Eighty percent of brain cells grow in a child’s first two years of life. When a child experiences trauma, even before the age of 2, that trauma can affect the child forever. Stephanie and Lance Schmidt have witnessed the effects of trauma firsthand in their two adopted children, both of whom joined their family as babies.
“Separation from a birth parent is very traumatic at any age, including at birth, and that trauma is carried throughout their lives,” said Stephanie Schmidt.
A child who has experienced trauma may respond to stress in unusual ways and oftentimes traditional parenting methods don’t work. The challenge for parents of children from hard places is that while they may look and act happy and healthy most of the time, they aren’t. The core of who they are, their very biology and physiology, has been changed by what they endured.
“What happens to kids in childhood doesn’t just go away because you change [their] environment,” said Deb Shropshire, pediatrician and deputy director of child welfare community partnerships for the Oklahoma Department of Human Services. “It affects their brain and development. It changes the hormones released in their body. They aren’t ‘good’ in a good environment.”
But one way to help set foster kids up for success is to provide therapeutic foster care (TFC). Through identifying children who need therapeutic care and training foster parents with special skills to help them, kids are getting the care they need after trauma.
“Parenting a child from trauma means extending grace in a way I never knew possible,” said Stephanie Schmidt. “It means finding and securing care and therapy so they can find healing. It means finding peace in their hearts and showing them how to trust and love and how to be loved.”
Therapeutic foster care families offer safe place to heal
While it’s true that every child in foster care has endured some level of trauma, with love, support and proper therapy, many can transition into traditional foster homes as they await permanency through reunification with biological parents or adoption.
For foster children who require a more intensive level of care than a traditional foster family can provide, TFC comes in. TFC is designed to serve foster children with special psychological, social, behavioral and emotional needs. Children must meet specific criteria for this level of care and remain eligible for TFC based on information submitted every 90 days to the Oklahoma Health Care Authority.
“These children need extra care and supervision to help them learn how to behave within a family and how to relate to family in appropriate ways,” said Sherlyn Conlan, child placement supervisor for TFC placement agency Eckerd Kids.
As Oklahoma has closed its two state-run shelters in favor of serving foster children more effectively in family environments, both traditional and therapeutic foster families are in even greater demand.
“The federal government, the administration, state child welfare agencies and legislatures and the research community all know that children do best in homes and with families,” said Dr. Laura Boyd, national pubic policy director for the Foster Family-based Treatment Association. “If it can’t be their own family, then it needs to be a family prepared to meet the needs of the child.”
Meeting the needs of a child with behavioral or mental health challenges requires adequate training and constant support from placement agencies for therapeutic foster families. TFC placement agencies contracted with OKDHS specialize in this type of care and must meet stringent national credentialing standards. Much is required of the foster parents as well.
Eckerd's TFC parents receive approximately 45 hours of training before taking a placement, compared to 27 hours for traditional foster parents. Those additional hours of training encompass topics like behavior crisis management, treatment of children with attachment disorder, treatment of children and families with substance abuse, and working with victims of abuse and sexual safety planning. TFC parents must receive a minimum of 18 hours of in-service training per year, compared to 12 for traditional foster parents. That annual training can be tailored to meet the specific treatment needs of children in the family’s home.
The services offered for TFC children and parents also are more intensive, with many available in the home. Services include individual and family therapy, educational support and advocacy, psychiatric care and daily instruction in basic living and social skills. Every TFC child is assigned a specific master’s level, professionally-licensed therapist who provides individual and family therapy an average of eight hours per month.
But according to Melanie Johnson, executive director of Choices for Life Foster Care & Outpatient, it’s the daily support and treatment provided directly by the therapeutic foster parents that sets this level of care apart and promotes growth and healing for the child.
“Treatment parents provide a high level of supervision, with daily support, interventions and skill building for a child,” said Johnson. “They build relationships while doing so, which is key to create change and healing. The children also learn structure, boundaries and love.”
TFC parents must complete daily paperwork for their placement agency, reporting on the learning, skill building and treatment activities completed with the child, as well as any concerns they have. And those TFC agencies are available to foster parents 24/7 for support or crisis response.
“TFC agencies are going to be there to train you appropriately, work with you to find kids for your home that you are equipped to help and support you during their stay in your home,” said Meghan Theobald, state director for Arrow Child & Family Ministries. “To see [the kids] make positive changes in their social and emotional functioning, improve their ability to interact with others and learn healthy habits is what this is all about.”
While it’s necessary to get a child in need in a home that can provide more intensive care, it’s also important that children in TFC homes don’t stay there. Theobald calls TFC a “temporary level of care,” helping children learn the skills they need until they no longer require such a high level of supervision and interaction with professional staff.
“We want kids to move through that [TFC homes],” said Shropshire. “We want them to get better and come out to a traditional family setting.”
Local agency offers unique resolution to TFC crisis
As the state of Oklahoma continues to lag behind in funding and treating mental health disorders, one Oklahoma City-based foster placement agency is making tremendous strides in providing a ground-breaking, evidence-based treatment option to children from trauma.
Developed by Angels Foster Family Network, HALO (Healing, Attachment, Loving, Outreach) is a 10-week intensive outpatient intervention designed for children who have experienced relationship-based trauma, institutionalization, multiple foster placements, maltreatment or neglect. Because of the trauma they have endured, these children have an extremely difficult time trusting the adults in their lives and forming healthy relationships with them. Those attachment challenges can declare themselves through anxiety, physical aggression, cognitive delays, an underdeveloped conscience, control issues and an aversion to physical affection.
“These are kids who need therapeutic care but there’s not a place for them,” said Jennifer Abney, executive director for Angels. “We’re getting referrals all the time from DHS because it keeps kids out of TFC.”
HALO is based on the Trust Based Relational Intervention (TBRI) model created by Dr. Karyn Purvis and Dr. David Cross at the Texas Christian University Institute of Child Development. TBRI and HALO both focus on addressing a child’s physical needs, developing healthy attachments and disarming fear-based behaviors. Children who flourish in these connection-based therapies are often those for whom other interventions, therapies and medications have failed.
“TBRI is a research-based way of life that helps our children to trust us and connect with us,” said Stephanie Schmidt. “TBRI helped us to understand that we can’t parent in a punitive way if we want our children to heal from deep wounds.”
Like Stephanie Schmidt, many foster and adoptive parents have to completely rethink their parenting methods. Children from trauma often operate out of fear of the worst-case scenario. Traditional parenting methods, like reward and punishment systems or consequences for negative behavior, may have little to no impact. It’s no wonder that the foster and adoptive parents of these children are often at their wit’s end, with a strong desire to help their children but depleted of the emotional and mental capacities to do so.
“Cindy [HALO founder] called us just as we felt our lives crumbling around us from parenting children with such great needs,” said Stephanie Schmidt, who, along with her husband, already had 10 hours of TBRI training under her belt as required by their adoption agency. “We had no idea how much we would need [TBRI] … until we did.”
Perhaps even more important than the therapy the child benefits from is the training the parent receives through the HALO program. Unlike a traditional therapy environment where a foster parent would wait in the lobby while a child receives counseling, foster and adoptive parents are fully engaged in the HALO program. While therapists work with children on attachment and bonding activities, parents learn about what trauma has done to their child’s very brain chemistry and develop a new methodology for things like everyday conversation and discipline. For the Schmidts, that means no spanking and no time outs.
“We do re-dos, allowing them to practice doing things the right way, and time-ins, allowing them to get regulated near you instead of sending them away,” said Stephanie Schmidt. “We playfully engage them and often this disarms anger and poor behaviors.”
A parental support group builds connections with others sharing the same struggles, and parents practice play therapy techniques designed to empower, correct and connect with their children. Speech and occupational therapy are provided to children as needed. Stephanie Schmidt appreciated that HALO is a holistic, comprehensive program, offering proper assessments and evaluations of her child and connecting their family to other trained professionals to help them all continue to heal.
“Where we most benefited from the program was by having someone help us find the other help we needed outside of counseling, and piece that together with counseling for the maximum benefit,” said Stephanie Schmidt. “We had a really difficult time knowing what therapy to try next until we had a diagnosis. The diagnosis was such a blessing for us because it showed us exactly what we needed to do for healing, and we finally began to see drastic results.”
Sixty-five children have gone through the HALO program since its inception. Families who have participated report a decrease in relational frustration and an increase in attachment, parenting confidence and involvement. Families also cite an increase in compassion and understanding of their child and his or her history.
“One hundred percent of kids in HALO who are in Angels’ placement have remained in their home and not been moved,” said Abney, which is especially impressive because many of the foster parents who have participated in HALO weren’t sure if they could successfully continue to parent their foster children.
The program has grown so much that Angels now offers four HALO programs each week. HALO is available to any foster or adopted child struggling with attachment.
As Stephanie Schmidt noted, connection-based therapies like HALO and TBRI are a lifestyle and must continue to be practiced to see kids heal, grow and thrive. Though she expects her kids will be grown before she has it mastered, her family’s focus on connection therapy has relieved fear for her kids and frustration for she and her husband.
“When they connect, they begin to trust,” said Stephanie Schmidt. “When they trust you, they can heal.”
Becoming part of the healing process
The challenges, fear, frustration and worry in fostering or adopting a child with such a difficult past can feel extremely daunting to seasoned and prospective parents alike. As echoed by so many in Schmidt’s shoes, “Parenting a child with trauma is draining.”
The Schmidts make a point to care for their marriage and their individual emotional health by taking time away when they need it. They are fortunate to have family nearby who not only love their children but also respect and support their unique parenting methods.
“Families who don’t have support really struggle because it’s tough to leave kids from trauma with people they don’t know they are safe with,” said Stephanie Schmidt.
For agencies like Arrow, that means helping TFC families identify or connect with alternate caregivers, respite providers and community support. Theobald recognizes that while not everyone in our community is called to be a foster parent, building a strong support system around foster families can make the difference between a family giving up and choosing to continue offering their hearts and homes to children in need.
“The outcome of strong support networks will be that current foster families will be revived and sustained, new families can be involved and help kids in need, and kids will end up being in more stable homes,” said Theobald.
Angels’ HALO program needs more community members to become “buddies” assigned to each child enrolled in the program. Buddies provide one-on-one positive, nurturing interactions with a child during each of the program’s 10 sessions, serving as a role model for behavior and providing a secure base for the child to explore social, attachment and sensory activities. Buddies must undergo a background check, attend training sessions and commit to the full 10 weeks of the program. Some volunteers have found this a helpful way to determine whether to become a traditional or TFC foster parent.
“When you see kids at their worst and see them come through, you realize that you could do it,” said Abney.
Theobald agrees that while children from trauma can exhibit behaviors that may seem scary, adequate training and support of foster and adoptive parents can lead to progress and positive outcomes for kids from difficult places. That faith that children from trauma can succeed is what drives many foster parents to embrace what some call “the hardest job you’ll ever love.”
“TFC parents will tell you that working with these kids may be more challenging, but the rewards that come when these kids are successful are that much sweeter,” said Conlan.
Children in need of therapeutic care being forced to wait
As of January 2016, there were 525 foster children in therapeutic foster care homes in Oklahoma, representing about five percent of all children in care. According to Theobald, there are almost 150 kids on the waiting list for TFC homes. Many have previously been in the now-closed state-run shelters and are 10 or older.
“The need is very high for parents willing to take on the older and challenging kids,” said Johnson. “OKDHS is making progress in closing the gap between the available homes and the need for the traditional foster kids and the younger kids, but the gap is growing for the older kids and those with behavioral, emotional and medical issues.”
As Johnson indicates, older children can be more difficult to find homes for, perhaps because, according to Boyd, the intensity of their needs and their traumatic triggers have increased or become more ingrained over time.
“Delaying treatment for any illness risks that illness becoming more acute or even chronic,” said Boyd.
“For these youth, that is the same dilemma. Older youth have simply been ignored longer.”
But that doesn’t mean there is no hope. Boyd, who has a special fondness for working with older youth, said the TFC professionals’ and foster parents’ tools and training can make all the difference for a child who has endured significant trauma, no matter the age.
“The reality is that these older kids need a family and a home in order to avoid the negative outcomes that we know they are at an increased risk of if they age out of foster care,” said Theobald.
A study by Chapin Hall at the University of Chicago found that of the children who age out of foster care, meaning they haven’t found permanency thought adoption or reunification with biological family by age 18, half are unemployed and nearly a third are homeless by the age of 24. The study also found 55 percent of males and 29 percent of females will be arrested at least once. Boyd agreed that society is faced with the decision of responding to such mental health issues with the intensive, in home clinical services like a TFC home can provide, or delaying treatment until long-term institutional care, either clinical or prison, is the only answer.
“We have the training modules now,” said Boyd. “We know the therapies and approaches that are evidence-based and provide the outcomes needed for youths and families. Truly, what we need is the community to step up and open their hearts and homes to taking in a child in need.”
But willing TFC and traditional foster parents is only one piece of the puzzle.
“We also need adequate funding from state legislatures to pay for training of clinical staff and foster parents in these evidence-based interventions,” said Boyd. “And what this field requires from clinical staff and TFC parents needs to reflect more adequately in the stipends we give foster families and the salaries we pay the licensed clinical experts who can earn much more in private or agency practices.”