Therapy, part II

Since my last post on therapy, Dusty has now had one therapy session. Next week, she will have been in our home 8 mos and she had her first appointment yesterday. How's that for efficiency?

The good news: The people I have talked to that are familiar with this therapist say she is great (that was maybe 2 people). In my intake meeting with her she requested that Dusty not be present b/c we would be discussing many things she should not hear. This seems like duh common sense, but she is the first therapist I've ever worked with that seems to get that. In other intakes, the therpaist is asking me to talk about the child's history, their trauma, their bio parents' issues, their current behavioral issues - all while the child plays in the room next to us and pretends not to be listening or aware of anything we are saying. But they hear it ALL! And a therapist should know that. So, she earns points for that one from me.

Another good thing is she seems to understand trauma and how kids will play out their trauma as a way of processing it and coping with it.

Now for the not-so-good news:

In the intake, I asked if I would be present during the sessions. She said "no". I asked if we would talk after the sessions to discuss what is happening in them and things I should be working on with her at home. She said she was not able to discuss specifics with me about what goes on in the sessions, but could tell me if she had a particularly emotional session or if she had a hard time etc.

I have a problem with this. A BIG problem with this. But, I also know this is standard and my raising an issue only makes me seem weird.

Let me walk you through how yesterday went. Imagine this is your child.

We arrive at the counseling center (a place that Dusty has never been to before), we go into the "lobby" (I use that term loosely, the lobby is a very small room (think large closet)with a few charis, a table w/some coloring books and crayons), there is no one in the lobby, there is no receptionist or anyone to check in with or let know you have arrived. There is a sign on the door that says to wait there and someone will come get you. The therapist (who Dusty has never met before) opens the door, stands in the doorway and says "are you ready?" Dusty walks back into a room with her. I stay in the "lobby". About 30min later, she opens the door and Dusty comes out. The therapist says "She did good. See you next week".

Now, remember I said, pretend this is your child. Would you be ok with this? I know that I would never have done this to my bio kids. NEVER!

If I felt my child needed therapy it would be because they had probably suffered some trauma. As their mom, I'd want the help of a therapist the help me help my kids to process it. I would want to be there to assure my child that this person is safe and that I trust them. I would want to be there so that when my child did begin to process their trauma and experience big emotions as a result, I would be there as their mom to comfort them, support them, love them. I would want to be in the room at all times because there is absolutely NO reason for this therapist to develop a private relationship with my child. The therapist is simply a tool our family is using to cope with difficulties.

Now, let's consider foster children:

1. They have tons of confusion about who is safe and can be trusted.
2. They often will go off with anyone and have difficulty discriminating roles of people (particularly understanding the role of primary caretaker).
3. Therapists come and go like (I can't think of a funny cliche here for things that come and go - so enter your own), so working on getting a child to trust a specific therapist only to leave them and get a new therapist - bad idea!
4. Therapists only see this child 1 x per week - the goal should be to empower the family with the skills to work through the issues the other 6 days of the week.

Let's not take this issue of stranger danger too lightly here.

With all of our placements (and respite kids), we have had issues with an inability to distinguish between people they know well and trust and any random person that approaches them and calls them cute. Every. One. Of. Them. It's not a small problem, it's a pervasive problem.

In a child that is well adjusted and has a secure attachment, there will be some hesitation to being approached by strangers or even people they have met before, but are only casual acquaintances of their parents. There is a clear distinction between who you go to when you are sad and need comfort, when you scraped your knee, when you need to go to the bathroom. It's not normal for kids to just ask the nearest adult to help them with these things. But kids in foster care do. Not only do they do that, but they will intentionally seek out adults other than their parents. When my children were young and a stranger talked to them, they may avert their eyes, lower their head, move closer to me, take a step back from the stranger (all things that signal "I don't know you, I am being cautious of you"). I LOVE when my kids do that. Love it! I know some people have real issues with shyness in their children and work hard to help them to get over it. And I get that too. And if we are talking about kids that have grown up in healthy homes and have secure attachments with their primary caregivers, then that's ok. But for kids in foster care, we should rejoice over "shyness". It's good. It's progress.

Now, if I had taken one of my kids to see a therapist, pulled up to a strange building, sat in a strange room, asked them to walk through a door with a stranger while I stay back in the other room, we would have had some serious protesting (probably screaming and crying as though they were being abducted). In fact, just the therapist approaching and talking to them would have elicited something like this:

Had Dusty behaved as though she were uncomfortable going off with this strange lady, I'm sure she would have had me sit in on the session until she was more comfortable. But the fact that she willingly went should be a red flag to the therapist. And we should not exploit this child's disorder/issue (whatever you want to call it) by asking them to do something, that if not for their issues, they would not do. Essentially, therapists working with the most vulnerable children (those in CPS custody) are exploiting their unhealthy attachments and further encouraging unhealthy behavior. Wonderful!

Therapy

I try not to make my blog posts seem like one long gripe fest without at least some kind of tip or solution to the problem. If that is my goal, I should stay far, far away from this topic.

But, here I go anyway. So, let me apologize in advance that what you are about to read will be a substantial list of problems and a very short list of solutions (that is if I can think of any by the time I get to the end of this post. Otherwise, it will just be a list of problems).

We've all heard the stories, or maybe experienced first hand, how hard it is to get CPS to intervene and respond to reports of abuse and neglect. We all know about numerous kids who should be helped, but the problems going on in their home do not rise to the level of CPS intervention. So, what does that tell us about the kids in our homes, then? It tells me, the conditions they lived in were worse than most of us can even imagine. The abuse and neglect they suffered was severe. Most of the population will never experience this type of abuse and neglect in their entire lifetimes. Their needs are different than most every other kid you know. So, what kind of therapist would best suit this specialized, rare population?

Well, my answer would be a very experienced therapist, one who understands abuse, neglect, and trauma, one who knows the substantial effect abuse and neglect has on the development of growing children. They also need a therapist who understands that because their "child development" is different from most kids, they need to be parented different from most kids. They need a therapist that knows how to include the children's foster parents in all aspects of treatment and one that can help foster parents understand why these unconventional parenting methods work.

Now, what kind of therapists do kids in foster care get?

They get recent college graduates who may or may not have done some practicum hours on actual live people, but not necessarily children, let alone abused children. They get therapists who have taken this job as an entry level and plan to leave as soon as a better job becomes available (which means over the course of their time in care, foster kids may have as many therapists as they have case managers). They get therapists who are not required to take specialized training on child trauma and attachment disorder. They also get behavior coaches who have degrees in areas not even related to mental health, they often are not parents themselves and would probably struggle to help a parent, that is not a foster parent, understand behavior issues.

According to a study by Casey Family Programs, a disproportionate number of former foster children have mental disorders as adults. Foster children have nearly double the rate of PTSD as U.S. combat veterans. I know that I hear about programs to help veterans that suffer from PTSD (although, I don't doubt this is an underserved population as well). I hear of no such programs for children in foster care. While, I can't assume cause and effect with these studies, it does make me wonder if the number of foster children as adults with mental health issues would be much lower had they received the appropriate care when they were children?

Another huge issue with therapy and foster care is the amount of time and effort it takes to get services started. It often seems to be a big battle just to get services that I am not really sure I want, once I have them.

Here's an example that is not a rarity:

Little Dusty, 3yo (you can read about her here) came to us on 4/2/12. Within a couple of days of being placed with us, Rapid Response came to check on her (step 1 of system in place to ensure children receive services - check!). According to the information we supplied RR, a referral was made for play therapy for Dusty as well as a referral for speech assessment through public school district.

Enter Dusty's oh so wonderful CPS case manager, let's call her, Little Miss Scatterbrain (that's my nice name for her :).

So, Little Miss Scatterbrain did not inform anyone of the intake that had been set up as a result of the RR referral, so the date came and went and the referral closed. As I started reporting Dusty's behaviors to Little Miss Scatterbrain, she informed me that she had let it lapse. So, you would assume she would then get right on it and put in another referral, right? Wrong.

Fast forward to a court date (not sure what hearing this was, I was not informed of it eventhough I repeatedly asked for this info). The court ordered a Best for Babies Assessment (something the court has started routinely doing for 0-5yo in foster care).

We are now over a month into the placement and the Best for Babies assessor determines the same thing the RR person did and that is, Dusty needs play therapy. Due to the behaviros we were now reporting, Dusty was assigned an intensive case manager with Southwest Network (SWN). Oooh. This kind of sounds like someone might be taking her needs seriously.

Nah. Not really.

Now, we have an intensive case manager (ICM), who I will call Little Miss Helpful, which means, she needs to come interview the family about Dusty's behaviors, observe Dusty in the home, at daycare and on visits with mom. THEN she can make a recommendation for services. We have our first meeting with Little Miss Helpful at the end of May. She does her observations in our home and in the daycare over the next couple of weeks. Now, she has to observe during visits with bio mom.

Here's where Little Miss Scatterbrain is able to FUBAR the whole process, yet again. Since she is completely unresponsive to Little Miss Helpful, she is never able to observe Dusty during visits. But since this is how the process is supposed to go, Little Miss Helpful continues to run her head into the brick wall a.k.a. Little Miss Scatterbrain which results in delays for services for Dusty.

Little Miss Helpful eventually gives up on the idea of observing during bio mom's visit and just goes ahead with her recommendation. Shockingly, she recommends Play Therapy. That's right, the very thing RR recommended and put in a referral for within a few days of us being placed with Dusty. Little Miss Helpful came to the same conclusion. She needs Play Therapy.

Now, in order to put in a referral for play therapy (mind you this was already done months ago and let lapse by Little Miss Scatterbrain), Little Miss Helpful must hold a CFT. So, we are now in July. It takes that long for Little Miss Helpful to actually get in contact with Little Miss Scatterbrain and finally nail down a CFT date and time. Nevermind that this date and time conflicts with my schedule. I cancel certain things so that I can be sure to be there and get this whole therapy ball rolling.

Little Miss Scatterbrain does not show up to this CFT that we scheduled around her. Doesn't show up, doesn't call and actually never even addresses the fact that she completely blew this off. When I bring this to her attention a week later in an unrelated conversation, her response "I was sick and I didn't know you were going to be there, so I didn't realize I needed to let you know I wasn't going to make it". The CFT was at MY HOUSE. Not sure how she possibly thought I wasn't goin to be there. Anyway....

Little Miss Helpful gets right back at setting up another CFT. It's now August. Still no CFT, still no referral for therapy. Now, we have a new CPS CM. She is ready and willing to participate in a CFT, however, she feels bio mom should be present as well. So, we need to reschedule to accomodate bio mom.

Fast forward to 3 more reschedules due to bio mom's "family emergencies" and various other needs to cancel. It's now Sept. and Dusty still has no services now because mom a.k.a. Little Miss Attempted Murderer, ok, I shouldn't go there, is being allowed to delay her child's therapy (therapy she needs as a result of the actions of her mom in the first place). Is this making sense to anyone?

Anyone?

We finally decide to proceed with the CFT in mom's absence. And, now we can actually put in a referral for play therapy which was identified as a need over 5mos earlier. Yay for our system! And, yes, we tax payers actually pay for this incompetence.

Now, it's October. I was told a referral was put in weeks ago. I still have not heard anything from the agency that is supposed to be providing the therapy. She has been with us over 6mos. We identified this need immediately. And here we are.

And the worst part is, after all this pushing to get therapy started is over, we will have inadequate, ineffective therapy and I'll wonder why in the world I ever worked so hard to get it!

And that makes me....

Looks like this will just be a post about problems with no tips or solutions. Oh, how I wish it could be different :(

The Worst Part

The worst part of fostering, the stuff that makes me want to quit, is not the kids and their crazy behaviors. It's the system. It's so broken. Broken to a point that feels like it is completely beyond repair. It is a system that often feels like it is actively hurting the same children it was put in place to help. And I'm a part of it. I'm regularly asked to go along with bad decisions that hurt the children in my care, children that I have been asked to care for, love, keep safe, and make a part of my family. What a ridiculous system.


Molly, who I talked about here, will be turning 5 yo tomorrow. She will also be dropped off at daycare in the morning as she is many mornings, picked up by her Parent Aide as she is every Friday for a visit with her dad. Only tomorrow, her parent aide will not be bringing her home as she usually does. Instead, she will drive her to a new home, with new parents, new siblings, new rules, new surroundings, new schools where she will live until the next time CPS chooses to move her. The reason for this move is to be placed with her brother.


We will not be permitted to meet with the new family to give Molly some continuity, to give the family info about Molly and her needs, likes, routines etc. We will not be permitted to even share this info by phone. We will not be permitted to bring Molly's belongings to the new house and Molly will not be given a chance to say goodbye to the girls she has lived with for nearly 8 mos who have become her sisters or the people who have fed her, clothed her, loved her, kept her safe and have become her second set of parents. She will also not be permitted to see us or even call us once she's moved.


Why? Surely there is a good reason for such an unfortunate move. The truth is, we aren't being told why and the more we ask to help make her transition to her new home easier, the more resistance we encounter, the more we ask "why?" aren't we being allowed to do the very thing CPS claims they want foster families to do, the more the case manager digs in her heels.


And, lest you think this is a rare, unfortunate occurrence, I'm here to tell you it's not. Has our family perhaps done something to warrant this decision making by CPS? Maybe there is good reason not to allow future contact. There's not. There is no good reason. The sad reality is, CPS often struggles with power. CPS case managers are scrutinized for their decisions, they encounter angry birth parents regularly, they are admonished by judges for not doing enough, they have high case loads and a stressful job. And unfortunately, that combination sometimes (and really, when I say sometimes, I mean most of the time) makes for a person on a power trip, a person that refuses to be questioned in any way or consider that there may be a different way to do things.


You know what's hard about doing what's best for the child? It takes more time than just doing whatever works best in your schedule. It requires you to really listen to other members of the team, gather information and take your time in making decisions. It requires you to set aside the pressing matter before you to really think about what the child is experiencing. How many times have I seen a case manager do this? Not many. Sadly, not many.


Of all the things CPS case managers are required to do, the most important is doing what's best for the child. Of all the things CPS is required to do, what do they seem to do the least well? What's best for the child.


Today is a sad day for me where I am struggling to see the good in this situation. I am wrestling with the notion that I may not be fighting this bad decision hard enough. I have learned to fight CPS is to dig your own grave. It doesn't go well. Ever. So, I not only have to sit and let this happen, I have to be an active participant in it. This is the part of fostering that makes people want to give up.