emphasized the importance of expression of emotions and verbal interaction during visits.

Visitation: Foster Parents

 Foster mothers also have a struggle to get children emotionally ready for visits, as well as assist them emotionally afterwards. Haight, et al., 2002 Visitation: Child Welfare Workers  Child welfare workers struggle with encouraging emotional closeness between the parents and children while being supervised, as well as have the task of evaluating the behavior of parents during visitation sessions.

Visitation  Another struggle hurting the process was the varied degree of understanding of appropriate social work practice during visits.  The adults involved bring very valuable but different practice experience to the process of visitation that should be better understood by the parties involved. Haight et al., 2002 Visitation Example given by one study:  What foster care workers supervising the parent-child interactions thought was positively reinforcing, was actually perceived as demeaning by the biological parents who visit their children in foster care. Haight et al., 2002

Improving the Visitation Process  Understanding the struggles of those actually involved in the process can address the avoided interpersonal and psychological aspects that may affect visitation.

 Understanding such complexities of visits interpersonally and emotionally acknowledges the struggle for those involved, particularly the children, and can therefore offer suggestions of how to improve the visitation between parents and children towards the decision and goal for successful reunification Haight et al., 2002

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Comprehensive Plans for the Intervention to Increase Uniformity of Visitation and Strengthen Relationships in Foster Care (1) A Review of the Literature (2) Introduction to Key Issues in Foster Care (3) An Active Role in Visitation (4) Parent-Child Interaction (5) Safety (6) Preventive Planning Towards Successful Reunification (7) Education and Other Relevant Areas of Focus

INTRODUCTION AND BACKGROUND: INITIAL ASSESSMENTS

This manual was prepared for the purpose of addressing the training needs of human service providers serving children and youth in foster care. The uniqueness of this training is based on the belief that structured visitation can encourage the education of parents on the stages of child development, on positive parenting skills, emotional intelligence, and on the stages of bereavement for children and youth. It is the belief that families with the assistance and guidance of these human service providers can nurture and engage in prosocial behaviors to strengthen the relationship with their children The primary goals of this training are to eliminate professional biases, enhance professional skills, and as a result, increase education of parents and encourage positive growth and development of children and youth in foster care to expedite their reunification with their family.

Regrouping:

Welcome participants and attend to any housekeeping issues.

Comment: If you have multidisciplinary participants coming into this training, you may need to spend a few minutes allowing them to introduce themselves and reflect what they wish to achieve at the training. Supplies needed: scrap paper, easel, markers, and pens

State:  Although statistics vary, quantities of children in foster care indicate that as of 2001, there were approximately 542,000 children in the United States foster care system.

 There are many factors that have contributed to the disturbing quantities of children in the foster care system.

Instruct Participants: Have the participants reflect for 10 minutes and generate all the contributing factors which would place a child or youth in foster

Reconvene the large group.

Comment: Please state the factors which would place a child in foster care. The factors include:  Child maltreatment

 Physical Abuse

 Emotional Abuse

 Sexual abuse/Perpetrators

 Neglect (most common form of maltreatment)

 Addicted Parents or Child

 Alcoholism

 Parent’s of Child’s mental health

 Parent’s or Child’s health issues

 Domestic Violence

 Parental or Child Criminal Activity

 Inconsistent Parenting

Discuss: How many of the above issues are caused by children?

How many of the above issues are caused by parent?

Comment: The reason for these questions are to have human service providers reflect on how much lack of control children have in being in foster care and to accent the fact that children are vulnerable to the actions of their parents and the system. It also is meant to increase the awareness of the foster care workers to this dynamic.

Instruct Participants:

Have the participants take 10 minutes to complete the QUESTIONAIRE #1.

Reconvene the large group and discuss which questions seem to impact the participants.

Please circle the best answer to the questions below.

20% of children in foster care have a goal to be reunited with their parents. TRUE FALSE

 False. 43% of children in foster care have a goal of returning to parents

According to the 2001 Fiscal report, 38% of children existing foster care TRUE FALSE were reunified with parents.

 False. According to the 2001 Fiscal report, 57% or 148,606 of children existing foster were reunified with parents.

The average age of a child in foster care is 12 years old. TRUE FALSE

 False. The average age of a child in foster is 10 years old.

49% of reunified children are more likely to be arrested than children who are not reunified. TRUE FALSE

 True. Youth who were reunified with their biological families after foster care were more likely to have negative outcomes and problematic lives than those who are not reunified.

9% of reunified children are more likely to drop out of school than children who are not reunified. TRUE FALSE

 False. 20% of reunified children are more likely to drop out of school.

The proportion of boys to girls in foster care is 65% to 35%. TRUE FALSE

 False. According to the 2001 stats, the proportion of boys to girls is 52% to 48%. Research is conflicted regarding gender impacting type of placement.

The proportion of African American to Caucasians in foster care is 2:1. TRUE FALSE

 False. According to the 2001 AFCARS statistics, the proportion of African American children to Caucasian children is about 50/50. 38 % of children in foster care are African American; 37% of children in foster care are Caucasian. 17% of children in foster care are Hispanic. Although these numbers are fairly equal for African Americans versus Caucasian, Caucasians have more entrances and exits from foster care than African Americans since Caucasians exit foster care faster. In addition, there are more Caucasian children in the country (15% African American

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation versus 60% Caucasian children in the country). The fairly equal numbers of African and American and Caucasian children in foster care at one time is due to the fact that particularly the African American children are staying in care longer, and the numbers accumulate while the Caucasians exit faster.

The proportion of African American to Caucasians who enter TRUE FALSE foster care is 1:2.

 True. According to the 2001 AFCARS statistics, the proportion of African American children to Caucasian children is about 1:2. 28 % of children who entered in foster care are African American; 46% of children who entered in foster care are Caucasian. 16% of children who entered in foster care are Hispanic. Again, there are more Caucasians than African Americans nationally.

Research has found that when mothers adhered to court mandated visitation with their children in foster care, the visitation as dictacted by the court was the strongest predictor that the children were ten times more likely to be reunified. TRUE FALSE

 True. It is very evident that encouraging and fostering the parent/child relationship through visitation increases the likelihood of reunification. The child welfare system still needs to improve the quality of visitation to increase the likelihood of success of reunification.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation  The ‘bank’ of forms, handouts, and assessment tools begin from this point forward for the trainer to select from based on the categorical aims that are desired to cover. For easy reference, the categories are listed again below with the forms, handouts and assessment tools that may best address the aim desired. They include the education units (Unit C through Unit H, as Units A and B were presented previously in this manual), followed by the complete Appendix of forms and handouts in Unit I, and lastly the References in Unit J, OUTLINE OF MATERIALS: Unit C – Unit J

UNIT C Parent-Child Assessment

 Guidelines to Setting Up Visitation Plan  The Importance of Visitation  Visitation Intake Form  Parent-Child Relationship Assessment Form  Visitation Contract  Supervised Visitation Program Observation Form  Parent Impression of Supervised Visitation Program  Child Development Guide  Scenarios: Suggested Behaviors for Effective Parenting  Interventions to Ensure an Active Role in Supervising Visitation  Scenarios: Foster Care Workers Modeled Response to Scenarios for Parents  Erikson’s Theory on Psychosocial Development  Grief and Loss  Stages of Grief and Loss: Kubler-Ross  Danger Signals for Depression and Suicide  Burnout  Stress and Self-Rating Scale  Maternal Behavior Rating Scale  Reunification Planning Checklist  Follow-Up  Scenarios and Solutions for Adjustment During Follow-Up

 Guidelines to Setting Up Visitation Plan  The Importance of Visitation  Visitation Intake Form  Parent-Child Relationship Assessment Form  Visitation Contract  Supervised Visitation Program Observation Form  Parent Impression of Supervised Visitation Program  Basic Conflict and Resolution and Mediation Skills  Communication and Relationship Builders  Basic Parenting Tips: 101  Three Parenting Patterns of Discipline  Child Development Guide  Scenarios: Suggested Behaviors for Effective Parenting  Interventions to Ensure an Active Role in Supervising Visitation  Scenarios: Foster Care Workers Modeled Response to Scenarios for Parents  Key Factors for Emotional Intelligence  Erikson’s Theory on Psychosocial Development  Grief and Loss  Stages of Grief and Loss: Kubler-Ross  Bill of Rights for Grieving Children  Danger Signals for Depression and Suicide  Maternal Behavior Rating Scale  Reunification Planning Checklist  Follow-Up  Scenarios and Solutions for Adjustment During Follow-Up

 Guidelines to Setting Up Visitation Plan  Parent-Child Relationship Assessment Form  Supervised Visitation Program Observation Form  Parent Impression of Supervised Visitation Program  Basic Conflict and Resolution and Mediation Skills  Communication and Relationship Builders  Basic Parenting Tips: 101  Three Parenting Patterns of Discipline  Child Development Guide  Scenarios: Suggested Behaviors for Effective Parenting  Interventions to Ensure an Active Role in Supervising Visitation  Scenarios: Foster Care Workers Modeled Response to Scenarios for Parents  Key Factors for Emotional Intelligence  Grief and Loss  Stages of Grief and Loss: Kubler-Ross  Bill of Rights for Grieving Children  Danger Signals for Depression and Suicide  Stress and Self-Rating Scale  Maternal Behavior Rating Scale  Reunification Planning Checklist  Scenarios and Solutions for Adjustment During Follow-Up

 Guidelines to Setting Up Visitation Plan  The Importance of Visitation  Visitation Intake Form  Parent-Child Relationship Assessment Form  Visitation Contract  Supervised Visitation Program Observation Form  Parent Impression of Supervised Visitation Program  Basic Conflict and Resolution and Mediation Skills  Communication and Relationship Builders  Basic Parenting Tips: 101  Three Parenting Patterns of Discipline  Child Development Guide  Scenarios: Suggested Behaviors for Effective Parenting  Interventions to Ensure an Active Role in Supervising Visitation  Scenarios: Foster Care Workers Modeled Response to Scenarios for Parents  Key Factors for Emotional Intelligence  Grief and Loss  Bill of Rights for Grieving Children  Danger Signals for Depression and Suicide  Burnout  Stress and Self-Rating Scale  Maternal Behavior Rating Scale  Reunification Planning Checklist  Follow-Up

 Guidelines to Setting Up Visitation Plan  The Importance of Visitation  Visitation Intake Form  Parent-Child Relationship Assessment Form  Visitation Contract  Supervised Visitation Program Observation Form  Parent Impression of Supervised Visitation Program  Basic Conflict and Resolution and Mediation Skills  Communication and Relationship Builders  Basic Parenting Tips: 101  Three Parenting Patterns of Discipline  Child Development Guide  Scenarios: Suggested Behaviors for Effective Parenting  Interventions to Ensure an Active Role in Supervising Visitation  Scenarios: Foster Care Workers Modeled Response to Scenarios for Parents  Key Factors for Emotional Intelligence  Erikson’s Theory on Psychosocial Development  Grief and Loss  Stages of Grief and Loss: Kubler-Ross  Bill of Rights for Grieving Children  Danger Signals for Depression and Suicide  Burnout  Stress and Self-Rating Scale  Maternal Behavior Rating Scale  Reunification Planning Checklist  Follow-Up  Scenarios and Solutions for Adjustment During Follow-Up

Intensive Education:

State:

This Intensive Education training is provided to the Foster Care Workers as part of this Training Curriculum. However, the same Intensive Education is to be provided to the parents of the foster children. Ideally, it should be provided to the parents by Clinical Instructors. It is proposed that such Clinical Instructors hold routine regularly scheduled training sessions (held 2-3 times per week to offer frequent opportunities for training) where parents are required to attend on one occasion at the start of the period when their children first enter foster care. This is to ensure an optimum educational experience for the parents as well as to minimize the responsibility of the Foster Care Workers who are already under significant time constraints. It is believed that this training for the parents would take approximately 2.5 to 3 hours.

 Basic Conflict and Resolution and Mediation Skills  Communication and Relationship Builders  Basic Parenting Tips: 101  Three Parenting Patterns of Discipline  Child Development Guide  Scenarios: Suggested Behaviors for Effective Parenting  Interventions to Ensure an Active Role in Supervising Visitation  Scenarios: Foster Care Workers Modeled Response to Scenarios for Parents  Key Factors for Emotional Intelligence  Erikson’s Theory on Psychosocial Development  Grief and Loss  Stages of Grief and Loss: Kubler-Ross  Bill of Rights for Grieving Children  Danger Signals for Depression and Suicide  Burnout  Stress and Self-Rating Scale  Scenarios and Solutions for Adjustment During Follow-Up

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Instruct Participants: Please suggest to the participants to utilize TABLE 1 for additional statistical information

TABLE 1

Foster Care Entries, Exits and In Care on the Last Day for FY 1999-2002 State Entering Foster Care this Year Exiting Care during the Year In Care on Last Day of Year FY 1999 FY 2000 FY 2001 FY 2002 FY 1999 FY 2000 FY 2001 FY 2002 FY 1999 FY 2000 FY 2001 FY 2002 Alabama 2,734 2,661 2,672 3,181 2,062 2,334 2,271 2,725 5,511 5,621 5,859 6,078 Alaska 1,180 1,096 999 1,052 732 913 996 844 2,248 2,193 1,993 2,057 Arizona 4,372 4,644 4,515 5,069 4,853 5,056 4,729 4,763 7,034 6,475 6,050 6,211 Arkansas 2,489 3,542 3,347 3,330 2,160 3,679 3,244 3,195 2,919 3,045 2,959 2,952 California 43,587 45,685 45,176 46,323 39,156 50,112 44,096 44,743 117,937 112,807 107,168 101,078 Colorado 7,183 6,942 7,007 7,650 5,675 5,512 5,200 5,972 7,639 7,533 7,138 8,698 Connecticut 3,098 2,763 2,713 2,763 2,169 2,368 1,943 2,787 7,487 6,996 7,440 6,007 Delaware 1,002 950 939 918 811 886 916 928 1,193 1,098 1,023 886 District of Columbia 1,231 775 822 812 659 315 390 396 3,466 3,054 3,339 3,321 Florida 21,118 18,765 18,673 20,800 8,117 15,507 17,061 17,340 34,292 36,608 32,477 31,963 Georgia 7,218 7,028 9,065 9,766 6,267 4,657 7,250 9,431 11,991 11,204 13,175 13,149 Hawaii 1,683 1,929 2,193 2,350 1,634 1,682 1,920 2,097 2,205 2,401 2,854 2,762 Idaho 999 1,127 1,209 1,211 806 1,011 1,064 1,047 959 1,1015 1,114 1,244 Illinois 7,325 6,323 6,412 6,214 12,562 10,298 8,508 8,320 34,327 29,286 26,456 23,707 Indiana 4,808 5,576 5,399 5,844 4,313 5,197 4,750 4,590 8,933 7,482 8,383 8,640 Iowa 5,343 5,620 5,829 5,821 5,443 5,414 5,712 5,647 4,854 5,068 5,202 5,236 Kansas 3,376 3,191 2,834 2,766 1,562 1,788 1,801 1,710 6,774 6,569 6,409 6,190 Kentucky 4,170 4,128 4,456 5,188 3,350 3,364 3,599 3,877 5,942 6,017 6,141 6,720 Louisiana 2,912 3,157 3,014 2,974 2,854 3,146 3,184 2,996 5,581 5,406 5,024 4,829 Maine 1,014 1,052 1,047 850 535 721 715 740 3,154 3,191 3,226 3,084 Maryland 3,936 3,928 3,662 3,524 2,933 3,110 3,064 2,945 13,455 13,113 12,564 12,026 Massachusetts 7,368 7,381 7,174 6,562 7,749 6,392 6,636 5,538 11,169 11,619 11,568 12,529 Michigan 10,929 10,707 12,283 10,019 6,740 7,802 8,312 9,827 20,300 20,034 20,896 21,251 Minnesota 10,724 10,803 10,012 10,317 9,743 9,939 9,269 9,700 8,996 8,530 8,167 8,052 Mississippi 1,750 2,005 1,923 1,686 1,676 1,726 1,670 1,629 3,196 3,292 3,261 2,732 Missouri 6,341 7,216 7,268 7,145 5,304 5,509 5,749 6,238 12,577 13,181 13,349 13,045

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Montana 1,596 1,588 1,506 1,306 1,331 1,327 1,497 1,280 2,156 2,180 2,008 1,912 Nebraska 2,806 3,134 3,350 3,320 2,100 2,514 2,636 2,807 5,146 5,674 6,254 6,430 Nevada N/A 673 707 811 N/A 387 442 437 N/A 1,615 7,789 1,749 New Hampshire 522 484 534 563 401 491 468 512 1,385 1,311 1,288 1,291 New Jersey 4,768 4,654 5,433 6,016 4,178 4,1019 4,607 5,435 9,494 9,794 10,666 11,260 New Mexico 1,829 1,780 1,887 1,968 1,691 1,716 1,754 1,606 1,941 1,912 1,757 1,885 New York 18,172 16,605 15,135 14,289 20,497 20,337 18,703 13,617 51,159 47,118 43,365 42,730 North Carolina 5,391 5,458 5,301 5,615 4,317 4,481 5,239 5,404 11,339 10,847 10,130 9,527 North Dakota 965 1,006 1,013 1,044 827 851 828 864 1,143 1,129 1,167 1,197 Ohio 15,946 15,396 16,157 14,965 12,819 14,131 14,136 14,413 20,078 20,365 21,584 21,012 Oklahoma 6,484 6,558 6,487 6,923 4,746 5,364 5,864 6,328 8,173 8,406 8,674 8,812 Oregon 4,818 4,675 4,537 5,095 4,558 4,563 4,587 4,646 9,278 9,193 8,966 9,101 Pennsylvania 13,299 12,235 12,420 13,616 12,419 11,926 11,730 12,031 22,690 21,631 21,237 21,434 Puerto Rico 2,703 N/A 3,254 3,483 1,510 N/A 977 2,369 7,760 N/A 8,476 8,179 Rhode Island 1,403 1,409 1,493 1,582 1,018 1,348 1,227 1,378 2,621 2,302 2,414 2,383 South Carolina 2,923 3,172 3,405 3,537 2,853 3,137 3,107 3,407 4,545 4,525 4,774 4,818 South Dakota 1,308 1,441 1,357 1,355 1,106 1,042 1,173 1,185 1,101 1,215 1,367 1,415 Tennessee 5,968 5,480 5,667 6,047 3,481 4,370 5,089 5,443 10,796 10,144 9,679 9,359 Texas 8,938 9,869 10,680 11,766 8,200 7,989 8,858 9,108 16,326 18,190 19,739 21,353 Utah 2,383 2,148 2,006 2,177 2,332 2,264 2,009 2,118 2,273 1,805 1,957 2,025 Vermont 750 788 697 854 722 684 581 637 1,445 1,318 1,360 1,461 Virginia 2,683 2,738 2,904 3,274 1,715 1,826 2,096 2,307 6,778 6,789 6,866 7,109 Washington 7,369 7,590 7,273 7,019 7,376 7,129 6,438 6,230 8,688 8,945 9,101 9,215 West Virginia 2,151 2,392 2,234 2,358 1,973 2,256 2,340 2,502 3,169 3,388 3,298 3,220 Wisconsin 5,941 6,001 5,158 5,074 4,463 4,039 4,358 4,083 10,868 10,504 9,497 8,336 Wyoming 715 786 896 903 683 731 689 783 774 815 965 1,036 Total 289,721 287,054 292,134 299,095 247,181 267,453 265,502 270,955 565,265 543,953 541,343 532,698

Source: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Administration on Children, Youth and Families Children's Bureau Adoption and Foster Care Analysis and Reporting System (AFCARS) Data as of July 2003

Updated on August 12, 2003

GUIDELINES TO SETTING UP VISITING PLAN

Instruct Participants: Please suggest to the participants to utilize HANDOUT.

(State the Bold and Bulleted statements and reflect using the foundation material in brackets.)

 Have we considered and been sensitive to the issues of culture, language, family systems, and other issues that may impact the success of the visitation plan?

(We need to open our perspectives beyond our own cultural experiences and meet the family where they are at. Are the family systems patriarchal, matriarchal, who leads the family, and how are decisions made?)

 Have we clearly communicated beforehand to the parents about the expectations and visiting rules? Has the purpose of the visitation plan been discussed with parent?

(Often, many families are apprehensive about engaging with case workers; therefore, encouraging that dialogue helps build rapport and establish a relationship. We also cannot assume that the parties involved are aware of the details of the process)

 Has the parent been asked to participate in developing the visitation plan? Has the family invited other significant people to the planning meeting?

(This would accent the partnership between parent and caseworker and reflect the importance of their input and involvement. In addition, since various situations have seemingly removed the parents’ power, this act of ensuring the involvement of the parents likely will empower them.)

 Does the parent recognize that the goal of the visitation plan is to help the family move toward reunifications? Have the obstacles or barriers for reunification been discussed with the parent?

(Discussion of this is a preventive measure to ensure the best success. Obstacles include:

(a) parents’ resistance (b) parents’ mental health issues and/or addictions (c) parents’ lack of parenting skills (d) child maltreatment and abuse (e) damage attachment and relationships problems due to various family problems (f) failed reunifications due to return to foster placements.

 Have we created an environment that is parent strength based? Is the environment family oriented such as activities (i.e. games, art supplies, and etc.) are provided or meals or supportive people?

(Do the parents have the time management and organization and communication skills to function sufficiently and accomplish such goals? Are there games and toys and age appropriate toys? Are there televisions so that children can watch videos?)

 Have we considered the logistics of the visitation plan? Can a parent meet the expectation of time, travel, and real-life parenting situations?

(Is the visit site too far from their home? Do parents’ have resources to get to visits? Do tokens need to be provided or cab service or bus pass?)

 Has an assessment occurred regarding parent’s skill level in areas of parent-child attachment, communication, parents response to child, parent’s response to crisis situations, parent’s ability to financially budget, and parent’s ability to plan and structure daily living (i.e. cooking, laundry, hygiene, cleaning, and etc.)?

(It is very important that human service professionals do not express their biases toward families. Discussion on the above categories will foster trust and establish rapport.)

 Has an assessment occurred regarding parent’s knowledge of child(ren)’s needs (i.e. mental health, nutrition, sleeping pattern, child’s hobbies and interests, school behaviors, peer relationships, and etc.)?

(The research states that human services professionals are concerned with gaining knowledge about our children today and child development, but the same effort is not put into education of parents today about assessing the needs of their children. Addressing such children’s needs is necessary and comprehensive in being attuned to the social-emotional, cognitive, and physical realms of the child’s life.)  Have we been attentive to the attachment needs and the developmental needs

(Despite that we may come from an upbringing of a positive attachment ourselves, we cannot assume that our clients have the same foundation of a healthy attachment. We often believe that others have the same experiences as we do ourselves. However, we must stop and examine the quality of the relationship between parent and child, as well as special needs or conditions of the family related to this. This is based on the premise that a positive attachment and parent- child relationship contributes to more successful visitation, which contributes to a successful reunification)

State: The next section covered is the IMPORTANCE OF VISITATION.

Instruct Participants: Ask the participants to imagine and list factors of how children and parents feel about foster care and their perspective on the importance of visitation.

Comment: Please have each participant state a factor. The factors include:

From a CHILD’S point of view:  Child misses parents.  Child needs reassurance.  Child needs to know parents are okay.  Child is awaiting and excited to spend time with parents.  Child needs clarification on why child is in placement.  Child needs to feel connected to biological family.  Child needs to feel connected to relatives.  Child needs to have questions regarding family answered.  Child needs to be informed about what is going on in the family.  Child needs to be ask ,”When can I go home?”.  Child needs to feel like they still belong to their family.  Child needs to play with siblings and family members.  Child needs to feel that things are getting better.  Child may be confused about roles/loyalty.  Child may want to get things from family: presents, pictures, money, and other sentimental things.  Child may advocate for parents to participate in counseling.  Child may have need to defend family and show that they are not “evil”

From a PARENT’S point of view:  Parents miss and love child.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation  Parent wants to keep bond with child.  Parent wants to keep child’s sense of connection with his/her own family  Parent wants to relay information about people and pets significant to the child.  Parent does not want to be forgotten.  Parent wants to be reassured that child is doing well in foster care.  Parent wants to reassure child that they are still here.  Parent wants to learn new parenting skills.  Parent wants to know what child is saying and being told.  Parent wants to know what is going on in child’s life.  Parent want to comply with expectations (even if they do not have the skills).  Parent wants to lessen the child’s worries.  Parent wants to prove to the system that they care about their children.  Parent wants to nurture the child with gifts, money, or other sentimental things.  Parent wants to give child hope and something to look forward too.

(The two previous lists were done to have the foster care workers increase self-awareness and empathize with how the parent and foster children feel and understanding what they are experiencing)

Ask the participants to list factors of what the human service professionals feel about foster care and their perspective on the importance of visitation.

Comment: Please have each participant state a factor. The factors include:

From a FOSTER CARE WORKER’S(FCW) point of view:  FCW wants to advocate for the child.  FCW wants to advocate for the parent.  FCW wants to provide the tools to foster engagement.  FCW wants to enforce visitation rules.  FCW wants to model appropriate behavior.  FCW wants to intervene if necessary.  FCW wants to observe/evaluate interactions between parents and children.  FCW wants to allow parents to have some choices.  FCW wants to assess attachment and bonding.  FCW wants to maintain bonding and to help maintain a connection.  FCW wants to report on relationship between parent and child and the interactions observed.  FCW wants to provide guidance in parenting skills.  FCW wants to provide encouragement to parents and child.  FCW wants to give hope to both child and parent.

Ask participants to review the VISITATION INTAKE FORM. This form was created to encourage a universal approach to assessing the families involved in visitation and to ensure that information is comprehensively gathered on each family’s visitation plan and process. Review each section and clarify any concerns or issues. These forms maybe entirely used or modified for the need of the professional.

I. BACKGROUND INFORMATION

CHILD INFORMATION

Name of Child: DOB:

Child’s County of Origin:

Child’s County Case Manager (Name): (Address):

(Telephone #):

Child’s Law Guardian: Telephone #:

Child’s Current Foster Parent: Current Resident:

Telephone #:

Gender: Race/ Ethnicity: Social Security #:

School Name/Location:

School Phone Number: Contact at School: Educational level: Classification Level: Regular Education or Special Education (Circle One) (If Special Education) Classroom Setting:

Reason for Placement:

BIOLOGICAL/LEGAL GUARDIAN INFORMATION

Name: DOB:

Current Resident:

Telephone #:

Employment: (Name): (Address):

VISITATION INTAKE FORM P.2

FAMILY HISTORY Explanation(s) History of drug use History of alcohol use History of physical abuse History of sexual abuse History of mental/emotional abuse History of CPS involvement History of legal involvement History of Developmental Disabilities History of Mental Health issues History of Employment difficulties History of Learning Disabilities History of Educational Disabilities Other:

Other Comments:

______

II. INITIAL VISITING PLAN

A. PARTICIPANTS: Bio Parent (s)/ Child(ren) Bio Mother/ Child(ren) Bio Father/Child(ren) Bio Relative(s)/Child(ren) Adoptive Parent(s)/Child(ren) Primary Discharge Resource/Child(ren) Other/Child

B. PRIMARY LOCATION – Please rank order where the visits will take place ( 1-3 possibilities). Foster Home Bio Parent’s Home Child Advocacy Center Community Resource Congregate Care Facility Court Day Care Adoptive Home Hospital/Health Facility Service Provider/Contract Agency OMH Facility DSS Office/Field Office OMRDD Facility Precinct/Law Enforcement Office Prison Public Location Relative’s Home School Shelter- Domestic Violence Shelter – Homeless

ADDRESS

TELEPHONE:

VISITATION INTAKE FORM P. 3

C. FREQUENCY Daily Multiple times per week DAYS SELECTED: Weekly Multiple times per month Monthly Other

D. DURATION Under 1 hour 1 – 2 hours TIME SELECTED: 2 – 4 hours Full Day (8 – 12 hours) Multiple Full Days (2 -7 days) Overnight Weekends

E. CHILD(REN) – List all the child(ren) that this visiting plan addresses. NAME AGE

F. ADULTS – List all the adults and relationship to the child(ren) that are involved in this visiting plan.

NAME RELATIONSHIP

G. SPECIAL CONSIDERATIONS

1. Is a supervised visitation required? YES or NO PLEASE EXPLAIN(Who will be supervising the visit?):

2. Are there any special considerations regarding visitations? (i.e. court orders) YES or NO PLEASE EXPLAIN:

3. Does the child have any physical health impairments that need to be accommodated during visitation? YES or NO PLEASE EXPLAIN:

4. Does the bio parent(s)/legal guardian have any physical health impairments that need to be accommodated during visitation? YES or NO PLEASE EXPLAIN:

5. Does the bio parent/ legal guardian need assistance with transportation? YES or NO PLEASE EXPLAIN:

H. VISITING PLAN STATUS Pending Active Suspended Closed

SIGNATURE OF THERAPIST/CASE WORKER DATE

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Instruct Participants: Ask participants to review the PARENT-CHILD RELATIONSHIP ASSESSMENT FORM. This form was created to clarify the professional’s assessment of the parent’s status of their relationship with their child, and to determine if the parent is performing developmentally appropriate interactions and is aware of the developmental status of the child. Review each section and clarify any concerns or issues.

PARENT-CHILD RELATIONSHIP ASSESSMENT FORM

Name of Child: DOB:

PARTICIPANTS: Who is involved in the interaction with the child? Bio Parent (s)/ Child(ren) Bio Mother/ Child(ren) Bio Father/Child(ren) Bio Relative(s)/Child(ren) Adoptive Parent(s)/Child(ren) Primary Discharge Resource/Child(ren) Other/Child

PRIMARY LOCATION – Where is the observation occurring? Foster Home Bio Parent’s Home Child Advocacy Center Community Resource Congregate Care Facility Court Day Care Adoptive Home Hospital/Health Facility Service Provider/Contract Agency OMH Facility DSS Office/Field Office OMRDD Facility Precinct/Law Enforcement Office Prison Public Location Relative’s Home School Shelter- Domestic Violence Shelter – Homeless Other:

INFANCY (Birth – 14 Months) Parent initiates behaviors that foster attachment and bonding. Parent makes eye contact with child. Parent positions child to engage in physical and verbal exchange (i.e. talks, sings, rocks infant) Parent shows pleasure toward infant in gaze, voice, or smile. Parent responds positively toward infant’s cues. Parent engages in pleasurable give and take with infant during play. Parent is able to meet the physical needs of child (i.e. feeding, changing diaper, changing soiled clothing). Parent recognizes infant’s cry and responds immediately.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation TODDLER (15months – 35 Months) Parent initiates behaviors that foster attachment and bonding. Parent makes eye contact with child. Parent positions child to engage in physical and verbal exchange (i.e. talks) Parent shows pleasure toward toddler in gaze, voice, or smile. Parent responds positively toward toddler’s cues.

Parent-Child Relationship Assessment Form P. 2 Parent engages in pleasurable give and take with toddler’s during play. Parent is able to meet the physical needs of child (i.e. feeding, changing diaper, changing soiled clothing). Parent recognizes toddler’s cry and responds immediately. Parent uses appropriate response toward negative behaviors.

PRE-SCHOOL AGE (3 – 6 years) Parent initiates behaviors that foster attachment and bonding. Parent makes eye contact with child. Parent positions child to engage in physical and verbal exchange (i.e. talks) Parent shows pleasure toward child in gaze, voice, or smile. Parent responds positively toward child’s cues. Parent engages in pleasurable give and take with child’s during play. Parent is able to meet the physical needs of child (i.e. feeding, changing diaper, changing soiled clothing). Parent recognizes child’s cry and responds immediately. Parent uses appropriate response toward negative behaviors.

LATENCY AGE (7 – 11 YEARS) Parent initiates behaviors that foster attachment and bonding. Parent makes eye contact with child. Parent initiates activities and games that are shared and encourages talking (i.e. board games). Parent’s affect matches message being given.. Parent responds positively and openly to questions regarding family or placement history.. Parent engages in pleasurable give and take with child’s during play. Parent is able to meet the physical needs of child (i.e. feeding,). Parent uses appropriate response toward negative behaviors. Parent understands how child is feeling and responds positively. Parent recognizes and understands child’s need for time and attention and responds positively.

ADOLESCENT AGE (12-18 YEARS) Parent initiates behaviors that foster attachment and bonding. Parent makes eye contact with child. Parent initiates activities and games that are shared and encourages talking (i.e. board games). Parent’s affect matches message being given.. Parent responds positively and openly to questions regarding family or placement history.. Parent is able to meet the physical needs of child (i.e. feeding,). Parent encourages discussion of such topics as history, peer relationships, family, school, and etc. Parent uses appropriate response toward negative behaviors. Parent understands how child is feeling and responds positively. Parent recognizes and understands child’s need for time and attention and responds positively.

Ask participants to review the VISITATION CONTRACT. This form was created to encourage a partnership between parent, human service professional, foster parent and foster child. These forms maybe entirely used or modified for the need of the professional.

VISITATION CONTRACT

PLEASE CHECK EACH ITEM AS YOU REVIEW THE FOLLOWING VISITATION POINTS.

I will contact at weekly to schedule a visit (THERAPIST/CASE WORKER) (TELEPHONE NUMBER) with my child(ren).

I will notify at as soon as possible if I can (THERAPIST/CASE WORKER) (TELEPHONE NUMBER) not attend the scheduled visit.

I will arrive at at a.m./p.m. . I will commit (LOCATION) (TIME) to arriving 15minutes before the visit to begin and leave 15minutes after the visit has ended.

I will not visit with my child(ren) outside the scheduled visit.

(If applicable) I will not use drugs or alcohol before visiting with my child(ren). I understand that my schedule visit will be cancelled if there is any suspicion that these substances have been used.

I will not bring any weapons or articles that could be used as a weapon to visits. I understand that my schedule visit will be cancelled if there is any suspicion that these items are present.

I will not speak negatively about the child(ren)’s custodial parent or foster parent in front of the child(ren)’s.

I will not speak negatively (i.e. swearing, use of inappropriate sexual language, and etc.) toward the child(ren)’s during the visit. I will commit to discussing concerns or issues during family counseling sessions.

I will not use physical punishment or threaten to use physical punishment with the child(ren) during visits.

I will not make promises to the child(ren) about the future living arrangement or unsupervised visits.

I will not send any correspondence (i.e. regarding child support, court proceeding, & etc.) or messages to the custodial or foster parent by means of the child(ren).

I will ask prior approval from the THERAPIST/CASE WORKER and/or any other deemed authority before

I will ask prior approval from the THERAPIST/CASE WORKER and/or any other deemed authority before bringing any gift, cards, or personal items (such as hygiene products, toys, and etc…) to the visit.

I will follow the suggestions of the THERAPIST/CASE WORKER and their assistants while visiting with the child (ren). VISITATION CONTRACT P. 2

I understand that it is responsibility of the THERAPIST/CASE WORKER to report to the appropriate agencies, or courts any circumstances such as (a) any child abuse or maltreatment, (b) any substance abuse issues , and (c) any other visitation contract violations that relates to my ability to parent my child(ren) in a safe, and positive manner.

(If applicable) I understand that written Supervisory Reports will be sent to .

Other Comments or Requirements:

______

I understand that breaking this agreement may lead to supervised visits or termination of visitation.

I have received a copy of this Visitation Contract.

SIGNATURE OF VISITING PARENT SIGNATURE OF FOSTER PARENT

SIGNATURE OF THERAPIST/CASE WORKER SIGNATURE OF CHILD

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Instruct Participants: Ask participants to review the SUPERVISED VISITATION PROGRAM OBSERVATION FORM. This form was created to assist the professional with assessing the visits and the dynamics of the parent-child interactions. Review each section and clarify any concerns or issues.

SUPERVISED VISITATION PROGRAM OBSERVATION FORM

Date of Visit: Time started: am/pm Time ended: am/pm

VISITING CHILD(REN)’S NAMES/AGES VISITING ADULT’S NAMES

ADDRESS:

TELEPHONE #:

LOCATION ASSESSMENT –What are the conditions of the home/visiting location?

Has the Therapist/Case Worker assess the home/visiting location prior to the scheduled visit? YES NO N/A

Does the home/visiting location have furniture (i.e. couch, chairs, &etc)? YES NO N/A

Does the child have a bed? YES NO N/A

Does the child have blankets and sheets? YES NO N/A

SUPERVISED VISITATION PROGRAM OBSERVATION FORM P. 2

Does the home/visiting location have a working refrigerator? YES NO N/A

LOCATION ASSESSMENT (Continued) Does the home/visiting location have a working stove? YES NO N/A

Does the home/ visiting location have working smoke detectors and carbon monoxide detectors? YES NO N/A

Are there any electrical or wiring concerns? YES NO N/A

Does the family have any problems with utilities? YES NO N/A

Are there any animals/pets in the home/visiting location? YES NO N/A

Is the environment clean of debris and clear of garbage? YES NO N/A

Do you feel safe in the environment? YES NO N/A

Please explain any area of concern:

PARENTAL INTERACTION Did the parent dress appropriately ? YES NO N/A

Did the parent appear impaired by alcohol or drugs? YES NO N/A

Did the parent demonstrate affection (i.e. hug, kiss, state “I love you”)toward the child(ren)? YES NO N/A

Did the parent verbally greet the child(ren)? YES NO N/A

Did the parent have appropriate activities planned? YES NO N/A

Did the parent appropriately set limits? YES NO N/A

Did the parent redirect the child(ren)’s negative behaviors? YES NO N/A

Did the parent appear to be moody or frustrated with the child(ren)? YES NO N/A

Did the parent appear to be nurturing toward child(ren)? YES NO N/A

Did parent need assistance from supervisor to manage child? YES NO N/A

______SUPERVISED VISITATION PROGRAM OBSERVATION FORM P. 3

CHILD(REN) INTERACTION Did the child(ren) dress appropriately ? YES NO N/A

Did the child(ren)appear impaired by alcohol or drugs? YES NO N/A

Did the child(ren) demonstrate affection (i.e. hug, kiss, state “I love you”)toward the parent? YES NO N/A

Did the child(ren) verbally greet the parent? YES NO N/A

Did the child(ren) have appropriate engage in planned activities? YES NO N/A

Did the child(ren) adhere appropriately to set limits? YES NO N/A

Did the child(ren) adhere to the parent’s redirection of the child(ren)’s negative behaviors? YES NO N/A

Did the child(ren) appear to be moody or frustrated with parent? YES NO N/A

Did the child(ren) demonstrate any physical aggression toward parent? YES NO N/A

Did the child(ren) have any emotional outburst (i.e. crying, angry, yelling)? YES NO N/A

SUPERVISORS IMPRESSION

Did the parent attend the visit at the appropriate scheduled time? YES NO N/A

Did the parent need assistance with redirecting the child(ren)? YES NO N/A

Was the parent receptive to any suggestions or feedback made by the supervisor? YES NO N/A

Did you feel that the parent provided an emotionally safe environment? YES NO N/A

Did you feel that the parent provided a physically safe environment? YES NO N/A

Did you feel that the visit was positive? YES NO N/A

Did you feel that the parent needs assistance with developing parenting skills? YES NO N/A

SUPERVISIOR SIGNATURE DATE Instruct Participants: Ask participants to review the PARENT IMPRESSION OF SUPERVISED VISIATION PROGRAM. This form was created to encourage a parent’s perspective about the visits. Feedback provided by the parents can assist with assessing parental concerns or parental fears. This form also allows for dialogue and education to begin to occur with parents and strengthen a relationship among those involved. Review each section and clarify any concerns or issues. It can be completed occasionally by the parent so as to obtain such feedback but not to overburden them with questionnaires and paperwork. PARENT IMPRESSION OF SUPERVISED VISITATION PROGRAM Date of Visit: VISITING CHILD(REN)’S NAMES/AGES VISITING ADULT’S NAMES

Please provide your impression by circling the appropriate response. Did you feel that the visitation began on time? YES NO N/A

Did you feel that your child(ren) was appropriately dressed? YES NO N/A

Did you feel that your child(ren) demonstrated affection YES NO N/A (i.e. hug, kiss, state “I love you”)toward you?

Did you feel that your child(ren) was happy to be in the visit? YES NO N/A

Did you feel that you child(ren) was moody or frustrated today? YES NO N/A

Did you feel that your child(ren) engaged appropriately in planned activities? YES NO N/A

Did you feel that your child(ren) were receptive to your redirection on YES NO N/A negative behaviors?

Did you feel that your child(ren) adhered to your set limits? YES NO N/A

If you received suggestions or comments from the supervisor, YES NO N/A did you feel that you were being judged?

If you received suggestion or comments from the supervisor, YES NO N/A did you feel that you could use the suggestions?

Did you feel that the environment for the visit was appropriate? YES NO N/A

Did you feel that your overall impression of the visit was positive? YES NO N/A PARENTAL FEEDBACK What things did you like about the visit?

What things did you dislike about the visit?

What things (if any) would your like to see go differently?

PARENT’S SIGNATURE DATE

Instruct Participants: Ask participants to locate the BASIC CONFLICT RESOLUTION & MEDIATION SKILLS Handout. This form was created as part of the education section to teach foster care workers and parents positive methods of communicating and working through any possible conflicts with others in such communication, as well as building relationships. This may be helpful given that there may be a great deal of tension among the parties involved given the challenging closely related interactive situations, as well as the compromised ‘freedom’ particularly for the parent. Information on the handout is in BOLD; explanation and reflection are in regular type

BASIC CONFLICT RESOLUTION & MEDIATION SKILLS a) active listening – When communicating with someone, maintain eye contact, nod your head to reflect that you understand. When responding, make comments or ask questions that reflect that you heard and understood what was just communicated to you. b) “I” messages – Stating things in an accusatory manner puts the other person on the defensive. Instead, when speaking, use “I” statements, which usually reflect how you felt about a situation, informing a person about how another person or situation made you feel. They often may start out by saying “I feel…” Saying, “I felt frustrated when no one appeared for the scheduled visit” is more tactful than putting the other person on the defensive by saying, “You never show up for visits.” Another example is to say that “I feel sad that I am not with my child right now” or “I am angry that my child is not with me right now;” instead of “You took my child away from me.” c) needs vs positions – When communicating, it is helpful in the resolution process if needs versus positions are clarified. Involved parties can state what they need to take place to feel satisfaction in the situation conflict. This is different from their position in the matter, which may involve morals and values and if different from others, must be recognized as such and these separateness positions may merely have to be respected as one may not sway to “the other side.” d) negotiable vs non-negotiable conflict – Mature parties need to recognize that some conflicts are not able to be negotiated or compromised. It is helpful to stop and think and recognize what they are so as not to keep trying to ‘sell’ one’s point and negotiate what cannot be negotiated. We have to ask ourselves if there is room for compromise or negotiation and not deny the reality in some situations. e) individual conflict style – Having self-awareness of one’s conflict style will be helpful in mediating and resolving issues with others. Knowledge of one’s own actions such as offensive nonverbal actions (rolling of eyes), as well as tendencies to deny role and responsibility in matters will help one to monitor their own behaviors, work more effectively with other people, be less offensive, and not add tension to a situation. f) putting myself in other people’s shoes – The ability to empathize with another and recognize how that person is feeling is one of the keys to relationship building and resolving conflicts with another. If you are

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation thinking about how you have to be at a meeting, or how you think that this person with whom you are speaking is not a quality person because of what you know of them, then it may be difficult to think about what is going on in that person’s life that has brought them to where they are today, and how they are feeling about their situation. Trying to understand how a person may be feeling is key to bridging gaps and bringing people closer. g) anger and violence – Becoming angry and violent while communicating with others serves no healthy purpose. It is important to keep oneself safe if another person becomes violent. If the other person becomes angry, studies show that they should have approximately 4 minutes to vent without interruption. It should also be pointed out to the angry person that becoming angry is not helpful. Although they have a right to feel how ever they feel, feelings should be expressed in a healthy and safe manner. h) reframing the issues in conflict – Are the issues in conflict framed in a positive or negative manner? If a situation is viewed from a “cup half empty” philosophy, then the negativity of the situation shadows over all aspects of it as a whole. One may then start projecting negative self-fulfilling prophecies which are set up for failure. Instead, try to look at situation in a positive manner with possibilities for success and productivity in working together. i) criticize ideas, not people – Care should be taken so as not to direct criticism at the people who share ideas; if applicable, discuss ideas that may not be practical or plausible, but do not criticize the individual creator. j) win-win solutions to conflict vs compromises – Communicate and examine the “big picture” of the situation to determine whether all parties involved can actually have their needs fulfilled, or if compromise is necessary. Sometimes during conflict mediation, the members involved may instantly think that they will not have their interests fulfilled and will end up having to compromise, a result that everyone may not necessarily support. However if good, open communication of needs takes place, both sides may actually able to win.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Instruct Participants: Ask participants to locate the COMMUNICATION AND RELATIONSHIP BUILDERS Handout. This form was created as part of the education section to teach foster care workers and parents positive methods of communicating and working through any possible conflicts with others in such communication, as well as building relationships. This may be helpful given that there may be a great deal of tension among the parties involved given the challenging closely related interactive situations, as well as the compromised ‘freedom’ particularly for the parent. Information on the handout is in BOLD; explanation and reflection are in regular type

COMMUNICATION AND RELATIONSHIP BUILDERS

 Listening to others; making comments of what others are saying – Again, as mentioned on the previous handout, make comments or ask questions that reflect that you heard and understood what was just communicated to you by the person with whom you are speaking.

 Eye contact – Good eye contact shows that you are engaged with the other person. Be aware that some cultures (such as the American Indians) feel that it is rude and offensive to hold eye contact with a person.

 Talking less about yourself; asking more about them – Talking exclusively about oneself and not about the person with whom you are speaking indicates to them that they are not important and that you are not interested in their lives.

 Showing interest in others – You can show interest in other people, engage, and build a stronger relationship by asking questions about that person, as well as showing that you remember details about them and their lives when you bring up information that they previously shared with you.

 Taking the five extra minutes – If you are always in too much of a hurry to take the time to talk with someone and build a relationship, there will be little to no relationship later on. Take the five extra minutes and show an interest in nurturing relationships with others; relationships are the basis of being able to weather crises in the future. If you constantly clash with another because of a poor relationship that you are not taking time to nurture, then the battles will likely continue.

 Empathizing with others (showing that you can understand how they feel) – Again, as previously mentioned, the ability to empathize with another and recognize how that person is feeling is one of the keys to relationship building and resolving conflicts with another. If you are thinking about how you have to be at a meeting, or how you think that this person with whom you are speaking is not a quality person because of what you know of them, then it may be difficult to think about what is going on in that person’s life that has brought them to where they are today, and how they are feeling about their situation. Trying to understand how a person may be feeling is key to bridging gaps and bringing people closer.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation  Proving yourself, establishing a reputation that you care and are there for others – How do you want to be known among your colleagues and clients? Do you want to make a difference in the lives of children and families and work together to make that difference? Your actions will speak loudly when you choose advocacy and to care enough to support and empower families.

 Ensure that how each side feels is communicated – It is frustrating when one does not have the opportunity to express oneself. Ensure that each side is heard and has the opportunity to express feelings. Otherwise at least one person will leave the discussion with unresolved and unheard feelings.

 Get to the true issue so as not to merely put a band-aid on the situation – What are the core issues that need to be addressed to truly rectify the situation? Without acknowledging these and instead ignoring them and only tending to the surface issues, the problems will recur and cause conflict in the future.

 Come up with ideas and solutions that all will feel are satisfying and meet each other’s needs – Communication about what is important as well as how everyone involved feels is important. Unheard interests and needs will not spark the discussion necessary to create solutions that will be supported by all.

 Don’t appear to take sides – Mediators cannot appear to take sides. If this occurs, involved parties will feel as if they are bring attacked. It helps to clarify that the mediator is neutral and wants to help the whole situation and all parties involved.

 Do appear to want to help – If you do not appear invested in wanting to help, it will be evident to others around you.

 Shake on it and agree not to discuss it with others / gossip when it is said and done – After a conflict has been addressed and resolved, out of privacy and respect for others, agree to put it behind you and not discuss the matter with other people. If you do, it will create animosity and ill feelings to involve others in business that has already been closed.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Instruct Participants: Ask participants to locate the BASIC PARENTING TIPS: 101 Handout. This form was created as part of the education section to teach parents positive methods of parenting. It will also be presented to the foster care workers so that they are aware of the parenting skills education provided to the parents. Since research indicates that poor parenting skills are correlated with poor attachment between parent and child, this may be helpful in improving the skills of the parents of foster children. The handout below is an exact copy of the handout produced for the training audience.

BASIC PARENTING TIPS: 101

(1) No Means No: Don’t change your ‘No’ answers to ‘Yes’ answers despite the constant nagging you may get from your child. If you do, your authority may mean little to them.

(2) Be Preventive: Inform your child of plans for what they can expect, as opposed to springing something on them last minute without any discussion. Doing this will likely to avoid their tantrum or difficult oppositional behavior.

(3) Learn From the Past: When encountering any new situation in which you are unsure of what to do, think about if you have encountered this situation in the past and how you handled it then. Learn from your successes and failures to decide how you will proceed in the future, whether it involves your own or your children’s behaviors.

(4) Schedule Appointments for Quality Time: Relationships can weaken and become distant if you are not getting quality time and interactions with your child. Schedule the time in, from family meals at the dinner table to outings for ice cream or long walks.

(5) Incorporate Structure and Rules that are Maintained: Believe it or not, kids want structure, limits, rules and a routine. Without it, they are lost and may perceive others to not care enough about them and what they do.

(6) Balance the Negatives with the Positives: Many times there is much negative attention in children’s lives that is received by the child from the parent or teacher because of a child’s wrong-doings. If they only get the negative attention without any pats on the back and positive reinforcement, then your relationship becomes strained. Make sure there are positives to enhance the relationship and balance the negatives.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation (7) Try Other ‘Doors’ When Your Approach is not Working: If your approach is not working despite your efforts, think about other options of how to work with your child and go ‘in the back door’ towards entertaining another approach.

(8) Pass Their Tests: Without being manipulated or treated in a negative manner, show that you can be trusted and pass their tests when children increase their confidence and trust in you. If they perceive that you are responding well to what they seek you out or trust in you for, they may be more likely to seek you out and trust in you again in the future.

(9) Do the Basics: When you are struggling with what to do, do the basics. Such valuable basics can be as simple as just being a loving and supportive parent. It may be that easy.

(10)Seek Professional Help When Help is Needed: If it is getting too challenging and you need some extra help, seek a professional for your child’s individual and family intervention work. When you recognize that extra help may be needed, call and make an appointment. Although many people come in for counseling in a crisis, you don’t have to wait for a crisis to get the help that may be needed and be preventive.

HANDOUT PARENTING PATTERNS OF DISCIPLINE By Donna Baumrind

State: There are three types of Parenting Patterns of Discipline (by Donna Baumrind) to educate about towards greater self-awareness and evaluate areas for reform. (Review and discuss the different styles.)

 AUTHORITARIAN PARENTS – are controlling, punitive, rigid, and cold, and whose word is law; they value strict, unquestioning obedience from their children and do not tolerate expressions of disagreement; they yield passive & dependent kids.

 PERMISSIVE PARENTS – provide lax and inconsistent feedback and require little of their children.

Permissive – Indifferent parents – are usually uninvolved in their children’s lives. Their children tend to be dependent and moody and have low social skills and low self-control the children also have little motivation to do work

Permissive – Indulgent Parents – are more involved with their children, but they place little or no limits or control on their behavior children typically show low control and low social skills, but they feel that they are especially privileged.

 AUTHORITATIVE PARENTS – are firm, setting clear and consistent limits, but try to reason with their children giving explanations for why they should behave in a particular way. Children of authoritative parents tend to fare the best: they are independent, friendly with their peers, self-assertive, and cooperative parents are not always consistent in their parenting or discipline styles.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Instruct participants: Have participants divide into 3 groups and role play parent/child interaction. As the instructor, select a characteristic from the chart below and assign it to a group. Regroup and have the participants reflect what it felt like to be the parent or the child.

Instruct Participants: Ask participants to locate the CHILD DEVELOPMENT GUIDE. This form was created as part of the education section to teach parents the stages of development. It will also be presented to the foster care workers so that they are aware of the stages of development. Since research indicates that poor parenting skills are correlated with poor attachment between parent and child, this may be helpful in improving the skills of the parents of foster children. The handout below is an exact copy of the handout produced for the training audience.

CHILD DEVELOPMENT GUIDE

CHILD PHYSICAL EMOTIONAL SOCIAL COGNITIVE DEVELOPMENT DEVELOPMENT DEVELOPMENT DEVELOPMENT DEVELOPMENT STAGE  Develops own  Shows  Discriminates  Learns rhythm in feeding, sleeping excitement through primary caregiver through senses and elimination waving arms, kicking, (usually parent) from  Coos and  Gains early control and wiggling shows others and is more vocalizes of eye movement pleasure in anticipation responsive to that person spontaneously; babbles  Develops motor of being fed or picked up  Likes to be in nonsense syllables control in orderly sequence:  Cries in played with, tickled, and  Learns balance head, rolls over, different ways when jostled through the physical pulls self to sitting position, cold, wet, or hungry  Smiles senses, especially by and briefly sits up alone  Fears loud or  “Talks” to way of mouth  Begins to grasp unexpected noises and others, using babbling  Likes to put objects sudden movement sounds things in and take INFANCY  Begins to crawling,  Needs warmth ,  Finds parents things out of mouth, and walking, security, and attention important cupboards, boxes, etc. Birth – 14months  Developing motor  May have  Eating skills  Likes to skills temper tantrums develop repeat words  Begins to dress and  In generally  Able to play undress happy moods games  Is learning to trust and needs to know that someone will provide care and meet needs

 Runs, kicks,  Needs to  Still considers  Continues to climbs, develop a sense the mother (or primary learn through senses; is throws a ball, jumps, pulls, of self and to do caregiver) very still very curious pushes, etc. something for important; does not like  Has a short  Begins to potty him/herself strangers attention span training  Enjoys praise  Imitates and  Uses three to  Increasingly able to  Tests his/hers attempts to participate in four work sentences

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation TODDLER manipulate small objects powers; say “No!” often adults behaviors such as  Begins to sing with hands; scribbles; eats  Shows lots of washing dishes, mopping simple songs and make 15Months – 35Months with spoon; helps to dress emotion: laughs, squeals, floor, applying make-up rhymes self throws temper tantrum,  Is able to cries violently participate in activities  Fears loud (such as listening to a noises, quick story) with others moves, large animals, and departure of mother CHILD PHYSICAL EMOTIONAL SOCIAL COGNITIVE DEVELOPMENT DEVELOPMENT DEVELOPMENT DEVELOPMENT DEVELOPMENT STAGE  Runs, jumps, and  Is sensitive  Child begins to  Continues to begins to climb ladders; about the feelings of leave mother for short learn through physical may start to ride tricycles; others toward period of time senses tries anything; very active; him/herself  Imitates adults  Uses tends to wander away  Is developing and begins to notice imagination  Scribbles in circles; independence differences in the ways  Starts likes to play with mud, sand,  May fear that men and women act dramatic play and role finger paints, etc…; may unfamiliar people  Starts to be playing begin to put together simple  Is anxious to more  Likes to play puzzles please adults interested in others and grown-up  Dresses him/herself  Often “test” begins group play;  Begins to fairly well others to see who can be though groups are not observe and recognizes  Child still cannot manipulated and well formed; likes cause and effect tie controlled company, but not ready relationships shoes  Is often bossy, for games  Is curious and  Is able to feed self demanding, and  Begins to play inquisitive PRE-SCHOOL with spoon or fork aggressive with others  Has a larger YEARS  Has rapid muscle  Has growing  Has a good vocabulary growth confidence in imagination  Likes to shock 3 – 6 years  Is able to care for his/hers performance  Enjoys adults personal toilet needs  Is beginning to conversation during  Experiences  Eye/hand demonstrate some meals nightmares coordination problems may feelings of insecurities  May fear that  Has imaginary begin  If tired, parent may not return friends and an active  Is full of energy nervous,  Knows the fantasy life  Has growth spurts or upset, differences  May occasionally may exhibit the between the sexes and wet or soil him/herself when following behaviors: nail becomes modest upset or excited biting, eye blinking, throat clearing, and/or thumb sucking  Is concerned with pleasing adults  Is easily Embarrassed

 Is full of energy  May complain a  Will avoid and  Uses and lot (“Nobody likes me”) withdraw from adults reflective, serious generally restless  May forget  Has strong thinking and becomes  Has growth spurts and/or be easily emotional responses to able to solve  May be clumsy due distracted teachers and may increasingly complex problems, using logical

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation to  May withdraw complain that teacher is thought processes; is LATENCY poor coordination and/or be or not interact with unfair or mean eager for learning in an “ugly duckling” stage others  Enjoys/wants  Wants to 7 – 11 years  May occasionally  Has more more responsibility and know the reasons for wet or soil him/herself secrets independence things  Has marked  May be  Is often  Has definite awareness of sexual excessive in self- concerned about “doing interests and lively differences criticism, tends to well” curiosity  May want to look dramatize everything,  May use  Likes, at and is very sensitive aggression as means of reading ,writing and bodies of opposite sex  Has fewer and problem solving using books (“playing more

CHILD PHYSICAL EMOTIONAL SOCIAL COGNITIVE DEVELOPMENT DEVELOPMENT DEVELOPMENT DEVELOPMENT DEVELOPMENT STAGE doctor”, playing house) reasonable fears  Demands love  May begin to  Has unpredictable  May argue and and understanding from demonstrate talents in a preferences and strong resist requests and caregivers particular field refusals instructions, but will  Enjoys school,  Challenges  Eats with fingers eventually obey doesn’t like to be absent, adult knowledge and talks with mouth full  Likes tends to talk more about  Has increased  Suffers more colds, immediate things that happen there ability to use logic sore throats, and other rewards for behaviors  Is not interested  Is critical of illnesses  Is usually in family table own artistic products  Drives self until affectionate, helpful, conversations, but  May have exhausted cheerful outgoing, and instead wants to finish interest in earning  May frequently curious, but can also be meals in order to get to money pout rude, selfish, bossy, other business  Begins to  May have more demanding, and silly  Boys and girls argue logically minor accidents  May have some differ markedly in  Is less interested in behavior problems personality, sex play and  Is becoming characteristics, and LATENCY experimentation very independent, interests, with most being  May be very dependable, and interested in being part of 7 – 11 years excited trustworthy a group or club (but about new baby in family  Likes privacy always the same sex);  May develop  Is casual and Sometimes silliness nervous habits or assume relaxed emerges within groups awkward positions (sitting  Maturation rates  Begins to test upside down) differ (girls faster than and exercise a great deal  May engages in boys) of Independence active , rough and tumble  Seldom cries, (especially boys) play and has great interest in but may cry when angry;  Is affectionate team games while this is not an angry with parents; has great  May have rapid age, when anger comes it pride in father and finds weight increase is violent and immediate mother all-important  Continues to  Is concerned  Is highly develop motor skills and worried about school selective in friendships and peer relationships and may have one “best  Often Moody; friend” dramatizes and  Finds it exaggerates own important to be “in” with expressions (“You’re the the gang worst mother in the

CHILD PHYSICAL EMOTIONAL SOCIAL COGNITIVE DEVELOPMENT DEVELOPMENT DEVELOPMENT DEVELOPMENT DEVELOPMENT STAGE  Experiences  Commonly  Needs less  Thrives on sudden sulks family companionship arguments and and rapid increases in  May direct and interaction than discussions height, weight, and strength verbal anger at authority previously  May read a with the onset of figure  Has less intense great deal adolescents  Is concerned friendships with those of  Needs to feel  Maturation rates the same sex differ (with girls gradually about fair treatment of important in world and reaching physical and sexual others  Usually has a to believe in something maturity and boys just  Is usually gang of friends (With  Needs to feel beginning to mature reasonably thoughtful, girls showing more important in world and ADOLESCENCE physically and sexually) and is generally unlikely interest in boys than boys to believe in something in girls at this age)  Is concerned with to lie  Thrives on 12 – 18 years appearance  Worries about  May be annoyed arguments and at younger siblings  May be concerned failure discussions about appearance of acne  May appear  Has relationship  Is increasingly (especially with certain moody, anger, lonely, ranging from friendly to able to memorize, to types of skin) impulsive, self centered, hostile with parents think logically about  Experiences confused, and/or  Sometimes feels concepts, to reflect, to increased likelihood of stubborn that parents are “too probe into personal acting on sexual desires  Experiences interested” thinking processes, and to plan realistically  Has essentially conflicting feelings  May be strongly completed physically about dependence/ invested in a single, maturation independence romantic relationship  Physical features are mostly shaped and defined

Instruct Participants: Ask participants to locate the HANDOUT CHILD DEVELOPMENT GUIDE SUGGESTED BEHAVIORS FOR EFFECTIVE PARENTING. This form was created to teach parents positive methods of parenting. Scenarios of possible characteristics are followed by suggested parent-responses. When parents are unaware of the appropriate child development stage, it may create stress within the family. This contributes to the inability for the child to cope and effectively express oneself. The emotional stress on the families involved may contribute to their struggle to function in an emotionally healthy way. Thus, discussing developmental aspects will decrease negative responses from parents and encourage positive interactions. The handout below is an exact copy of the handout produced for the training audience. HANDOUT CHILD DEVELOPMENT GUIDE SUGGESTED BEHAVIORS FOR EFFECTIVE PARENTING Adopted from 2002 The Child Development Guide by SUNY Research Foundation/CDHS

CHILD CHARACTERISTIC SUGGESTED PARENT BEHAVIORS DEVELOPMENT STAGE A. A child begins to develop early control of eye A. Supply visual stimuli such as mobiles and bright movement. colors. Parent can maintain eye contact with child to ensure and develop bonding.

B. A child cries in different ways when cold, wet, or B. A parent learns to “read” the different cries; respond to hungry. crying consistently, and don’t be afraid of “spoiling” the INFANCY infant. Please remember that crying is the child’s only way to communicate and express their needs. Birth – 14months C. Do not change primary caregiver before six months. C. Child can discriminate the primary caregiver Parent needs to maintain contact to establish trust and (usually mother) from others and is more responsive to security. that person. D. Provide objects to see, hear, and grasp. Sensory D. Learns through senses (sounds of rattles, feelings of development is significant for bonding and cognitive warmth, etc.) development.

E. Say the name of objects as the child sees or uses them, E. Likes to hear objects named and begins to and begin to look at very simple picture books with the understand familiar words (“eat”, “ma-ma”, “bye-bye”, child. “doggie” A. Begins to walk, creep up and downstairs, climb on A. Provide large, safe spaces for exercising arms and furniture, etc. legs, and teach the child how to get down from furniture, stairs, etc.. Parent needs to begin to develop and set limits for behaviors.

B. Is learning to trust and needs to know that someone B. To ensure safety and trust, parent needs to respond to will provide care and meet needs. the needs of the child consistently with sensitivity.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation C. Do not be rigid and demand compliance all the time; C. May have many temper tantrums and may become do not give in to the child’s demands, but do not angry when others interfere with certain activities. discipline, as the child is expressing him/herself the only way he/she knows how. Accept the child’s reaction as TODDLER normal and healthy, and not as a threat to your authority; if necessary, modify the environment to reduce the need 15Months – 35Months to interfere in the child’s activities.

D. Uses one-word sentences (“No,” “Go,” “Down,” D. Teach the names of body parts and familiar objects; “Bye-Bye”); points to and names body parts and tell stories, read picture books, and repeat familiar familiar objects. nursery rhymes.

E. Imitates and attempts to participate in adult E. Allow the child time to explore and begin to do behaviors such as washing dishes, mopping floors, things for him/herself. This will foster cognitive and applying make-up. physical development.

A. Scribble in circles; likes to play with mud, sand, A. Provide materials and activities to develop finger paints, etc.; may begin to put together simple coordination (sand, crayons, paint, puzzles). These puzzles and construction toys. activities help the child develop cognitively and help develop motor skills.

B. Take care of toilet needs, more independently; stays B. Label all body parts without judgment, and answer dry all day (but perhaps not all night); becomes very questions about body functions interested in his/ her body and how it works. simply and honestly. This interaction will help open the door for open communication in the future.

PRE SCHOOL C. Uses imagination a lot; starts dramatic play and role C. Provide props for dramatic play (old clothes, shoes, YEARS playing; likes to play grown-up roles make-up). This is a great opportunity for you to role play (Mommy, Daddy, firefighter, spaceman, super hero, and engage in role modeling. 3 – 6 years etc.).

D. Is becoming aware of right and wrong; usually has D. Parents need to help child(ren) to be responsible and the desire to do right, but may blame others for discover the consequences of his/hers behavior(s); be personal wrongdoing(s). aware of your feelings and try to understand the child(ren)’s perspective.

E. Plays with other boys and girls; is calm, friendly, E. Provide age appropriate board games and provide and not too demanding in relations with others; is able opportunities for group play (i.e. soccer, baseball, etc.). to play with one child or a group of children (though prefers members of the same sex). A. Has marked awareness of sexual differences. May A. Answer questions about body functions want to look at bodies of opposite sex (“playing simply and honestly. This interaction will help open the doctor”, “playing house”, etc.); touches and plays with door for open communication in the future. gentials less frequently; will accept the idea that a baby grows in the womb.

B. Is generally rigid, negative, demanding, B. Set reasonable limits, provide suitable explanations for unadaptable, and slow to respond; exhibits violent them, and help the child keep within the limits. extremes, and tantrums reappearing. C. Encourage child to communicate any concerns or C. Will avoid and withdraw from adults; has strong issues. Provide support and show understanding and LATENCY emotional responses to teacher and may complain that concern.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation teacher is unfair or mean. 7 – 11 years D. Ask many thought provoking questions; stimulate D. Uses reflective, serious thinking and becomes able thinking with open-ended stories, riddles, and thinking to solve increasingly complex problems, using logical games; provide opportunities for discussions about thought processes; is eager for learning. decision making and selecting what he/she would do in particular situations.

E Direct child toward attempting what can be E. Often overestimates personal abilities; generalizes accomplished, but continue to provide challenges; Stress instances of failure (“I never get anything right!”). what child has learned in a process and not the end product.

CHILD CHARACTERISTIC SUGGESTED PARENT BEHAVIORS DEVELOPMENT STAGE A. Often is moody; dramatizes and exaggerates own A. Help youth set the rules of conduct and determine expressions (“You’re the worst mother in the world!”). personal responsibilities, and allow frequent opportunities to make personal decisions. Don’t overreact to moodiness and exaggerated expressions.

B. Maturation rates differ (with girls gradually B. A parent needs to continue to openly discuss and reaching physical and sexual maturity and boys just explain the changes in physical development. beginning to mature physically and sexually). Adolescents needs to be discouraged from comparison to older sibling or peers. Parent must also monitor development be aware of problems associated with late maturation. Also, be open to discuss and appreciate possible differences in values and needs; Communicate your own feelings about sexual relationships. Provide correct information about human sexuality, sexually transmitted disease, HIV/AIDS, birth control, intimacy, and safe types of sexual experimentation.

C. Be sensitive to adolescent’s feelings and thoughts and C. Becomes seriously concerned about the future; try to bring them out in the open; be sure to understand begins to integrate knowledge leading to decisions your own values and not project them onto your child. about future. Discuss possible opportunities and explore options.

ADOLESCENT D. Adolescents need to be encouraged to make their own AGE decisions within reason, and that their decision making D. Adolescents struggles with decision making, should be founded on healthy values and morals that 12 – 18 years exploration, and how they answer the question of who should have already been instilled. They should be they are and what they want to do with their lives. encouraged to decide who they are and what they want to do for the long term in life as part of their identity formation. Parents should be loving, supportive and ask questions that promote their adolescent to think and make good decisions. This will result in their children being independent and self-assertive and more psychologically well-adjusted. Parents who are controlling instead may result in having children who are passive, dependent, or possibly rebellious to authority and unable to make good decisions. Parents who are lax and not supportive instead may result in having children who are likely to be dependent., moody, and have low social skills, low self- control and poor work ethic as a result of having little guidance and involvement from their parents.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation E. Adolescents need the acceptance and involvement of their peers. They are developing their of sense of self and independence. Parents who are controlling and fearful of the adolescents decisions maybe creating a hostile and E. Adolescents become involved with peers and unfriendly environment for the adolescent. Parents need separates from family. to provide a supportive environment which allows adolescents to be inquisitive or exploratory.

Instruct Participants to locate the INTERVENTIONS TO ENSURE AN ACTIVE ROLE IN SUPERVISING VISITATION. (The Handout below is exactly as it appears on the copy for the audience for sections A and B. State: This HANDOUT, INTERVENTIONS TO ENSURE AN ACTIVE ROLE IN SUPERVISING VISITATION, was created for the purpose of offering both (A) general guidelines and techniques for Foster Care Workers to model for parents during visitation, and (B) Foster Care Workers’ responses to various possible scenarios during visits. Let’s review the Guidelines and Techniques, followed by the Scenarios.

HANDOUT: INTERVENTIONS TO ENSURE AN ACTIVE ROLE IN SUPERVISING VISITATION

(A) Guidelines and Techniques for Foster Care Workers to Model for Parents During Visitation

 (a) Although the Visitation Contract is reviewed and signed upon initially beginning work together, reminders of the Ground Rules for respectful, positive interactions and visits should be reviewed during the first visit and as needed over time.

 (b) Completion of the Supervised Visitation Program Observation Form during visits intermittently at times is acceptable, in order to record what is being observed. However the Foster Care Worker should be involved, engaged, interactive, and clearly a part of the visit with the foster child and Parent.

 (c) The Foster Care Worker does not facilitate the visit and does not interrupt the relationship- building that the parent is in the process of doing.

 (d) The Foster Care Worker should sit in close proximity to both the foster child and the parent, be a part of any dialogue, and physically and verbally model positive, healthy interactions and relationship-building skills toward the child for the parent.

 (e) Since it may be easy to continuously recall the negative aspects of the case or the negative history of the child, in order to remain open to helping, caring, and being an unbiased advocate, it will be helpful to empathize and be conscious of how both parent and child are feeling. It is important to recognize what they may be experiencing in life at this time to bring them to the point at which they are at today.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation  (f) Depending on the child’s age (for example, age four and older), when you are unsure of what a child wants, needs, or how they feel, just ask them. The child will not be making major decisions, but too often, human service professionals forget to ask the children themselves.

 (g) Visits should take place frequently. As was mentioned, visits can be supervised and have the presence of the uniformally active role on a frequent basis by Foster Care Workers, foster parents, or others such as a volunteer. This should help with the increase of frequency, which the research states contributes to enhancing parent-child relationships. Although the research does not give recommendations for the duration of visits, a frequency of 2 to 3 visits per week at 1 to 2 hours per week is recommended.

 (h) Visits should take place in a designated visitation center or the foster parent’s home, and should be prepared with a sufficient supply of developmentally age appropriate toys and materials. For the privacy and comfort of those involved, as well as to best facilitate this uniform intervention, visits should not be held at places such as McDonalds or other such places.

(B) Foster Care Workers’ Responses to Scenarios During Visits

Scenario Suggested Response of Foster Care Worker to Parent (1) Child may not verbally communicate any Help parent recognize how the child may be problems, however the child’s nonverbal language feeling given the nonverbals displayed. Carefully is indicating anger or frustration (ie) strong sighs, point out the observed behavior and ask how the rolling eyes child is feeling. (2) Silence with long gaps in conversation. Model initiating conversation about the basics of the child’s routine and life currently (ie) school, favorite and / or difficult subjects, sports schedules, lessons, after-school activities, friends, and feelings about their current life situation (3) Child speaks about various aspects and parent Become part of the conversation by making does not take the opportunities to have child statements and asking questions that would build elaborate further on such subjects. on what the child has been discussing, in an effort to educate parents regarding recognizing opportunities for conversation and relationship- building. This will show increase interest in the child, their topic of interest, and act to build the relationship. (4) Child seems anxious, angry, and / or agitated, Make statements such as, “You seem frustrated / passive / aggressive, as evidenced by jittery angry, etc. Is there anything that you want to talk behavior, seeming tense, possible physical distance about with your mom / dad? It may be helpful for kept from parent, and / or verbal statements. you to talk about how you feel.” If child chooses to discuss their feelings, validate their feelings and

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation warmly positively reinforce their choice to share. (5) Mom / Dad becomes inappropriately angry or Redirect mom / dad and set limits as to how the upset at the child or the child’s behavior and parent can and cannot treat the child, while also displays negative behavior to convey this. conveying to the child that not at fault.

Instruct Participants: Ask participants to locate HANDOUT, EMOTIONAL INTELLIGENCE. This handout was created to teach Foster Care Workers and Parents about the importance of Emotional Intelligence. It will be helpful in gaining awareness as to how to increase one’s own Emotional Intelligence, have better interpersonal relationships, and improve at emotions. The following portions on the handout that are in BOLD are the portions of the handout as provided for the audience. The information and reflections are in regular type.

HANDOUT

Emotional Intelligence (based on Theory by Daniel Goleman)

State: Life revolves around Relationships and Communication. Therefore, Emotional Intelligence is at the core of relationships and communication

Emotional Intelligence:  Emotional Intelligence includes a variety of personal characteristics and abilities, aside from academic intelligence, that contribute to overall success in life: (a) being able to motivate oneself and persist in the face of frustrations (b) control impulse and delay gratification (c) to regulate one’s moods and keep distress from preventing the ability to think (d) to empathize

State: Think of the expression, “When Smart Is Dumb” – How could someone of such obvious intelligence say something so irrational?  People who are poor at receiving and sending emotions are prone to problems in their relationships, since people often feel uncomfortable with them, even if they cannot articulate why this is so.  Academic Intelligence has little to do with emotional life. Just because someone maybe “book smart” does not mean that they are able to adequately manage interpersonal situations or their emotions.  Academic IQ offers little to explain the different destinies of people with roughly equal promises schooling and opportunity (Example: Harvard longitudinal study)  The brightest among us with the highest of academic IQ’s can act irrationally due to passion and unruly impulses as well as poorly pilot their private lives.  Knowing One’s Emotions – Self Awareness - recognizing a feeling as it happens – is a keystone of emotional intelligence. (a) One needs an ability to monitor feelings from moment to moment to enable psychological insight and self-understanding.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation (b) An ability to notice our true feelings leaves us at other’s mercy. (c) People with greater certainty about their lives are better navigators and higher functioning in their lives, having a surer sense about how they feel about personal decisions from whom to marry to what job to take.  The art of relationships is, in large part, skill in managing emotions in others. (a) There is an art of emotional intelligence involving social consensus about which feelings can be properly shown when: Minimizing the Show of Emotion – minimizing feelings of distress in the presence of someone in authority / whom they would not want to show emotions to. Exaggerating What One Feels by magnifying the emotional expression. Substituting One Feeling For Another where it is at times impolite to say no, and positive (but false) assurances are given instead. (b) These abilities underlie popularity, leadership, and interpersonal effectiveness. (c) People who excel at these skills do well at anything that relies on interacting smoothly with others. (d) Socially, people who are poor at receiving and sending emotions are prone to problems in their relationships, since people often feel uncomfortable with them, even if they cannot articulate why this is so. (e) Whether adults or children, various behaviors almost always lead to rejection. They include trying to take the lead too soon and being out of synch with the frame of reference (This is what unpopular children tend to do since they push their way into a group, trying to change the subject too abruptly or too soon, or offering their own opinions, or simply disagreeing with the others right away – all apparent attempts to draw attention to themselves).

State: Daniel Goleman offers Four Keys to healthy, successful, Emotional Intelligence. It can be taught, and should be taught to children today. Many school teachers have the job of teaching emotional intelligence since the family configuration has changed over the years resulting in parents who do not take the time to teach such skills to their children. The four keys to Emotional Intelligence are (refer to handout / list below): (Audience’s handout only lists the 4 underlined keys, NOT the explanation)

DANIEL GOLEMAN’S FOUR KEYS TO EMOTIONAL INTELLIGENCE:

 (1) Ability to read others’ feelings – This involves recognizing emotions in others; Empathy, another ability that builds on emotional self-awareness, is the fundamental “people skill.” (a) There are social costs of being emotionally unaware of how others are feeling. (b) People who are empathetic are more attuned to the subtle social signs that indicate what others need or want. (c) This makes them better at the caring professions such as counseling, teaching, sales and management.

 (2) Ability to soothe oneself - This involves being able to cope and calm one’s feelings appropriately. One should have self-awareness about the feelings that they possess, what they are displaying, and how they effect others. This may be motivating for them to focus on soothing themselves.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation (a) People cope in various ways (b) Those who cannot soothe oneself may act impulsively or have outbursts that they may regret later and act to damage relationships with others. (c) Such people do not demonstrate the ability to interact smoothly when they cannot remain composed during stressful situations where their coping abilities are tested.

 (3) Ability to manage one’s emotions - Handling feelings so they are appropriate is an ability that builds on self-awareness. (a) This includes ability to shake off anxiety, gloom and irritability, and the consequences of failure at this basic emotional skill. (b) People who are poor in this ability are constantly battling feelings of distress. (c) Those who excel in it can bounce back far more quickly from life’s setbacks and upsets.

 (4) Ability to delay gratification - Emotional self-control – delaying gratification and stifling impulsiveness – underlies accomplishments.  People with this skill are more highly productive and effective in whatever they undertake.  Motivating Oneself – Controlling emotions towards meeting a goal is essential for paying attention, for self-motivation, mastery, and creativity

State: TALENTS AND ABILITIES THAT ARE COMPONENTS OF INTERPERSONAL INTELLIGENCE: (The necessary ingredients for charm, social success and charisma…These people are natural leaders, can express group sentiments well and guide a group to their goals, and are emotionally nourishing where they leave people in a good mood and evoke comments like “What a pleasure to be around someone like that!”)  (1) Organizing Groups – initiating and coordinating efforts of a network of people (theater directors, producers, military officers, heads of organizations)

 (2) Negotiating Solutions - the talent of the mediator, preventing conflicts and resolving those that flare up (Diplomacy, arbitration or law, or a middle-persons or managers of takeovers)

 (3) Personal Connection – the talent of empathy and connecting. This makes it easy to enter into an encounter or to recognize and respond fittingly to people’s feelings and concerns (team players, dependable spouses, good friends or business partners, sales people, excellent teachers)

 (4) Social Analysis – being able to detect and have insights about people’s feelings, motives and concerns. This can lead to intimacy and sense of rapport. (Competent therapist or counselor or even a gifted novelist or dramatist)

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Source: Goleman, Daniel (1997). Emotional Intelligence: Why It Can Matter More Than IQ. Bantam Books: New York.

Instruct Participants to locate HANDOUT, ERIK ERIKSON: STAGES OF PSYCHOSOCIAL DEVELOPMENT. This handout was created to teach Foster Care Workers and Parents about the importance of development across the life span. It is important for people to be aware of the possible positive and negative psychosocial outcomes at each life stage. Awareness of this may assist with helping others to make personally healthy decisions, and realize the detrimental impacts to development that may occur as a result of negative interactions, such as unsupportive treatment from parents. (The following portions on the handout that are in BOLD are the portions of the handout as provided for the audience. The information and reflections are in regular type.)

HANDOUT

Erik Erikson: Stages of Psychosocial Development

ERIK ERIKSON’S THEORY OF PSYCHOSOCIAL DEVELOPMENT

State:  Psychosocial Development – encompasses changes in the understanding individuals have of themselves as members of society, and in their comprehension of the meaning of others’ behavior.  Erikson proposed an eight stage theory of psychosocial development, from infancy to old age; he considers how individuals come to understand themselves and the meaning of others’ – and their own – behavior.  State: The child’s personality is impacted and developing as a result. Personality is defined as the sum total of the enduring characteristics that differentiate one individual from another; this begins in infancy  There is a conflict that must be addressed at each stage. Each conflict stage has a positive or negative outcome that can result. However, the conflict may not be resolved at each stage and therefore is continuous growth in progress as the person moves to the next developmental stage.  When reviewing the Erikson stages, it will be helpful to keep in mind how the experience of being in foster care can impact the child at each stage. For example, the child of a parent with severe emotional disturbances or the child of a parent who is a physical abuser may be made to feel shameful, doubtful or guilty during their early years of development. The added psychological struggles of the parents increase the likelihood that parents will struggle to parent the children supportively, and therefore may result in the negative outcomes described for the child.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation  When we come to the Adulthood stages, we can think about how the earlier life foster care experiences may have impacted the developing adult. In addition, it is important to consider the possible struggles of the parents and the life stage issues that they may be experiencing that may cause them to think and act in the manner that they are.  We will now explain the eight Erikson Psychosocial Developmental stages across the life span.

(1) TRUST-VS-MISTRUST STAGE (Birth to 12 - 18 months) -  This is the time during which infants develop a sense of trust or mistrust, largely depending on how well their needs are met by their caretakers.  Erikson states that the task at the first stage is to achieve trust for the infant’s primary care giver. Due to developmental needs possibly being unmet, it may instead result in Mistrust.  Trust will result the infant’s needs are met: including love, attention, time, touch, food, shelter, and attachment to a primary care giver to meet such needs.  If such needs are not met, the infant will Mistrust its environment.

(2) AUTONOMY VS SHAME AND DOUBT STAGE (12 - 18 Months to 3 years)  Toddlers develop either independence and autonomy is they are allowed the freedom to explore or shame and doubt if they are restricted and overprotected.  Independence and autonomy may result if they are made to feel like they have freedom to explore without being overly reprimanded or harshly treated when seeking to explore.  Shame and Doubt will result if children are constantly harshly treated and reprimanded so much that they feel ashamed about wanting to explore their immediate world and doubtful of their actions and themselves if they do seek to explore.

(3) INITIATIVE VS GUILT STAGE (Ages 3 to 5 - 6)  This is the period during which children experience conflict between independence of action and the sometimes negative results of that action  Children can be initiative by asking questions and seeking to act independently. If they are not supported to do this and instead are reprimanded or harshly treated when they do such actions, they will feel guilty, which often is an inappropriate feeling as they may feel remorseful for something that does not seem to be wrong in any way.

(4) INDUSTRY VS INFERIORITY (5 – 6 years to adolescence)  This is the period characterized by a focus on efforts to attain competence in meeting the challenges presented by parents, peers, school, and the other complexities of the modern world.  If a child is successful academically and socially at school, they should feel positive about themselves and therefore feel industrious personally.  The child’s “job” is to be successful in school. Failing a grade in school or struggling severely academically, as well as being very unsuccessful socially are factors that can yield an outcome of inferiority for a child.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation (5) IDENTITY VERSUS ROLE CONFUSION (adolescence to adulthood, ages 12 – 20)  Adolescents seek to determine what is unique and distinctive about themselves.  Their task is to search for and independently choose a healthy identity for themselves.  If they are guided by harsh controlling parents, they may either become passive and not choose an identity, or arbitrarily select the identity of their parents. They also may instead become rebellious resulting from the need to break away from their parents. Children who have a weak self-esteem or self-concept as a result from a disruptive, unsupportive upbringing may not have the psychological strength and confidence to search for and make a selection of their identity.

(6) INTIMACY VS ISOLATION (early adulthood, ages 20 – 40)  The positive outcome of Intimacy comprises several aspects. o A degree of selflessness o Sacrificing one’s own needs to those of another o Joint pleasure from focusing not just on one’s own gratification but also on that of one’s partner o Deep devotion, marked by efforts to fuse one’s own gratification but also on that of the partner  Those who experience Isolation during this stage are often lonely, fearful of relationships with others, and withdraw themselves to a varied degree.  They may withdraw and be isolated on one or a few aspects, such as choosing not to have social or physical intimacy; they may withdraw completely and virtually do not leave their homes.  A poor experience at the previous Erikson stages coupled with a challenging, long foster care experience involving multiple placements may result in lack of trust for others, poor relationships with others, low self-esteem, little initiative and a wavering identity that may produce the isolated young adult described here.

(7) GENERATIVITY VS STAGNATION (Middle Adulthood, ages 40 – 60)  During this period, people consider their contributions to family, community, work and society.  Generativity is guiding and encouraging future generations, and leaving a lasting contribution to the world through creative or artistic output.  Generativity means looking beyond oneself to the contributions on one’s life through others.  Stagnation means people focus on the trivialization of their life, and they feel they have made only a limited contribution to the world, that their presence has counted for little.  If a middle aged person is not happy with where they are in their career, as well as society and their family’s life, they may feel stagnant and unhappy, and be a good candidate for a midlife crisis. Stagnation may be a likely outcome if a parent is unhappy with their family situation and feeling hopeless given that their child is in foster care for any great duration and they do not seem to be having a promising impact on changing that status.

(8) EGO INTEGRITY VS DESPAIR (Late Adulthood, ages 60 to death)

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation  This period is characterized by a process of looking back over one’s life, evaluating it, and coming to terms with it.  Integrity comes when people feel they have realized and fulfilled the possibilities that have come their way.  Despair occurs when people feel dissatisfied with their life, and experience gloom, unhappiness, depression, anger, or the feeling that they have failed.  The negative outcomes of the Erikson Psychosocial stages can continue throughout the life span unless one or more changing agents can begin to produce positive healthy outcomes. Thus the need for positive foster care experiences, successful reunifications, and emotionally healthy families working together. Feldman, R. (2003). Development Across the Life Span. (2nd Edition) Prentice Hall; NJ. HANDOUT

UNDERSTANDING THE GRIEF AND LOSS FELT BY FOSTER CHILDREN & PARENTS

 Things to Know about Children Experiencing Loss (Sr. Teresa M. McIntier, MS, RN)

(a) Children can be traumatized in the same way as adults

(b) Children and adults share similar reactions to loss but they exhibit unique responses to their pain

(c) Children can fear events they were not exposed to, such as news of a playmate’s death, neighborhood violence, etc.

(d) Grieving children require: o Considerable adult patience o Care and compassion o Reassurance o Consistent routine

(e) Children are not always capable of deciphering euphemisms, so use real terms: death, dead, dying

(f) Children only want answers to what they ask. Be sure you understand their question.

(g) Children do not want to be told how they should feel. They should be encouraged to express their feelings. Share your own feelings openly and honestly.

(h) Children are further stressed when after a significant loss they are faced with drastic changes: moving to a new neighborhood and / or school.

(i) Children want to share their favorite memories.

State: When children are placed in foster care, their primary disruption occurs in the emotional dimension. Grief will manifest itself. If it is not experienced and expressed within the

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation emotional dimension; it will be expressed in the physical, mental, and spiritual dimensions in a manner which may be harmful to the individual. Please refer to Elizabeth Kubler – Ross and the Five stages of response to Grief and Loss. The following are stages of response to grief and loss situations as proposed by Elisabeth Kubler-Ross. Although that some professions may disagree, she proposes that the response to grief takes place in this order. Regardless of this, the response to grief is important to understand, as children grieve the loss and react to the abandonment of having been suddenly separated from their parents. Such reactions will likely be observed while the child is in a foster care placement. In addition, some experts say that additional reactions to the grief and loss of having been in foster care will take place once the child is returned home. Hypothetically, a distraught and angry reaction from a child once returned home likely takes place because they are feeling safe enough in their home environment again to show their distress of the placement that they experienced over the last weeks. The reaction must be addressed by the parent. *** At this point, the child then needs (a) love, attention and nurturing from the parent, as well as (b) a sincere apology that the child left the home and experienced the Foster care placement, and (c) honest reassurances that it will not happen again. Belief and trust in the parent may largely be lost if another removal from the home does take place.

State & Discuss the following Stages of Grief & Loss with the audience: (the list of stages below is exactly as it appears on the audience’s handout.)

 Elisabeth Kubler – Ross: Identified Five stages of response to Grief and Loss

(1) Denial – resisting the whole idea of death (no I’m not dying; or, no she’s not dying)

(2) Anger – “Why me?;” “Why not her?” These people are very difficult to be around

(3) Bargaining - individuals are trying to make deals with God

(4) Depression – overwhelmed by a deep sense of loss

(5) Acceptance – individuals near death make peace and want to be left alone.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Instruct participants: Ask the participants to locate the BILL OF RIGHTS FOR GREIVING CHILDREN. This form was created as part of the education section to teach parents and foster care workers that child do experience grief and how to assist them with the healing process. The handout below is an exact copy of the handout produced for the training audience.

BILL OF RIGHTS FOR GRIEVING CHILDREN

(PLEASE REMEMBER TO STATE THE REGULAR-TYPE TEXT TO THE PARTICPANTS.)

 THE CHILD HAS THE RIGHT TO HAVE HIS/HER OWN FEELINGS.

The child may feel mad, sad, or lonely. He/she may feel scared or relieved. The child may feel numb or perhaps nothing at all.

 THE CHILD HAS THE RIGHT TO TALK ABOUT HIS/HER GRIEF WHENEVER.

The child will find someone who will listen and allow them not to talk if they don’t want to.

 THE CHILD HAS THE RIGHT TO SHOW HIS/HER FEELINGS OF GRIEF IN THEIR OWN WAY.

When they hurt sometimes they want to play so they’ll feel better. Some like to laugh, get mad and even scream. When children behave in this way they are telling us how scared they behave.

 THE CHILDREN HAVE THE RIGHT TO EXPECT HELP FROM ADULTS (@HOME, SCHOOL, CHURCH, ETC.).

They really need someone to pay attention to them; what they are feeling and saying, and to know they will be loved no matter how they behave.

They will have their grumpy days and have difficulty getting along. Please recognize that children may not be able to express their concerns verbally; therefore, the parent or foster care worker need to ask probing questions and be supportive and patient.

 THE CHILD HAS THE RIGHT TO HAVE “GRIEFBURSTS”.

The child may exhibit sudden, unexpected feelings of sadness at anytime even late in the grief process. They can be strong, scary feelings and the child may be more clinging than usual.

 THE CHILD HAS THE RIGHT TO USE HIS/HER BELIEF SYSTEM TO DEAL WITH GRIEF.

Praying may make the child feel closer to their family. The child should never be forced to pray.

 THE CHILD HAS THE RIGHT TO QUESTION THE CAUSE OF PLACEMENT.

Questions regarding “Why do I have to be here?”, “What did I do to deserve this?”, and “When am I going home?”. These are very hard questions to answer. However, if you are honest and open with the child, then the child will not become frustrated and anxious. Even if the answers to these questions are “I don’t know.”.

 THE CHILD HAS THE RIGHT TO TALK ABOUT THEIR MEMORIES OF THEIR FAMILIES.

Memories help the child to keep alive the love he/she has for their families.

 THE CHILD HAS THE RIGHT TO EXPERIENCE HIS/HER GRIEF EVEN WHEN OTHERS THINK THEY SHOULD “BE OVER IT”.

At every developmental phase, the child will be re-grieve the loss of their family. He/she may not grieve as acutely as when the actually separation occurred.

Adapted from Sister Teresa M. McIntier, MS,RN handout in the the American Academy of Bereavement 2002 Manual.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation State:  The grieving child often goes unnoticed because children do not have the verbal skills to express themselves.

 There are many factors which inhibit a child’s grief. These factors are : . Adults denying the child’s feelings and expression. . The child may feel lack of security. . The child may feel that the environment is not caring. . The child may be confused about the situation. . The child may have inability to articulate feelings and memories. . The child may feel disconnected from family. . The child may have had prior experience with loss.  Additionally, there are many common responses to grief and loss demonstrated by children. These are: . The child is confused about the changes. . The child may withdraw from groups. . The child may appear anxious. . The child may appear angry. . The child may be frighten. . The child may have guilt. . The child may be worried. . The child may have impulsive behaviors. . The child may behave touch as though nothing happen. (This may be a warning sign for possible signs of depression and suicide. Please review the list below.)  Once a child experiences the loss of their family, there are many therapeutic interventions that can be used such as: . Minimizing further separation from significant others . Encourage the expression of feelings . Be consistent in caregiving . Provide the opportunities for the child to ask questions

 If a child is not given the opportunity to process their concerns, fears, and issues, then a child may be at risk for Depression and Suicide.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Instruct participants to locate the DANGER SIGNALS FOR DEPRESSION. Review and discuss the handout. The handout below is an exact copy of the handout produced for the training audience.

DANGER SIGNALS FOR DEPRESSION

 A general and lasting feeling of hopelessness and despair.  Inability to concentrate, making reading, writing and conversation difficult.  Changes in physical activities, such as eating, sleeping and sex. Frequent physical complaints with no evidence of physical illness.  Loss of self-esteem, which brings on continuous questioning of personal worth.  Withdrawal from others due to intense fear of rejection.  Threats or attempts to commit suicide.  Hypersensitivity to words and actions of others and general irritability.  Misdirected anger and difficulty in handling most feelings.  Feelings of guilt in many situations.  Extreme dependency on others.  Loss of interest in activities that were once enjoyed.  Avoiding friends and family.

WARNING SIGNS OF POTENTIAL SUICIDE

 Withdrawal from contact with others.  Sudden swings in mood.  Recent occurrence of a life crisis or emotional shock.  Personality change.  Gift-giving of cherished belongings.  Depression and helplessness.  Aggression and/or risk-taking.  Direct threats to commit suicide. DETERING SUICIDE

 Get professional help to intervene with the situation. Take charge of finding help, without concern about invading the person’s privacy. Do not try to handle the problem alone.  Talk to the person, listen without judging, and give the person an understanding forum in which to try to talk things through  Talk specifically about suicidal thoughts, such as learning about whether or not the person has a plan, do they have the resources to carry out the plan, and do they have a history of impulsivity.  Evaluate the situation, trying to distinguish between general upset and more serious danger, as when suicide plans have been made. If the crisis is acute, do not leave the person alone.  Be supportive, let the person know you care, and try to break down his or her feelings of isolation.  Make the environment safe, removing from the premises (not just hiding) weapons such as guns, razors, scissors medication, and other potentially dangerous household items.  Do not keep suicide talk or threats a secret; these are calls for help and warrant immediate action.  Do not challenge, dare, or use verbal shock treatment, they can have tragic effects.  Make a contract with the person, getting a promise and commitment, preferably in writing, not to make any suicidal attempt until you have talked further.  Beware of elevated moods and seemingly quick recoveries; sometimes they are illusory, and may reflect some relief of their feeling of wanting to commit suicide and the temporary release of talking to someone, though the underlying problems have not yet been resolved.  Hotlines for immediate help with suicide problems: National Hotline (800) 448-3000, or locally Crisis Services (716) 834-3131.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation State: The following handout regarding BURNOUT and STRESS MANAGEMENT is additional information that foster care workers should review on their own time. These handouts acknowledge the fact that foster care workers are overworked and stressed regularly in their roles. Thus, it is important to remind foster care workers that taking care of themselves is beneficial for their mind, body, and spirit and it allows them to be more efficient and positive in their professional and personal lives.

(These handouts are also located in the Appendix.)

BURNOUT  Some people experience BURNOUT, which occurs when highly trained professionals experience dissatisfaction, disillusionment, frustration and weariness from their jobs.  Defined in regards to the medical field, BURNOUT is a negative psychological state characterized by physical and emotional exhaustion, an increased cynicism about and dehumanization of patients, a decreased concern and respect for patients, a loss of positive feeling for others, and a tendency to blame others for distress.  Common results of burnout include quitting the job that has brought burnout, abusing drugs and alcohol, and an increase in mental illness as well as marital and interpersonal discord.  Burnout occurs among individuals whose job it is to care for other people, particularly when the demands are seen as excessive – (i.e.) human service workers and medical professionals.  Medical professionals who care for vary ill or dying children and psychotic patients have been found to be particularly prone to burnout, as have those with excessive patient loads and the inability to have much input into their practice  Individuals with burnout focus on the problems they encounter rather than the positive rewarding aspects of their jobs.  *** The chances of developing burnout increase drastically in setting where the probability of successful intervention is low, and in idealistic, competent workers who realize after much time and effort that they cannot make a difference.  For many workers, unemployment is a harsh reality of life and the implications are more psychological than economic.  Middle-aged adults tend to stay unemployed longer than do young workers.  Employers may discriminate because of age.  Research shows that older workers have less absenteeism, hold their jobs longer, are more reliable, and are more willing to learn new skills.  Some workers, particularly middle-aged adults, change their jobs voluntarily.  Their old job gave little satisfaction; they achieved mastery of the old job’s challenges; they no longer enjoy what they do; many women return to the job market after having children.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation PREVENTING BURNOUT (personally and with regards to work): Providing professionals with encouragement and the opportunity for emotional expression is important both through individual counseling & support groups to reduce stress, understand their emotions and arrive at the best course of action to follow. Set realistic goals as to what you’d like to accomplish at a particular job / position, so as not to strive for the impossible and wear yourself out in the process. Ensure you have positives to balance the negatives in life, or you will feel little to no personal satisfaction in life, and question what you’re working for. You may be depressed due to such a lack of satisfaction. Meet your needs too; ensure adequate physical activity & do relaxation exercises. When personal and work aspects irritate you, take time-outs and calm yourself down to put things in perspective and not let the negative aspects of the experience get the best of you, wear you down, or make you resentful of your job or others. Evaluate and Re-evaluate – if you are burning out and not enjoying your job and career, question if this is what you wanted and set out for in the first place. Consider how to add happiness, meaning, and positives to your life and work. It may result in changing jobs / careers to ensure that you are doing what you want to be doing in life. One spends a significant majority of their time at work; how and where do you want to be spending such time?

Instruct Participants to locate the Self rating Scale: Monitoring of Stress Levels. This can be used by Foster Care Workers as well as Parents to monitor their stress levels and recognize signs of danger earlier on as indicators needing to be addressed. Review this scale now; the handout below is an exact copy of the handout provided to the audience.

Self-Rating Scale : Monitoring of Stress Levels

 Select the value that indicates your stress level ranging from “1” least stressed, to “10” most stressed. Record number value in your journal book.

1. No stress – Largely relaxed, no tension, slow pace of routine, clear-headed.

2. Very infrequent stress or tension; a seemingly healthy stress level.

3. Slight stress and tension – tightened muscles & slight anxiety occasionally.

4. Constant anxiety, tension, worry and / or stress experienced only mildly to moderately.

5. Moderate stress, tension and anxiety experienced in a steady manner.

6. Increasing stress, tension and anxiety to level at which thought processes and functioning becomes mild-to-moderately disrupted.

7. Moderate to high stress level where one has difficulty concentrating, appears clumsy and forgetful at times, makes errors in work, functioning becoming inhibited to where basic aspects of routine are compromised or not completed.

8. Approaching high level of stress to where one experiences frequent tension in muscles, anxiety, difficulty concentrating, worry about completing tasks and responsibilities, increasing forgetfulness and clumsiness, and ability to complete all aspects in routine are frequently inhibited, or there is such worry about doing this that one experiences extreme tension and anxiety.

9. Moderately high level of stress where one experiences constant tension, worry, anxiety, makes errors in work, tearful at times, forgets / noticing frequent lapses in memory for basics to be accomplished, large struggle to accomplish the basics ( hygiene slipping, increased struggle in taking care of kids / parents, meals compromised), and one experiences such a high level of stress that they cancel / avoid tasks or responsibilities, and dread their routine immensely.

10. Highest level of stress where one experiences such tension, anxiety and worry that they cannot relax physically or mentally after many attempts, they are frequently tearful / crying, they have become depressed due to their stress-causing agents / lifestyle, they dread the events in their routine to the point to where they experience extreme anxiety and worry about their routine, their functioning at basics in their routine in greatly inhibited and may be finally halted.

State:  The interactions between parent and child must be assessed to confirm, or if necessary, evaluate for a different plan should reunification not be possible. The Maternal Behavior Rating Scale is an instrument that has been adapted for use in this curriculum. It has the purpose of increasing uniformity among foster care workers in assessing the impact of the training and visitation intervention process on parent-child interaction. As you will see as the instrument is reviewed, it assesses parent-child interaction across several realms.  The creator, Gerald Mahoney, a Professor at Case Western Reserve University, Cleveland, Ohio, stated that this assessment is satisfactory for both mothers and fathers despite the name of the instrument. He recommends its use in a formalized study where baseline data is accessible. He also recommends that parents be videotaped and that the tapes are viewed and rated by people other than the Foster Care Workers. However due to the realistic limits of this training process and employment setting involving the time constraints of the foster care workers and accessibility of the parents and foster children, the foster care workers will be utilizing the instrument merely as a uniform guideline for evaluation. Because it will be used in this manner, it may likely lose some validity given the bias that may enter the situation. However, the uniformity of the instrument being utilized among foster care workers may increase the reliability of rating parent-child interactions, as it is believed that there is no current uniform measurement instrument being used at this time to evaluate and support discharge recommendations. The use of this instrument as a more uniform guideline is meant to be helpful in considering the various realms on which to make decisions, however, is not a guarantee of readiness for certain placements or that one will behave in a certain manner. No claims or guarantees are made of the instrument’s functions or abilities.  If used as designed, a minimum score of “three” on each scale is viewed to be acceptable and desirable. Foster Care Workers must use caution to ensure that they are answering as objectively as possible and conscious of any biases that they may have for their clients. They should seek consultation from a supervisor if they realize that they cannot complete the assessment in an objective manner.  The Foster Care Workers are to complete this adapted Maternal Behavior Rating Scale at the completion of a SIX MONTH period. That is viewed to be sufficient time for the parents to have received their training, and for Foster Care workers, and others who are exposed to and supervising the visitation, to model and educate the parents during visitation sessions. At the end of the six month period, Foster Care workers can continue to work with the foster children and parents on linkage plans itemized in the REUNIFICATION PLANNING CHECKLIST (following in this section) to ensure that all necessary linkages have been made. If the plan for reunification will not be taking place due to a failed comprehensive assessment of the parent(s) by the Foster Care Worker, then other plans will be considered instead of reunification.  In addition to the linkages and tasks addressed on the Reunification Planning Checklist, steps should be made to ensure that both the foster child and parent are involved in individual and family therapy, and attending regularly.  Please follow along as this adapted uniform guideline instrument is reviewed:

RESPONSIVE/CHILD ORIENTED

SENSITIVITY TO CHILD’S INTEREST

This item examines the extent to which the parent seems aware of and understands the child’s activity or play interests. This item is assessed by the parent’s engaging in the child’s choice of activity or play interests. This item is assessed by the parent’s engaging in the child’s choice of activity, parent’s verbal comments in reference to child’s interest and parent’s visual monitoring of child’s behaviors or activity. Parents may be sensitive, but not responsive – such as in situations where they describe the child’s interests, but do not follow or support them.

Rating of (1): Highly insensitive. Parent appears to ignore child’s show of interest. Parent rarely comments on or watches child’s behavior and does not engage in child’s choice of actively.

Rating of (2): Low sensitivity. Parent occasionally shows interest in the child’s behavior of activity. Parent may suddenly notice where child is looking or what child is touching, but does not continue to monitor child’s behavior or engage in activity.

Rating of (3): Moderate sensitivity. Parent seems to be aware of the child’s interests; consistently monitors the child’s behavior, But ignores more subtle and hare-to-detect communications from the child.

Rating of (4): High sensitivity. Parent seems to be aware of the child’s interests; consistently monitors the child’s behavior and follows interest indicated by subtle and hard to detect communications from the child.

Rating of (5): Very high sensitivity. Parent seems to be aware of the child’s interests; consistently monitors the child’s behavior and follows interest indicated by subtle and hard to detect communications from the child.

RESPONSIVITY

This item rates the appropriateness of the parent’s responses to the child’s behaviors such as facial expression, vocalizations, gestures, signs of discomfort, body language, demands, intentions.

Rating of (1): Highly unresponsive. There is a chronic failure to react to the child’s behaviors such as facial expression, vocalizations, gestures, signs of discomfort, body language, demands, intentions.

Rating of (2): Unresponsive. Parent’s responses are inconsistent and may be inappropriate or slow.

Rating of (3): Consistently responsive. Parent responds consistently to the child’s behavior, but may at times be slow or inappropriate.

Rating of (4): Responsive. Parent responds to the child’s behavior appropriately and promptly throughout the interaction.

Rating of (5): Highly responsive. This parent responds promptly and appropriately to even subtle and hard to detect behavior of the child.

EFFECTIVENESS (RECIPROCITY)

This item refers to the parent’s ability to engage the child in the play interaction. It determines the extent to which the parent is able to gain the child’s attention, cooperation and participation in a reciprocal exchange characterized by balanced turntaking in play or conversation.

Rating of (1): Very ineffective. Parent is very ineffective in keeping the child engaged in the interaction. The parent makes attempts to elicit the child’s cooperation, but almost invariably fails. Most of the attempts are characterized by poor timing, lack of clarity or firmness, and/or

appear to be half-hearted. Parent may give the appearance of helplessness where the child is concerned.

Rating of (2): Ineffective. Parent mostly ineffective in keeping the child engaged in the interaction. In a few instances only, the parent is able to gain the child’s cooperation, but is most often unsuccessful.

Rating of (3): Moderately effective. Parent is successful in keeping the child engaged in the interaction, but there is not r reciprocal exchange of turns.

Rating of (4): Highly effective. Parent keeps the child engaged throughout most of the interaction and often there is a Reciprocal exchange of turns in play or conversation.

Rating of (5): Extremely effective. Parent is able to keep the child engaged willingly throughout the entire interaction. Additionally, the interaction will be characterized by balanced turntaking in play or Conversation.

AFFECT/ANIMATION

ACCEPTANCE

This item assesses the extent to which the parent approves of the child and the child’s Behavior. Acceptance is measured the intensity of positive affect expressed toward the child and the frequency of approval expressed either verbally or nonverbally.

Rating of (1): Rejecting. This parent rarely shows positive emotion. Parent is continually disapproving of the child and child’s behavior.

Rating of (2): Low acceptance. This parent shows little positive affect toward the child. Parent may show some disapproval of the child and the child’s behavior, but mostly remains neutral.

Rating of (3): Accepting. This parent indicates general acceptance of the child; parent approves of the child and child’s behavior in situations where approval would normally be appropriate. Moderate intensity of positive affect is displayed throughout the interaction.

Rating of (4): Very accepting. Emphasis is on approval; this parent shows higher than average positive affect and is generous with approval.

Rating of (5): High acceptance. This parent is effusive with approval and admiration of the child. Parent approves and Praises even ordinary behavior; intense positive affect is displayed throughout the interaction.

ENJOYMENT

This item assesses the parent’s enjoyment of interacting with the child. Enjoyment is experienced and expressed in response to the child himself – this spontaneous expression reactions, or his behavior when interacting with his parent. There is enjoyment in child’s being himself rather than the activity the child is pursuing.

Rating of (1): Enjoyment in absent. Parent may appear rejecting of the child as a person..

Rating of (2): Enjoyment is seldom manifested. Parent may be characterized by a certain woodenness. Parent does not seem to enjoy the child per se.

Rating of (3): Pervasive enjoyment but low-intensity. Occasionally manifests delight in child being himself.

Rating of (4): Enjoyment is the highlighted of the interaction. Enjoyment occurs in the context of a warm relaxed atmosphere. Parent manifests delight fairly frequently.

Rating of (5): High enjoyment. Parent is noted for the buoyancy and display of joy, pleasure, delighted surprise at the child’s unexpected mastery.

EXPRESSIVENESS

This item measures the tendency of the caregiver to express and react emotionally to toward the child. It assesses the voice quality to express a range of emotions toward the child. Both intensity, animation and frequency are considered in these ratings.

Rating of (1):Highly inexpressive. Caregiver may inhibit body language appearing rigid; almost motionless. Caregiver exhibits flat affect; voice quality is dull and facial expression varies little.

Rating of (2): Low overt expressiveness. Parent appears bland, but does exhibit some affective quality in body language, voice quality and facial expression. May not respond to situations that would normally elicit an emotional reaction.

Rating of (3): Moderate overt expressiveness. Parent responds to situations that would normally elicit an emotional reaction.

Rating of (4): Overtly expressive. Parent uses body language, voice quality and facial expression in an animated manner to express emotion toward the child. Parent is generally enthusiastic, but not extreme in expressiveness.

Rating of (5): Highly expressive. Parent is extreme in expression of all emotions using body language, facial expression and voice quality. Appears very animated, these parents are “gushers”.

INVENTIVENESS

This item assesses the range of stimulation parents provide their child; the number of different approaches and types of interactions and the ability to find different things to interest the child, different ways of using toys, combining the toys and inventing games with or without toys. Inventiveness is both directed toward and effective in maintaining the child’s involvement in the situation. Inventiveness does not refer merely to a number of different, random behaviors, but rather to a variety of behaviors which are grouped together and directed towards the child.

Rating of (1): Very small repertoire. Parent is unable to do almost anything with the child, parent seems at a loss for ideas stumbles around, is unsure of what to do. Parent’s actions are simple, stereotyped and repetitive.

Rating of (2): Small repertoire. Parent does find a few ways to engaged the child in the course of the situation, but these are of limited number and tend to be repeated frequently, possibly with long periods of inactivity. Parent uses the toys in some of the standard ways, but does not seem to use other possibilities with toys or free play.

Rating of (3): Medium repertoire. Parent performs the normal playing behaviors of parenthood, show ability to use the standard means of playing with toys, and the usual means of free play. Parent shows some innovativeness in play and use of toys.

Rating of (4): Large repertoire. Parent shows ability to use all the usual playing behaviors of parenthood, but in addition is able to find uses which are especially appropriate to the situation and the child’s momentary needs.

Rating of (5): Very large repertoire. Parent consistently finds new ways to use toys and/or actions to play with the child. Parent shows both standard uses of toys as well as many usual, but appropriate uses, and is continually able to change his/her behavior in response to the child’s needs and state.

WARMTH

This item rates the demonstration of warmth to a child which is positive attitude revealed to the child through pats, lap-holding, caresses, kisses, hugs, tone of voice, and verbal endearments. Both the overt behavior of the parent and the quality of fondness conveyed are included in this rating. It examines positive affective expression; the frequency and quality of expression of positive feelings by the parent and the parent’s show of affection.

Rating of (1):Very low. Positive affect is lacking. Parent appears cold and reserved, rarely expresses affection through touch, voice.

Rating of (2): Low. Parent occasionally expresses warmth through brief touches and vocal tone suggests low intensity of positively affect.

Rating of (3): Moderate. Pervasive low-intensity positive affect is demonstrated throughout the interaction. Fondness is conveyed through touch and vocal tones.

Rating of (4): High. Affection is expressed frequently through touch and vocal tone. Parent may verbalize terms of endearment.

Rating of (5):Very high. Parent openly expresses love for the child continually and effusively through touch, vocal tone and verbal endearments.

ENJOYMENT

ACHIEVEMENT ORIENTATION

ACHIEVEMENT

This item is concerned with the parent’s encouragement of sensorimotor and cognitive achievement. This item assesses the amount of stimulation by the parent, which is overtly oriented toward promoting the child’s developmental progress. This item assesses the extent to which the parent fosters sensorimotor and cognitive development whether through play, instruction, training, or sensory stimulation and includes the energy which the parent exerts in striving to encourage the child’s development.

Rating of (1): Very little encouragement. Parent makes not attempt or effort to get child to learn.

Rating of (2): Little encouragement. Parent makes a few mild attempts at fostering sensorimotor development in the child, but the interaction is more oriented to play for the sake of playing rather than teaching.

Rating of (3): Moderately encouragement. Parent continually encourages sensorimotor development of the child either through play or training, but does not pressure the child to achieve.

Rating of (4): Considerable encouragement. Parent exerts some pressure on the child toward sensorimotor achievement, whether as unilateral pressure or in a pleasurable interaction way and whether wittingly or unwittingly.

Rating of (5): Very high encouragement. Parent exerts much pressure on the child to achieve. Parent constantly stimulates him toward sensorimotor development, whether through play or obvious training. It is obvious to the observer that it is very important to the parent that the child achieve certain skills.

PRAISE (VERBAL)

This scale assesses how much verbal praise is given to the child. Examples of verbal praise are “good boy”, thatsa girl, “good job.” Praise in the form of smiles, claps or other expressions of approval are not included unless accompanied by a verbal praise. Praise may be given for compliance, achievement or for the child being himself.

Rating of (1): Very low praise . Verbal praise is not used by the parents in the interaction even in situations which would normally elicit praise from the parent.

Rating of (2): Low praise. Parent uses verbal praise infrequently throughout the interaction.

Rating of (3): Moderate praise. Parent uses an average amount of verbal praise during the interaction. Parent praises in most situations which would normally elicit praise.

Rating of (4): Praise frequently. Parent verbally praises the child frequently for behavior which would not normally elicit praise.

Rating of (5): Very high praise. Very high frequency of verbal praise from the parent even for behavior which would not normally elicit praise.

DIRECTIVENESS

This item measures the frequency and intensity in which the parent requests, commands, hints or attempts in other manners to direct the child’s immediate behavior.

Rating of (1): Very low directive. Parent allows child to initiate or continue activities of his own choosing without interfering. Parent consistently avoids volunteering suggestions and tends to withhold them when they are requested or when they are the obvious reaction to the immediate situation. Parent ‘s attitude may be “do it your own way”.

Rating of (2): Low directive. Parent occasionally makes suggestions. This parent rarely tells the child what to do. He/she may respond with advice and criticism when help is requested, but in general refrains from initiating such interaction. On the whole, this parent is cooperative and non-interfering.

Rating of (3): Moderately directive. The parent’s tendency to make suggestions and direct the child is about equal to the tendency to allow the child self-direction. The parent may try to influence the child’s choice of activity, but allow him independence in the execution of his play, or he may let the child make his own choice, but be ready with suggestions for effective implementation.

Rating of (4): Very directive. Parent occasionally withholds suggestions not more often indicates what to do next or how to do it. Parent produces a steady stream of suggestive remarks and may initiate a new activity when there has been no previous sign of inertia and/or resistance shown by the child.

Rating of (5): Extremely directive. Parent continually attempts to direct the minute details of the child’s “free” play. This parent is conspicuous for the extreme frequency of interruption of the child’s activity-in-progress, so that the parent seems “at” the child most of the time – instructing, training, eliciting, directive controlling.

This item examines the parent’s rate of behavior. The parent’s pace is assessed apart from the child’s; it is not rated by assessing the extent to which it matches the child’s pace, but as it appears separately from the child.

Rating of (1):Very slow. This parent is almost inactive. Pace is very slow with long periods of inactivity.

Rating of (2): Slow. This parent’s tempo is slower than average and there may be some periods of inactivity.

Rating of (3): Average pace. This parent is neither strikingly slow nor fast. Tempo appears average compared to other parents.

Rating of (4): Fast. The parent’s pace is faster than average.

Rating of (5): Very Fast. Parent’s rapid fire behavior does not allow the child time to react.

MATERNAL BEHAVIOR RATING SCALE (MBRS) SCORING SHEET MBRS OBSERVATION 1 OBSERVATION 2 OBSERVATION OBSERVATION 3 4 ITEMS Date ______Date ______Date ______Date ______RESPONSIVE CHILD ORIENTED SENSITIVITY RESPONSIVITY EFFECTIVENESS SCALE SCORE (SEN +RES+EFF)/3 AFFECT ANIMATION ACCEPTANCE ENJOYMENT EXPRESSIVENESS INVENTIVENESS WARMTH SCALE SCORE (ACC+ENJ+EXP +INV +WAR)/5 ACHIEVEMENT ORIENTATION ACHIEVEMENT PRAISE SCALE SCORE (ACH+PRA)/2 DIRECTIVE DIRECTIVENESS PACE SCALE SCORE (DIR+PAC)/2

COMMENTS:

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation HANDOUT Instruct Participants to locate the HANDOUT REUNIFICATION PLANNING CHECKLIST. This form is a comprehensive checklist to ensure that steps are taken to prepare the child and parent for necessary plans and linkages as they get ready to be discharged home. This should be completed in the 2 months prior to discharge.

REUNIFICATION PLANNING CHECKLIST

Case Name: DOB:

RESIDENCE Has the Therapist/Case Worker assess the home/visiting location prior to the scheduled visit? YES NO N/A

Have the safety factors within the home been reviewed? YES NO N/A

Does the home/visiting location have a working stove? YES NO N/A

Please comment on any area of concerns.

FINANCES Has the paperwork been filed for special projects? YES NO N/A

Does the child(ren) receive SSI? YES NO N/A

Does the child(ren) receive SSD? YES NO N/A

Does the child(ren) receive survivors benefits? YES NO N/A

Does the parent(s) receive SSI? YES NO N/A

Does the parent(s) receive SSD? YES NO N/A

REUNIFICATION PLANNING CHECKLIST P. 2

FINANCES (Continued) Has the family been linked to food pantries (if needed) YES NO N/A

Does the family have financial resources for utilities? YES NO N/A

Does the family receive a Public Assistance grant? YES NO N/A

Does the child have an inheritance? YES NO N/A

Does the family have financial resources for counseling? YES NO N/A

Are there financial resources for extra curriculum activities? YES NO N/A

Can the family afford medical insurance? YES NO N/A

Are the parent(s) employed? YES NO N/A

Are the parent(s) in need of vocational training? YES NO N/A

MEDICAL Does the family have medical insurance? YES NO N/A

Has the family filed for medical insurance? YES NO N/A

Has the family filed for Medicaid? YES NO N/A

Has the family filed for Medicare? YES NO N/A

Does the child(ren) have Medicaid? YES NO N/A

Does the family need to be linked to support groups? YES NO N/A

Does any family member have any physical disabilities? YES NO N/A

Does the child(ren) have any physical disabilities? YES NO N/A

Does any family member have a mental health disability? YES NO N/A

LEGAL Is the child(ren) a ward of the state? YES NO N/A

Has the county worker been notified of discharge plan? YES NO N/A

Does the child have a law guardian? YES NO N/A

Has the law guardian been notified of the discharge plan? YES NO N/A

Is there CPS involvement? YES NO N/A

Has the CPS worker been notified of the discharge plan? YES NO N/A

Has custody for the child(ren) been determined? YES NO N/A

Are parent(s) undergoing a divorce? YES NO N/A

Are the parental rights being terminated? YES NO N/A

Is the child(ren) a candidate for adoption? YES NO N/A

Is the child(ren) 18years old or older? YES NO N/A

Is the child(ren) involved in criminal court? YES NO N/A

Are the parents involved with criminal court? YES NO N/A

If the child is 18 years old, has he applied for selective services? YES NO N/A

Has your court diversion programs been contacted? YES NO N/A

Does the family need legal representation? YES NO N/A

Has the Bar Association been contacted for legal advice? YES NO N/A

Does the family need to be linked to Crime Victim Programs? YES NO N/A

Does the family need to be linked to Child Advocacy Program? YES NO N/A

SCHOOL Is the child(ren) in regular education? YES NO N/A

Has an academic credit evaluation occurred? YES NO N/A

SCHOOL (Continued) Does this child(ren) have a 504 plan? YES NO N/A

Does the child need to be assessed for Special Education services? YES NO N/A

Does the family have a parent advocate for CSE? YES NO N/A

Has the child(ren) been classified by the CSE Committee? YES NO N/A

Has the CSE classified the child(ren) as learning disabled?? YES NO N/A

Has the CSE classified the child(ren) as emotionally disabled? YES NO N/A

Has the CSE classified the child(ren) as other health impaired? YES NO N/A

Is the child(ren) in the appropriate classroom setting? YES NO N/A

Has an emergency amendment been filed to the CSE regarding discharge? YES NO N/A

Has the school district been contacted about the discharge? YES NO N/A

Has a safety plan been created for school? YES NO N/A

Has a crisis plan been created for school? YES NO N/A

Does the child(ren) need academic tutoring? YES NO N/A

Does the child(ren) need special services such as Speech Therapy or Occupational Therapy? YES NO N/A

Does the child(ren) need any after school programs? YES NO N/A

Has the child explored his/hers vocational interests? YES NO N/A

CHILD COUNSELING Have all the presenting problems been addressed? YES NO N/A

Has the child been linked to individual counseling? YES NO N/A

In the home setting, does the child have a safety plan? YES NO N/A

In the home setting, does the child have a crisis plan? YES NO N/A

CHILD COUNSELING (Continued) Does the child(ren) participate in individual counseling? YES NO N/A

Has the child(ren) participated in creating the treatment plan? YES NO N/A

Has the child(ren) participated in family counseling? YES NO N/A

Does the child(ren) have homevisits? YES NO N/A

Does the child(ren) participate in visits with family? YES NO N/A

Does the child(ren) return early from homevisits? YES NO N/A

Does the child(ren) have conflicts with parents on homevisits? YES NO N/A

Does the child(ren) have conflicts with siblings on homevisits? YES NO N/A

Did the child(ren) participate in creating the reunification plan? YES NO N/A

FAMILY Do the parent(s) have mental health issues? YES NO N/A

Do the parent(s) need to be linked to mental health services? YES NO N/A

Do the parent(s) need to be referred to the Adult SPOA? YES NO N/A

Has the family been linked to support groups? YES NO N/A

Does the family need In-Home Respite? YES NO N/A

Does the family need Crisis Respite? YES NO N/A

Does the family positively interact during visitation? YES NO N/A

Does the family engage in activities (i.e. game night, movie night, and eic.)? YES NO N/A

Does the family utilize community resources such as YMCA or Boys and Girls Clubs? YES NO N/A

Does the family have a support network? YES NO N/A Please comment on any area of concerns.

SUPERVISIOR SIGNATURE DATE

FOLLOW-UP:

State:

 There is no extensive, formal training structure itemized here as part of a follow-up plan. However, it is highly recommended that Foster Care Workers do a minimum of monthly (in frequency) telephone or in-person contacts with the foster child and parent(s).

 Follow-up will ensure that the items decided upon and detailed from the Reunification Planning Checklist are taking place, such as attending and participating in the Individual and Family Psychotherapy, or that a Pediatrician remains linked.

 Follow-up will also reflect a presence on the case for the family that they still remain supported and are not left to struggle on their own during the initial vulnerable time of the first six months.

 Follow-up will help identify signs and symptoms that may indicate high stress and a possible return to the same methods of functioning that yielded placement in foster care initially.

 In essence, follow-up must occur, and the presence of it is qualitatively different from current practices. Thus it is hoped that it will make a difference, preserving the continuity of care for the child and family.

 Research says that foster children once reunified are likely to regress back to negative acting out behaviors within the first six months of reunification at home.

 Therefore, follow-up must occur consistently over the first six months at minimum.

 Follow-up should include contacts with the foster child and parent separately as well as together.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Instruct Participants to locate the HANDOUT SCENARIOS AND SOLUTIONS FOR ADJUSTMENT DURING FOLLOW-UP. In preparation for Follow-Up, several scenarios are provided which may commonly occur during the first several weeks after the child is reunified. A few of them have been adapted from the scenarios for Foster Care Workers during Visitation Sessions with Parents. This Handout is an exact copy of the handout that the training audience will be receiving. Review the Scenario table at this time.

HANDOUT SCENARIOS AND SOLUTIONS FOR ADJUSTMENT DURING FOLLOW-UP

Scenarios Suggested responses from Parent (1) The child is wound up, such as hyperactive, loud, Aside from a truly hyperactive child such as with an and silly beyond basic control. How do you diminish ADHD diagnosis where there would be a different, this behavior? specific treatment regimen, such “wound up” behavior may possibly indicate anxiety in a child. Parents can gently point out the behavior and ask children how they are feeling that they would think that they need to act silly. Parents can talk to the children of various ages about what kinds of behaviors or words they would see or hear that would indicate that they were sad, mad or scared. Lastly, dialogue can take place to understand what they are struggling with that is making them anxious, sad, fearful, etc. Listen, be supportive, validate their feelings. Do not get angry or chide them for the feelings that they have. (2) A child (of any age) seems cranky, irritable, is Infants may be over-tired or want their basic needs met having a tantrum. including nurturing and attention. The same may apply for children who are Toddler age through adolescence.

With Toddlers, Do not be rigid and demand compliance all the time; do not give in to the child’s demands, but do not discipline, as the child is expressing him/herself the only way he/she knows how. Accept the child’s reaction as normal and healthy, and not as a threat to your authority; if necessary, modify the environment to reduce the need to interfere in the child’s activities.

Regarding temper tantrums during Preschool through Adolescence, recognize that they have adopted an irrational manner of coping, and that temper tantrums should not be rewarded. Help them to realize that aspect, as well as that positive behavior gets rewarded, and that the way that they obtain what they want is

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation through healthy, calm behavior and communication. Aside from this, temper tantrums can also be indicators of their feelings that they are not happy with their worlds currently, and the behavior can be a trigger, once calm, to the discussion of how they are feeling and the inner truth about what they really personally need. (3) Parents do not follow through with a promise. Children who are cognitively able to recognize that their parent did not follow through with a promise may display anger, sadness and frustration. Over time, the child’s trust for the parent will be diminished or lost, and this may generalize to others as well. Parents should own responsibility for their behavior, talk about how they may have made their child feel, and talk about the importance of keeping promises and ways that the parent can try to continue to keep promises in the future. (4) A child is unexpectedly sick at school. Who will Despite that such plans (such as who the Pediatrician transport the child and to where? is) may be indicated on the Reunification Checklist, specific plans as to what to do in instances such as this need to be discussed should such unexpected situations arise. Who are the people on the family’s support list that can be called upon to help at this time? Schools and School-age children should have lists, phone numbers and basic written plans on their person so that such emergency “safety plans” are in place. Consents need to be on file at the school to enable such plans as well. (5) Parents seem particularly stressed and challenged In order to prevent taking such struggles out of the by the events on a given day. They may start to show child, parents should get in the practice of taking their signs weariness or agitation of being triggered by own “time-out.” They should first ensure the safety of stressors. the child and have a plan that the child is aware of that “Mom needs 10 minutes to rest and have time for herself.” Due to the need for increased monitoring of infants, supportive people of a parent’s emergency “safety plan” that was mentioned previously may be called for some relief. Such people maybe called upon to give parents the needed breaks in their regular routine. (6) A child needs to talk about some issues that are on Parent and child can agree as to what the child will do his/her mind. or say when they need to approach a parent and discuss something. They can have a code word, or simply make a brief statement that they need to talk. Parents should be ready and open to the situation, and try to assure the child of their willingness to listen without having their own irrational, emotional reaction. Parents need to realize that is they respond supportively and correctly and “pass their child’s tests,” their child will be more likely to approach them in the future. (7) The Preschooler through Adolescent child is having This may usually take place within weeks of having

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation an outburst of tears and / or anger aimed at Mom or been reunified once the child feels safe enough to Dad due to their feelings of having had to go to a Foster display their feelings on the matter to the parent at Care placement. home. Parents should nurture if the child allows, and be supportive and loving, resisting temptation to become defensive and explain. The parent should clearly apologize to the child for the placement(s) that they had to endure and make a promise that they will make every effort to keep that a foster care placement will not happen again for this child. (8) Child may not verbally communicate any Recognize how the child may be feeling given the problems, however the child’s nonverbal language is nonverbals displayed. Carefully point out the observed indicating anger or frustration (ie) strong sighs, rolling behavior and ask how the child is feeling. eyes (9) Silence with long gaps in conversation. Initiate conversation about the basics of the child’s routine and life currently (ie) school, favorite and / or difficult subjects, sports schedules, lessons, after-school activities, friends, and feelings about their current life situation, life-plans (10) Child speaks about various aspects and parent Making statements and ask questions that would build does not take the opportunities to have child elaborate on what the child has been discussing. Recognize further on such subjects. opportunities for conversation and relationship- building. This will show increase interest in the child, their topic of interest, and act to build the relationship. (11) Child seems anxious, angry, and / or agitated, Make statements such as, “You seem frustrated / angry, passive / aggressive, as evidenced by jittery behavior, etc. Is there anything that you want to talk about with seeming tense, possible physical distance kept from your mom / dad? It may be helpful for you to talk parent, and / or verbal statements. about how you feel.” If child chooses to discuss their feelings, validate their feelings and warmly positively reinforce their choice to share. (12) Mom / Dad becomes inappropriately angry or Mom / Dad may reword and apologize for their upset at the child or the child’s behavior and displays inappropriate behavior; use “I feel…” statements as negative behavior to convey this. discussed earlier to convey their feelings; however, they should convey to the child that not at fault. In addition, it is important to clarify that the information that they convey that “(They) feel…” to their children should not have the content where they are inappropriately venting to their child or blaming their child for their current life situation. While ensuring the safety of the child, remove themselves from a situation to the next room for their own “time-out” if they need time and space to compose themselves.

APPENDIX: COMPLETE SET OF FORMS, HANDOUTS, AND EDUCATIONAL MATERIALS AND ASSESSMENT TOOLS

Please circle the best answer for the questions below.

20% of children in foster care have a goal to be reunited with their parents. TRUE FALSE

According to the 2001 Fiscal report, 38% of children existing foster care TRUE FALSE were reunified with parents.

The average age of a child in foster care is 12 years old. TRUE FALSE

49% of reunified children are more likely to be arrested than children TRUE FALSE who are not reunified.

9% of reunified children are more likely to drop out of school than TRUE FALSE children who are not reunified.

The proportion of boys to girls in foster care is 65% to 35%. TRUE FALSE

The proportion of African American to Caucasians in foster care is 2:1. TRUE FALSE

The proportion of African American to Caucasians who enter TRUE FALSE foster care is 1:2.

It is reported that court mandated maternal visitation that with a child TRUE FALSE is the strongest predictor indicating that a child was 10x more likely to be reunified.

Foster Care Entries, Exits and In Care on the Last Day for FY 1999-2002 State Entering Foster Care this Year Exiting Care during the Year In Care on Last Day of Year FY 1999 FY 2000 FY 2001 FY 2002 FY 1999 FY 2000 FY 2001 FY 2002 FY 1999 FY 2000 FY 2001 FY 2002 Alabama 2,734 2,661 2,672 3,181 2,062 2,334 2,271 2,725 5,511 5,621 5,859 6,078 Alaska 1,180 1,096 999 1,052 732 913 996 844 2,248 2,193 1,993 2,057 Arizona 4,372 4,644 4,515 5,069 4,853 5,056 4,729 4,763 7,034 6,475 6,050 6,211 Arkansas 2,489 3,542 3,347 3,330 2,160 3,679 3,244 3,195 2,919 3,045 2,959 2,952 California 43,587 45,685 45,176 46,323 39,156 50,112 44,096 44,743 117,937 112,807 107,168 101,078 Colorado 7,183 6,942 7,007 7,650 5,675 5,512 5,200 5,972 7,639 7,533 7,138 8,698 Connecticut 3,098 2,763 2,713 2,763 2,169 2,368 1,943 2,787 7,487 6,996 7,440 6,007 Delaware 1,002 950 939 918 811 886 916 928 1,193 1,098 1,023 886 District of Columbia 1,231 775 822 812 659 315 390 396 3,466 3,054 3,339 3,321 Florida 21,118 18,765 18,673 20,800 8,117 15,507 17,061 17,340 34,292 36,608 32,477 31,963 Georgia 7,218 7,028 9,065 9,766 6,267 4,657 7,250 9,431 11,991 11,204 13,175 13,149 Hawaii 1,683 1,929 2,193 2,350 1,634 1,682 1,920 2,097 2,205 2,401 2,854 2,762 Idaho 999 1,127 1,209 1,211 806 1,011 1,064 1,047 959 1,1015 1,114 1,244 Illinois 7,325 6,323 6,412 6,214 12,562 10,298 8,508 8,320 34,327 29,286 26,456 23,707 Indiana 4,808 5,576 5,399 5,844 4,313 5,197 4,750 4,590 8,933 7,482 8,383 8,640 Iowa 5,343 5,620 5,829 5,821 5,443 5,414 5,712 5,647 4,854 5,068 5,202 5,236 Kansas 3,376 3,191 2,834 2,766 1,562 1,788 1,801 1,710 6,774 6,569 6,409 6,190 Kentucky 4,170 4,128 4,456 5,188 3,350 3,364 3,599 3,877 5,942 6,017 6,141 6,720 Louisiana 2,912 3,157 3,014 2,974 2,854 3,146 3,184 2,996 5,581 5,406 5,024 4,829 Maine 1,014 1,052 1,047 850 535 721 715 740 3,154 3,191 3,226 3,084 Maryland 3,936 3,928 3,662 3,524 2,933 3,110 3,064 2,945 13,455 13,113 12,564 12,026 Massachusetts 7,368 7,381 7,174 6,562 7,749 6,392 6,636 5,538 11,169 11,619 11,568 12,529 Michigan 10,929 10,707 12,283 10,019 6,740 7,802 8,312 9,827 20,300 20,034 20,896 21,251 Minnesota 10,724 10,803 10,012 10,317 9,743 9,939 9,269 9,700 8,996 8,530 8,167 8,052 Mississippi 1,750 2,005 1,923 1,686 1,676 1,726 1,670 1,629 3,196 3,292 3,261 2,732 Missouri 6,341 7,216 7,268 7,145 5,304 5,509 5,749 6,238 12,577 13,181 13,349 13,045

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Montana 1,596 1,588 1,506 1,306 1,331 1,327 1,497 1,280 2,156 2,180 2,008 1,912 Nebraska 2,806 3,134 3,350 3,320 2,100 2,514 2,636 2,807 5,146 5,674 6,254 6,430 Nevada N/A 673 707 811 N/A 387 442 437 N/A 1,615 7,789 1,749 New Hampshire 522 484 534 563 401 491 468 512 1,385 1,311 1,288 1,291 New Jersey 4,768 4,654 5,433 6,016 4,178 4,1019 4,607 5,435 9,494 9,794 10,666 11,260 New Mexico 1,829 1,780 1,887 1,968 1,691 1,716 1,754 1,606 1,941 1,912 1,757 1,885 New York 18,172 16,605 15,135 14,289 20,497 20,337 18,703 13,617 51,159 47,118 43,365 42,730 North Carolina 5,391 5,458 5,301 5,615 4,317 4,481 5,239 5,404 11,339 10,847 10,130 9,527 North Dakota 965 1,006 1,013 1,044 827 851 828 864 1,143 1,129 1,167 1,197 Ohio 15,946 15,396 16,157 14,965 12,819 14,131 14,136 14,413 20,078 20,365 21,584 21,012 Oklahoma 6,484 6,558 6,487 6,923 4,746 5,364 5,864 6,328 8,173 8,406 8,674 8,812 Oregon 4,818 4,675 4,537 5,095 4,558 4,563 4,587 4,646 9,278 9,193 8,966 9,101 Pennsylvania 13,299 12,235 12,420 13,616 12,419 11,926 11,730 12,031 22,690 21,631 21,237 21,434 Puerto Rico 2,703 N/A 3,254 3,483 1,510 N/A 977 2,369 7,760 N/A 8,476 8,179 Rhode Island 1,403 1,409 1,493 1,582 1,018 1,348 1,227 1,378 2,621 2,302 2,414 2,383 South Carolina 2,923 3,172 3,405 3,537 2,853 3,137 3,107 3,407 4,545 4,525 4,774 4,818 South Dakota 1,308 1,441 1,357 1,355 1,106 1,042 1,173 1,185 1,101 1,215 1,367 1,415 Tennessee 5,968 5,480 5,667 6,047 3,481 4,370 5,089 5,443 10,796 10,144 9,679 9,359 Texas 8,938 9,869 10,680 11,766 8,200 7,989 8,858 9,108 16,326 18,190 19,739 21,353 Utah 2,383 2,148 2,006 2,177 2,332 2,264 2,009 2,118 2,273 1,805 1,957 2,025 Vermont 750 788 697 854 722 684 581 637 1,445 1,318 1,360 1,461 Virginia 2,683 2,738 2,904 3,274 1,715 1,826 2,096 2,307 6,778 6,789 6,866 7,109 Washington 7,369 7,590 7,273 7,019 7,376 7,129 6,438 6,230 8,688 8,945 9,101 9,215 West Virginia 2,151 2,392 2,234 2,358 1,973 2,256 2,340 2,502 3,169 3,388 3,298 3,220 Wisconsin 5,941 6,001 5,158 5,074 4,463 4,039 4,358 4,083 10,868 10,504 9,497 8,336 Wyoming 715 786 896 903 683 731 689 783 774 815 965 1,036 Total 289,721 287,054 292,134 299,095 247,181 267,453 265,502 270,955 565,265 543,953 541,343 532,698

Source: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Administration on Children, Youth and Families Children's Bureau Adoption and Foster Care Analysis and Reporting System (AFCARS) Data as of July 2003

Updated on August 12, 2003

HANDOUT

GUIDELINES TO SETTING UP VISITING PLAN

 Have we considered and been sensitive to the issues of culture, language, family systems, and other issues that may impact the success of the visitation plan?

 Have we clearly communicated beforehand to the parents about the expectations and visiting rules? Has the purpose of the visitation plan been discussed with parent?

 Has the parent been asked to participate in developing the visitation plan? Has the family invited other significant people to the planning meeting?

 Does the parent recognize that the goal of the visitation plan is to help the family move toward reunifications? Have the obstacles or barriers for reunification been discussed with the parent?

 Have we created an environment that is parent strength based? Is the environment family oriented such as activities (i.e. games, art supplies, and etc.) are provided or meals or supportive people?

 Have we considered the logistics of the visitation plan? Can a parent meet the expectation of time, travel, and real-life parenting situations?

 Has an assessment occurred regarding parent’s skill level in areas of parent-child attachment, communication, parents response to child, parent’s response to crisis situations, parent’s ability to financially budget, and parent’s ability to plan and structure daily living (i.e. cooking, laundry, hygiene, cleaning, and etc.)?

 Has an assessment occurred regarding parent’s knowledge of child(ren) needs (i.e. mental health, nutrition, sleeping pattern, child’s hobbies and interests, school behaviors, peer relationships, and etc.)?

 Have we been attentive to the attachment needs and the developmental needs of the child? Are there any health conditions or special needs for the family?

From a CHILD’S point of view:  Child misses parents.  Child needs reassurance.  Child needs to know parents are okay.  Child is awaiting and excited to spend time with parents.  Child needs clarification on why child is in placement.  Child needs to feel connected to biological family.  Child needs to feel connected to relatives.  Child needs to have questions regarding family answered.  Child need to be informed about what is going on in the family.  Child need to be ask ,”When can I go home?”.  Child needs to feel like they still belong to their family.  Child needs to play with siblings and family members.  Child needs to feel that things are getting better.  Child may be confused about roles/loyalty.  Child may want to get things from family: presents, pictures, money, and other sentimental things.  Child may advocate for parents to participate in counseling.  Child may have need to defend family and show that they are not “evil”.

From a PARENT’S point of view:  Parents miss and love child.  Parent wants to keep bond with child.  Parent wants to keep child’s sense of connection with his/her own family  Parent wants to relay information about people and pets significant to the child.  Parent does not want to be forgotten.  Parent wants to be reassured that child is doing well in foster care.  Parent wants to reassure child that they are still here.  Parent wants to learn new parenting skills.  Parent wants to know what child is saying and being told.  Parent wants to know what is going on in child’s life.  Parent want to comply with expectations (even if they do not have the skills).  Parent wants to lessen the child’s worries.  Parent wants to prove to the system that they care about their children.  Parent wants to nurture the child with gifts, money, or other sentimental things.  Parent wants to give child hope and something to look forward too.

From a FOSTER CARE WORKER’S (FCW) point of view:  FCW wants to advocate for the child.  FCW wants to advocate for the parent.  FCW wants to provide the tools to foster engagement.  FCW wants to enforce visitation rules.

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation  FCW wants to model appropriate behavior.  FCW wants to intervene if necessary.  FCW wants to observe/evaluate interactions between parents and children.  FCW wants to allow parents to have some choices.  FCW wants to assess attachment and bonding.  FCW wants to maintain bonding and to help maintain a connection.  FCW wants to report on relationship between parent and child and the interactions observed.  FCW wants to provide guidance in parenting skills.  FCW wants to provide encouragement to parents and child.  FCW wants to give hope to both child and parent.

VISITATION INTAKE FORM

I. BACKGROUND INFORMATION

CHILD INFORMATION

Name of Child: DOB:

Child’s County of Origin:

Child’s County Case Manager (Name): (Address):

(Telephone #):

Child’s Law Guardian: Telephone #:

Child’s Current Foster Parent: Current Resident:

Telephone #:

School Name/Location:

School Phone Number: Contact at School: Educational level: Classification Level: Regular Education or Special Education (Circle One) (If Special Education) Classroom Setting:

Reason for Placement:

BIOLOGICAL/LEGAL GUARDIAN INFORMATION

Name: DOB:

Current Resident:

Telephone #:

Employment: (Name): (Address):

(Telephone #):

VISITATION INTAKE FORM P.2

FAMILY HISTORY Explanation(s) History of drug use History of alcohol use History of physical abuse History of sexual abuse History of mental/emotional abuse History of CPS involvement History of legal involvement History of Developmental Disabilities History of Mental Health issues History of Employment difficulties History of Learning Disabilities History of Educational Disabilities Other:

Other Comments:

II. INITIAL VISITING PLAN

I. PARTICIPANTS: Bio Parent (s)/ Child(ren) Bio Mother/ Child(ren) Bio Father/Child(ren) Bio Relative(s)/Child(ren) Adoptive Parent(s)/Child(ren) Primary Discharge Resource/Child(ren) Other/Child

J. PRIMARY LOCATION – Please rank order where the visits will take place ( 1-3 possibilities). Foster Home Bio Parent’s Home Child Advocacy Center Community Resource Congregate Care Facility Court Day Care Adoptive Home Hospital/Health Facility Service Provider/Contract Agency OMH Facility DSS Office/Field Office

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation OMRDD Facility Precinct/Law Enforcement Office Prison Public Location Relative’s Home School Shelter- Domestic Violence Shelter – Homeless Other:

ADDRESS :

TELEPHONE:

K. FREQUENCY Daily Multiple times per week DAYS SELECTED: Weekly Multiple times per month Monthly Other

L. DURATION Under 1 hour 1 – 2 hours TIME SELECTED: 2 – 4 hours Full Day (8 – 12 hours) Multiple Full Days (2 -7 days) Overnight Weekends

M. CHILD(REN) – List all the child(ren) that this visiting plan addresses. NAME AGE

N. ADULTS – List all the adults and relationship to the child(ren) that are involved in this visiting plan.

NAME RELATIONSHIP

O. SPECIAL CONSIDERATIONS

1. Is a supervised visitation required? YES or NO PLEASE EXPLAIN(Who will be supervising the visit?):

2. Are there any special considerations regarding visitations? (i.e. court orders) YES or NO PLEASE EXPLAIN:

4. Does the bio parent(s)/legal guardian have any physical health impairments that need to be accommodated during visitation? YES or NO PLEASE EXPLAIN:

5. Does the bio parent/ legal guardian need assistance with transportation? YES or NO PLEASE EXPLAIN:

P. VISITING PLAN STATUS Pending Active Suspended Closed

Name of Child: DOB:

INFANCY (Birth – 14 Months) Parent initiates behaviors that foster attachment and bonding. Parent makes eye contact with child. Parent positions child to engage in physical and verbal exchange (i.e. talks, sings, rocks infant) Parent shows pleasure toward infant in gaze, voice, or smile. Parent responds positively toward infant’s cues. Parent engages in pleasurable give and take with infant during play. Parent is able to meet the physical needs of child (i.e. feeding, changing diaper, changing soiled clothing). Parent recognizes infant’s cry and responds immediately.

TODDLER (15months – 35 Months) Parent initiate behaviors that foster attachment and bonding. Parent makes eye contact with child. Parent positions child to engage in physical and verbal exchange (i.e. talks)

© 2004 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Parent shows pleasure toward toddler in gaze, voice, or smile. Parent responds positively toward toddler’s cues. Parent engages in pleasurable give and take with toddler’s during play. Parent is able to meet the physical needs of child (i.e. feeding, changing diaper, changing soiled clothing). Parent recognizes toddler’s cry and responds immediately. Parent uses appropriate response toward negative behaviors.

PARENT-CHILD RELATIONSHIP ASSESSMENT FORM P. 2