Foster Care in Early Childhood

CHAPTER 34

Anna T. Smyke Angela S. Breidenstine

Both the serious maltreatment that precipitates children. Whenever a decision is made about a a young child’s entry into out-of-home care and young child in foster care, we should be asking the experience of separation from parents and ourselves: “Whose needs are being met here?” family members can impact the child and his or If the answer is not that the child’s needs are her family for years to come. Removal is initiat- being met, but rather that priority is being given ed when it is believed the risks caused by sepa- to the easiest transportation option, or the child rating a child from his or her parents/caregivers protection worker’s schedule, or the biological are secondary to the risks posed to the child’s parents’ lack of resources, or the foster parent’s well-being if allowed to remain in the home. aversion to meeting the biological parents, or Reunifying the family remains the primary any such non-child-centered reason, then we goal for almost all young children brought into must rethink our decision-making process to foster care. Some maltreating parents were fos- prioritize the needs of the child. ter children themselves (Lillas, 2010) and went This chapter is based on the premise that fos- into and out of the system without adequate res- ter care should be understood not only as a safe olution of the factors that brought them to the place for children to reside in out-of-home care attention of child protective services. Involving but also as a systematic means to help young biological parents, foster parents, and child pro- children to recover from the impact of abuse tection workers as a team, in a respectful way, and neglect (Smyke & Breidenstine, 2009). In as they work toward the goal of reunification is this chapter, we review statistics about young an essential element in meeting the young foster children in foster care and examine specific child’s need for love and stability (Lutz, 2005). challenges for caregivers of young children, Notably, when foster and biological parents including those who are interested in family “coparent” young children, that is, work to- building through foster care and relative care- gether in partnership, focused on creating the givers. We also explore interventions aimed at best experience possible for the young child, improving the experience of out-of-home care there is the opportunity for young foster chil- for young children. Throughout, we emphasize dren to thrive (Petcovich, 2010). Maintaining the importance of prioritizing developmen- child-centered foster care, rather than extend- tally informed foster care for young children ed-respite foster care (Smyke & Breidenstine, (Zeanah, Shauffer, & Dozier, 2011) aimed at 2009) or adult/system-centered foster care, strengthening relationships between young fos-

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In addition to protecting the child from fur- (Smyke & Breidenstine, 2009). Subclinical in- ther abuse or neglect, a child’s stay in foster juries that do not result in full-blown shaken care should be an opportunity for maltreating baby syndrome or prenatal exposure to illicit parents to improve their protective capacity substances may cause greater infant distress and learn more empathic, appropriate ways to and crying, thus further stressing parents who interact with their children. There are many in- are ill-equipped to handle their babies’ distress. terventions used with biological parents for this We focus in this chapter on the ways in which purpose, but we note that interventions focused the youngest children in the foster care system on increasing the parents’ understanding of have special needs that are dictated by their age, the child’s attachment needs, such as Circle of their cognitive capabilities, and their develop- Security (COS; Powell & Cooper, 2014), those mental imperative to establish and maintain at- facilitating sensitive parenting for mothers in tachment relationships with their caregivers. substance abuse treatment, such as the Mothers and Toddlers Program (Suchman, DeCoste, & Mayes, 2009), or those that treat parent–child Developmentally Informed Foster Care relationships affected by trauma, such as child– for Young Children parent psychotherapy (CPP; Lieberman, Ghosh Ippen, & Van Horn, 2016; Lieberman & Van A primary developmental task of the young Horn, 2009), may be invaluable for children af- child is to establish an attachment relationship fected by maltreatment and their parents. with a caregiver. It is beyond the scope of this chapter to go into depth about the development and maintenance of the parent–child attachment Who Are the Young Children in Foster Care? relationship (see Boris, Aoki, & Zeanah, 1999), although issues of attachment and loss have par- Children under 5 years of age are at increased ticular relevance to the maltreated young child physical risk for maltreatment given their small in foster care (Zeanah, Berlin, & Boris, 2011). size and absolute dependence on adult care to If the child enters foster care before 6 months survive. In the United States, children less than of age, we would expect that he or she has not 4 years of age accounted for 77.7% of those yet reached the stage of forming a focused at- under age 18 who died from child abuse in 2014 tachment with his or her biological parents and (Child Welfare Information Gateway, 2016a). may readily establish one instead with the fos- On September 30, 2014, there were 164,542 chil- ter parents later in the first year. Children who dren ages 5 and younger residing in the U.S. fos- enter state’s custody during the time when they ter care system. They were 39% of the 415,129 are expected to be developing a focused attach- children in foster care in the United States (U.S. ment relationship (ages 7–9 months), or after Department of Health and Human Services, they have already established one, are likely to 2016). Overall, foster children were evenly rep- experience a disruption of that relationship. resented in gender (female 48%) and their me- Visitation with biological parents often oc- dian age was 8 years. Among all foster children, curs on a weekly basis for an hour or two, which 42% were European American, 24% were Af- is insufficient time either to develop or maintain rican American, 22% were of Hispanic origin, an attachment relationship (Smariga, 2007). Be- and 10% were categorized as other/biracial. In cause of their immature cognitive development, fiscal year 2014, the last year for which we have even multiple visits a week are usually insuf- data, 126,091 (46%) of the 264,746 total children ficient for young children to maintain or create entering foster care were 5 and younger when a meaningful attachment relationship, which they entered the child welfare system (U.S. De- depends on repeated, daily caregiving interac- partment of Health and Human Services, 2016). tions over time. Especially objectionable is the Whereas a school-age child can convey to mandated minimum number of visits per week. adults that he or she is being abused and ne- Individualizing recommendations is always glected, this is much more difficult for a young preferable because of myriad factors that must child who may be limited by his or her lan- be considered. guage capabilities, or who may not be around Many factors affect a child’s comfort level other adults capable of providing protection. when he or she visits with his or her biological Injuries to infants and toddlers, such as shaken parents, including the nature of the parent–child

Copyright @ 2019. The Guilford Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. baby syndrome, can lead to lifelong disabilities relationship before entry into foster care (e.g.,

neglectful, role-reversed/inappropriate), as well There are a number of reasons why the fit be- as whether there were traumatic events involv- tween the foster parent and the child protection ing the parents prior to the child’s removal (e.g., worker may not be a good one (e.g., the foster physical abuse, sexual abuse, intimate partner parent is seen as advocating “too much” for the violence). The presence of the foster parent (the child, blocking access to the biological parents child’s attachment figure), with proper prepara- by scheduling appointments during visit times, tion, can make the visit more meaningful for or refusing to transport the child). Consistent both child and biological parent. communication between the foster parent and In our experience, the importance of parents child protection worker is essential to the young making progress in needed interventions while foster child’s well-being. having one or two supported, well-designed weekly visits with their children typically su- Uncertainty persedes the idea that all children and their parents should visit multiple times per week, for Foster parents are asked to commit to children long periods of time. As parents make mean- in the context of a great deal of uncertainty. ingful progress in their case plans and approach Too often, children are moved precipitously reunification, visits can be increased to build for reasons that are system-related rather than the attachment relationship prior to a transition due to a focus on the needs of the young child. home (as we discuss later). If visitation is con- For example, although efforts to place a child sistent and frequent (e.g., weekly), it is possible with family members so he or she can be with for children to become or to remain comfortable people he or she knows are important, these ef- with their biological parents (Smyke, Brown, & forts sometimes occur after a child has been in Sommer, 2012) but they are quite likely, and a foster placement for many months, developed indeed biologically driven, to establish an at- an attachment, and become fully part of the fos- tachment relationship with the caregivers with ter family. Foster parents who care for the child whom they spend the most time, their foster as they would their own biological child may parents. sometimes be judged as “too attached” by child Not surprisingly, young children in foster welfare professionals who do not understand care may need and benefit from a variety of the importance of attachment for the young fos- types of support in accomplishing the impor- ter child. tant milestone of forming an attachment rela- Reunification, even when biological parents tionship. For example, they may need support in have learned to be safe parents for the child, can establishing attachment relationships with their become a significant challenge for foster par- new caregivers, the foster parents, particularly ents who have cared for the child in their home if they have experienced multiple placements for a long period of time. Occasionally, we hear since coming into the state’s custody (Pasalich, reports that child welfare personnel have told Fleming, Oxford, Zheng, & Spieker, 2016). prospective foster parents that there is “no way” Young children may also “miscue” their emo- the biological parents will be able to get their tional and relational needs (Powell & Cooper, child back, but the parents do indeed work hard 2014) based on their past histories of maltreat- and become safe enough to parent their child. ment, which can push away or confuse new Even foster parents who did not plan to be long- caregivers and interfere with the formation of term caregivers for a child and who supported healthy attachment relationships. Young chil- reunification efforts may have anticipatory grief dren also may need support in the context of when faced with a child leaving their home and visitation (Beyer, 2004), especially if they expe- may worry about the child’s future. rience their parents as “trauma triggers,” due to Increasingly, judges and child protection their association of their parents with traumatic workers have begun to recognize the impor- events. tance of developing an individualized transition plan when a child must move from one placement to another (Smyke, Miron, & Larrieu, Challenges for Foster Parents 2012). Such a plan might typically extend over a Relationships with Child Protective Services month or so and allow the child to add another attachment figure (the biological parent) rather In our experience, even committed foster par- than experiencing an abrupt disruption from

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establishing a new attachment relationship. We of the young child, with the goal of continuing recognize that abrupt transitions are essential those connections as the child is transitioned when there is danger to the child, such as dur- home and allowing the child to maintain impor- ing the initial removal of the child from unsafe tant relationships as he or she grows. biological parents. However, other transitions in Planful transitions, which meet the specific the child welfare system (e.g., from foster par- needs of the transitioning child and are respon- ent to foster parent, from foster parent to rela- sive if those needs change, rather than a “one tive caregiver, from foster parent to biological size fits all” approach, constitute another essen- parent) are rarely emergencies, and every ef- tial element for the appropriate care of young fort should be made to allow the child to first foster children. This is particularly true given form a relationship with the biological parents the evidence that multiple and abrupt transi- or prospective caregiver. Weekly hour-long vis- tions are associated with negative outcomes for its, for example, are not sufficient to develop young foster children (Pasalich et al., 2016). or maintain an attachment relationship, so increasing contact both in terms of hours per visit Family Building and number of days on which visits occur allows for a less disruptive transition for the child. Caregivers who are building their families Scheduling abrupt transitions because a worker through foster care may have experienced pre- is going on vacation, for example, is not a suffi- vious feelings of grief and loss if they have cient reason to create an attachment disruption had fertility challenges or been unable to have for a young child. biological children (Cudmore, 2005). Rates of Unfortunately, many child welfare workers international adoption have decreased steeply and judges may not recognize the importance since a peak in 2004 (U.S. Department of State, of planful transitions and may abruptly move 2015), making this avenue to parenthood less the child from a placement (Smyke, Miron, et available. For those unable to afford the expense al., 2012). This may result in the child being of a private adoption, or who are drawn to help- transferred at a court hearing, without returning ing children who are already in the system, fos- to the foster home, causing feelings of loss and ter care may be a viable alternative. distrust in the foster parent (Edelstein, Burge, Over 50% of biological parents are reunified & Waterman, 2001), but more importantly, in with their children (U.S. Department of Health the young child. Given the child’s biological and Human Services, 2016), another factor con- imperative to attach and to learn to trust at tributing to the inherent uncertainty for foster this age, there is no supportable reason for un- caregivers. Like most parents, foster parents planned transitions other than safety. develop hopes and dreams about the children Of course, there may be times during reuni- placed with them (Edelstein et al., 2001). The fication, for example, when foster parents and challenge is that it is necessary for foster par- biological parents are unable to cooperate in ents to care for young children as if they were fulfilling a planful transition (Edelstein et al., their own: Love the child, advocate for the 2001), creating tension for the child as he or she child, and provide a nurturing, attachment-rich transitions from caregiver to caregiver. Each environment. Nevertheless, multiple factors plan should be reassessed continually to ensure may disrupt the dream of forming a permanent that the young child’s needs are being met. If the family with that child, including decisions to adults are unable to work together in the interest move the child to reside with family members of the young child and are creating more rather or to reunify the child with his or her biological than less stress for the child, then the transition parents after they have become safer caregivers. should be accelerated. The adults should, of Even if all the adults are focused on the needs course, be able to work together to promote the of the young child, the foster parents’ desire to young child’s well-being. Stating expectations create a family may be in conflict with the bio- clearly from the beginning would be one way to logical parents’ desire to reunite their family. help foster parents understand their role if the This uncertainty and associated emotional vul- parents have done or may do the work to reunify nerability is a challenge that most foster parents with their children. Another goal of approaches are able to manage, but there are times when such as the Quality Parenting Initiative (QPI) is foster parents may seem to undermine efforts to establish positive interactions between bio- at reunification by scheduling appointments

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negatively affected by visits with the parent, or family, this is not always the case. Maltreating scheduling a family vacation during the reunifi- parents may become resentful and angry with cation period (Edelstein et al., 2001). the caregiver, accusing him or her of “trying With regard to postvisit behavior, the foster to steal my child.” Biological parents who find parent typically knows the child best and is an themselves in this circumstance may have diffi- important reporter on the child’s responses to culty coming to grips with taking responsibility visits. Although most foster parents understand for their child’s placement in the child welfare their role and fulfill it to the best of their capa- system, preferring instead to blame the relative bility, some foster parents may seem to sabo- caregiver. On the other hand, relative caregivers tage reunification efforts. This, in turn, may may have difficulty recognizing the impact of cause child welfare personnel to feel that foster the abuse and neglect that the young child has parents, in general, cannot be trusted to accu- experienced. For grandparent caregivers, rather rately represent the child’s experience. This is than encouraging their adult child to seek as- a disservice to the child and another reason that sistance in alleviating the factors that brought efforts such as the QPI, to support foster par- the child into foster care, they may instead join ents and help them to prioritize the child’s well- with them in their anger toward “the system,” being, are so important. and allow the young child for whom they care to visit their parents without informing the child welfare professional, regardless of whether or Challenges for Relative Caregivers not the maltreating parent is a “trauma trigger” for the child. Overall, 29% of children in out-of-home place- Many maltreating families have ongoing is- ments are cared for in relative foster care (U.S. sues that may involve multiple generations, and Department of Health and Human Services, it is impossible to remove these strained feel- 2016). Kinship caregivers experience a range of ings from the relative caregiving scenario. For emotions as they care for their youngest rela- example, a biological parent who feels that his tives. Some may not have learned that the child or her own parent was abusive, but never in- was in foster care for some time (Youth Law teracted with the child welfare system, may be Center, 2014). The transition from the role of angry that the grandparent now has their child. grandparent or favorite aunt to that of primary The choice that grandparents must make as to caregiver can bring with it a sense of loss, as whether to meet the needs of the young child the relative must take on a variety of roles he or or the needs of their adult child can be a diffi- she did not previously have. These roles include cult one. On the one hand, they love their adult assuming the significant instrumental care that child; on the other hand, they disapprove of the comes with being the primary caregiver for a adult child’s use of substances, engagement in young child, from feeding to diaper changing, intimate partner violence, or maltreatment of to getting up during the night with a baby who the child. They may feel loyalty to their adult needs a bottle or a traumatized young child who child or, at times, frightened or intimidated by needs reassurance. In addition, they may need the biological parent of the young child. They to provide discipline, whereas previously they may feel that the visiting schedule arranged for had expected this to be the parents’ responsi- the biological parent or the various services that bility. Many relative caregivers have shared they must complete are unfair. A grandparent that they did not anticipate that their dreams of may feel some shame with regard to their adult travel or retirement would be replaced by the child’s behavior that has involved them with relentless day-in, day-out work involved in the “the system.” care of a young child. Grandparents may find that they have a Relative caregivers also are frequently in- growing attachment to the young child in their volved in intense loyalty conflicts—between home and may feel ambivalent about this. Many what is best for their young foster child and relative caregivers note that they must con- what their adult relatives wish. How they navi- stantly remind the young child not to call them gate these dilemmas, if they occur, has impor- “Mama,” saying instead, “I’m not your mama, tant implications for the young child. Although I’m your grandma.” Of course, it is difficult for the parent whose child has been removed from the young child to make this distinction, par- them may appreciate the sacrifice that their rel- ticularly if there are other children in the home

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It may be painful for the adult child to hear the Diversity in Foster Care: child “slip” and refer to the relative caregiver as Racial Disproportionality “Mama.” In a situation filled with feelings of loss on the part of many people, this is a par- White children represent 42% of children in ticularly difficult challenge. Nevertheless, the foster care, the largest single racial group of salient developmental task of the young child children in the U.S. Child Welfare system (U.S. is to become attached to a caregiver capable of Department of Health and Human Services, protecting him or her and organizing his or her 2016). There is an overrepresentation of non- feelings. It is both natural, and expected, that white children in the system (56%) compared to the young child would develop an attachment their percentage in the overall population (41%; to the caregiver, often quite quickly, sometimes Kaiser Family Foundation, 2015). Black people, within a few weeks of placement. for example, comprise 12% of the overall popu- Biological parents may feel that because the lation but represent 22% of the children in foster child is placed with a relative, they should be care. This disproportionality exists throughout able to call the child at any time, or to drop by the system, from the child’s first entry into and visit whenever they want, despite the child care to the child’s achievement of permanency welfare worker’s statement that there would be (Child Welfare Information Gateway, 2011, specific visitation times set up. The relative 2016c). Differential handling of children of caregiver can be caught in the middle as he or color and their families, which may indeed be a she tries to respect the rules set up by the fos- function of implicit bias, can be found through- ter care worker. He or she may be reluctant to out the family’s timeline (Annie E. Casey Foun- upset or create conflict with the child’s parent, dation, 2011). Whereas white families are more but afraid that if he or she does not comply with likely to receive family preservation services the system’s decisions, the young child might be designed to keep the maltreated child in the removed. home, these services are less likely to be pro- Among myriad feelings, relative caregivers vided to families of color, as are interventions sometimes experience profound sadness that once the child is placed in foster care (Child their adult child finds him or herself in these Welfare Information Gateway, 2011, 2016c). circumstances, that their young grandchild Furthermore, efforts to achieve permanency has been abused or neglected, or even that the may be significantly affected by the race of the private business of their family has become child. The North American Council on Adopt- so public. Additionally, they may be certain able Children (NACAC; 2014) lists the current that they did not raise their adult child to act rates and criteria for children to receive adop- in this way and ask themselves what happened tion subsidies. Subsidies are designed to assist to cause this. In addition, relative caregivers children with “special needs,” that is, children open themselves up to the judgment of those in who are more difficult to place, in achieving the child welfare system who worry that “the permanency through adoption. Such special apple does not fall far from the tree,” as they needs may include older age, behavioral diffi- try to find a safe placement for the young child. culties, sibling group, gender, and minority sta- In addition, relative caregivers may feel ham- tus (NACAC, 2014). strung by rules that state they are not allowed In a report from the National Center for Youth to use physical punishment to discipline their Law (NCYL), Lee, Bell, Ackerman-Brimberg, young relatives. Harris, and Benton (n.d.) examined the effects More resources for relative caregivers are be- of implicit bias in the child welfare, education, coming available, including newsletters about and mental health systems. Although NCYL fo- relative caregiving (e.g., Adoption Resources of cuses primarily on Juvenile Justice issues, they Wisconsin, 2011), as well as handbooks to guide noted that involvement in that system was often the experience of those caring for young rela- preceded by difficulties involving the other tives both informally, and in the case of foster systems. Implicit bias against children of color care, more formally (Child Welfare Information and their families impacted their trajectory to- Gateway, 2016b). It is also important to provide ward Juvenile Justice involvement and could be funding sources for caregivers who wish to profound at all levels of child welfare, from initial vide permanency for their young relatives but screening to decisions about placement in fos- do not have resources to do so (Child Welfare ter care (Lee et al., n.d.). They suggested, for

Copyright @ 2019. The Guilford Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. Information Gateway, 2016b). example, that criteria for deciding that a child

should enter foster care may be more subjec- nency decisions (National Society for the Pre- tive than they appear. Given this subjectivity, vention of Cruelty to Children, 2016; Zeanah & child welfare personnel may use other criteria Smyke, 2006). or may rely more on their own beliefs about It is important to note that in addition to the certain types of families than on truly objec- specific interventions we describe next, many tive criteria. Goff, Jackson, DiLeone, Culotta, young maltreated children may need additional and DiTomasso (2014) found that black boys, therapeutic interventions to address symptoms for example, are judged to be older and “less related to past trauma. There are a number of de- innocent” than their similar appearing white velopmentally appropriate, evidence-based in- counterparts, factors which may affect child terventions that can be implemented with young welfare decision making. Like other parts of children and their foster parents in order to re- our society, taking steps to eradicate implicit duce trauma symptoms and promote healthier bias from our institutions and helping agencies social–emotional functioning, such as CPP (Li- will result in fairer provision of services. In eberman et al., 2016) and Preschool Posttrau- the case of young children in foster care, more matic Stress Disorder (PTSD) Treatment (PPT; equitable provision of services might lead to Scheeringa, Weems, Cohen, Amaya-Jackson, & better recovery from the trauma of abuse and Guthrie, 2011). Other interventions, such as At- neglect, and for maltreating parents, improved tachment and Biobehavioral Catch-Up (ABC) ability to more effectively prioritize their chil- developed by Dozier, Lindhiem, and Ackerman dren’s safety. (2005) and Trust-Based Relational Intervention (TBRI), developed by Purvis, Cross, Dansereau, and Parris, are reviewed below. They represent Interventions for Young Children direct interventions in the foster caregiver– in Out-of-Home Care child relationship. In addition, we review the Quality Parenting Initiative (QPI), which aims Interventions in the lives of young children to rebrand foster care in a more positive light in the child welfare system must maintain a and include the foster parent as a respected, full trauma-informed and developmentally appro- member of the team addressing the needs of the priate perspective as they attempt to optimize young child in foster care, thereby strengthen- the young foster child’s experience. There are ing foster care and those who provide it. a variety of approaches to improve the care that young children receive when they are removed Attachment and Biobehavioral Catch-Up from parents who are unwilling or unable to care for them safely. Some, such as the Bucha- Young children who have experienced maltreat- rest Early Intervention Project, represent a radi- ment, neglect, and separation from primary cal shift in the life of the young child (Dozier, caregivers are at risk for a variety of concur- Zeanah, Wallin, & Shauffer, 2012), with the rent and future behavioral, emotional, and in- child’s removal from the institution and place- terpersonal difficulties. The ABC intervention ment in the family setting of foster care (Smyke was created by Mary Dozier and her colleagues, & Breidenstine, 2009; Smyke, Zeanah, Fox, & with a focus on improving caregiver–child re- Nelson, 2009). Others include the New Orleans lationships and the regulatory capacities of in- Intervention Model (Zeanah & Smyke, 2006), fants and toddlers in foster care (Dozier, Higley, which was developed in Louisiana and more re- Albus, & Nutter, 2002; Dozier et al., 2005). We cently has been implemented elsewhere in the briefly review the intervention here. For more United States and tested in the United Kingdom information and details about the ABC inter- (Turner-Halliday, Watson, & Minnis, 2016). vention, see Dozier and Bernard (Chapter 31, The New Orleans Intervention Model approach this volume). provides assessment and direct support to fos- The development of organized attachment re- ter parents, as well as developmental screen- lationships and regulatory capabilities are two ings/treatment and behavioral interventions for important tasks of infancy and early childhood young foster children (Zeanah & Smyke, 2006). that are vulnerable to the damaging effects of In addition, this approach delivers assessment inadequate care and relationship disruptions and psychotherapeutic interventions for biolog- (Dozier, Albus, Fisher, & Sepulveda, 2002). ical parents and provides information to child Because of their histories, infants and toddlers

Copyright @ 2019. The Guilford Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. welfare personnel and judges for use in perma- in foster care often fail to elicit nurturance, are

at high risk for behavioral and neuroendocrino- al., 2006, 2009; Dozier, Peloso, Lewis, Lau- logical dysregulation, and are at increased risk renceau, & Levine, 2008; Lewis-Morrarty, for forming disorganized attachment relation- Dozier, Bernard, Terraciano, & Moore, 2012; ships (see Bick & Dozier, 2013, for a review). Lind, Bernard, Ross, & Dozier, 2014). ABC has Traumatized young children need particularly been given the highest rating, a “1,” on the Cali- sensitive and nurturing care to help reduce fur- fornia Evidence-Based Clearinghouse for Child ther risk and increase the likelihood of health- Welfare scientific rating scale, indicating that ier outcomes (Dozier, Stovall, Albus, & Bates, ABC is well supported by research evidence 2001), but many caregivers may not be prepared (www.cebc4cw.org/program/attachment-and- to provide this type of care without assistance. biobehavioral-catch-up). ABC was originally designed to enhance foster An expanded version of ABC, called Attach- parents’ sensitivity, so that they could meet the ment and Biobehavioral Catch-Up for Toddlers special needs of young foster children, thereby (ABC-T), was also created to help foster parents improving children’s ability to regulate their with children ages 2–4 years provide sensitive physiology, behavior, emotions, and cogni- caregiving, promote secure attachment relation- tion (Bick & Dozier, 2013; Lind, Raby, Caron, ships, and assist children in developing healthy Roben, & Dozier, 2017). Incorporating prior re- physiological and behavioral regulation (Lind search findings, ABC was designed to be rela- et al., 2017). There is also an adapted version tively brief, to be conducted with children and of ABC, called Fostering Relationships (previ- caregivers together, to focus on changing par- ously ABC for Visitation, or ABC-V), which enting behaviors rather than internal represen- has the goal of improving visits between par- tations, to be manualized, and to be conducted ents and children recently removed from their in the home (Bernard et al., 2012). care due to maltreatment. A preliminary evalu- ABC is a 10-session, manualized interven- ation of Fostering Relationships was recently tion for children ages 6–24 months. Sessions conducted with a group of 11 foster children, take place in the foster home, with the child and birth parents, and foster parents. The research- caregiver present, delivered by a trained parent ers found that six of the seven families partici- coach who reviews session content as specified pating in Fostering Relationships and one out of by the manual, tailors the session to meet in- four families in the control group followed the dividual foster parent needs, and comments on child’s lead in visits more often than not. Also, ongoing interactions between the foster parent all birth parents in Fostering Relationships at- and child (Bick & Dozier, 2013). The interven- tended all five visits, as opposed to two of the tion focuses on helping caregivers behave in four parents in the control group, who did not synchronous ways with their children, in order complete visitation (Roben, Neely, Shauffer, & to target and enhance children’s self-regulatory Dozier, n.d.). Dozier and colleagues intend to capabilities (Dozier et al., 2012). ABC also tar- further examine Fostering Relationships and its gets the quality of the caregiver–child attach- effect on parent-child visits. ment relationship by teaching caregivers to act in nurturing, nonfrightening ways, even when Trust-Based Relational Intervention children do not clearly demonstrate their need for closeness and nurturance (Dozier et al., TBRI is described as an attachment-based, 2012). trauma-informed, “therapeutic model that Well-designed randomized controlled trials trains caregivers to provide effective support have examined the effects of ABC, both when and treatment for at-risk children” (Purvis et used with foster parents and with high-risk al., 2013, p. 360). Developed at the Texas Chris- birth parents. Overall, ABC has been shown tian University (TCU) Institute of Child De- to improve caregiving sensitivity and posi- velopment (now the Karyn Purvis Institute of tive parenting behaviors (Berlin, Shanahan, & Child Development), TBRI aims to teach care- Carmody, 2014; Bick & Dozier, 2013; Caron, givers ways to promote the healing of children Weston-Lee, Haggerty, & Dozier, 2016); pro- who have experienced complex developmental mote secure attachment (Bernard et al., 2012); traumas. The intervention tries to help caregiv- and enhance the physiological, emotional, and ers recognize the needs of children who have cognitive regulatory capabilities of young chil- experienced relational trauma and do what is dren who experienced early adversity, with both needed to meet the children’s needs (Purvis et

Copyright @ 2019. The Guilford Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. foster parents and biological parents (Dozier et al., 2015). The TBRI model grew out of a TCU

summer day camp for foster children and adopt- The developers of TBRI have described it ed children that began in 1999. Over time, the as addressing “all major issues that are linked developers sought to incorporate strategies that with complex developmental trauma” and as they believed were effective at the camp into a being adapted “for a variety of settings includ- program for caregivers. The TBRI model bor- ing international orphanages, residential group rows principles and techniques from a variety homes and treatment centers, adoptive and fos- of theoretical orientations, disciplines, and inter homes, schools, therapeutic day camps, and terventions, and lists its three core principles as for all ages of children, including adolescents” Empowerment, or attention to physical needs; (Purvis et al., 2013, p. 376). Anecdotally, there Connection, or attention to attachment needs; is enthusiasm for TBRI among some foster and and Correction, or attention to behavioral needs adoptive parents, and there are elements of the (Purvis et al., 2013). intervention that appear grounded in principles Each TBRI core principle has associated and techniques from other evidence-based in- strategies to help create felt-safety, self-reg- terventions. At this point, the research evidence ulation, and connection for traumatized chil- supporting the broad effectiveness of TBRI, dren (Purvis et al., 2015). The Empowerment as described by its developers, is quite lim- principle has two sets of strategies: ecological ited. The research conducted to date suggests strategies, such as creating rituals and manag- that it may be associated with improvements in ing transitions, and physiological strategies, child functioning and may hold some promise, such as providing for nutritional and hydration but the evidence is still quite limited in terms needs, and offering regular physical activities of identifying the nature and level of the in- and sensory experiences. They posit that these tervention’s effectiveness (McKenzie, Purvis, strategies can enhance a child’s ability to self- & Cross, 2014; Purvis & Cross, 2006; Purvis regulate, reduce the likelihood of negative in- et al., 2013, 2015; Purvis, McKenzie, Razuri, cidents, and increase successful experiences of Cross, & Buckwalter, 2014). TBRI has been connecting and correcting (the second and third given a moderate rating, a “3” on the California principles) (Purvis et al., 2015). Strategies as- Evidence-Based Clearinghouse for Child Wel- sociated with the Connecting principle include fare scientific rating scale, indicating that it has mindful awareness, including awareness of self, some promising research evidence. In terms of the child, and the environment, and engagement TBRI’s effectiveness and appropriateness for strategies, such as eye contact, healthy touch, young children in foster care, there are no stud- attunement, and engaging in playful interac- ies examining it with infants and toddlers under tions (Purvis et al., 2013, 2015). The Connect- the age of 4 years. The promising results reporting principle is described as critical for form- ed to date have also been found with highly mo- ing trusting adult–child relationships and is tivated foster/adoptive parents and may not be considered a necessary foundation for the other generalizable to the overall population of foster two principles to work (Purvis et al., 2015). The parents. Correcting principle includes two sets of strategies: proactive strategies, including what are The QPI termed “Life Value Terms” and “Behavioral Scripts,” and responsive strategies, which are The QPI was developed through collaboration called the “IDEAL Response” and “Levels of with the Youth Law Center (YLC) and the Eck- Response,” to address challenging child behav- erd Family Foundation. In 2004, foster care in iors (Purvis et al., 2015, p. 203). Some of the the state of Florida was characterized by bur- Correcting strategies involve practices such as geoning foster homes that accepted many more teaching children to use words rather than en- children than they were capable of caring for; gage in inappropriate behavior, enacting be- children for whom placements could not be havioral “re-dos” to practice effective rather found, who were forced to sleep at child pro- than ineffective behaviors, and learning life tective services offices; and frequent moves values such as using respect and accepting con- for foster children (Shauffer, 2012). The state’s sequences, and using a sequence of suggested system of foster care was in crisis. The YLC, adult responses to misbehavior to maintain con- based in California, joined with Florida State nection with the child, while helping the child University to bring suit against the Florida De- to regulate and return to appropriate behavior partment of Children and Families (DCF) on

Copyright @ 2019. The Guilford Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. (Purvis et al., 2013, p. 373). behalf of Florida’s foster children (Shauffer,

2012). The department settled the suit and the monplace caregiving situation and advocate for new Secretary for DCF met with the YLC and the child to receive appropriate trauma treat- the Eckerd Family Foundation to find ways to ment. address the significant issues that had been In a recent report, the Annie E. Casey Foun- raised. Given the premise that foster care is a dation (2016) reviewed several programs, in- systematic means of addressing the impact of cluding the QPI, whose aim is to transform abuse and neglect, it was clear that the Florida foster parenting. They suggested three mecha- child protection services had fallen short of nisms to improve foster parenting: (1) work- their mission to protect their youngest citizens ing toward improving the quality of care that (Shauffer, 2012). The QPI (www.ourcommunity- children receive through targeted foster parent ourkids.org/qpi) has expanded to several other training and making sure that resources dedi- states and includes some counties in California. cated to young foster children are sufficient for QPI training is conducted in person, and re- their needs; (2) building strong relationships source materials are available online, allowing with foster caregivers particularly in terms of access to materials that clearly describe the na- communication and involvement in the team’s ture of foster parent training in the QPI model. efforts (dedicating child welfare staff to pro- The QPI has gathered a series of videos, often mote this partnership would be one marker of featuring respected professionals in the fields of the agency’s commitment to creating and culti- attachment, trauma, foster care, and child wel- vating strong relationships with foster caregiv- fare (for an example, see http://centervideo.usf. ers); and (3) making concerted efforts to find edu/qpi/rad/start.html). Also included are vid- more foster caregivers, representing diversity eotaped discussions of foster parents’ experi- in age, religious background, sexual orienta- ences in reaching out to form relationships with tion, and race, who would be open to fully meet biological parents as “coparents” of the same all the needs that the young traumatized child child (Pozo, 2010). This allows foster parents brings to foster care, as well as support the ef- to understand basics such as what type of food forts of biological parents to reunify with their the child likes to eat and what toys he or she children. enjoys playing with. In the QPI context, foster The QPI is a means of “strengthening foster parents can also serve as supports or mentors care . . . using branding and marketing prin- for biological parents learning to safely parent ciples” (YLC, 2012, p. 1). The YLC contends their children. that foster care, as it is currently viewed, has a The Annie E. Casey Foundation (2016) also negative connotation rather than being a service has actively promoted the strengthening of fos- about which providers and others in the com- ter parenting in the interest of the best possible munity are excited. The YLC did not create a care for children in out-of-home care. Instead manual dictating the best approach to foster of thinking of foster parents as long-term baby- care, but it identified core elements that should sitters, it is important to acknowledge their es- be part of the QPI process: being clear about sential contribution to the young traumatized what is expected of caregivers, communicating child’s well-being and to include them as active, these expectations to caregivers, then ensuring respected members of the caregiving, child-fo- that the agency is set up to support the achieve- cused team. This important concept addresses ment of these expectations by foster caregivers. the strengths of both relative caregivers and cer- Implementation of the QPI includes an initial tified foster parents. planning period and formulation of the steps to Failing to include foster parents as members be taken by an entity, such as a county or state, of the team restricts their access to information interested in using the QPI approach. This type critical to their ability to best meet the needs of detailed planning for implementation results of their young foster child. For example, if the in enthusiastic stakeholders throughout the sys- child experienced a traumatic event at bath time tem and ensures that recruiting efforts are suc- and the foster parent has not been informed cessful. Informing caregivers, on the front end, about this, he or she may be confused and un- of the philosophy of the program and expecta- certain when a young foster child has a severe tions of caregivers will help them to understand reaction to his or her attempts to bathe the child. the mission they are being called upon to fulfill. In turn, foster parents who feel that their ideas Efforts to provide continuing support and and observations are respected could inform the education to foster parents should help them to

Copyright @ 2019. The Guilford Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. team about a child’s unusual reaction to a com- realize that assistance is available if they expe-

rience challenges rather than make them feel Connection, pp. 1–2. Retrieved from www.davetho- they will be judged if they have difficulties. masfoundation.org/wp-content/uploads/2015/03/ Foster parents who empathize with the young, changingroles.pdf. traumatized child also may experience second- Annie E. Casey Foundation. (2011). Race matters. Re- ary trauma (Conrad, n.d.; Parker, 2009) as they trieved from www.aecf.org/resources/race-matters- unequal-opportunity-within-the-child-welfare-sys- hear about horrific experiences their young fos- tem. ter children have survived. Appropriate and fo- Annie E. Casey Foundation. (2016). A movement to cused training before a child is placed, as well transform foster parenting. Retrieved from www. as continued support after the placement of the aecf.org/resources/a-movement-to-transform-fos- child, will help foster caregivers to recognize ter-parenting. what they are experiencing and to reach out for Berlin, L. J., Shanahan, M., & Carmody, K. A. (2014). assistance rather than feeling that they must Promoting supportive parenting in new mothers with manage challenging situations alone. The QPI substance-use problems: A pilot randomized trial of represents a promising new approach to im- residential treatment plus an attachment-based par- proving foster care for all children, but its prin- enting program. Infant Mental Health Journal, 35(1), 81–85. ciples might be expected to particularly impact Bernard, K., Dozier, M., Bick, J., Lewis-Morrarty, E., the experience of very young children in foster Lindhiem, O., & Carlson, E. (2012). Enhancing at- care. The QPI has not been formally evaluated, tachment organization among maltreated children: and next steps should include research aimed Results of a randomized clinical trial. Child Devel- at validating the approach and comparing it to opment, 83(2), 623–636. standard foster care with regard to its impact on Beyer, M. (2004). Visit coaching: Building on family families and systems. strengths to meet children’s needs. New York: NYC Administration for Children’s Services. Retrieved from www.martybeyer.com/sites/default/files/visit_ Conclusions coaching_manual.pdf. Bick, J., & Dozier, M. (2013). The effectiveness of an attachment-based intervention in promoting foster Foster care remains an essential intervention to mothers’ sensitivity toward foster infants. Infant protect young children from maltreatment, to Mental Health Journal, 34(2), 95–103. assist them in recovering from trauma, to pro- Boris, N. W., Aoki, Y., & Zeanah, C. H. (1999). The vide maltreating parents with the opportunity development of infant–parent attachment: Consider- to learn to safely parent their young children, ations for assessment. Infants and Young Children, and, ultimately, to achieve permanency for the 11, 1–10. child. Though there are challenges inherent in Caron, E. B., Weston-Lee, P., Haggerty, D., & Dozier, foster care, providing interventions that focus M. (2016). Community implementation outcomes of on helping the child to develop secure relation- attachment and biobehavioral catch-up. Child Abuse and Neglect, 53, 128–137. ships in the context of out-of-home care is an Child Welfare Information Gateway. (2011). Address- important way to meet the needs of young foster ing racial disproportionality in child welfare. Re- children. Furthermore, recognizing the impor- trieved from www.freestatesocialwork.com/articles/ tance of foster care and those who provide it is racial_disproportionality.pdf. a vital means of improving the experience of Child Welfare Information Gateway. (2016a). Child young traumatized children. It is essential that abuse and neglect fatalities 2014: Statistics and in- all those in the child welfare system, including terventions. Retrieved from www.childwelfare.gov/ child protection workers, judges, interveners, pubpdfs/fatality.pdf. as well as biological and foster parents, remain Child Welfare Information Gateway. (2016b). Kinship mindful of the imperative to provide child- caregivers and the child welfare system. Retrieved from www.childwelfare.gov/pubpdfs/f _kinshi.pdf. centered, developmentally appropriate, and Child Welfare Information Gateway. (2016c). Racial trauma-informed foster care, rather than mak- disproportionality and disparity in child welfare. Re- ing the important developmental needs of the trieved from www.childwelfare.gov/pubpdfs/racial young child subordinate to those of the system. _disproportionality.pdf. Conrad, D. (n.d.). Secondary trauma and foster parents: Understanding its impact and taking steps to protect REFERENCES them. Retrieved from https://muskie.usm.maine.edu/ helpkids/rcpdfs/sec.trauma-foster.pdf. Adoption Resources of Wisconsin. (2011, April). The Cudmore, L. (2005). Becoming parents in the context of changing roles of caregivers: Grandparents. Kinship loss. Sexual and Relationship Therapy, 20, 299–308. Copyright @ 2019. The Guilford Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Dozier, M., Albus, K., Fisher, P. A., & Sepulveda, S. ciano, S. M., & Moore, S. V. (2012). Cognitive flex- (2002). Interventions for foster parents: Implications ibility and theory of mind outcomes among foster for developmental theory. Development and Psycho- children: Preschool follow-up results of a random- pathology, 14, 843–860. ized clinical trial. Journal of Adolescent Health, 51, Dozier, M., Higley, E., Albus, K. E., & Nutter, A. 517–522. (2002). Intervening with foster infants’ caregivers: Lieberman, A. F., Ghosh Ippen, C., & Van Horn, P. Targeting three critical needs. Infant Mental Health (2016). Don’t hit my mommy! (2nd ed.). Washington, Journal, 23(5), 541–554. DC: Zero to Three Press. Dozier, M., Lindhiem, O., & Ackerman, J. P. (2005). At- Lieberman. A. F., & Van Horn, P. (2009). Child–parent tachment and Biobehavioral Catch-Up: An interven- psychotherapy: A developmental approach to mental tion targeting empirically identified needs of foster health treatment in infancy and early childhood. In infants. In L. J. Berlin, Y. Ziv, L. Amaya-Jackson, C. H. Zeanah, Jr. (Ed.), Handbook of infant mental & M. T. Greenberg (Eds.), Enhancing early attach- health (3rd ed., pp. 439–449). New York: Guilford ments: Theory, research, intervention, and policy Press. (pp. 178–194). New York: Guilford Press. Lillas, C. (2010, May). Parallel process is the key. Foster Dozier, M., Lindhiem, O., Lewis, E., Bick, J., Bernard, Care Review, p. 3. K., & Peloso, E. (2009). Effects of a foster parent Lind, T., Bernard, K., Ross, E., & Dozier, M. (2014). In- training program on young children’s attachment tervention effects on negative affect of CPS-referred behaviors: Preliminary evidence from a random- children: Results of a randomized clinical trial. ized clinical trial. Child and Adolescent Social Work Child Abuse and Neglect, 38(9), 1459–1467. Journal, 26(4), 321–332. Lind, T., Raby, K. L., Caron, E. B., Roben, C. K. P., & Dozier, M., Peloso, E., Lewis, E., Laurenceau, J.-P., & Dozier, M. (2017). Enhancing executive functioning Levine, S. (2008). Effects of an attachment-based in- among toddlers in foster care with an attachment- tervention on the cortisol production of infants and based intervention. Development and Psychopathol- toddlers in foster care. Development and Psychopa- ogy, 29, 575–586. thology, 20, 845–859. Lutz, L. L. (2005). Relationship between public child Dozier, M., Peloso, E., Lindhiem, O., Gordon, M. K., welfare workers, resource families and birth fami- Manni, M., Sepulveda, S., & Ackerman, J. (2006). lies: Preventing the triangulation of the triangle of Developing evidence-based interventions for foster support. New York: National Resource Center for children: An example of a randomized clinical trial Family-Centered Practice and Permanency Plan- with infants and toddlers. Journal of Social Issues, ning. Retrieved from www.hunter.cuny.edu/soc- 62(4), 767–785. work/nrcfcpp/downloads/triangle_of _support.pdf. Dozier, M., Stovall, K. C., Albus, K. E., & Bates, B. McKenzie, B., Purvis, K. B., & Cross, D. R. (2014). A (2001). Attachment for infants in foster care: The trust-based home intervention for special-needs ad- role of caregiver state of mind. Child Development, opted children: A case study. Journal of Aggression, 72(5), 1467–1477. Maltreatment and Trauma, 23(6), 633–651. Dozier, M., Zeanah, C. H., Wallin, A. R., & Shauffer, C. National Society for the Prevention of Cruelty to Chil- (2012). Institutional care for young children: Review dren. (2016). The New Orleans Intervention Model: of literature and policy implications. Social Issues Testing a new approach to looking after infant men- and Policy Review, 6, 1–25. tal health through Infant and Family Teams: A case Edelstein, S. B., Burge, D., & Waterman, J. (2001). study of practice. Retrieved from www.nspcc.org.uk/ Helping foster parents cope with separation, loss and globalassets/documents/publications/new-orleans- grief. Child Welfare, 80, 5–25. intervention-model-case-study.pdf. Goff, P. A., Jackson, M. C., DiLeone, B. A. L., Culotta, North American Council on Adoptable Children. C. M., & DiTomasso, N. A. (2014). The essence of (2014). Ohio State Subsidy Profile. Retrieved from innocence: Consequences of dehumanizing Black www.nacac.org/adoptionsubsidy/stateprofiles/ohio. children. Journal of Personality and Social Psychol- html. ogy, 106, 526–545. Parker, T. (2009). Compassion fatigue in foster parents: Kaiser Family Foundation. (2015). Population distribu- Executive summary. Unpublished master’s thesis, tion by race/ethnicity. Retrieved from http://kff.org/ California State University, Fresno, CA. other/state-indicator/distribution-by-raceethnicity/? Pasalich, D. S., Fleming, C. B., Oxford, M. L., Zheng, Y., currenttimeframe=0. & Spieker, S. (2016). Can parenting intervention pre- Lee, J., Bell, Z., Ackerman-Brimberg, M., Harris, M., vent cascading effects from placement instability to & Benton, H. (n.d.). Implicit bias in the child wel- insecure attachment to externalizing problems in mal- fare, education and mental health systems. Oakland, treated toddlers? Child Maltreatment, 21, 175–185. CA: National Center for Youth Law. Retrieved from Petcovich, T. (2010, May). Selling co-parenting. Foster https://youthlaw.org/wp-content/uploads/2015/07/ Care Review, p. 2. implicit-bias-in-child-welfare-education-and-men- Powell, G., & Cooper, G. (2014). The Circle of Security tal-health-systems-literature-review_061915.pdf. Intervention: Enhancing attachment in early child– Lewis-Morrarty, E., Dozier, M., Bernard, K., Terrac- parent relationships. New York: Guilford Press. Copyright @ 2019. The Guilford Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Pozo, A. M. (2010, May). Co-parenting: The key to re- dren in the Child Welfare System for the National unification. Foster Care Review: The Reviewer, pp. Center for Child Traumatic Stress. 1–2. Retrieved from www.fostercarereview.org/wp- Smyke, A. T., Miron, D., & Larrieu, J. A. (2012, June content/themes/theme/theme45009/files/co-parent- 7). Addressing transition issues for young foster ing%20newsletter%202010.pdf. children. Webinar presented as part of the Zero to Purvis, K. B., & Cross, D. R. (2006). Improvements in Six Webinar series on Young Children in the Child salivary cortisol, depression, and representations of Welfare System for the National Center for Child family relationships in at-risk adopted children uti- Traumatic Stress. lizing a short-term therapeutic intervention. Adop- Smyke, A. T., Zeanah, C. H., Fox, N. A., & Nelson, tion Quarterly, 10(1), 25–43. C. A. (2009). A new model of foster care for young Purvis, K. B., Cross, D. R., Dansereau, D. F., & Par- children: The Bucharest Early Intervention Project. ris, S. R. (2013). Trust-based relational intervention Child and Adolescent Clinics of North America, 18, (TBRI): A systemic approach to complex develop- 721–734. mental trauma. Child and Youth Services, 34, 360– Suchman, N., DeCoste, C., & Mayes, L. (2009). The 386. Mothers and Toddlers Program: An attachment- Purvis, K. B., McKenzie, L. B., Razuri, E. B., Cross, based intervention for mothers in substance abuse D. R., & Buckwalter, K. (2014). A trust-based inter- treatment. In C. H. Zeanah, Jr. (Ed.), Handbook of vention for complex developmental trauma: A case infant mental health (3rd ed., pp. 485–499). New study from a residential treatment center. Child and York: Guilford Press. Adolescent Social Work Journal, 31(4), 355–368. Turner-Halliday, F., Watson, N., & Minnis, H. (2016). Purvis, K. B., Razuri, E. B., Howard, A. R. H., Call, C. Process evaluation of the New Orleans Interven- D., DeLuna, J. H., Hall, J. S., et al. (2015). Decrease tion Model for Infant Mental Health in Glasgow. in behavioral problems and trauma symptoms among Retrieved from http://cdn.basw.co.uk/upload/ at-risk adopted children following trauma-informed basw_74226–8.pdf. parent training intervention. Journal of Child and U.S. Department of Health and Human Services. Adolescent Trauma, 8(3), 201–210. (2016). The Adoption and Foster Care Analysis Roben, C., Neely, E., Shauffer, C., & Dozier, M. (n.d.). and Reporting System (AFCARS) Report #22. Re- First look at effects of an intervention to improve trieved from www.acf.hhs.gov/sites/default/files/cb/ visitation for young children in foster care. Unpub- afcarsreport22.pdf. lished manuscript, Department of Psychological and U.S. Department of State. (2015). Adoption statistics. Brain Sciences, University of Delaware, Newark, Retrieved from https://travel.state.gov/content/ DE. adoptionsabroad/en/about-us/statistics.html. Scheeringa, M. S., Weems, C. F., Cohen, J. A., Amaya- Youth Law Center. (2012). Quality Parenting Initiative. Jackson, L., & Guthrie, D. (2011). Trauma-focused Retrieved from www.lyc.org/our-work/action-litiga- cognitive-behavioral therapy for posttraumatic tion/quality-foster-care/quality-parenting-initiative. stress disorder in three through six year old children: Youth Law Center. (2014). Relative caregivers: A fact A randomized clinical trial. Journal of Child Psy- sheet prepared by the Youth Law Center. Retrieved chology and Psychiatry, 52(8), 853–860. from www.ylc.org/wp/wpcontent/uploads/relativec- Shauffer, C. (2012, May/June). The Quality Parenting aregiversfactsheet%202014.pdf. Initiative: Fostering in the 21st century. Fostering Zeanah, C. H., Berlin, L. J., & Boris, N. W. (2011). Prac- Families Today, pp. 24–25. titioner review: Clinical applications of attachment Smariga, M. (2007). Visitation with infants and tod- theory and research for infants and young children. dlers in foster care: What judges and attorneys need Journal of Child Psychology and Psychiatry, 52, to know. Retrieved from www.americanbar.org/ 819–833. content/dam/aba/administrative/child_law/visita- Zeanah, C. H., Shauffer, C., & Dozier, M. (2011). Foster tion_brief.authcheckdam.pdf. care for young children: Why it must be developmen- Smyke, A. T., & Breidenstine, A. S. (2009). Foster care tally informed. Journal of the American Academy of in early childhood. In C. H. Zeanah, Jr. (Ed.), Hand- Child and Adolescent Psychiatry, 50, 1199–1201. book of infant mental health (3rd ed., pp. 500–515). Zeanah, C. H., & Smyke, A. T. (2006). Building at- New York: Guilford Press. tachment relationships following maltreatment and Smyke, A. T., Brown, L., & Sommer, A. R. (2012, May severe deprivation. In L. J. Berlin, Y. Ziv, L. Amaya- 24). Optimizing visitation for young traumatized Jackson, & M. T. Greenberg (Eds.), Enhancing early children and their caregivers. Webinar presented as attachments: Theory, research, intervention, and part of the Zero to Six Webinar series on Young Chil- policy (pp. 195–217). New York: Guilford Press. Copyright @ 2019. The Guilford Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

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