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The Undervalued Foster Parent
The roots of foster care are lost in antiquity. In the so-called
category of "custom adoption" there remains a tradition within
some aboriginal populations of an informal blur between the
status of fostering and adoption. In their extended families,
a child may be raised by an aunt, uncle or grandparent, on
a temporary or permanent basis. It has not been unusual for
breast feeding to be provided by one of these relatives.
However, for society in general, there is an absolute legal
distinction between fostering and adoption.
Foster homes are classified under Ministry of Social Services
guidelines, mainly according to the formal qualifications
and experience of the foster parents. Payment for their services
are graded accordingly. Acknowledging the 24-hour periods
of responsibility, foster parents' hourly rates could be calculated
sometimes as only a fraction of the minimum wage. This is
unfortunate given the important responsibilities of fostering,
as described in the following concepts of care requirements:
Foster care in general
Unspecialized foster care for children will extend over
periods of weeks, months or years, either until the natural
parents are able to resume custody, or until adoption is arranged,
or in some instances for an indefinite period of time. A special
function in the case of infants is to avoid any unnecessary
delay in inaugurating and maintaining a caregiver-infant attachment
process.
Receiving home
A receiving home is prepared to accommodate a child of any
age on an emergency basis during deliberations for assessment
and planning in accordance with perceived ongoing needs. The
managing foster parent must adapt to the admission of a new
foster child at any hour of the day or night, with little
or no information about special needs. The role of a receiving
home is to provide basic food, shelter and clothing on a short-term
basis.
The home's logistics may require a system of coding to identify
formula bottles in the refrigerator in accordance with a particular
infant and a supply of clothing of many sizes to be kept in
readiness. Usually, the stay in a receiving home is quite
short in terms of days. Thus, the administrative turnover
of admissions, discharges, and individual arrangements for
visits present daunting challenges. Many "natural" parents
would be unable to meet the social and protective needs.
Special needs fostering
In a special needs foster home, care is given to children
who may require careful administration of medications, home
administered physiotherapy (as for cystic fibrosis), application
of dressings, special measures to cope with a hearing defect,
or other requirements that may be met if the affected child
were to be brought up within her/his own family.
Therapeutic foster parents
Finally, the most demanding fostering requirements are presented
by infants and children born after prenatal exposure to a
mother's addicting drugs, such as heroin, methadone, codeine,
cocaine, or diazepam (Valium). They are said to have Neonatal
Abstinence Syndrome (NAS), recently referred to as Infants
of Substance Using Mothers (ISUMs).
Some of these infants appear to cope with ordinary care,
or they may show withdrawal symptoms within a few days after
birth or after weaning deprives them of a mother's drug that
was present in the breast milk. Most of the severe NAS effects
in infancy require special management in hospital, in rooms
protected from the stimulation of ordinary light and noise.
Discharge from hospital is promoted at the earliest possible
time to allow a beginning of infant-caregiver attachment (bonding).
Some of these infants require special care that most parents
are unable to provide during early infancy. They are visited
weekly at home or in a foster home by a supportive and educating
community health nurse. Hopefully there are periodic medical
and developmental assessments.
These infants require such extraordinary skills and tolerance,
that foster parents with the required proficiency for these
demands have come to be termed Therapeutic Foster Parents
(TFPs). Rather than an NAS infant being transferred because
of their exasperating needs and provocations, these special
TFPs pride themselves on their determination to retain them
without transfer.
Initially in 1988, in conducting the monthly reviews at
Sunny Hill Hospital, the Medical Director1
of the NAS program noted that some foster mothers were more
successful than others, and that on occasion his decision
to transfer a non-thriving infant to another foster home resulted
in immediate improvement in weight gain, acceptance of feeding,
and reversal of symptoms of regression, such as tremors.
After examining some details that characterized the more
successful foster parents, the hospital's imaginative social
worker2 collaborated with an equally
creative resource person3 in the
Ministry of Social Services to inaugurate a special selection
system for the Ministry to establish this elite category of
TFPs.
They accepted requests from foster parents previously screened
by the Ministry, and conducted a more stringent selection
protocol - hence the birth of the informal category of Therapeutic
Foster Parents.
The hospital social worker's successor4
collaborated with the Ministry's resource worker to establish
a series of monthly meetings of the TFPs to exchange views
and experiences, and to hear lectures by authorities on such
subjects as attachment, separation, or comforting a very agitated
child.
As some NAS infants emerge into childhood, there may be
a new set of complications that require special handling,
and possibly timely intervention to limit the chance of a
serious handicap extending or worsening into adolescence and
adulthood. These medical problems appear similar to those
found among some children who had been exposed prenatally
to mother's alcohol habit (so-called Fetal Alcohol Syndrome).
The need for special management and attempted nurturing can
be met, if at all, by the same elite group of foster parents.
Challenges presented by some affected children
With individual variations, some of the infants and children
who require therapeutic foster parent care may present a combination
of any of the following challenges to their caregiver:
Frequent agitation, explosive outbursts, irritability and
whininess, shrill and implacable screaming which provokes
exasperation in the caregiver, embarrassment caused by continuously
screaming in a mall or other public place (with an inability
to respond to soothing), episodic destruction of household
objects, injurious aggressiveness toward a caregiver or other
children, self-destructiveness (hair pulling, finger biting,
injurious head banging), and fearless self-endangering activities.
In addition, the child may suffer from night terrors and
habitually insist on sleeping with one caregiver, thereby
forcing the caregiver's partner to seek a peaceful night's
sleep in another room. The child may exhibit impulsive behaviour,
show unreasonable fear of a new situation, or be easily frustrated.
Compulsive behaviours the child may exhibit include insistence
on a spoon or bottle to be always in precisely the same place,
refusing food even to the point of impending malnutrition,
tremors and/or rejecting food when confronted by low stimulation,
(such as ordinary household sounds or a bright sky, a lighted
television screen or a skylight). In some cases, the child
may suffer with hyperactivity and a short attention span.
Special capabilities of therapeutic foster parents
Therapeutic foster parents must have special proficiency
in dealing with the challenges presented by some children
with special needs. Their care giving strengths include, with
individual differences:
Uppermost, therapeutic foster parents are dedicated to providing
empathetic and sensitive nurturing, including opportunities
for promoting a caregiver-infant attachment process. They
are required to maintain a 24-hour-a-day responsibility with
only occasional respite of a few hours, must have the ability
to comfort or provide calm for an agitated child, and sensitivity
and wisdom to select between affectionate cuddling and/or
isolation in dealing with unacceptable behaviour.
Therapeutic foster parents exhibit a readiness to provide
companionship and feeding when a foster child must be hospitalized
(even with other foster children being cared for in the foster
home). They have self-control to resist when provoked to spank,
an interest and ability to teach "natural" parents who may
be jealously hostile or to counsel prospective adopting parents.
They recognize subtle gains and reinforce a child's new achievements,
as well as having an early perception of a new problem requiring
therapeutic intervention. They are effective in using their
own family supports to assist in providing foster care.
In addition, they may require the ability and dedication
to administer prescribed exercises and medications reliably,
to cope with city traffic while transporting an unruly child
to clinic, be careful to maintain safe conditions in the home
and surroundings, and have a proficiency in humoring a child
who misbehaves compulsively. They may need resourcefulness
and skills in assuring dietary intake in the face of feeding
refusal or habitual regurgitation that threatens malnutrition,
a proficiency to maintain a daily log of all parental visits
and visits to clinics, and ability to record significant developmental
events in a style useful to doctors, infant development professionals
and social workers. They may feel a need to invest in a larger
home and vehicle for fostering activities. Some therapeutic
foster parents also exhibit a readiness to adopt and provide
nurturing of a foster child whose compulsive needs cannot
be met by anyone else.
Unjustified notoriety
In some instances unjustified notoriety is attached to some
foster parents who have become so exhausted by a child's extraordinary
provocations that they are unable to care for the child anymore;
with the child becoming so unbearable as to require serial
transfers to a succession of foster homes. The transfers themselves
worsen the child's ability to socialize, and unjust criticism
is placed on the foster parents.
A major, unsung activity of foster parents is their dedication
to developing a thorough familiarity with the details of growth
and development of their foster children, and to be reasonably
competent to provide nurturing and access to the child's needs
for attachment to her/his long term caregiver.
Unfortunately, in the wake of the recent enlightened concept
about the credibility of child witnesses, foster parents who
provide a home for older children may be scapegoated by a
disturbed foster child, with false and mischievous accusations
of sexual abuse in the foster home, whereupon it becomes mandatory
for Ministry officials to immediately remove the child or
the alleged molester. Fostering cannot be resumed until an
arduous investigation establishes the falsity of the accusation,
if indeed such an outcome can be achieved.
Infants engaged in a delicate attachment process in the
same home will be removed at the same time. A particular threat
to these foster parents is the prospect of losing their own
blood-related children as well, if the accusation is not disproved
beyond a doubt.
Sydney Segal, M.D.
1 This author
2 Kathryn Arkko, B.S.W.
3 Norma Carey, M.S.W.
4 Patricia Reid, B.S.W.
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