Fostering Success:

Addressing The Treatment

Needs of Foster Children

Presented By
Kevin R. Bochenek, MA, MS
 Educational Learning Goals:
Participants will be sensitized
to issues related to children
in foster care.
Participants will learn about
important therapeutic themes
and ways children react to
the foster care experience.
Participants will explore
various therapeutic issues,
aspects of treatment, and
helpful therapeutic
techniques.
 Factors Influencing Development:
Eight factors which
influence development
will be explored in the
context of how they
relate to the foster care
experience.
Factors Influencing Development:
Heredity:

Certain aspects of
development are
influenced by biological
factors such as genes.
 Factors Influencing Development:
Level Of Environmental
Stimulation:

Enriched environments that

offer a high degree of
stimulation influences
development positively.

Healthy stimulation should

involve all of the senses.
Factors Influencing Development:
Modeling:

Children will learn from

their role models in their
environments.

Humans are truly

copycats.
 Factors Influencing Development:
Family Culture:

Family values and culture

influence the childs
personality development.
Factors Influencing Development:
Birth Order:

A childs birth order in

the family can influence
the rate of development
and the childs overall
personality.
 Factors Influencing Development:
Level Of Support:

How supportive and

attentive the caregivers are
will influence a childs
development.

Included in this area would

be whether or not the birth
was wanted, maturity of the
caretakers, and support from
relatives.
Factors Influencing Development:
Style Of Parenting:

Parenting style can influence

certain personality variables and
overall development.

Dictator-style parents run the risk

of having children who are overly
dependent and who act out of fear.

Permissive parents may have

children who are unable to follow
basic rules and limits established in
structured environments.
 Factors Influencing Development:
Expectations:

Development is influenced
by the expectations of
caregivers and those in the
childs environment.

Your expectations should not

be too low or high.
 Diagnostic Issues:
It is frequently difficult to diagnose foster children. It is
sometimes unclear if behaviors are part of a diagnostic
cluster or the result of coping with being in foster care.
Some behaviors look like one diagnosis (i.e. AD/HD)
while they may actually be something else (i.e. anxiety).
Substance exposure in foster care complicates diagnosing.
They can exhibit very impulsive, explosive, and labile
behavior. It is unclear if those children should be
diagnosed as AD/HD, Bipolar Disorder, or Intermittent
Explosive Disorder.
 Diagnostic Issues:
It is helpful to understand the childs pre-
morbid functioning and to know the
biological familys medical and mental health
history.
Common diagnoses: Adjustment Disorder,
Oppositional Defiant Disorder, Dysthymic
Disorder, Intermittent Explosive Disorder,
and Reactive Attachment Disorder.
Ways Children React To Foster Care:
1. The Needy Child: Therapeutic Goals: Teach
He is clingy and has independence and appropriate
indiscriminate attachments; boundaries, teach personal safety,
likes a lot of physical and educate child on how to deal
touch, does anything to with strangers
relate to you and others;
constantly wants to please
you and fears rejection; is
at risk for victimization.
Ways Children React To Foster Care:
2. The Control Freak: Therapeutic Goals: Help the child
This child was often explore trust issues; help child
parentified; has difficulty learn to take an appropriate child
accepting authority and role; establish appropriate adult-
attempts to relate to adults child boundaries; offer client-
as a peer; child likes to take directed time in therapy.
charge; often the child is
overly neat and organized;
does not trust that adults
will be in control; often
perceived as annoying to
adults.
Ways Children React To Foster Care:
3. The Distant Child:
This child keeps his
distance from you;
becoming too emotionally
connected to you or anyone
is too threatening to him;
this child needs space and
time to feel close to you;
often this child never fully
unpacks at his foster home;
this child has great
difficulty sharing thoughts
and feelings.
Therapeutic Goals: Help the child
learn to identify and share feelings;
focus on building a trusting
relationship; help the child with
communicating thoughts and needs;
help the child to engage with
others; help child label feelings to
initiate discussion and
understanding
Ways Children React To Foster Care:
4. The Volcanic Child: This
child is like a volcano ready
to explode; he has a lot of
anger about his situation
this is frequently displaced
to others; he is often
oppositional; sometimes he
can be well-behaved for
days before exploding.
Therapeutic Goals: Teach anger
control and impulse control; find
appropriate physical outlets for the
client; teach relaxation skills;
develop a plan to help child when
angry and involve foster parents
and/or school staff with the plan;
give a lot of support to the foster
parents.
Ways Children React To Foster Care:
5. The Avoidant Child: This Therapeutic Goals: Help the child
child avoids issues to explore his feelings; develop a
surrounding foster care; child trusting therapeutic relationship
will disagree with need for over time; be there for the client
therapy; child avoids sharing and do not push too hard during
feelings; acts as if he has two the initial stage of therapy.
separate worlds; often
disowns his biological family;
often acts as if everything is
fine despite hurting on the
inside.
Ways Children React To Foster Care:
6. The Manipulative Child:
Because of his experiences
with neglect, this child often
uses people to get his needs
met at any cost; can be
charming; will strive to gain
your trust and then will do
something to break that
trust.
Therapeutic Goals: Teach about
the importance of honesty in
relationships; confront
manipulation; assist child in
finding ways to get needs met
appropriately; help child to develop
genuine relationships
Ways Children React To Foster Care:
7.The Anxious Child: This Therapeutic Goals: Offer a
child is very cautious; often lot of reassurance; help the
functions like a deer in child to know what is coming
the headlights; often next; avoid surprises; teach
worried about punishment relaxation techniques
or disappointing adults;
fears & worries tend to be
reality-based.
Five Essential Therapeutic Themes:
Eliminating
Responsibility
Building Self-Worth
Believing In Yourself
Maintaining Connections
Developing A Future
Orientation
Therapeutic Issues:

Feeling different
Enormous sense of grief
and loss
Am I worthy of love?
Need for control
Feeling responsible for
younger siblings
 Therapeutic Issues:
Learning to trust
Learning to be a kid
Anxiety What is next?
Fitting in
Caught between two worlds
Dealing with
disappointments
Aging out
Coming to terms
 Aspects Of Treatment:
Support To The Foster Parents:
A primary goal of therapy for foster children is
to offer support to the foster parents in order to
preserve the placement.
Support includes involving foster parents in the
treatment process, conducting family therapy,
offering parenting suggestions, allowing foster
parents to vent, and to offer phone calls or e-
mails in between sessions.
 Aspects Of Treatment:
The Therapeutic Relationship:
It is essential that the therapist take adequate time to develop a
trusting therapeutic relationship.
The child should be clear on confidentiality policies.
It is often helpful when you want to share information about a
session to get the childs permission or have the child tell the
other party.
The therapist must be sure not to put herself in a situation in
which she attempts to rescue the client. Some children will try to
manipulate the therapist to get their needs met.
Therapeutic relationships with foster children can be intense.
The therapist provides a corrective relationship.
 Aspects Of Treatment
Three Key Issues:
Consistent therapeutic
relationship is
important.
Treatment issues are
complex.
Course of treatment
Healing takes time.
 Aspects Of Treatment:
Individual Therapy:
The therapeutic process is sometimes more important than the
content.
Consistency is extremely important in therapy with foster
children.
It is helpful to give the client some control of the session.
Reducing anxiety by teaching relaxation techniques is often
helpful during the initial stage of therapy.
The therapist must be comfortable confronting tough feelings
and issues directly.
The therapist needs to communicate closely with the foster
parents about the therapy process and goals.
 Aspects Of Treatment:
Sibling Work:
Many siblings in foster care do not have healthy
relationships with each other.
Working with siblings can often be challenging;
however, it can be beneficial to improving siblings
relationships, stabilizing a placement, sharing common
experiences, and working on social skills.
Other goals might include processing why they came
into care, expressing feelings surrounding removal,
discussing adjustment issues, discussing visitation, and
developing healthy communication patterns.
 Aspects Of Treatment:
Dyad Work:
Putting two foster children together to work on
common treatment goals can be very useful.
A therapy dyad can be a useful precursor to
placing a child in a group.
Many goals can be accomplished in the dyad
including processing feelings of loss, social skills,
communication skills, and relationship-building.
 Aspects Of Treatment:
Group Therapy:
Group therapy can be a powerful modality for
foster children because they can share common
issues and realize they are not alone.
Care should be taken in selecting children for a
group.
Groups could be process-oriented or focus on
topics such as social skills and anger
management.
 Aspects Of Treatment:
Trauma, Loss, and Adjustment Issues:
The need for trauma and/or loss work needs to
be carefully assessed.
Before embarking on trauma work, work with
the child at developing some basic coping skills.
A supportive therapeutic relationship should
allow for the child to feel safe discussing and
exploring issues related to adjusting to foster
care and to particular placements.
 Aspects Of Treatment:
Attachment Issues:
The therapist should involve the foster parents
in the treatment to help build healthy
relationships and attachments for the child.
Therapists should be careful not to have their
foster child become too dependent on them.
For children who develop indiscriminate
attachments, it is important to discuss personal
safety and appropriate boundaries.
 Aspects Of Treatment:
Self-Esteem:
Stephanie Marston defines self-esteem as a sense of
feeling lovable and capable. When those two things are
in sync, a person has high self-esteem.
Help the child develop and explore their identity.
Help the child to value their personal history instead of
being ashamed of it.
Help clients develop mastery and competency, in both
subtle and grand ways.
Aspects Of Treatment:
Coping Skills:
Getting needs met
appropriately
Identifying, exploring, and
sharing feelings
Tolerating distress and
reducing anxiety
Communication skills
Anger management skills
Impulse control skills
Problem-solving skills
Self-soothing skills
Self-care skills
 Aspects Of Treatment:
Social Skills:
Teaching social skills is critical in helping children
develop appropriate social skills.
The Boys Town model of breaking social skills down
into component parts and preventative & corrective
teaching are valuable ways to approach social skills.
Social skills training is most valuable with the support
of a reinforcing environment.
Role plays are helpful in helping clients learn social
skills.
 Aspects Of Treatment:
Teaching Values:
Because of placement changes and disruptions, children in care
may get minimal training in the area of morals and values.
The therapist and the foster parents need to play a critical role in
teaching values such as the golden rule.
Rosen (1998) suggests the importance of training children in out
of home placements in altruism, empathy, generosity, respect for
others, and right & wrong.
Foster children need to learn to take responsibility for their
actions.
 Aspects Of Treatment:
Processing Of Permanency Goals:
Children in foster care should be aware of their permanency goal.
The therapist should allow ample opportunity for the child to discuss
her goal and explore feelings surrounding the goal.
If the goal is adoption, all of the childs feelings surrounding adoptions
should be explored.
If the goal is termination of parental rights, the therapist must establish
a safe place for the child to explore his strong feelings related to the
issue.
If the goal is reunification, the therapist should work closely with the
biological family and help the child develop realistic expectations.
If the goal is independent living, this should be incorporated into
treatment. The therapist should be one of many preparing the child
for independence.
 Aspects Of Treatment:
Reunification Work:
If the goal is reunification, active steps should be taken to assist
with the process.
Family therapy is essential to prepare for reunification. It should
be scheduled as frequently as possible.
The therapist and foster parents must take a nonjudgmental and
supportive posture towards the biological family.
It is important to remember that most parents who
abuse/neglect their children do love them.
Ideally, the foster parents could be coached by the therapist to
provide parent training for the family.
 Aspects Of Treatment:
Reunification Work:
Biological parents can be taught to give supportive
messages to their children regarding their behavior in
the foster home.
While foster parents are assisting with parent-training,
the therapist can work on communication, problem-
solving, and coping skills within the family.
Solution-focused work is helpful in conducting
reunification work.
 Aspects Of Treatment:
Reunification Work:
Often the therapist will need to redirect the family back
to the reason for the removal to plan for the future.
Biological parents often minimize the circumstances
surrounding the removal.
It is often helpful for the childs individual therapist to
be the family therapist as well. The therapist is a bridge
between the biological family and the foster family.
The treatment team should be in place prior to the day
of reunification. It is important for therapeutic
relationships to be established so the biological family
will be more inclined to commit to services.
Helpful Therapeutic Techniques:
Letter writing
Journal writing in between
sessions
Nondirective play therapy
Directive play therapy
Use of toy phone
Creating a memory box
Creating a photo album
Empty chair technique
Helpful Therapeutic Techniques:
Creating stories and
metaphors
Puppet play with foster
child puppet
Teaching clients
something in session to
build competencies
Play with animal families,
dolls, or puppets
Use of art therapy
Helpful Therapeutic Techniques:
People who care about
me activity
Body drawing
Celebration ritual
Positive self-statement
journal
Taking care of a baby
doll or stuffed animal
Mapping out history and
placements
Lessons Learned From Foster
Children:
Carl: Repeated re-telling of
abuse story is not
therapeutic.
Nicholas: Abused kids are
hungry for a corrective
experience.
Jason: Some foster children
are eager to push others away
before they pulled away
Jacob & Jaxson: Unresolved
anger can lead to time in jail
 Lessons Learned From Foster
Children:
Felicity: Kids can teach
adults.
Tyler: Healing and moving
on takes time and the power
of a loving family.
Anthony: Fitting in at all
costs is important to many
foster kids.
Joe: Unconditional
acceptance leads to healing.
Lessons Learned From Foster
Children:
Stefano: Foster children are
quick to be accused.
Jonathan: Kids can be quite
resilient.
Justin: Relationships can
help to get through a crisis.
Germancy: Dont assume a
foster child has picked up
basic social graces. Pre-teach
to foster children.
 Someone Elses Child
Be there for me

I am someone elses child.

Wont you be there for me?
If not you, then who?
 Bibliography:
Baker, C.B., Burk, R.V., Herron, R.W., & Mott, M.A. (1996).
Rebuilding childrens lives. Boys Town, NE: The Boys Town Press.
Bowlby, J. (1988). A secure base: Parent-child attachment and
healthy human development. New York: Basic Books, Inc.
Boyd Webb, N. (Ed.). (1991). Play therapy with children in crisis:
A casebook for practitioners. New York: The Guilford Press.
Cohen, J.A., Mannarino, A.P., & Deblinger, E. (2012). Trauma
focused CBT for children and adolescents: Treatment applications.
New York: The Guilford Press.
Cohen, J.A., Mannarino, A.P., & Deblinger, E. (2006). Treating
trauma and traumatic grief in children and adolescents. New York:
The Guilford Press.
 Bibliography:
Combrinck-Graham, L. (Ed.). (1995). Children in families at risk:
Maintaining the connections. New York: The Guilford Press.
Combrinck-Graham, L. (Ed.). (1989). Children in family
contrexts: Prespectives on treatment. New York: The Guilford Press.
Delaney, R.J. (2006). Fostering changes: Treating attachment-
disorderd foster children. Bethany, OK: Wood N. Barnes.
Delaney, R.J. (2000). The healing power of the family: Illustrated
overview of life with the disturbed foster or adopted child. Bethany,
OK: Wood N. Barnes.
Delaney, R.J. & Kunstal, F.R. (2000). Troubled transplants:
Unconventional healing for disturbed foster and adopted children.
Bethany, OK: Wood N. Barnes.
 Bibliography:
Gil, E. & Briere, J. (2011). Helping abused and traumatized
children: Integrating directive and nondirective approaches. New
York: The Guilford Press.
Gil, E. (1996). Treating abused adolescents. New York: The
Guilford Press.
Gil, E. (1991). The healing power of play. New York: The
Guilford Press.
Hughes, D.A. (1998). Building the bonds of attachment:
Awakening love in deeply troubled children. Northvale, NJ: Jason
Aronson, Inc.
James, B. (1994). Handbook for treatment of attachment-trauma
problems in children. New York: Lexington Books.
James, B. (1989). Treating traumatized children. Lexinton, MA:
Lexington Books.
 Bibliography:
Jarratt, C.J. (1994). Helping children cope with separation and
loss. Boston, MA: The Harvard Common Press.
Minuchin, P., Colapinto, J., & Minuchin, S. (1998). Working with
families of the poor. New York: The Guilford Press.
Rosen, M. (1998). Treating children in out of home placements.
New York: The Haworth Press, Inc.
Temple-Pllotz, L., Stricklett, T.P., Baker, C.B., & Sterba, M.N.
(2002). Practical tools for foster parents. Boys Town, NE: The Boys
Town Press.
U.S. Department of Health and Human Services. (2012). The
AFCARS Report.