© 2005- 2006 cdhs college relations group buffalo state college/suny at buffalo research foundation...

© 2005- 2006 CDHS College Relations Group Buffalo State

College/SUNY at Buffalo Research Foundation

Reducing Separation Reducing Separation TraumaTrauma

Kathleen I. W. BrundageKathleen I. W. Brundage

University at Buffalo, SUNYUniversity at Buffalo, SUNY



““Attachment and Attachment and separation are the heart separation are the heart of child welfare work”of child welfare work”

– Fahlberg (1991)Fahlberg (1991)



OverviewOverview

•Attachment ReviewAttachment Review•Separation: Emotional & Separation: Emotional &

Psychological EffectsPsychological Effects•Promoting Attachment in the Promoting Attachment in the

Foster HomeFoster Home•Current Research StudyCurrent Research Study



AttachmentAttachment



What is Attachment?What is Attachment?• The emotional bond that forms between a child The emotional bond that forms between a child

and his or her first primary caregiverand his or her first primary caregiver and sets and sets the stage for all of the child’s future the stage for all of the child’s future relationships and the ways in which the child relationships and the ways in which the child interacts with the world (Bowlby, 1988)interacts with the world (Bowlby, 1988)

• The capacity for emotional security, closeness, The capacity for emotional security, closeness, and autonomy which develops in response to a and autonomy which develops in response to a predictable pattern of warmth, sensitivity, predictable pattern of warmth, sensitivity, responsiveness, and dependability from a responsiveness, and dependability from a significant caregiver (Karen, 1994)significant caregiver (Karen, 1994)



The Attachment CycleThe Attachment Cycle• The child has a needThe child has a need• The child expresses The child expresses

the need by fussing, the need by fussing, crying, or otherwise crying, or otherwise ragingraging

• The need is gratified The need is gratified by a caregiver, who by a caregiver, who provides movement, provides movement, eye contact, speech, eye contact, speech, warmth, and/or warmth, and/or feedingfeeding

• This gratification This gratification leads to the leads to the development of the development of the child’s trust in otherschild’s trust in others

NEED

GRATIFICATION

TRUSTAROUSAL

(Rage/Fussing)



Secure Attachment Secure Attachment throughout the Lifespanthroughout the Lifespan

• Greater curiosity and persistence as a Greater curiosity and persistence as a toddlertoddler

• Positive peer relationships in preschoolersPositive peer relationships in preschoolers• Advanced cognitive functioning during Advanced cognitive functioning during

middle childhoodmiddle childhood• Development of a social conscience and Development of a social conscience and

positive self-concept in adolescencepositive self-concept in adolescence• Healthy, reciprocal relationships in Healthy, reciprocal relationships in

adulthoodadulthood

– Webster (1999); Allen & Ladd (1999); Feeney (2000)Webster (1999); Allen & Ladd (1999); Feeney (2000)



Secure AttachmentSecure Attachment• Emotional ResilienceEmotional Resilience• Adaptability to new situationsAdaptability to new situations• Self-reliance and feelings of self-worthSelf-reliance and feelings of self-worth• Ability to cope with stress and frustrationAbility to cope with stress and frustration• Flexible thinkingFlexible thinking• Ability to modulate emotionAbility to modulate emotion• Attain full intellectual potentialAttain full intellectual potential• Able to sort out perceptions and think Able to sort out perceptions and think

logicallylogically• Development of social emotions and able Development of social emotions and able

to trust othersto trust others• Conscience developmentConscience development

– Kagan (2004)Kagan (2004)



Attachment StylesAttachment Styles

•SecureSecure•InsecureInsecure

– Insecure-AvoidantInsecure-Avoidant– Insecure-AmbivalentInsecure-Ambivalent– Insecure-DisorganizedInsecure-Disorganized



Insecure AttachmentInsecure Attachment• AvoidantAvoidant

– Act distantAct distant

• AmbivalentAmbivalent– Constantly clamor for attention and Constantly clamor for attention and

nurturance, never comfortednurturance, never comforted

• DisorganizedDisorganized– Contradictory behavior with the Contradictory behavior with the

caretakercaretaker



School-Age and School-Age and AdolescenceAdolescence

• AvoidantAvoidant– Affective disorder Affective disorder

(depression)(depression)– Obsessive Obsessive

Compulsive Compulsive DisorderDisorder

– Histrionic, Histrionic, borderline, and borderline, and schizotypal schizotypal personality personality disordersdisorders

• AmbivalentAmbivalent– Conduct disorderConduct disorder– Substance abuseSubstance abuse– Narcissistic or Narcissistic or

antisocial antisocial personality personality disorderdisorder

• DisorganizedDisorganized– Aggression Aggression – Oppositional Oppositional

Defiant DisorderDefiant Disorder- Lyons-Ruth (1996); Rosenstein & Horowitz (1996)



Attachment Problems Attachment Problems Can Cause:Can Cause:• Problems with Emotional developmentProblems with Emotional development

• Problems with Psychosocial developmentProblems with Psychosocial development• Problems with Cognitive development, esp. Problems with Cognitive development, esp.

Language delaysLanguage delays• Motor delaysMotor delays• Physical health problemsPhysical health problems• Neurological problems Neurological problems • Growth delays Growth delays • Problems with Behavioral regulation (see Problems with Behavioral regulation (see

Handout 1)Handout 1)

– Carlson et al.(2003); Fahlberg (1991); Feeney (2000); Carlson et al.(2003); Fahlberg (1991); Feeney (2000); Leslie et al. (2002); Moss (2205); Schore (2001); Seigel Leslie et al. (2002); Moss (2205); Schore (2001); Seigel

(2001)(2001)



Attachment DisorderAttachment Disorder• A constellation of aberrant attachment A constellation of aberrant attachment

behaviors and other social behavioral behaviors and other social behavioral abnormalities resulting from “pathogenic abnormalities resulting from “pathogenic care” (APA, 2000, p 130)care” (APA, 2000, p 130)

• Affects children who have beenAffects children who have been– TraumatizedTraumatized– NeglectedNeglected– Parents suffering from depression, mental Parents suffering from depression, mental

illness, addictionsillness, addictions– Experienced physical, sexual, and/or emotional Experienced physical, sexual, and/or emotional

abuseabuse

– APA (2000); Keck & Kupecky (2002)APA (2000); Keck & Kupecky (2002)



……ADAD

• Two clinical patterns: Two clinical patterns:

1) Emotionally withdrawn/inhibited1) Emotionally withdrawn/inhibited

2) Indiscriminately 2) Indiscriminately social/disinhibitiedsocial/disinhibitied

• Have learned that the world is unsafe Have learned that the world is unsafe and have trouble trusting othersand have trouble trusting others

• Characteristics (see Handout 2)Characteristics (see Handout 2)

– APA (2000); Cline (1990); Keck & Kupecky (2002); Levy & APA (2000); Cline (1990); Keck & Kupecky (2002); Levy & Orlans (1998)Orlans (1998)



AD in AdolescenceAD in Adolescence• Oppositional Defiant DisorderOppositional Defiant Disorder• Attention Deficit Hyperactivity Disorder Attention Deficit Hyperactivity Disorder • Affective Disorders (Depression) Affective Disorders (Depression) • Serious criminal behaviorSerious criminal behavior• Hard drug use Hard drug use • Psychiatric disturbances in adulthoodPsychiatric disturbances in adulthood

– Greenberg (1999); Ladnier & Massanari (2000); Dozier et Greenberg (1999); Ladnier & Massanari (2000); Dozier et al. (1999)al. (1999)



Attachment and Foster Attachment and Foster ChildrenChildren

• Loss of primary caregiver Loss of primary caregiver • Often experience multiple placementsOften experience multiple placements• 70%+ are removed due to abuse and/or 70%+ are removed due to abuse and/or

neglect neglect • About half have disordered attachmentsAbout half have disordered attachments• Expectations & adaptive strategies Expectations & adaptive strategies

learned in original attachment learned in original attachment relationship are maladaptive in context of relationship are maladaptive in context of new relationships new relationships – CWLA (2002); Finzi et al. (2001); Newton et al. (2000)CWLA (2002); Finzi et al. (2001); Newton et al. (2000)



SeparationSeparation



What do Foster Children What do Foster Children lose?lose?

• Parents/Parents/caregiverscaregivers

• Siblings (in Siblings (in some situations) some situations)

• Grandparents, Grandparents, other relativesother relatives

• FriendsFriends• Pets Pets

• Home Home • Neighborhood & Neighborhood &

communitycommunity• BelongingsBelongings• Image of Image of

themselves and themselves and their familiestheir families



Emotional Response to Emotional Response to SeparationSeparation

• FearFear• HelplessnessHelplessness

• HorrorHorror• Sense of lossSense of loss• AngerAnger• SadnessSadness• GuiltGuilt• ConfusionConfusion• LonelinessLoneliness

TraumaTrauma

GriefGrief• See Handout 3See Handout 3

- - Chapman et al. (2004); Hughes (1997); Johnson et al. (1995); Chapman et al. (2004); Hughes (1997); Johnson et al. (1995); Kagan (2004); Kobak (1999); Mauk & Sharpnack, (1999); Waddell & Kagan (2004); Kobak (1999); Mauk & Sharpnack, (1999); Waddell & Thomas (1998)Thomas (1998)



Behavioral Responses Behavioral Responses to Separationto Separation

• Bullying and hostile behaviorBullying and hostile behavior• LyingLying• StealingStealing• Aggression toward peersAggression toward peers• Thoughts of suicideThoughts of suicide• Substance abuseSubstance abuse

–Delaney (1991); Hughes (1997); Newton et al. Delaney (1991); Hughes (1997); Newton et al. (2000); Penzerro & Lein (1995); Rosenstein & (2000); Penzerro & Lein (1995); Rosenstein &

Horowitz (1996) Sroufe et al. (2003)Horowitz (1996) Sroufe et al. (2003)



When Separation Trauma When Separation Trauma Remains Unresolved:Remains Unresolved:

• Disproportionately high involvement Disproportionately high involvement in mental health, juvenile justice, and in mental health, juvenile justice, and adult criminal justice systemsadult criminal justice systems

• Difficulty in future relationshipsDifficulty in future relationships

– Delaney (1991); Hughes (1997); Newton et al. (2000); Delaney (1991); Hughes (1997); Newton et al. (2000); Penzerro & Lein (1995); Rosenstein & Horowitz (1996) Penzerro & Lein (1995); Rosenstein & Horowitz (1996) Sroufe et al. (2003)Sroufe et al. (2003)



Factors Affecting the Factors Affecting the Severity of a Child’s Severity of a Child’s

Reaction to SeparationReaction to Separation

• Child’s age and stage of Child’s age and stage of developmentdevelopment

• Significance of the lost person(s)Significance of the lost person(s)• Past experiences with separationPast experiences with separation• Child's perceptions of the reason Child's perceptions of the reason

for separationfor separation• Length of the separationLength of the separation



Factors Affecting the Factors Affecting the Severity of a Child’s Severity of a Child’s

Reaction to SeparationReaction to Separation• Child’s behavior and temperamentChild’s behavior and temperament• Preparation for the movePreparation for the move• Post-separation environment, Post-separation environment,

including caregiver state of mindincluding caregiver state of mind

– Barber (2001); Barber & Delfabbro (2003); Bernier & Barber (2001); Barber & Delfabbro (2003); Bernier & Dozier (2003); Chapman et al. (Dozier (2003); Chapman et al. (2004); 2004); Cournos (2002);Cournos (2002);

Fahlberg (1991); Heinicke & Westheimer (1966); Mauk & Fahlberg (1991); Heinicke & Westheimer (1966); Mauk & Sharpnack (1999); McFadden (1992); Newton et al. (2000); Sharpnack (1999); McFadden (1992); Newton et al. (2000);

Penzerro & Lein (1995); Redding et al. (2000); Rycus & Penzerro & Lein (1995); Redding et al. (2000); Rycus & Hughes (1998).Hughes (1998).



Promoting Attachment Promoting Attachment in the Foster Homein the Foster Home



Child Barriers to Child Barriers to AttachmentAttachment

• Prior relationship disruptions give a sense of Prior relationship disruptions give a sense of relationships as inconsistent and relationships as inconsistent and undependableundependable

• Disturbed expectations about relationshipsDisturbed expectations about relationships• Disturbances in interpersonal relatednessDisturbances in interpersonal relatedness• Developmental delays (esp. speech and Developmental delays (esp. speech and

language)language)• Behavior problemsBehavior problems• Disturbances in sense of selfDisturbances in sense of self• Emotion regulation problemsEmotion regulation problems

– Zeanah & Smyke (2005)Zeanah & Smyke (2005)



Foster Parent Barriers to Foster Parent Barriers to AttachmentAttachment

• Trained in previous era when foster Trained in previous era when foster parents were told not to “get too parents were told not to “get too attached” attached”

• The child is not raised by the foster The child is not raised by the foster parent from birthparent from birth

• Misrepresentation of child’s needs and Misrepresentation of child’s needs and experienceexperience– Viewing child as “damaged goods”Viewing child as “damaged goods”– Believe the child “merely” needs structure and Believe the child “merely” needs structure and

affectionaffection



……Foster Parent BarriersFoster Parent Barriers

• Stepping around/covering up the Stepping around/covering up the child’s traumatic history and painful child’s traumatic history and painful feelingsfeelings

• Foster parent’s unresolved lossesFoster parent’s unresolved losses• Insecure attachment style of foster Insecure attachment style of foster

parentparent

– Bernier & Dozier (2003); Dozier et al. (2001); Zeanah & Bernier & Dozier (2003); Dozier et al. (2001); Zeanah & Smyke (2005)Smyke (2005)



• Adults who care for needy children Adults who care for needy children are often those who have are often those who have experienced childhood trauma experienced childhood trauma themselvesthemselves

– Cournos (2002); Redding et al. (2000)Cournos (2002); Redding et al. (2000)



Foster Parent Foster Parent Attachment StylesAttachment Styles

Foster ParentFoster Parent Adult Adult PopulationPopulation Population at Population at

largelarge

SecureSecure 32%32% 70%70%

InsecureInsecure 68%68% 30%30%

– Steele et al. (2003)Steele et al. (2003)



The Issue of Foster Parent The Issue of Foster Parent AttachmentAttachment

• Foster parent state of mind with regard Foster parent state of mind with regard to attachment is a stronger predictor of to attachment is a stronger predictor of infant attachment than age at placement, infant attachment than age at placement, and may mediate the effects of and may mediate the effects of abuse/neglect history.abuse/neglect history.

– Children under 2 y/o, 3 months after Children under 2 y/o, 3 months after placement:placement:•Secure foster parent – 79% secure foster Secure foster parent – 79% secure foster

childrenchildren•Insecure foster parent – 37% secure foster Insecure foster parent – 37% secure foster

childrenchildren

– Dozier et al. (2001)Dozier et al. (2001)



Insecure AttachmentInsecure Attachment• Caregivers with insecure attachment Caregivers with insecure attachment

styles tend to step around the child’s styles tend to step around the child’s traumatrauma

• They tend to distance themselves They tend to distance themselves from troubling emotionsfrom troubling emotions

– Steele, Kaniuk, Hodges, Haworth, & Huss (2003)Steele, Kaniuk, Hodges, Haworth, & Huss (2003)



Secure Foster Parent Secure Foster Parent AttachmentAttachment

• More accurate interpretation of child’s More accurate interpretation of child’s behavior (recognize anger and despair behavior (recognize anger and despair underlying acting out behavior)underlying acting out behavior)

• Accurate understanding of child’s Accurate understanding of child’s developmental level (important for developmental level (important for attunement to child’s needs)attunement to child’s needs)

• Better foster parent-foster child Better foster parent-foster child bondingbonding

– Bernier & Dozier (2003)Bernier & Dozier (2003)



Training is KeyTraining is Key• Foster parents need to understand:Foster parents need to understand:

– The developmental status of the child The developmental status of the child (Handout 4)(Handout 4)

– The child’s particular backgroundThe child’s particular background•PersonalityPersonality•Attachment historyAttachment history•Thoughts & feelings about the familyThoughts & feelings about the family

– Bernier & Dozier (2003); Mennen & O’Keefe (2004); Rycus Bernier & Dozier (2003); Mennen & O’Keefe (2004); Rycus & Hughes (1998)& Hughes (1998)



……Training & SupportTraining & Support

• Foster parents benefit from training in Foster parents benefit from training in recognizing what young foster children recognizing what young foster children actually need, not necessarily what they actually need, not necessarily what they signal that they need signal that they need – Children placed later than 12 months old Children placed later than 12 months old

typically display behaviors of insecure typically display behaviors of insecure attachment stylesattachment styles

– Foster mothers tend to respond “in kind”Foster mothers tend to respond “in kind”– ““Powerfully self-perpetuating cycle”Powerfully self-perpetuating cycle”

– Dozier et al (2002); Stovall & Dozier (2000); Mennen & Dozier et al (2002); Stovall & Dozier (2000); Mennen & O’Keefe (2005); Zeanah & Smyke (2005)O’Keefe (2005); Zeanah & Smyke (2005)



……Training & SupportTraining & Support• Assessments of foster child Assessments of foster child

attachmentattachment• Regular phone contact with support Regular phone contact with support

teams (Child Welfare Workers)teams (Child Welfare Workers)• Support GroupsSupport Groups• Regularly scheduled foster parent Regularly scheduled foster parent

training sessions (child development, training sessions (child development, attachment, behavior modification)attachment, behavior modification)Significant decrease in child behavior Significant decrease in child behavior

problems (even for children with AD)problems (even for children with AD)– Mennan & O’keefe (2005); Zeanah & Smyke (2005)Mennan & O’keefe (2005); Zeanah & Smyke (2005)



……Training and SupportTraining and Support• Supporting collaborative relationships Supporting collaborative relationships

between foster parents and social workers between foster parents and social workers promotes foster parent self-efficacy and promotes foster parent self-efficacy and removes barriers to attachmentremoves barriers to attachment– Foster parents should be valued for their ability to Foster parents should be valued for their ability to

provide input regarding child developmentprovide input regarding child development

• Social workers should be encouraged to Social workers should be encouraged to provide foster parents with needed info but provide foster parents with needed info but also to be open to foster parent inputalso to be open to foster parent input

– Mennan & O’Keefe (2005); Zeanah & Smyke (2005)Mennan & O’Keefe (2005); Zeanah & Smyke (2005)



Current StudyCurrent Study

Needs Assessment for Needs Assessment for Reducing Separation Reducing Separation

Trauma: Trauma: Foster Child & Foster Parent Foster Child & Foster Parent Attachment and Preparation for Attachment and Preparation for

PlacementPlacement



Preparation for PlacementPreparation for Placement– History of abuse or History of abuse or

neglectneglect– Developmental level Developmental level

(especially (especially communication level) communication level)

– Habits and Habits and preferences for things preferences for things like eating, sleeping, like eating, sleeping, and bathingand bathing

– Medical needsMedical needs– Interests and skillsInterests and skills– Behavior problemsBehavior problems– Fears and anxieties Fears and anxieties

and how the child and how the child typically expresses typically expresses those and is those and is accustomed to being accustomed to being comforted comforted

Do foster parent and social worker reports agree? Do foster parent and social worker reports agree?

Do foster parents need more preparatory support?Do foster parents need more preparatory support?



Child’s Behavior & Child’s Behavior & TemperamentTemperament

• Attachment Disorder ChecklistAttachment Disorder Checklist (Becker-(Becker-Weidman, 2001)Weidman, 2001)– 50% of foster children nation-wide present clinically 50% of foster children nation-wide present clinically

significant symptoms of ADsignificant symptoms of AD– Many foster parents are under-trained to recognize Many foster parents are under-trained to recognize

possible signs of ADpossible signs of AD

Foster Parent and Child Welfare Staff reports of Foster Parent and Child Welfare Staff reports of child behavior to i.d. whether symptoms of AD are child behavior to i.d. whether symptoms of AD are recognized at the rate specified in the research recognized at the rate specified in the research literatureliterature

Implications for future research: may add to limited Implications for future research: may add to limited body of knowledge on school-age and adolescent body of knowledge on school-age and adolescent foster child attachmentfoster child attachment



Foster Parent State of Mind Foster Parent State of Mind with Regard to Attachmentwith Regard to Attachment

• Foster Parent self-report assessment of Foster Parent self-report assessment of attachment styleattachment style

• Child Welfare Worker observations of Child Welfare Worker observations of foster parent attachment behaviorsfoster parent attachment behaviors

Does self-reported attachment style agree with Does self-reported attachment style agree with social worker reports of attachment behavior? social worker reports of attachment behavior?

Need for education about attachment-Need for education about attachment-promoting attachment behaviors?promoting attachment behaviors?



Research QuestionsResearch QuestionsOverall, do foster parent and child Overall, do foster parent and child

welfare worker reports agree?welfare worker reports agree?Are there relationships between Are there relationships between

preparation for placement and preparation for placement and foster child behavior/foster parent foster child behavior/foster parent attachment?attachment?

Is there a relationship between Is there a relationship between foster child attachment behavior foster child attachment behavior and foster parent attachment style?and foster parent attachment style?



Thank you.Thank you.

Questions?Questions?



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