Creating a Family: Talk about Adoption & Foster Care

Evaluating Risk Factors in Foster Care

January 22, 2021 Creating a Family Season 15 Episode 4
Creating a Family: Talk about Adoption & Foster Care
Evaluating Risk Factors in Foster Care
Chapters
Creating a Family: Talk about Adoption & Foster Care
Evaluating Risk Factors in Foster Care
Jan 22, 2021 Season 15 Episode 4
Creating a Family

We talk about evaluating the risk factors for foster care with Dr. Kimara Gustafson, an Assistant Professor in the Department of Pediatrics at the University of Minnesota with appointments at both their Adoption Medicine Clinic and Pediatric Emergency Department.

In this episode, we cover:

  • The common risk factor that foster parents and those wanting to adopt from foster care need to be aware of include physical, emotional, developmental, educational, and behavioral problems rooted in childhood adversity and trauma.
  • What types of trauma are foster kids exposed to? Neglect, abuse, prenatal exposure, multiple caregivers, not having a reliable caregiver, constant stress 
  • What percentage of children in foster care have been exposed to drugs or alcohol prenatally? 
  • Impact of trauma on physical health. 
  •  Foster parents often have little information about prior health history. 
  • Overmedication of foster children and youth. 
  • Research has found that the average number of psychiatric diagnoses and psychotropic medications prescribed were significantly greater for youth and children in foster care. o Children in foster care are likely to be kept on them longer than other Medicaid-enrolled children who are not in foster care. 
  • What are psychotropic drugs and why are so many foster children on them? 
  • Who has authority to make health care decisions for foster children and youth? 
  • Impact of trauma on mental health. 
  • hyperactivity, inattention, and impulsivity. 
  •  What types of behaviors are common as a result of trauma? 
  • Sleep issues common to children in foster care. 
  • Food issues common to children in foster care. Creating a Family course: Practical Solutions to Typical Food Issues 
  •  Impact of trauma on a foster child’s education. 
  • Children in foster care need educational advocates. 
  • Risk factors to consider for children already in the home. Creating a Family course: The Impact of Fostering on Children Already in the Home 
  •  Children can heal and foster parents can and do make a difference! 

This podcast is produced  by www.CreatingaFamily.org. We are a national non-profit with the mission to strengthen and inspire adoptive, foster & kinship parents and the professionals who support them. Creating a Family brings you the following trauma-informed, expert-based content:
·         Weekly podcasts
·         Weekly articles/blog posts
·        Resource pages on all aspects of family building

Creating a Family also has an active presence on many social media platforms. Please like or follow us on Twitter, Facebook, LinkedIn, Pinterest, and Instagram

Support the show (https://creatingafamily.org/donation/)

Show Notes Transcript

We talk about evaluating the risk factors for foster care with Dr. Kimara Gustafson, an Assistant Professor in the Department of Pediatrics at the University of Minnesota with appointments at both their Adoption Medicine Clinic and Pediatric Emergency Department.

In this episode, we cover:

  • The common risk factor that foster parents and those wanting to adopt from foster care need to be aware of include physical, emotional, developmental, educational, and behavioral problems rooted in childhood adversity and trauma.
  • What types of trauma are foster kids exposed to? Neglect, abuse, prenatal exposure, multiple caregivers, not having a reliable caregiver, constant stress 
  • What percentage of children in foster care have been exposed to drugs or alcohol prenatally? 
  • Impact of trauma on physical health. 
  •  Foster parents often have little information about prior health history. 
  • Overmedication of foster children and youth. 
  • Research has found that the average number of psychiatric diagnoses and psychotropic medications prescribed were significantly greater for youth and children in foster care. o Children in foster care are likely to be kept on them longer than other Medicaid-enrolled children who are not in foster care. 
  • What are psychotropic drugs and why are so many foster children on them? 
  • Who has authority to make health care decisions for foster children and youth? 
  • Impact of trauma on mental health. 
  • hyperactivity, inattention, and impulsivity. 
  •  What types of behaviors are common as a result of trauma? 
  • Sleep issues common to children in foster care. 
  • Food issues common to children in foster care. Creating a Family course: Practical Solutions to Typical Food Issues 
  •  Impact of trauma on a foster child’s education. 
  • Children in foster care need educational advocates. 
  • Risk factors to consider for children already in the home. Creating a Family course: The Impact of Fostering on Children Already in the Home 
  •  Children can heal and foster parents can and do make a difference! 

This podcast is produced  by www.CreatingaFamily.org. We are a national non-profit with the mission to strengthen and inspire adoptive, foster & kinship parents and the professionals who support them. Creating a Family brings you the following trauma-informed, expert-based content:
·         Weekly podcasts
·         Weekly articles/blog posts
·        Resource pages on all aspects of family building

Creating a Family also has an active presence on many social media platforms. Please like or follow us on Twitter, Facebook, LinkedIn, Pinterest, and Instagram

Support the show (https://creatingafamily.org/donation/)

0:01  
Welcome, everyone to Creating a Family Talk about Adoption and Foster Care. I'm Dawn Davenport. I'm the host, and director of creating a family. We are a nonprofit, and you can get more information about us at creating a family.org. Today, we're going to be talking about the risk factors in foster care and how potential foster parents can evaluate these risk factors. We will be talking with Dr. Kumar Gustafson. She is an assistant professor in the Department of Pediatrics at the University of Minnesota with appointments at both their adoption medicine clinic, as well as their pediatric emergency department. Welcome, Dr. Gustafson to creating a family, we are so happy to have you here to talk about this topic, which is we we have topics on we've talked about evaluating risk factors in all types of adoption. And so we wanted to make certain we also talked about it in foster care. So welcome.

0:56  
Yeah, thank you so much for having me.

0:59  
So the common risk factors that foster parents and those wanting to adopt from foster care need to be aware of include things like physical, emotional, developmental, educational, and behavioral problems that are rooted in childhood adversity and trauma. So let's start by talking about what types of trauma our foster kids exposed to.

1:21  
Yeah, I think that oftentimes, when we see kind of kids that are taking into the child welfare system, in the media, where we hear about the stories of where there's more kind of active trauma that's been committed, you know, physical abuse, or sexual abuse, and, and for sure, we do see kids that have experienced that, unfortunately. But I think by and large, the majority of kids that come into the system, usually, it's more likely due to kind of what I call passive abuse in the sense of neglect, that there are factors that are going on within the homeschooling thing or within the care setting, that, unfortunately, have led to a point that it's unsafe for the child to be in that setting because of neglect, and they're not being cared for, or that they're, you know, not able to get adequate nutrition.

2:19  
Okay, so it's passive abuse in the sense that it's neglect. Also, I would assume that prenatal exposure as well as parental substance abuse is also not uncommon.

2:32  
Correct? Yeah. And we're definitely seeing increased rates. You know, we don't necessarily know that if a parent is actively using that there for sure was, confirmed prenatal exposure, though, there's, you know, kind of a strong relationship between those two, but we are seeing with especially the rise of opioids, and with methamphetamine, that there's much are increasing rates of parental substance abuse is kind of maybe one of the major contributing factors for neglect, you know, the parents are struggling with their own addiction, and are altered. And so therefore, you know, that it sometimes not uncommonly, we see where it flips where the child just out of necessity sort of becomes the caretaker for the parent, if the parent is, you know, high or kind of, there's been repeated, you know, episodes of overdose.

3:31  
And they're just simply, because of their addiction just simply aren't able to parent they are not, as you saying, they're not playing, they're not fulfilling the role of parent, they're not providing food and care, getting kids to school and things such as that, because they're, their lives are consumed. Do you have a I've, I've heard varying percentages, but the percentage of children in foster care that had been exposed to drugs or alcohol prenatally?

3:57  
Oh, you know, I think that the numbers would say probably about 60%. But we think that that's probably an underestimation, especially when it comes to alcohol. We, for alcohol, there's no, you know, blood tests or lab tests that can be done to definitively confirm that there is exposure. So we kind of use secondary data, you know, so either that they're self report by the caregiver, that they, you know, did use alcohol at some point during the pregnancy or kind of early childhood. And if that's not available, then we'll use, you know, kind of close contact reporting. So if there's another family member, that was the witnesses the use, and then kind of it goes, it spirals out from there. So if we see you know, that there's a pattern behavior, there's multiple DUIs or history of arrests, you know, what intoxicated or that they've been in and out of rehab facilities, for some of the other substances, we do have, you know, blood tests, you know, or, or other kind of ways to confirm by lab. But again, I always kind of counsel families, it's a, it's a point in time. And so if the, if the result is negative, we can't say that definitively that it's been negative for that full course of the pregnancy, we can only say that it was negative at the time of the testing.

5:32  
And I think a lot of people don't realize that, that I can't tell you the number of parents that I hear say, Well, he wasn't born dependent. He wasn't didn't have neonatal abstinence syndrome, or he didn't have to go through withdrawal. Therefore, he wasn't exposed. But that really isn't what that says, All that says, is that the X number of weeks prior to delivery prior to birth, was he not exposed?

6:00  
Correct? Yeah. And what I usually try to kind of stress to families is, you know, by and large, that pregnancies were not necessarily planned. And, you know, and so, there's nine months is a long time, and, you know, kind of within our society that there's, you know, a lot higher potential that the pregnancy is unknown, you know, for maybe the first half, or kind of a good chunk of that time. And so I always kind of say that it's not necessarily that the biological mother has the intent to, you know, kind of expose the baby to certain substances, but it could just be that she didn't know, you know, that she was pregnant. And, and so yes, maybe the benefit of you know, that once she knows that, she's able to kind of make some changes, or, you know, get help, in terms of support, and so that maybe the later part of the pregnancy, there's less exposure, but there's still that potential that there's exposure in the early part. And then the other thing I say, that, you know, is that, you know, kind of society, there's a huge stigma around exposure, and, you know, no one wants to kind of be, it's already, this relationship is already somewhat kind of fragile or delicate. Because, you know, we're in a position where potentially there's a, you know, a biological mother that is going to be the infant is going to be transferred to another family, or you know, that they're worried that child welfare will get involved, because there's other, you know, instances where, where that has happened in the past. And so again, you know, there's no test that we can say definitively, and I was actually just, you know, reading this article about human behavior, seeing that we expect to some degree, just in general, you know, when there's something that we're being told we shouldn't do, and we're not doing it, you know, that everyone will lie, we, that social social psychologists expect that. And so definitely, when we have something that has such a stigma attached to it, then we have to kind of take that into account, too, that, you know, they're they might feel like there's, you know, even more consequences if they kind of fully admit to the exposure.

8:28  
And there are, and it not only is their societal judgement, but there's also the very risk, or they wouldn't be in the situation of having their children removed. So there's a, there's a huge interest for, for dishonesty that you can understand. We've been, we hear a lot about the it's in the news, a lot of adverse childhood experiences, otherwise called aces. And that's really the impact of trauma on physical health. And a lot of what aces did was the impact on for aces and the study of aces, and that that's been reported, is the impact of childhood trauma, on health in adulthood, but it would also impact children's health, in childhood or health of children in childhood as well. So what are some of the physical health impacts that foster children have are more at risk for because they have been exposed to trauma, be it active trauma, or passive trauma through neglect? Yeah,

9:31  
well, we think that, you know, any sort of severe trauma, especially when it's sustained over a long period of time, then what is is the study kind of helped us to know is that it starts to change how the body actually functions. So what that means is that if there's trauma that or if a child experiences and is at a very, very early age, you know from infancy, or potentially even prenatally that it actually will impact kind of changing of how their brain functions and their brain development. And so that, you know, even if that kind of trauma or the aces are resolved in a way, by changing the environment that that child is in, we aren't able to kind of undo the the rewiring, essentially, of their brain function. And then similarly, you know, that the ACE study that was looking at adults and kind of looking retrospectively at the, the adverse childhood experiences that they had, and correlating it to their health versus adults to showing that even if you kind of remove that, those aces from their life, and when they get to adulthood, and they're supposedly, you know, doing all the right things, doing all that kind of healthy things, they're still going to be at higher risk for certain things like heart disease and strokes and blood pressure, compared to a peer that doesn't have the same eases, you know, that they experienced, they were a child.

11:19  
Mm hmm. And actually takes statistically significant number of years off of your life. And it's, it's directly correlated to each of your adverse childhood experiences. So it's a, it's real, and we it takes a toll, obviously, on their emotional health, but their physical health as well. And I think it's important to note that the reality is for most foster parents is that they often have very little information about the child's prior health history. Sometimes you do sometimes because the child has been taken to a pediatrician and you can go to the air, the caseworkers go to the pediatrician and get the information. But oftentimes, the child shows up and you don't have any information about their prior health history. And

12:06  
oftentimes, depending on the state, you know, and kind of the, the way that the confidentiality kind of laws are applied that for foster parents, specifically, they're going to be the ones that have the least amount of information, depending on the status of the child, because if they are not yet eligible for adoption, or if the plan is that it's a temporary Foster, and you know that there, there's hope, for reunification or for maybe, that they're going to join extended family through kinship care, then, usually, and again, it kind of varies state by state, but usually, the foster parent will be able to participate in ongoing or, you know, kind of future medical appointments, but they don't necessarily have access to that past medical, so birth record, or previous, you know, clinic visits or hospitalizations, or ER visits. And so sometimes now, especially with kind of the increase of electronic medical records and kind of medical record sharing, that we see within systems, sometimes the medical professional might be kind of in a unique and delicate position, because they actually can see records that the foster parent can't, isn't supposed to have access to. And so has to kind of be, you know, do a little bit of a dance in terms of not accidentally disclosing information that needs to remain confidential.

13:44  
But for find enough information so that the foster parents can be the best parents possible for this. And then

13:51  
also, I think, I usually encourage that if a foster parent or foster family is in the situation where you know, they're doing a foster to adopt and then they're able to adopt a child or, or children, just to kind of a gentle reminder that at that point, oftentimes, they're able to access the past medical records, they might need to be still redacted to, you know, protect other kind of extended family if there's sensitive information, but at a minimum, you know, they can they can access their own child's records, but then sometimes that can be kind of a process as well because they have to track down different hospitals and different health systems to do it.

14:43  
Okay, I want to talk now about the Obama already making a judgment when I say it, but overmedication of foster children and youth. There is research that has found that the average number of psychiatric diagnoses as well as psychotropic medications prescribed To foster kids were significantly greater for youth and children in foster care. And children in foster care are also more likely to be kept on these drugs longer than other Medicaid enrolled children who are not in foster care. So it's not at all uncommon for your foster child to arrive with a Ziploc full of caps and medication. Fortunately, it is going to have prescription information on the on the bottle. But let's start by talking about what are psychotropic drugs? And And quite frankly, why are so many foster children on them?

15:39  
Yeah, so I think you're absolutely right, that there's you know, higher rates of medication, and they think people within, you know, kind of the foster community do feel like it's, it's probably over medication. When I talk to families, I think that what I try to go back to is that we need to start from a point of, you know, that's child centered, and thinking about, kind of, what behavior is this child exhibiting, and I always kind of think that the behavior is the child's attempt at communication. And so if they're behaving in a certain way, that is maybe kind of undesired or negative, and we're trying to modify it, and we try to use medication to modify it, we're still we still don't really know what they're trying to communicate with us. And some of these children are quite young, or they might have other delays, that kind of impede their means of communication. And so the way they tell families is that, oftentimes, it's maybe gonna take the edge off a little bit, but it's still not kind of getting to the root cause. And so that's where also I think there's a lot of discussion within the foster community. But also, I think, fortunately, a lot of discussion just in the broader kind of community that works with children in the concept of trauma based or trauma focused care. And so, you know, in a school setting, or in a group care setting, you know, trying to look at, well, what is this behavior that this child is exhibiting if they're having tantrums, or they're being aggressive? Or they're acting out in some way, instead of just saying, Well, you know, we can't tolerate that here in a unique kind of shape up or, or face the consequences, like trying to dig a little bit and figure out well, what is it that they're reacting to, maybe they're overstimulated, or that there's some kind of trauma trigger that we don't know about, you know, that has to do with the eating or, you know, kind of their relationship to food or to sleep. And if we can try to figure that out a little bit might result in better kind of outcome than then the use of, of a medication to just quote unquote, control them. You know, and foster parents

18:18  
are often in a difficult position, because the child is is on these medications, and they don't know what what what events are, what symptom that was happening that the child was prescribed. And while they want to get to the root cause most foster parents do understand the impact of trauma. Sometimes the psychotropic medication itself, is is helping to obscure what some of those problems are. So but but the foster parent is what Let me ask who has the authority to make healthcare decisions for a foster child, so usually,

18:57  
the it would be, you know, whoever would be their legal guardian, so oftentimes, it would be kind of their social worker, their case manager. And so when we see families that are coming to the clinic that have just been placed, you know, it's within a couple weeks or months of placement, I recommend we don't make drastic medication changes, because like you said, we don't have information to know kind of how it was started, or why it was started, you know, through the case manager, oftentimes, we can access some of the previous records, like you said that they typically will come with medication that has the prescribing information, including, you know, who was prescribing provider, you know, if it's a doctor or nurse practitioner, so we can try to get the records to say, you know, okay, what was their thought process in terms of, you know, starting this child on this medication? And then, you know, I know that the people are eager to get them off, but I think oftentimes you say, well, let Kind of just start attending to some of the other things in terms of, you know, providing a safe and secure environment and some consistency and, and see what some of the non medication kind of interventions result in. And then if we're seeing that, you know, improvement, which oftentimes we do with their behavior, then we can start to peel back and say, you know, do they really need all of these meds or, you know, let's, let's see what happens if we kind of stop each one. But what's hard is if you tried to do you know, cold turkey, and you stop all of them, you know, that's not recommended as well, because some of them you need to kind of wean off or you could have some exaggerated effects. And so, so we have to be somewhat methodical about it, when we're trying to figure out what's needed and what's not.

20:52  
The foster parent can be an advocate, but the ultimate decision is very often not theirs. And so they can be an advocate working through the child's caseworker and through through the medical professional, but they really have to rely on the medical professional and the foster care and caseworkers decision, and sometimes, particularly if reunification is nearing the the biological parents are also involved in the decision. Yeah, yeah. Okay. I think that's from I, we talked with a lot of foster parents and that sometimes frustrating, but number one, we're not medical professionals. So we don't know what is safe to take somebody off of. That's number one. And number two, we don't have the authority to do that. So we have to be, we have to work. We can be an advocate. But we have to work through the who is the legal guardian, which as you point out is, is the state. Big news everyone, the jockey being Family Foundation has provided us with scholarships for free access to five of our most popular courses, you can find these courses and the coupon code at the website Bitly slash j b f support that is Bitly bi T dot L y slash all cap j, b, f, then cap s for support. So j BF s, that's all capitalized, and you PP o RT. Again, the coupon code to get to these courses free is going to be on that page as well. And the courses are raising resilient kids with Dr. Ken Ginsberg raising a child with ADHD to a successful and healthy adulthood with Dr. Ned Halliwell, addicted unexpected stresses for newly adoptive parents practical solutions to typical food issues with Dr. Katya Rao and parenting children who have experienced trauma with Karen Buckwalter. Make sure you go to the Bitly slash j. b. f support to get information on these courses. Alright, so we've talked a little about the impact of trauma on physical health. And I think I think that was new information along well wait a when a study came out what many years ago, that was new information that that there was long term physical health impacts from childhood trauma. But what isn't new information is the impact of trauma on mental health. I think most of us just assume that trauma does impact a child's and then later on into adulthood. So let's talk about the impact of trauma on mental health. What are and I'd like to start by actually talking about the brain. Because I think that trauma there is research indicates that trauma can actually shift the way that actually we could look at a brain of a child or an adult who has experienced significant trauma, and that brain will look different. So what are some ways that trauma impacts the brain?

24:10  
Yeah, so in in some of the studies that we've seen, you know, there is a recently there was a large study in The Lancet, about the Bucharest study. So children that were in an orphanage setting, they were severely deprived, neglected. And it caused all kinds of kind of negative outcomes for children. And one of the things that, you know, to, to the degree, we think that there's malnutrition in terms of lack of nutrition, that can cause problems with growth, but just the impact we know of trauma, and kind of, to the severe trauma to the brain can cause the brain to not grow. And so that, you know, kind of the extreme and we see that That their brain is just, you know, not getting bigger, and it couldn't cause their kind of head to be a smaller size. And, but, you know, the what I think sometimes can be confusing or, you know, frustrating for families is that we can still see kids that are very kind of, quote unquote, typical appearing, you know, their growth is average, their, you know, head size is average, even if we were to do imaging of their head, the anatomy of it is, doesn't look abnormal. But the what I recommend, and I lean very heavily on my colleagues in neuro psychology for is when we look at kind of cognitive functioning of that child, that their, their brain functions different than kind of maybe a brain that hasn't experienced trauma. And so that can be very difficult for the child and then difficult for, you know, the kind of the care network that's around that child, because since they don't look different, you know, they don't have a physical disability or have a visible syndrome, you know, such as maybe Down syndrome, the expectation that they're going to function is that of a typical child. And so, but oftentimes, we find that they're not, and so it's that it's that difference in kind of their, their ability to meet expectations and the expectations that are being asked of them, that can cause the majority of the friction. And then, you know, the these children, oftentimes, they know, they're, they're not, you know, kind of, quote, unquote, delayed in the sense that, it's just that I say that they're kind of functioning in a, in a different capacity, but they know enough to know that they're not meeting the expectations of those around them. And so then that, you know, if you think about how frustrating it is to try to do something, and you can't achieve it, well, that's kind of what's going on continually. So that's where I see it's a secondary,

27:22  
it is another form of trauma, you know, constantly failing, and knowing you're failing, even though you're trying,

27:31  
I mean, there are some of these kids, you know, they're trying, you know, 150, or 200%, of, of their effort. And so. So that's where I think the kind of the sequelae, or the resulting, you know, mental health, you know, we see increased risk rates of anxiety and depression, and kind of the either internal or external kind of focusing of, you know, negative emotions and thoughts. But my hope is that if we can kind of better identify some of these gaps and support them as kind of the adults around, and we can decrease that, you know, frustration, or that secondary trauma, like you talked about, it's not kind of a, it's not given, you know, that they're going to have to struggle with these things. Because we can then, you know, positively reinforced and say, Look at how capable you are, and look at how much potential you have, and you're so successful and, and there's all these areas of strings that you have, and really building that up instead of kind of either intentionally or unintentionally reinforcing kind of the negative.

28:48  
Exactly. So let's talk about some of the behaviors that are common as a result of trauma, early childhood adversity, neglect, and toxic stress. That's another one, you know, it's living in an environment that is chaotic, especially for a child. So what are some of the behaviors that we might say you've mentioned one, and that is increased anxiety and increased pressure? That's too increased anxiety and increased depression. So and just in general, poor emotional regulation? I think that that's probably a common thing that you would see with foster children.

29:24  
Yeah, for sure. And I think it's somewhat depends on the age as a foster child, but for younger children, oftentimes, even things like anxiety, depression, tend to come out as more physical symptoms. They don't necessarily have the language or the understanding of what you know, anxiety means to them, but they, they know what it feels like. And they know that it feels like you know, my heart, my kind of my chest hurts or I can't breathe, or I have this funny butterfly feeling in my stomach, or My head hurts. And so there's, they oftentimes have a lot of these kind of what we call it vague symptoms where it's hard to kind of point to what it is, and you have to be a little bit of a detective because, you know, there's other things like if they have trauma around toilet training, you know, and they have resulting constipation or kind of anxiety related to going to the bathroom that could be kind of separate from or in addition to just their generalized anxiety. But that's, you know, one thing that we can see where they have kind of a lot of these kind of nonspecific, you know, kind of aches and pain type of symptoms. Another one, as they start to get older, you know, like you said that they have difficulty with emotional regulation, oftentimes, the way that I think of it is not in, not across the board maturity level, but in an emotional regulation, maturity level, that even if there may be 910 11, they're still reacting to things as if they're two or three. And so that, you know, their ability to self de escalate, if they get upset, or, you know, to be able to kind of see the situation from multiple angles, that it's not necessarily there, because they're still kind of viewing the world, you know, from that toddler's perspective. You know, like, I was just, I have young children, and my youngest is almost two and you know, yesterday I was fighting with him or not fighting, but he was he was demanding water. And I said, you have water? He says, knowing what more water and you have what you know, and so that it's Yes, Yes, I

31:41  
do.

31:42  
And so I think as a parent like it too, we can we can step back and say, okay, you know, this is supposed to be this is age appropriate. This is this is kind of where they are cognitively, it's a lot harder. And I you know, I say oftentimes I see the families really is Do as I say, not as I do, and I and I empathize, that it's so hard when you're staring at your 12 year old. And you're still having that you have water, no, I want water kind of come, you know, conversation or, or Yes. Because in the heat of the moment, you're like, Oh, my gosh, you know, why are we fighting about this? But if you're able to kind of give yourself a little bit of a timeout or a break or you know, and be like, Okay, well what, you know what led up to this, oftentimes we can say okay, well, they, you know, they didn't get enough sleep, or I'm pushing them too much, or, you know, something happened at school, and it's kind of just pushing them to go down the tantrum pathway.

32:42  
Yeah, some of the what we assume is the logical response, we don't get in when it's there to doing it, it seems, even if annoying, but still cute. But when they're 12 behaving what feels like the same way. It's both scary and very frustrating. From a parent's standpoint,

33:03  
I think that for the older kids, especially when they've been in foster care, until an older age, or if, you know, they've coming into foster care and older age, the one thing that I tell families, the, you know, that your, your level of maturity is, is not necessarily consistent, like what we might expect of another child. And so in some ways, it can also be difficult for the caregiver, because in some ways, they can be very high functioning. But that was high functioning out of necessity, they had to be the parent or the caregiver in certain ways. You know, we've we've had foster children, that they're the interface with their school because their their caregiver, or their parents is, you know, is kind of saw neglectful or is struggling with their own that they're not able to assign the permission slips or, you know, kind of make sure so, and especially if they're an older sibling, they're having, you know, we've seen siblings as young as two, that out of necessity have cared for infant siblings.

34:15  
Mm hmm. The term we use for that is a perintah FIDE, yeah, child is taking over the role of a parent. And oftentimes, as you mentioned earlier, taking over the role of parenting their parents, so it's both their younger siblings, as well as their parents.

34:34  
But then on the flip side, you know, that they may not have had kind of guidance or modeling in terms of, you know, emotional regulation, or kind of coping. And so on one hand we say well, gosh, they're very high functioning and the other hand we say, gosh, you're acting so immature, and in both are true, but it's it's oftentimes it's hard for a caregiver To kind of fully reconcile that, or not so much the caregiver, but that in where I really kind of tried to encourage the caregiver, you know, because a lot of the foster parents are so well trained, they have good experience, but for them to be the advocate in other studies, and so in school, you know, can be a setting that is a potential area for conflict, and to really help for that child's primary teacher or the kind of staff within the school to understand yes, some days, they might be functioning ahead of their age, in terms of ability or maturity, but in other days, they're going to function well behind their peers. And that's kind of to be expected, and we can't punish, you know, in the same way, we can't punish kind of that immaturity because they just haven't had a chance.

35:53  
And, and actually, one of the signatures of early trauma is often uneven levels of maturity, you may be mature that beyond your years in, in, in cleaning up your room, or cleaning up the house, or doing, you know, tasks such as that, but when it comes to responding to frustration, you may be much younger, so it's you can be mature in different areas. And you know, another area that I think sometimes confuses adults, particularly with older elementary and into adolescence is these kids are often appear to be streetwise, you know, they, they appear to be know a whole lot of the world. And that gives the aura of adulthood Miss of that's not even a word as an adult in this era of maturity gives the aura of somebody who is acting like a, an older teen or somebody in their 20s. And and that confuses adults as well.

36:55  
Yeah, absolutely. And I think that sometimes the children don't even recognize that, or oftentimes, I guess, I should say, they don't recognize that that's what they're doing. And so depending on the developmental stage, you know, if they're coming in, and they're preteen, or their teen, developmentally, we expect that, you know, if they had been in a loving, insecure and kind of consistent, stable environment, by preteen and teenage, we expect that they are going to start pushing boundaries. So what's difficult is when they're preteen and teen, and they're pushing boundaries, and it usually comes out as saying, you know, I know what to do, you know, don't tell me what I'm supposed to do. And they've also had this lived experience of having to do everything for themselves or for their younger siblings. That it, it's a difficult position to be in as the kind of the actual adult and caregiver, because, you know, you have to kind of, as again, you know, I don't have, I don't, I don't have like the perfect solution, but you know, had a kind of a macro level, you just have to say, you just have to keep kind of delivering it with, you know, with as much comfort and love as possible in the sense of reminding them, like, they don't have to be the adult. And they, it's okay to be a kid sometimes and, and that the adults around them, it's their responsibility to care for them. It's not their responsibility to care for themselves or to care for their younger siblings. And so I think that that's also something that sometimes gets mistaken. I was, you know, just on a panel with, with another woman who's a professional within the child welfare system, and she was a foster care kid. And she said, how, you know, she bounced around that was kind of a sad, but typical story, she bounced around, and then she was with a family for most of her high school time, but was never adopted. So she aged out of foster care. And but she still has a relationship with the family. And she was saying how that, in retrospect, they kind of came back and apologized to her and said, you know, we, we just kind of thought that, you know, we're providing like, a safe home and environment and food. And that that was going to be enough. And, you know, but they but she was so you know, as you said, streetwise. And it was kind of just like, you know, leave me alone attitude that they didn't really kind of try to bring her into the, to the family more than that. And so the way that she interpreted it was, well, they don't want me and the way that they were kind of coming at it was well, we don't want to kind of violate your your boundaries or you know, force anything on you. So it's just I think it's, we have to remember, as the adults that we are Adults and that I don't advocate for forcing anything. But I think that even if a kid is acting like an adult, or thinks that they're an adult, you know, to remember what they've had, you know, 1516 years on this world, you've had 3040 years, you know, and so it's, it's kind of, okay to use that increased experience to say, you know, it's okay, we can, we can be the ones that are going to take care of you, you don't have to do all of it on your own.

40:31  
What, how common are hyperactivity and attention impulsivity, and children who are in foster care.

40:40  
So we see the behavior commonly, and we see the diagnosis commonly. But what I would say is difficult is, again, kind of what we talked about before that, you know, how much of it is inherent to the child, and how much of it is because of the environment that that child has been in, or other unrecognized contributing factors like prenatal exposure. So the specifically when we're thinking about fetal alcohol spectrum disorder, the way that alcohol impacts the brains functioning, even if we don't have outward physical changes, you know, that one might kind of lead you to think of FA s, we can definitely still see brain changes. And those brain changes oftentimes mimic what we think of as kind of your typical ADHD. So they have difficulty with focus, they have difficulty with attention and memory, they have difficulty staying on task. The difference is that if we treat them like we would kind of a garden variety, ADHD, they don't respond in the same way. And so oftentimes families will say, you know, we can't tell when we give them the medicine, and we don't give them the medicine. And not to say that you can't have both, you can definitely have Fs and ADHD. But I usually say to families, again, getting back to that medication question, you know, try if you want, you can try the medication for a couple months. But if you know, two, three months down the road, you're not seeing any difference, then it's probably not garden variety, ADHD, because we would expect that they would start to be having some improvement if this were the case. The other thing that we're finding this year, which is very difficult, and we're still I think within the medical community, trying to figure out how to best navigate is the way in which we make these diagnoses, like ADHD, or autism, or even FPS is a relies a lot on kind of pulling together the observation of multiple sources, so a child caregiver, and then in the school setting, and since a lot of children haven't been in the school as consistently, as they maybe were previously or the school is being done in a distance learning form. It's hard to get some of the information to make an accurate diagnosis. And it can still be done. But I think what we're discussing in the medical community is, you know that our diagnosis is only as strong as our diagnostic tools. And right now, our diagnostic tools are not kind of best suited for things being in a more virtual or distance setting.

43:41  
This show as well as all the many resources provided by creating a family and our website, creating a family.org could not and would not happen without the generous support of our partners, who not only believe in our mission of providing unbiased education and support to pre and post adoptive Foster and kinship families, but they believe in that mission so much that they're willing to put their money where their mouth is. One such partner is VISTA Del Mar, they are a licensed nonprofit adoption agency with over 65 years of experience helping to create families. They offer home study only services as well as full service, infant adoption, international adoption, home studies, and post adoption and foster to adopt programs. You can find them and get more information about them at VISTA del mar.org. All right, what type of sleep issues are common to children in foster care? Both and let's talk about the two time periods the child when the child first comes into your home. And then just across the board, sleep issues that may be common to children who have experienced neglect or trauma.

44:54  
Yeah, so we oftentimes you know, and again, everything is so potential interconnected. So it's hard to know, you know, chicken or the egg is it is the poor sleep, because of you know, the behavior during the day or the behaviors during the day because of poor sleep, I will say that, you know, I am, I am of the, the mindset that kind of regardless of the, you know, the behaviors during the day, or the potential impact of which came first. And, you know, I don't think there's any harm in trying to improve sleep, if sleep is not good, common things that we can find. One is that they don't, they struggle to fall asleep, some of it can be that maybe they just didn't have any semblance of a sleep structure. You know, a lot of times we'll see kids where, again, if they're having to self parent, or sibling is parenting, they just, they don't have a bedtime, they just fall asleep when they get tired. And if there's kind of if the home environment is somewhat chaotic, that could be midnight, or one in the morning, two in the morning, you know, and then we can see that, you know, if they if the environment was somewhat punitive, you know, that there was like punishment related to being in the bedroom, or that they had to be, you know, they're in a locked space for punishment, they don't want to be in a room by themselves, or they don't want to sleep with the lights turned off. And then definitely, if there was any kind of history of sexual abuse, you know, there's often you know, oftentimes, not always, but oftentimes that is perpetrated in a bedroom studying. So that that is another potential trigger for sleep. And so I think that it's very common that we see all kinds of sleep issues in the early, you know, transition period, just really trying to establish a good consistent kind of sleep routine or, or, you know, and so having, you know, again, having to be the parent, but saying, okay, bedtime is at eight o'clock, you know, when we're going to do books, that bed, or whatever the routine is, you know, kind of getting rid of any devices, a lot of times for some of these kids, that device was, as you know, another kind of surrogate for parenting, and so they're allowed to just watch a phone until they, you know, pass out essentially. And so, you know, turning off devices, kind of an hour or so, before bedtime, and, and just seeing if then, kind of knowing that that early transition is, is going to be maybe not smooth, you know, they're gonna have to kind of stick with it. And then if, after a couple months, that they're still struggling with sleep, either falling asleep or staying asleep, then that's something that we can kind of reevaluate, you know, do they need maybe some use of melatonin or other kind of sleep aids? Or is this something that warrants you know, getting a sleep specialist involved or doing a sleep study? Those you know, and usually, if there's kind of a comprehensive medical evaluation, like we do at the University of Minnesota, for our kids, were also checking out other medical things, you know, so do they have restless leg syndrome, and we want to make sure that their iron levels are good, do they have obstructive sleep apnea, and that you know, that they're snoring and that's impacting their quality of sleep? So definitely, you would want kind of the medical evaluation to make sure to rule out those kind of things as well.

48:39  
Alright, so let's move on to another issue we hear a lot from, from foster parents, and that is food issues. We hear things like extreme picky eating or eating, just wanting to eat what foster parents often considered junk food, just tightly processed food, so that or overeating or hoarding our sneaking food, things such as that. Those are things that we hear from foster parents, what other food dishes are, including those, what do you see from foster parents?

49:14  
Yeah, definitely. I mean, there's a lot of potential issues that come around the relationship of food, you know, food insecurity, or kind of food choice. I think it's, again, it's something that Eve a trader to help families to think that it didn't happen overnight. And so on the flip side, it's not going to resolve overnight and that it's something that kind of needs to be supported and kind of encouraged over time. So in terms of like pickiness, you know, trying to make sure that maybe there's one thing that they have available that that they like, or you know, at least once But then there's other things that are pushing kind of their comfort level a little bit in terms of their willingness to try, in terms of, you know, food security, I think that you're just continuing to consistently kind of reinforce, you know, the food is, is here, and they don't have to kind of steal it or hoard it or hide it. And oftentimes, you know, we, depending on the age of the child, you can kind of talk to them about, you know, we don't want it to be hidden in your room, because of, you know, concern for cleanliness, you know, or kind of those types of things. But that it can be, you know, available in the kitchen setting, or, you know, in the pantry setting. And I think that when it comes to like overeating, I mean, typically, what we've seen for kids that have had restricted access is that we don't necessarily want to overly regulate their, their kind of food intake in the beginning, because we do want them to start to establish kind of that sense of food security. And so for those families talking about, you know, we offer healthy food choices, but that if they want to eat kind of what you think would be more than they might need, you know, based on their size, that that's okay, and that they might, in the beginning be eating, to the point where they do feel uncomfortable, but hopefully, if there's that consistency, they will start to gain kind of the skills of self regulation, you know, and realizing, like, gosh, I don't have to shovel all this food in, you know, all the time, because it's gonna be there again, in an hour if I need it. But and if that kind of the shuttling of the food or the overeating isn't kind of resolving, with just that consistency, that's something again, that we can talk about just that need to be addressed a little bit more specifically. And then the other thing that we always recommend, you know, when they're coming into a new care setting is, you know, in our clinic with the comprehensive model, we have them also evaluated by developmental specialists. And so in our case, it's an occupational therapist. And then usually our OTS are looking to see, you know, is there a sensory component to it? So for their pickiness, is it something to do with texture? Or is there something kind of anatomic, like they have difficulty with swallowing and chewing and swallowing, we just expanded to include some of our dental colleagues, but we're always, you know, historically have been on the medical side, looking at whether they need a dental referral. And now we've kind of transition to actually being able to have dental kind of partner with us. But that's another thing is making sure that they don't have kind of untreated cavities that's causing pain. And so that, you know, especially if they haven't had access to dental care before, or if they've been eating a lot of processed food, you know, and so then that the pickiness is maybe not so much picky, but like kind of Cheetos or type of things actually feel better, you know, when they're trying to eat versus, you know, crunchy crunchy carrots.

53:23  
Let me point out to everyone that we have creating a family has a course, that's directly related to this topic of food issues. It's titled practical solutions to typical food issues. And you can find it by going to our website, creating a family.org and then clicking on the horizontal bar online courses. And that course is there and it's gives you I guess, as the title implies a lot of practical solutions that will help you as a foster parent. All right, now let's talk about education because the impact of trauma on education is huge. The we've talked about the unlevel uneven maturity. We also see a lot of unevenness in education and just general falling behind. What are some of the What do you say, as someone who sees a lot of foster kids on the impact of trauma on their education?

54:22  
Yeah, well, so I think that the first one would be just the practical impact of not not specifically trauma, but just being in the in, you know, coming into the foster care system. There's potential that they haven't been consistently in school, maybe prior to coming into the foster care system. But unfortunately, once they're in the foster care system, we haven't done such a great job of also kind of continuing to support them in that consistency. And so we see that with each you know, change of foster care placement, potentially that creates another transition. School wise is Well, and so, you know, we, we've seen kids that have been in, you know, seven different schools in the course of less than a year. And if you imagine how kind of disorienting it is to switch schools, at least once, you know, think about trying to do it seven times, and having to have a school system, you know, get to know you and your needs, and you know, where you are kind of academically, emotionally, and developmentally, but then also having you tried to figure out what kind of this new system is. So I think that's a foster parents are, this is definitely an area in which they can be a very strong advocate, and try to help the schools to best understand, you know, what they think is needed for the child. Sometimes, what we see for some of our kids is that kind of going back to that idea of the kind of their premature parenting is, some of the kids tend to be what I call people pleasers, or they, they want to be able to meet the expectations of those around them, and, you know, specifically in the school setting, so they can be, quote, unquote, really good in school. But in order to meet those expectations, and like I said before, they're having to just exert so much effort, and then when they get home, and if home is kind of, in their mind, a safe environment, that's when they just kind of let loose, and you see a lot of tantrums or a lot of kind of, you know, breakdowns. And appearance, you know, feel a little bit, kind of like other people think that they're crazy, because they're like at home, they're having all these behaviors in school, they're, you know, perfectly well behaved. But when I hear those instances, I usually kind of push to see, okay, maybe the school is under supporting, and so that they're having to kind of hold it all in together at school, and then they let it out at home.

57:00  
Yeah, definitely. On the flip side, I

57:01  
think that and in our area, I feel like we are very fortunate. And then the for the most part, I think the case managers do a good job of saying, you know, their support the school support plans, kind of with the child. So if it's in place in one place, it's you know, in place, and another, but the way that it works in our state in Minnesota, the school support plan is usually put together in partnership or in conversation with the primary care of home caregivers, and then the school staff. And so if the primary home caregivers are not present enough enough to care, and that maybe has led to child being kind of pulled into the foster care, it may be that that child would benefit from having a school support plan. But no one has, you know, advocated or the school has kind of said, Hey, we think that you need to do X, Y and Z. But just because the parents didn't show up, it never was developed. So that's kind of an area where I think that the foster parents again, can definitely advocate and say, you know, maybe even if they didn't have one at their old school, we think that they should have one at their new school.

58:17  
Mm hmm. Yeah, being an advocate, children in foster care need educational advocates just across the board. So when you go into being a foster parent, one of the things you need to accept is that you need to be involved in this child's education and advocate for her if they're out that system.

58:36  
Yeah, and I know that creating a family has lots of resources, you know, in terms of how to be kind of a better advocate in academics, you know, studying it locally, in our area, there's, you know, additional kind of organizations that really can help, you know, to walk families through for children who are all kinds of disabilities, you know, the but So, if, you know, if you're not in the Minnesota area, encourage families to look kind of in their areas. And I know creating family has a lot of those good resources to help point to local organizations to to say, you know, because it's complicated, it's not necessarily straightforward. But But know that there are people usually in the community that have done this before, so you don't have to kind of make it up from scratch. And they can help you walk through the system to say, How do I you know, because sometimes it comes down to knowing just the right language to use that the school kind of if you say it a certain way, then the school is legally obligated to do an evaluation or assessment.

59:42  
Yes. And there are people that you could turn to and get that practical and work regardless of where you live. There are there are organizations that are set up to help you figure out how to navigate and we do have a lot of resources, creating your family as well. Yeah, absolutely. Before we Leave it, we're not going to talk about it. But I do want to mention this because I think it's a topic that we often don't talk about enough and that I know most foster families are concerned about, especially when they're at the beginning stages of considering fostering. And that is the, what happens to the children already in the home and I? And what are the what are the risks to those children? And what are the benefits to those children that are already in the home when you decide to become a foster parent. So I wanted to mention that we have a course called the impact of fostering on children already in the home. It is excellent. And that's what we talked about the entire course. Because that is a when you're evaluating risk factors in foster care. That is something most if you have children, most foster parents are concerned about. So I we have come to the end, I guess what I want to I want to end on a hopeful note, we've talked about risk factors. But I think that the impact that foster families can make on children is huge. So Dr. Gustafson, I'm going to give you the last word here about the importance of foster parents in the ability foster parents to make a difference.

1:01:10  
Yeah, absolutely. I think we know that by the research. Depending on developmental age, it varies a little bit in terms of the way that it's delivered and received. But we know that kind of at a larger scale of the research that having someone in your life that cares about what happens to you, is such a protective factor. And you know that even for some of our older kids that you think that you know, they're kind of already on their way to their own adulthood, it's still important to them to know, it doesn't necessarily have to be their, their parents are their foster parents, sometimes it's a coach or a teacher or just an adult in the community. But we know through that research, that it's still important to them have an adult in their life that cares about them. And that, you know, expresses that in a way that the child or the adolescent knows that they care about them. And so, you know, sometimes they think we can get a little bit kind of just discouraged in the sense that when, you know, when we talked about aces and things that yes, it can, you know, create higher risk for you down the road, even if things change, but we also know kind of the power of resiliency. And part of the reason why I love working in pediatrics is that kids are incredibly, incredibly resilient. And they you know, in this area, these kids have experienced things that we would hope no one would have to have experienced. But there's still that potential for resiliency. And so are I think what I really tried to do and what I hope to be able to encourage families to do is how do we best kind of come together and support these kids so that they can reach their fullest potential and, and build up on that resiliency that they kind of already have. And we just have to help them to best recognize.

1:03:06  
Well said, Thank you so much, Dr. Kumara Gustafson for being with us today to talk about evaluating risk factors in foster care. Let me remind everyone that the views expressed in this show are those of the guests and do not necessarily reflect the position of creating a family, our partners, our underwriters. Also, keep in mind that the information given in this interview is general advice. To understand how it applies to your specific situation. You need to work with your adoption or foster care professional. Hey, everyone, I hope you are liking and getting a lot out of this podcast. We pride ourselves on being the only podcast on adoption and foster care that is unbiased and fully expert base. We also pride ourselves on being the top ranked podcasts in these areas. And the only way I can brag on being number one is if we have the most subscribers, I would truly appreciate it if you would subscribe to this podcast. The easiest way is to click subscribe on whatever app you are listening to us on. You may have to search for us under creating a family and then hit subscribe, or you could go to iTunes and search for creating a family. Either way, you will get there and find us and we would really appreciate your subscription. Thanks for joining us today and I will see you next week.

Transcribed by https://otter.ai