In 2020, more than half a million children were served by foster care systems across the nation. Yet, the topic is seemingly nonexistent; unmentioned in the media, forgotten in political discourse, and even overlooked in the field of public health. The initial removal of children from their homes is itself a traumatic experience, in addition to whatever circumstances led to removal; an entire traumatized population is left to a system that kicks them out at midnight on their 18th birthday.
The Data
Beyond assuming the presence of traumatic experiences in children in foster care, research demonstrates that children in foster care are significantly more likely to experience adverse childhood experiences (ACE) than their peers. In one study, children in foster care had a 75.5% likelihood of experiencing at least one ACE versus children not in foster care, whose likelihood was only 33.2% (Turney & Wildeman, 2017). ACEs are especially problematic for children in foster care as greater cumulative ACE exposure has been shown to dramatically increase placement instability. For example, children with six to nine ACEs had a 52% greater chance of changing placements three or more times in a year when compared to those with one to five ACEs (Liming et al., 2021). Placement instability has been shown to decrease the likelihood of reunification, exacerbate academic problems, and result in generally negative health outcomes.
Placement stability/instability is measured by the rate of placement moves per 1,000 bed days in out-of-home care. The federal standard is 4.12 moves per 1,000 (U.S Children’s Bureau, 2021). Florida is not far above at 4.9, but Pinellas and Pasco counties, comprising state Circuit 6, far surpass this at 5.58 and 7.43 respectively (Florida Department of Children & Families, 2022). For perspective, Florida’s largest county, Miami-Dade, has a rate of 3.57. Placement instability is a crisis in Circuit 6. Due to the nature of foster care, these children do not have a stable and supportive adult figure to serve as a protective factor against the effects of ACEs (Crouch et al., 2018). The proposed grant aims to buffer the impact of ACEs on the well-being of children in foster care by providing focused support through the integration of occupational therapy into regular operations at Lutheran Services Florida, (a social services agency in Circuit 6). In turn, the positive role of occupational therapy and improved well-being will reduce placement instability. It is important that children experiencing placement instability have access to therapeutic services, as they paradoxically only have access when in long-term placements.
Utilizing Trauma-Informed Principles
The proposed program will utilize trauma-informed approaches across the organization, beginning with one team of family support workers and case managers. To establish a baseline of knowledge, all team members and support staff will attend training on the topic, learning strategies to employ in everyday tasks around and with the children we serve. This supports the trauma-informed principle of collaboration & mutuality (SAMHSA, 2014). Such a change in organizational knowledge and culture inherently strengthens the principle of safety in the program (SAMHSA, 2014). Another key principle that will be integrated into the program is peer support (SAMHSA, 2014). Our team is comprised of people of a variety of backgrounds, some having grown up in the foster care system. Through strengthening collaboration & mutuality, staff will become accustomed to genuine interactions with children and families (SAMHSA, 2014). Finally, empowerment, voice, and choice will be emphasized in our work. In working with occupational therapists, children in foster care will gain a new understanding of emotions, actions, and the agency they hold (SAMHSA, 2014). Given the unstable and uncontrollable nature of the foster care system, empowering children within it will offer a sense of control and strengthen resilience. Our team is very strong on cultural, historic, and gender issues, a principle already emphasized in our work. We will continue to develop these topics directly with children through their experiences with occupational therapy.
Utilizing A Social-Ecological Model
This program primarily addresses the individual and relationship levels of the CDC’s social-ecological model (n.d.). Children and occupational therapists will be working together to improve emotional regulation, social skills, and individual agency. However, the program’s reach does not stop at these two levels. The community level is inherently involved in this process. The child’s relationship with their community and institutions (i.e. school, medical care, community support) will be strengthened; this in turn will change the relationship of the community and institutions with the child. Even if it seems the work is only occurring between the therapist and child, the results will be felt by those on the outside of the process as well. Social context is a mutual experience between both the individual/internal and community/external; the child’s success will create a positive feedback loop between the two, helping to sustain their collective progress.
A broad goal of this program is to provide an example of an effective and progressive structure for social services organizations. This addresses the societal level. It will prove the feasibility and value of providing a comprehensive approach to children’s welfare, motivating other agencies to adopt similar or expanded and improved programs, and will influence legislation related to the funding of such efforts in the future.
A Public Health Approach
The proposed program utilizes a public health framework by considering the many factors affecting a child’s placement stability and seeks to address the topic using a multidisciplinary approach. It emphasizes collaboration between occupational therapists, staff, family members, and children; all involved parties will be presented with a multitude of learning experiences. Also, collaboration, such as a partnership with the University of South Florida’s occupational therapy program, plays a critical role in the program’s operations.
Through this comprehensive approach, the proposed program directly addresses the secondary and tertiary levels, but there are also benefits at the primary level. At the primary level, the program increases awareness of ACEs and their significant impact on placement instability. As staff, clients, and community partners become aware of factors that contribute to the issue, they can take steps towards practicing trauma-informed care. Also, as staff observe occupational therapy techniques, they will be able to teach other children simple coping mechanisms to enhance resilience. At the secondary level, the program’s process of identifying children at risk of placement instability serves as a screening process. In reviewing cases, it will also help identify children who may have endured significant trauma. The main operations of the program work at the tertiary level, working with children already facing placement instability and managing the impacts of ACEs.
Conclusion
Foster care is already a tough experience for children. When considering their greater likelihood of experiencing ACEs and its implications for placement instability, it can define the rest of their lives if not addressed. Providing affected children with therapeutic services while not in long-term placement can help them achieve that very goal of staying in one home. Finding creative solutions, such as the proposed program, can bring us one step closer to improving the lives of whole generations.
References
CDC. (n.d.). The Social-Ecological Model: A Framework for Prevention. Centers for Disease Control and Prevention. Retrieved March 2, 2022, from https://www.cdc.gov/violencepr...ecologicalmodel.html
Crouch, E., Radcliff, E., Strompolis, M., & Srivastav, A. (2018). Safe, Stable, and Nurtured: Protective Factors against Poor Physical and Mental Health Outcomes Following Exposure to Adverse Childhood Experiences (ACEs). Journal of Child & Adolescent Trauma, 2, 165–173. https://doi.org/10.1007/s40653-018-0217-9
Florida Department of Children & Families. (2022, February). Office of Child Welfare Dashboard. MyFLFamilies.Com; Florida Department of Children and Families. https://www.myflfamilies.com/s...d-welfare/dashboard/
Liming, K. W., Akin, B., & Brook, J. (2021). Adverse Childhood Experiences and Foster Care Placement Stability. Pediatrics, 6. https://doi.org/10.1542/peds.2021-052700
SAMHSA. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. HHS Publication No. (SMA) 14-4884.
Turney, K., & Wildeman, C. (2017). Adverse childhood experiences among children placed in and adopted from foster care: Evidence from a nationally representative survey. Child Abuse & Neglect, 117–129. https://doi.org/10.1016/j.chiabu.2016.12.009
U.S. Children’s Bureau. (2021a). The AFCARS Report. Administration for Children and Families; U.S Department of Health & Human Services. https://www.acf.hhs.gov/cb/rep...foster-care-adoption
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