AIDS tests on foster children in the 1990s

I apologize for the intermission in my blog entries... I've been in California on a family vacation. During that time, I met with three wonderful people who are each working in their own ways to make a positive difference in foster care. It was definitely one of the best trips I've ever taken, but I'm sorry to be silent for so long!

I'd like to begin this blog entry by inviting readers to share specific cases of psychotropic drugging of California foster children. KCBS investigative producer Karen Foshay is very passionate about this subject, and your insights would add to her current research.

I have already passed on this request to several other sources, but I figured one more "shout-out" wouldn't hurt.

Historical prospective
In light of unresolved nationwide issues in drugging foster children, I wanted to turn back the pages of time to share another atrocity: Hundreds of foster children received experimental AIDS drugs in the 1990s without the oversight of medical advocates.

Yes, you read that correctly: Foster children who were HIV-infected were used to test potent AIDS drugs by federally funded researchers.

Using foster kids as guinea pigs
Testing took place in seven states: Texas, Colorado, New York, North Carolina, Maryland, Lousiana and Illinois. This research was funded by the National Instititutes of Health.

The guidelines for the "Protection of Human Subjects" require researchers to inform the subject of possible side effects and obtain parental consent.

Due to the lack of parental involvement, researchers initially promised NIH in writing that they would appoint medical advocates for each child, in accordance with federal law.

Where were the advocates?
Between 600-1300 foster children, ranging from infants to teenagers, participated in the HIV experiments. Many suffered side effects, such as rash, vomiting and plunging levels of infection-resisitant blood cells.

In some cases, medical advocates were promised but not provided. In others, research oversight boards later determined that medical advocates where not necessary.

-The Columbia Presbyterian Medical Center in New York provided advocates for 142 of the 465 foster children used by researchers to test AIDS drugs in their state. Approximately two-thirds of subjects did not receive advocates, which was in violation of state policy.

-Illinois officials reported that foster children tested at the Chicago Memorial Hospital received no medical advocates.

-At the John Hopkins University in Baltimore, medical advocates were also absent.

Where was the informed consent? What about a guardian at litem?

Did the end justify the means?
During the investigation led by the U. S. Office for Human Research Protections, medical researchers asked that the experiments be viewed within the context of the late 80's and early 90's, when a million Americans were estimated to be HIV-positive.

The Maryland medical oversight board claimed that, according to state policy, in trials where the child patients face minimum risk or are expected to draw direct benefit from the research, no medical advocate is required to oversee medical experimentation.

The ethical paradox was that foster children were recieving costly, life-extending care from the world's most eminent doctors, at a time when no other viable treatments existed.

John J. Farley, associate professor of pediatrics at the University Maryland School of Medicine said, "I join with my colleagues in feeling that they weren't exploited and probably a number of those children are alive today because they had access to those medications."

It would be difficult to verify or nullify the truth to his statement, since no further information was forthcoming about the subjects of the research. After denying medical advocacy to foster children, medical officials now claim to be protecting their confidentiality.

Foster children deserve medical advocacy
The staff of the Houston Chronicle wrote that, "Few members of society are more vulnerable than children without permanent parents. Foster care kids with dire illnesses are more fragile still."

They concluded that, "Because of their vulnerability, each of these foster children should have had a medically qualified advocate. It is a high standard of legal protection - but not too high for children with so few defenses."

As Representative Fortney Stark, from California pointed out that prisoners involved in medical research have advocates to oversee all participation in medical trials. Similar protections should be offered to foster children.

He said, "I think we'd all sleep a little better at night if we put in a requirement that children have sufficient advocacy."

Sources
Brainard, Jeffrey. Report faults studies using foster children. Chronicle of Higher Education, May 27, 2005, Vol. 51, Iss. 38, p.A23.
Editorial: Put child advocacy before science. Atlanta Journal, Constitution, Atlanta, GA, May 13, 2005, p.A14.
Hopper, Leigh. AIDS study of foster kids scrutinized: No advocates were provided for children given drugs in trials that included Baylor. Houston Chronicle, Houston, TX, May 5, 2005: p.B6.
Otto, Mary. Drugs tested on HIV-positive foster childre: Hill investigates ethical questions raised by 1990s trails in Md., elswhere. The Washington Post, Washington, DC, May 19, 2005: p.B1.
Spencer, Jim. Lack of informed consent dulls good news in kids' study. Denver Post, Denver, CO, May 9, 2005, p.B5.
Standards of caring: Legal protections for foster children should be at least as high as they are for kids with parents. Houston Chronicle, Houston, TX, May 14, 2005, p.B8.
Walters, Ron. Minority foster children used as guinea pigs in HIV tests. Tri-State Defender, Memphis, TN, June 4-June 8, 2005, Vol. 54, Iss. 23, p.4A.

Making the most of every opportunity

As mentioned in a previous post, I have been chosen to help design the Ohio chapter of FCAA. As co-founder with my friend Gayle, my first challenge will be getting in touch with foster alumni throughout the state, and inviting them to help positively influence nationwide policy.

History of Foster Care Alumni of America
In 1999, the Casey Foundation conducted the largest ever retrospective study of foster alumni. Their research was based on extensive interviews with 1400 foster alumni, who had aged out of care between 1966-1986.

Because this study was the first of its kind, they had no idea what to expect. One thing that they didn't expect was that every participant, whether their ultimate placement had been positive or negative, wanted to change the foster care system.

They were actively engaged on all levels. One woman who was destitute, spent hours talking on a calling card, in the hopes that her experience could be used to positively impact others.

As a result of their findings, the Casey Foundation founded an Alumni Relations Board in 2000. Two years later, the board recommended the need for a national organization. Why? Because foster alumni needed to have a collective voice.

FCAA achieved national 501 3c status in 2004. In May of 2006, representatives from seven states (including yours truly) attended the summit in Seattle.

The need for a collective voice
Foster care alumni are an invisible population. If you met me, you wouldn't know I grew up in foster care unless I told you. There is no scarlet "F" label on my chest.

Because of the stigma and stereotyping that most foster youth experience growing up, alumni are often reticent to identify themselves as former foster children. We have experienced firsthand the low expectations and lack of credibility that foster youth are often afforded.

It has been a conscious choice on my part to identify myself with my past. I do it because of my passion to speak up for those who cannot speak for themselves.

But, a national foster alumni organization takes this idea one step further: It empowers foster alumni to speak for themselves.

Connecting with other foster alumni
Many challenges are inherent in trying to arm the passion and power of former foster children. We have learned not to connect, not to commit, not to trust. We have learned to be individuals, and to stand on our own. We have experienced feeling "different," which often leads to self-isolation.

So, how can we connect with one another? Trust one another? Work with one another, when our first impulse will be to tackle problems individually?

Obstacles exist, but I believe the outcome is worth the effort. Before leaving for my trip to California, I printed out 200 fliers, inviting adults who grew up in group homes, foster homes or with a relative (kinship care) to contact me and be a part of Ohio FCAA.

My initial plan was to visit every Krogers in town and post fliers on the bulletin boards. Unfortunately, Krogers have replaced their bulletin board with plastic display cases, and wire shelves designed specifically for Krogers-approved publications.

My back-up plan was to post fliers all over the local college campus, with the help of my oldest stepdaughter. I also visited every store downtown in the Short North area. This is an area frequented by people of all backgrounds, from professionals to college students, to homeless individuals.

I posted fliers in college coffee shops, tattoo parlors, downtown restaurants, laundrymats and car repair establishments.

Opportunity for a television appearance?
I have recently been in contact with Michael Bloom, the associate producer of the Dr. Keith Ablow Show. He is looking for a foster child or alumni who is struggling.

Here is the dilemma, as I see it:
Mr. Bloom has a deadine to deal with... He seems to be sincere in his belief that Dr. Keith Ablow is a reputable and sensitive doctor. He cannot understand why different agencies that he has contacted, including Foster Care Alumni and the California Youth Connection, appear to be stonewalling him.

The way he sees it, this could be a great opportunity for someone. Free counseling, and the show would pay for their follow-up care. The reason that Mr. Bloom works for the Dr. Keith Ablow Show is because he believes that it positively changes lives.

However, I can also understand why organizations might hesitate to respond. When I received Mr. Bloom's email, my first instinct was to feel protective...

My concerns:
1.) Not to betray anyone's trust. (I will not give out contact information for the foster youth / alumni that I am in contact with without their permission).

2.) What I call the "Drew Barrymore syndrome:" If you take an emotionally raw person and they air their experiences publicly, that is very sensitive information that they are putting out there. It could potentially follow them throughout their life.

Foster children already grow up with a case file, which is not always permanently closed when they reach adulthood. They don't need to be haunted by anything else.

3.) Not to waste an opportunity to give a voice to someone in/from foster care. There are many emotional issues affliction foster children that can and should be brought to life. Post-traumatic stress disorder is one of them.

Foster alumni often don't have medical insurance. If the show provided follow-up therapy, that would be a generous and helpful gift. It might lead to greater emotional health and healing...

I think that the two biggest challenges that Mr. Bloom faces in trying to find foster youth/alumni willing to appear on the show are:

1.) We as foster youth don't want to come across as weak, needy or broken. Not allowing us to talk about our successes and progressive healing is a turn-off. We need to be able to say how far we've come, before we risk the vulnerability of sharing an area or two wherein we might still need to heal.

2.) The television format is "now, now, now." If you really do want to contact someone straight off the streets, homeless due to aging out of foster care without proper resources and/or emotionally raw, you have to put in some time.

You will have to earn their trust. Work at it. Foster alumni have often been exploited in the past, and they will be ultra-sensitive to being exploited in the future.

For you, it's a show. For them, it's their life. Because deep-down, underneath the tough exterior that we might put on, foster care alumni are vulnerable.

Fathers & Daughters

My favorite scene from the movie, "Good Will Hunting," is the one wherein Robin Williams assures Matt Damon that he (Matt) is not to blame for the abuse he suffered as a child. "It's not your fault... It's not your fault... It's not your fault."

Robin keeps repeating this phrase, until finally Matt bursts into tears and reveals the feelings of guilt and shame that he has been carrying.

Running from a feeling of shame
Sadly, children often internalize traumatic events. Part of being a child is sometimes viewing self as "all-powerful." Also, feelings of loyalty toward the parent can cause children to shift the burden of blame onto themselves.

Shame can be a depressing, disturbing and deadening experience. Dr. Norman Wright describes it this way: "Shame is like a hole in the cup of our soul. Since the child in the adult has insatiable needs, the cup cannot be healed."

What do insatiable needs look like?
Shame often demonstrates itself in the form of compulsive behavior. Workaholic, sexaholic, money hunger, eating disorders, substance abuse... Take your pick.

Alan Jones describes it this way, "I consume things - to stop myself from being consumed... trying to gratify an immediate hunger, without accepting that hunger is part of being human and so cannot be dealt with or understood by an endless succession of leakplugging operations."

Compulsions can be self-destructive in the long-run, but in the present, they serve a specific purpose. They distract us from fear, worry, loneliness, anger and pain.

Father loss & daughter reaction
A father might die, abuse or abandon his child or be present physically, but not emotionally. In the case of divorce, he might want to see his children more often, but be unable to do so...

Regardless for the reason for paternal absence, the impact on a child can be astrononical.

Abandonment and neediness
When I was in college, my roommate was father-hungry. She feared abandonment, and reacted to that fear by clinging to her boyfriends.

Her behavior was not always endearing. One night, when her boyfriend said he needed space and was about to drive off to his apartment, Andi took his keys and through them into the bushes, so that he couldn't leave.

Deep inside Andi was the little girl she once was... The little girl who stood at her bedroom door, counting cars and telling herself that one of them would be her father coming to visit her.

Insatiable needs can be difficult for others to deal with...

Achievement as a substitute for intimacy
After living in foster care from age 12-16, I was also father-hungry. But my father hunger manifested itself in a different way than my roommates. I experienced the same fears, the same anxiety as Andi -- but my conclusion at the time was that it would be better to rely on myself.

A father's absence teaches a young woman the precariousness of love. One response is to invest emotions in activities, rather than people. There is often an underlying desire for paternal approval.

Living under a father's shadow
For any experience, there can be a myriad of reactions. Why did Andi and I react so differently? One factor can be the role that the father plays in a child's life prior to his absence. Before his absence, how did the daughter perceive her father?

Dr. Wright describes weak fathers as unreliable, undependable and having no strength to offer. Weak fathers do things like ending their relationship with their daughter because their new wife asks them to choose.

Daughters of weak fathers worry that they might overwhelm others with their emotional needs. They have been disillusioned by witnessing their father's ineffectiveness.

My father was a weak father. I can say that now, after having married a strong man.

Source
Jones, Alan W. SoulMaking.
Wright, H. Norman. Always Daddy's Girl.

Delayed Health Care for Foster Children

Drugging foster children unnecessarily is not good.

Denying foster children medical services due to citizenship concerns is equally disastrous.

Deficit Reduction Act of 2005 Revisited
Due to recent concerns about illegal immigration, the federal government is now implementing a provision of the DRA which requires that all U.S. citizens who apply for, or renew, their eligibility for Medicaid coverage must document their citizenship.

This ruling was effective on July 1, 2006. It is intended to prevent illegal immigrants from receiving benefits through Medicaid, the government program of health care for the poor.

What About Foster Children Receiving Medicaid?
Therein lies the rub. All children who eligible for Title IV-E funds can be enrolled in Medicaid. Up until now, the very fact that they receive federal foster care payments has been accepted as proof of citizenship.

Likewise, low-income children and children with disabilities within the foster care have had access to Medicaid as well.

Well... not anymore.

New regulations are requiring the documentation of citizenship for every child entering foster care. Without the proper documentation, foster children will remain uninsured.

Approximately 300,000 children enter foster care each year. How many of them will be carrying their birth certificates with them? Many of these children are coming from abusive and neglectful homes, and their families might not have (or be willing to relinquish) vital information.

Due to the circumstances surrounding the emergency removal of children from their homes, state agencies frequently use electronic birth records to establish case files. Now, only the original document, or a copy certified by the issuing agency will be considered acceptable.

Will foster parents be given enough information to apply for birth certificates on children's behalf?

What about the waiting period? Obtaining a birth certificate can take weeks or months.

Denying Foster Children Access to Health Care
Upon entry into foster care, a child might be developmentally delayed or underweight. They may never have visited a dentist or lack up-to-date immunizations.

It is for all these reasons that the American Academy of Pediatrics Committee on Early Childhood recommends a comprehensive medical screening upon entry into foster care.

Children who enter foster care are at high medical risk. How long should they wait to receive treatment?

I agree wholeheartedly with this quote from Robert Greenstein, Executive Director of the Center on Budget and Policy Priorities:

"These children are among the most vulnerable members of our society. To deny them health care coverage for beaurocratic reasons that readily could be resolved, and refuse them coverage while their documents are being located is not defensible."

Kudos to Montana for coming up with a creative solution
Montana's Motor Vehicle Division will issue state identification cards to nearly 2000 foster children.

Casey Family Programs contacts the Department of Health and Human Services
The following agencies joined Casey Family Programs in voicing (and documenting) their collective concern over this issue:

Association of Jewish Family & Children's Agencies
Arkansas Center for Health Improvement
Bazelon Center for Mental Health Law
California Mental Health Directors Association
California State Association of Counties
Child Welfare League of America
County Commissioners Association of Pennsylvania
County Welfare Directors Assocaition of California
Familes USA
Foster Care Alumni of America
Illinois Department of Children and Famiyl Services
Jim Casey Youth Opportunties Initiative
National Advocacy Center of the Sisters of the Good Shepherd
National Association of County Human Services Administrators
National Association of Social Workers
National Education Association
NETWORK, a National Catholic Social Justice Lobby
Pennsylvania Children and Youth Administrator's Association
Public Children Services Association of Ohio
Safe Place: Center for Child Protection and Health
Alliance for Children and Families
Arc of the United States
Children's Health Fund
Vermont Department for Children and Families
Voices for America's Children
United Cerebral Palsy
Wisconsin Counties Association

Sources
Kids in foster care receive state cards. Montana News Station, Great Falls, MT: July 2006.

National organizations warn HHS that citizenship-verification rules could lead to denial of critical medical services to foster children. Casey Family Programs press release: June 30, 2006.

Redmond, Pat. Children in foster care may have to delay health care because of federal regulations on citizenship requirement. Center on Budget and Policy Priorities: July 7, 2006.

Spillane, Shannon. Changes in Medicaid rules 'commendable,' but further changes needed to precent loss of health coverage by poor children and parents. U. S. Newswire: July 7, 2006.

Drugging Foster Children

If I hadn't read these articles, I (a former foster child) would have thought that drugging foster children was an urban legend.

It is the stuff of a science fiction novel:
-States such as Texas, Florida and Minnesota discover an alarming number of foster youth on behavior-altering drugs.

-California state regulations provide financial incentive for group home staff to request and administer psychotropic drugs to children in their care -- because rates are based on mental-health treatment services per child.

-A seventeen-year old foster child in California is threatened that if she doesn't take the drugs she was prescribed, she will not receive transitional housing.

Unfortunately, all these things are happening - and it is time for them to stop.

Medicating wounds, rather than healing them
Medications have their place in helping members of society. But foster youth who experience grief, fear and sadness are simply displaying normal reactions to their living situations.

Consider this scenario:
Girl's mother dies - Girl feels sad - Staff recommends Zoloft - Group home receives more money.

What's wrong with this picture? It creates a system that is ripe for abuse.

In Texas, 12,000 foster youth received psychotropic drugs in 2004. Each child averaged 21 psychotropic drug prescriptions a year.

In Massachusetts, two-thirds of 17-year-old foster children have recieved inpatient or outpatient medical treatment (as opposed to only 37% in Illinois, Iowa and Wisconsin). State Representative Marie Parente believes that state reimbursement checks from the federal government might be a financial incentive to misdiagnose and overmedicate foster children.

In California, the use of drugs remains unchecked and unregulated. The California Psychiatric Assocation blocked the passing of a 2004 bill by then-Senator Mountjoy to analyze the administration of drugs to children in foster care.

Judges approving dosages
According to the California rules of court, Rule 1432.5: "Once a child is declared a dependent child of the court and is removed from the custody of parents or guardian, only a juvenile court judicial officer is authorized to make orders regarding the administration of psychotropic medicine to the child."

Is the judge now considered a medical expert? Does he or she even meet the child in question? Often, all that judge has to go by are the reports handed in by social workers and group home staff.

In 1999, when Governor Gray Davis gave final approval to the law requiring judges to sign off on medication requests, many juvenile judges said that they didn't know much about medications, nor the doctors prescribing them.

One judge reported that he simply trusted that the 'doctor knows best.' While Los Angeles Juvenile Court had the funding to screen requests through the county's medical health unit, other judges lacked the money for such a review.

Also, according to California rules of court: "In emergency situations, psychotropic medications may be administered to a dependent with or without court authorization..."

This is both disturbing and vague.

What constitutes an emergency situation? Is it only that the child is sad, and the group home will recieve more money? California group homes receive anywhere between $2000 and $6000 per foster youth, depending on what medications they are on, according to Jennifer Rodriguez, legal representative for the California Youth Connection.

Foster youth are not informed of their right to refuse medication. Foster youth reported being punished for refusal by losing privilges and threatened that they will be evicted from the group home.

Risks of overmedicating
Attorney Andrea Moore, of Florida, is currently representing several children who began lactating after taking antipsychotics .

One of her clients is also a twelve-year-old whose heart condition was exacerbated by the Geodon she had been prescribed. According to Moore, the doctor who prescribed Geodon did not even have the child's medical history. The drug's label clearly states that patients with heart problems shouldn't take it.

Actions being taken in California:
-Assembly members Noreeen Evans and Karen Bass, both members of the Select Committee on Foster Care, have requested a public hearing in August, focusing on medication, foster care and the lack of communication (and accountability).

-Attorney General Bill Lockyer is investigating the amount of tax dollars being spent to overmedicate foster youth.

-State Comptroller Steve Westly has called upon Governor Schwartznegger to take immediate action on this issue "in order to ensure that no one profits by forcing kids to take mind-altering drugs."

Nationwide concern
Paul Vincent, of the Child Welfare and Policy Group, believes that the number of foster children being prescribed antipsychotics has risen over the past few years.

Children as young as four-years-old are being prescribed antipsychotics. And, who is doing the prescribing? Vincent says, "They aren't even psychiatrists or counselors. I have considerable worry over the accuracy of these diagnoses."

According to USA Today:
-There was a 77% increase in Med-Cal prescription claims in California between 2001-2005.

-Illinois had a 39% increase betwen 2003-2005.

-In Florida, the number of Medicaid children taking antidepressants jumped from 9,500 to 17, 000 over the past five years.

Sources:
For foster kids, oversight of prescriptions is scarce. USA TODAY. McLean, Va.:May 2, 2006. p. D2

Hayasaki, Erika. Teens speak out about foster care; Thirty young people attend a summit at Occidental College to tell policymakers about problems they face and suggest some solutions. Los Angeles Times Los Angeles, Calif.:Jun 6, 2006. p. B2

To our children's defense. San Francisco Chronicle San Francisco, Calif.:Jun 14, 2006. p. B8

Vascellero, Jessica. Prevalence of drugs for DSS wards questioned. Boston Globe Boston, Mass.:Aug 9, 2004. p. B1

Weber, Tracy. California and the west: Foster children on medication get protections; Health: Davis signs measure to prevent youths in state care from getting improper or unmonitored doses of psychiatric drugs. Los Angeles Times Los Angeles, Calif.:Sep 30, 1999. p. 3

Distancing Self From Relationships

In upcoming postings, I will continue to explore the issue of drugging foster children and the need for medical advocacy. However, in this posting, I want to address why survivors of foster care might seem to distance themselves from relationships.

I've been editing the second half of my book, and as I read through old journals of mine from college and graduate school, it seemed so obvious what my peers were trying to tell me.

The messages had a common theme:
-"Connect with us."
-"Take a risk and date me."
-"All men aren't bad or dangerous."
-"Slow down and let people love you."
-"Take a break from saving the world, and play a game of volleyball."

Time to mourn
One thing that I believe foster care survivors need is time to mourn. Even more than the initial loss experienced upon entry into the foster system, the denial of that loss and inability to mourn it can impede personal development.

As Joanne Bernstein wrote, "If in the face of trauma, mourning remains absent or delayed throughout childhood, it can interfere with normal adult life. Children who will not allow their emotions direct expression are in effect saying, This event hurt me so much that I can never again let anything touch me."

Walled off from pain - and from love
Remaining fearful of rejection and abandonment, those who cannot mourn as children often shy away from relationships as adults.

As long as the initial losses remain unprocessed, new attachments will be difficult to form and internalize. As Fynn noted, "The soul is imprisoned, protected. Nothing can get in to hurt it, but then it can’t get out either."

What's the cure? No magic bullet to be sure, but there are several factors which can help:

1.) Time plays an enormous factor. Time to be nurtured, time to heal, time to wait before taking big risks again.

2.) Emotional expression within a context of acceptance and a caring community is also very important. Learning to react to losses as they occur also helps survivors reconnect with their core emotions. (I found my 'second home' in my college dorm).

3.) Reaffirming personal identity is vital. Foster care survivors often disassociate from past trauma in order to survive. Much of their emotional energy is spent on adjusting to each new placement.

To quote from Heineman, "For children whose histories are littered with separation, loss and abandonment, time with a past, present and future is anything but linear. Many of these children have little sense of self through time.

Consider it from the point of view of the foster child:
1.) No time to mourn initial loss of family; the child (or teen) must adjust to foster care.

2.) At each placement is a new environment with different expectations. In a sense, at each new placement, the child is forced to prove themselves.

3.) By going from one placement to another, the child learns the tenuousness of relationships and the inevitability that people will fail them.

Risking intimate relationships
Once a foster alumni has aged out of foster care, adult relationships pose a tremendous risk. Paradoxically, what they fear most is also often what they need most. However, it is their choice as to whether or not to receive it.

Speaking from my personal experience, I had a bad dating experience in college - and reacted to it by not dating again for eight years. An overreaction? Yes, most certainly. (I was reacting less to the young man I dated, and more to earlier experiences with men in my life. The breakup was a trigger that forced me to reexamine them).

Yet, looking back, I don't regret the time I took to heal. Those eight years before I met my husband were among the most productive in my life. I needed that time:

- To reflect, and process through the events in my past.
- To immerse myself in a caring community, and spend carefree time with friends.
- To build positive memories of friendships with many "good" men.
- To finish college and graduate school, and start my career.

I believe that the time that it took me to be ready for a serious relationship was well-spent. I wouldn't be as stable as I am today without it.

Sources
Bernstein, Joanne. Books to help children cope with separation and loss, Vol. 2, p. 11-12.
Fynn. Mr. God, This is Anna. Ballantine Books; 1985.
Heineman, Toni and Diana Ehrensaft. Building a home within: Meeting the emotional needs of children and youth in foster care. Brookes Publishing, 2006.

Texas Foster Care System

Ongoing investigations into the Texas foster care system
Comptroller Carole Keeton Strayhorn's current allegations should not come as a surprise to Texas officials.

What is surprising is that she is still being stonewalled and her efforts are still being resisted after three years.

Comptroller Strayhorn and her staff have been investigating the Texas foster care system and publishing their negative findings since 2003.

In 2004, due to deficient services and inadequate oversight, a complete overhaul of the Texas foster care system was recommended by Strayhorn.

At that time, Strayhorn called for accountability:

1.) Accountability for service providers: Strayhorn recommended that direct services be outsourced, and that DPRS conduct unannounced site visits and financial audits.

Direct services providers would be assessed based on:
- Safety
- Placement stability
- Maintenance of familial connections
- Shorter stays in foster care.

2.) Financial accountability: Money was to be directed toward funding programs for foster youth.

3.) Accountability for facilities: If a facility compromised the health and safety of foster youth through noncompliance to standards, their license was to be revoked.

4.) Accountability for DPRS*: (which is now DFPS)
- Caseworker visits were to be thoroughly documented.
- Comprehensive background checks were to be conducted.
- Complaints were to be thoroughly reviewed.
- Minimal number of foster placements.
- Children were not be placed with peers who had a history of violent crimes and /or juvenile sexual predators.
- A crisis management team was to be created, in order to decrease the number of child fatalities in foster care.

*Texas Department of Protective and Regulatory Services is now Texas Department of Family and Protective Services.

Let's Not Forget Medical Accountability

Comptroller Strayhorn's 2004 investigation uncovered that:
- 60% of children in the Texas foster care system were being given psychotropic drugs that were not been approved for children.

- Physicians had prescribed mind-altering drugs to children as young as three years old.

- Two Texas doctors who weren't psychiatrists were prescribing mental health medications to foster children.

- It was not uncommon for some foster children to have up to 14 different prescriptions.

- Many of these drugs were labeled "not for use by children," and listed as having serious side effects such as diabetes, cardiac arrhythmia, suicidal tendencies.

In 2004, as is currently happening in 2006, Texas health officials cited "privacy concerns" and patient confidentiality as reasons for their reluctance to share information.

Sources:
Garrett, Robert. Drug fraud alleged in foster care: Strayhorn believes kids are getting unnecessary psychiatric medication. Dallas Morning News, November 12, 2004.

Hughes, Polly Rose. Strayhorn will probe drug use on children: Comptroller asks for medical data on children in foster care. Houston Chronicle, Austin Bureau, Novemver 12, 2004.

Lilliedoll, Wendy. Texas Comproller says state foster care in crisis; "appalled" by conditions; called for "massive overhaul." Youth Law News, April-June 2004.
http://www.youthlaw.org/publications/yln/2004/april_june_2004/texas_comptroller_says_state_foster_care_in_crisis/

Death Rate in Foster Care

Is a child is four times more likely to die in the Texas foster care system than outside it?

Yes, according to Comptroller Carole Keeton Strayhorn, when she released data last Friday on foster care deaths, poisonings, rapes and pregnancies, saying, "Many children are in more abusive situations now than they were before the state intervened."

-Between 2003 and 2005, the number of children in foster care increased 24%.

-Meanwhile, the number of deaths in foster care between 2003-2005 increased 60%. According to the Texas Department of Family and Protective Services, 30 children died in foster care in 2003, 38 in 2004 and 48 children died in foster care in 2005.

Strayhorn alleged that the Health and Human Services Commission and the governor tried to block her attempts to gather more information about children in foster care.

Strayhorn began her investigation in 2004 after releasing a report on the foster care system called "Forgotten Children." It was at that time that she noticed that an alarming number of poisonings, rapes and pregnancies were taking place within the Texas foster care system.

In 2004:
- 100 Texas foster children were treated for poisoning due to medications they had received while in foster care.
- 63 Texas foster children received medical treatment because of rape occurring within the foster care system.
- 142 Texas foster children gave birth while in foster care.

Death in foster care:
- Two young men died at the Star Ranch residential treatment facility near Kerrville.
- A 12-year-old died last December after being restrained by a staffer
- A foster child drowned in a creek during a May outing.

"The state is supposed to be protecting our forgotten children, but in all too many cases these children are taken from one abusive situation and placed in another abusive situation," said Strayhorn.

Representatives from the Citizens Commission on Human Rights Texas, Justice for Children and Judicial Watch are calling on the Texas Health and Human Services Commission to release additional foster care data.

Sources
-Hughes, Polly Ross. Comptroller reports foster care abuse; Data show deaths increasing but agency calls comparison unfair. Houston Chronicle, Houston, TX, June 24, 2006: pg. 1.

-MacLaggan, Corrie. Strayhorn: Foster care in crisis. Auston American Statesman, Austin TX: June 24, 2006: p. B1.

-Moritz, John. Strayhorn seeks changes in foster care. Star Telegram Austin Bureau.

Youth Presentation at Statewide Foster Parent Conference

I have just returned from a statewide foster parent conference at Deer Creek, Ohio.

My friend Gayle and I led two presentations each:
1.) She presented to foster parents and social workers, in a session titled "Independent Living is a Lie."

2.) We each presented a youth workshop. I took the younger youth, while Gayle worked with teens.

3.) I gave a lunchtime presentation to an audience of 175 people. It was very sweet, because two foster children who had attended my youth workshop came running up to hug me afterward, "You did a great job, Miss Lisa!"

Youth Workshops
In this posting, I will focus on the youth workshops. With the teens, Gayle led a dramatic workshop, based on a class in issue-based drama that she had taken at OSU. Her twelve teenagers broke up into smaller groups to act out the issue and risks of running away.

In my workshop, I had 14 younger children and one adult helper. I had created a powerpoint presentation, sharing my foster care story with the children, explaining the power of stories and inviting them each to write their own personal "mission statement," with their goals for the future.

Art first exists in the artist's mind. Books first exist in the author's mind. There would be no buildings without the architect's blueprint. I explained to the children that their futures would need planning and determination.

My college mission statement was to work my way through school and graduate school, and to learn how to love and be loved.

Acheiving goals is not a race. It took over 20 years for me to accomplish a family of my own. I was 26 years old before I had the money to buy my first car. I was 30 when my husband and I moved into our first house, which we designed ourselves.

Important goals often take years to accomplish. The first step is to make a plan for yourself and work towards it. The time it takes is a worthwhile investment. What could be more important that your future?

When the children heard that, they were excited to write down their personal goals. Education, house, family, permanency... Much was revealed by what they wrote. I told them to think big and aim high. I also reminded them that these goals change over time.

Attribution Theory and Foster Children
One thing that I found very interesting about my youth workshop relates to attribution theory:

-In a study, boys and girls were given two puzzles. The first was impossible to solve; the second was super-easy.
-The girls blamed themselves for not solving the first puzzle, and said the second was too easy.
-The boys claimed that the first puzzle must be broken. They were great at puzzles, as proven by their success at the second puzzle.

I wondered how foster youth might respond... and at this conference, I found out. Every one of the 14 foster children in my conference blamed themselves for both their failure to solve the first puzzle and their success at the second.

It was all up to them. Think of what a weight that must be to carry.

Book Giveaway
We did not have much of a budget this year. Ohio Family Care Association had planned the conference, and due to funding concerns, they had not budgeted in an honorarium for speakers or our conference supplies. Gayle and I shared a hotel room with the woman who planned the conference and her two adopted children.

Because of the lack of funding, I supplied my own equipment (powerpoint, laptop) and purchased books for children and teenagers out of my own money.

I went to Half Price Books, and purchased:
1 copy of "Speak" by Laurie Halse Anderson
3 copies of "Dicey's Song" by Cynthia Voigt
1 copy of "Hidden Talents" by David Lubar
2 copy of "Won't Know Till I Get There" by Walter Dean Myers
1 copy of "Where the Lilies Bloom"
2 copies of "Homecoming" by Cynthia Voigt
1 copy of "Solitary Blue" by Cynthia Voigt
2 copies of "Bud Not Buddy" by Christopher Paul Curtis
3 copies of "Anne of Green Gables" by L.M. Montgomery
1 easy-reader copy of "Anne of Green Gables"
1 copy of "Secret Garden" by Frances Hodgson Burnett
1 copy of "Pinballs" by Betsy Byars
4 copies of "Great Gilly Hopkins" by Katherine Paterson

All things considered, I was very happy that the two Half Price Books I visited had so many options of juvenile books that deal with foster care and foster care-related issues. However, I would have been happier if there had been more multicultural options and more books with male characters.

Next year, I plan to seek funding myself, and strategically plan out my book purchases. I wish there were more Picture Books for foster children... (not just adoption).

Ohio Foster Youth Deserve Their Own Conference
Gayle and I have an ultimate goal, which is to have a concurrent foster youth conference. It would take place at the same location and time as the adult conference. We believe that foster youth deserve their own conference, centered in on their needs.

We discovered that there once was a separate foster youth conference in Ohio, but it "dried up, due to lack of funding." Gayle and I plan to seek funding for 2007. We might contact Foster Care Alumni of America, and ask if they would consider this as a pilot project for FCAA of Ohio.

Foster Children & Eating Disorders, Part 1

Children in foster care often have very serious issues around food. This might take the form of stealing or hoarding food, refusing to eat certain foods or exhibiting an eating disorder.

Behavior does not come out of a vacuum. Rather, it stems from personal experiences and thought patterns. People behave in ways that appear logical from their perspective, even if that behavior might seem strange or even harmful to other people.

Eating Disorders and Early Insecurity
Dr. Alfonso Troisi and his colleagues have recently published a study measuring the relationship between insecure attachment/early separation anxiety and a negative body image for women. The outcome was a strong association between the two.

Children who lack a safe and secure foundation in infancy are more vulnerable to eating disorders. They are more likely to have weight concerns and low self-esteem than children with secure attachments.

Insecure Attachment
According to attachment theory, if a child is secure in his or her relationship with a caregiver, that child will feel free to explore, because he or she is confident that a secure base exists, to return to in times of need.

The secure child explores freely while the mother is present, engages with strangers, is visibly upset to see mother depart, recovers and then is happy to see her return.

The insecure child lacks that self-assurance. When a primary caregiver disappears, he or she goes through a series of three stages of emotional reactions.

1.) Protest: The baby cries and refuses to be soothed by others.
2.) Despair: The baby is sad and passive.
3.) Detachment: The baby actively disregards and avoids the parent if the parent returns.

Attachment and Self Worth
Children who have been consistently loved by their caregivers develop a perception of themselves as "loveable," whereas children who are neglected and/or rejected by a caregiver often report feeling "unworthy of love."

Early connection with the caregiver makes it possible for a child to develop a model of themselves as loveable and valued. It reassures that child that there are loving, trustworthy people available and that the world is a safe place.

Interestingly, the most damaging style of attachment is neither anxious nor avoidant, but disorganized. Avoiding pain and worrying are both active strategies for dealing with the world. Children with disorganized attachment view human interactions as erratic and unpredictable. It's difficult to plan a response to perceived chaos.

Foster Children & Eating Disorders
I plan to contact Dr. Troisi, and invite him to do a study on foster children and/or foster alumni. My rationale is the following:

-Who has more first-hand experience with separation anxiety than a foster child?
-Sexual and physical abuse are also associated with both eating disorders and foster care placement.
-Eating disorders are often an issue of control.
-Is it surprising that some foster children might use eating disorders as a way to cope with change, trauma and stress?

Sources
-Ainsworth, M. D. S., et al (1978). Patterns of attachment: A psychological study of the Strange Situation. Hillsdale, NJ: Erlbaum.
-Bowlby, J. (1969). Attachment and Loss, Vol. 1: Attachment. London: Hogarth Press and the Institute of Psycho-Analysis.
-Hernandez, Jeanne (1995). "The Concurrence of Eating Disorders with Histories of Child Abuse among Adolescents." Journal of Child Sexual Abuse, 4, 3: 73-85.
-Holmes, J. (1993) John Bowlby and Attachment Theory. Routledge;
-Holmes, J. (2001) The Search for the Secure Base: Attachment Theory and Psychotherapy; Brunner-Routledge;
-Miller, Katherine J. (1996). "Prevalence and Process of Disclosure of Childhood Sexual Abuse among Eating-Disordered Women." In Sexual Abuse and Eating Disorders, ed. Mark F. Schwartz & Leigh Cohn, 36-51. New York, NY: Brunner/Mazel.
-Troisi, A., et al (2006). Body dissatisfaction in women with eating disorders:
relationship to early separation anxiety and insecure attachment. Psychosomatic Medicine, 68(3): 449-5.

Foster Children and Hoarding

I would like to start this blog entry with an embarassing - but, in retrospect, rather funny - story... When the man who is now my husband and I were dating, he looked in my kitchen cupboards and noticed something strange.

I did not own dishes, nor glasses. Rather, I had shelves filled with plastic cups; the kind you get at fast food establishments. I also had a huge assortment of empty cottage cheese containers. Lots of cups. Many, many empty cottage cheese containers. This was what I ate and drank from, every day.

The man who would one day become my husband looked at me and said, "Lisa, you are hoarding."

I said, "What are you talking about? What is that?"

Hoarding
The clinical definition of 'hoarding' is: "the acquisition of, and failure to discard, a large number of possessions that appear to be of useless or of limited value."

Why Would People Hoard?
- Because the items are perceived as valuable
- The items provide a source of security
- Fear of forgetting or losing items
- Constant need to collect and keep things
- Obtaining love not found from people
- Fear others will obtain their personal information
- Inability to organize
- Self neglect
- Stressful life events

Children often communicate needs through behavior. A foster child might hoard food, for example, due to early neglect and a fear of being hungry.

The fictional book "Money Hungry" by Sharon Flake tells the story of a young girl who is obsessed by earning and accummulating money. What first appears as greed begins to make sense when the reader learns that the protagonist and her mother were once homeless. By hoarding money, this young lady is making certain that she can provide for her mother, if the situation ever arises again.

How to Deal With Hoarding
This behavior does not come out of a vacuum. Rather, it is an adaptive response to deprivation.

For a foster parent, who has just taken in a child who hoards good, a plastic bowl with a tight fitting lid may be the answer. As the child adjusts to the new placement, this will allow him to regulate his supply of food and assure him that food is available. The lid will keep out odor and insects.

As trust increases, the need to cling to an alternative food source might decrease.

Don't Overreact
Above all, I would encourage people not to "pathologize" the hoarding. I am a firm believer that there is a reason for behavior - it might not make sense to outsiders, but in some way it seems logical to the person displaying that behavior.

Do not rush to a diagnosis. Don't assume that hoarding indicates that the person in question has OCD (obsessive-compulsive disorder). Try not to afix a label on a child, teenager or adult too quickly.

After all, compulsive hoarding was originally diagnosed as a psychological disorder that most frequently affects the elderly. It was described as "accumulation of useless possessions that clutter the person’s living space, often creates complex legal and social problems for the hoarder."

Think about it from the elderly person's point of view: What were they doing? Trying to hold onto memories. Attempting to relive the past. Treasuring momentos. Is that behavior pathological? Or normal?

Empathy
Viewing behavior within the context of the person who is displaying it is vitally important. Empathy has been defined as "understanding of another's situation, feelings, and motives."

If you were to visit my house today, you would see dishes and glasses. I no longer collect plastic containers. Yet I am as sane now as I was when my husband met me. What has changed is the fact that I am assured that I am financially secure enough that I can afford normal household items.

Source
Hoarding fact sheet. Los Angeles County Department of Mental Health.

Foster Care & Statutory Rape

I recently spoke with a former foster child, who is now a college-educated young woman. She revealed to me that, when she was 16 years old, her foster father raped her. He made a bet with her, and when she won, he "rewarded" her with alcohol.

I asked her if charges had been filed. She responded that her social worker knew that sex had taken place, but assumed that it was consensual. That was how the incident was documented in her case files.

I pressed on, "But it can't be considered consensual. That's impossible. You were sixteen and he was an adult. Legally, you were a child and unable to consent to this act with him."

In my opinion, that social worker should be held accountable for her severe lapse in judgement. I offered to help to legally pursue this matter. However, this young woman has not had enough time to heal. She is not now, and does not know if she will ever be emotionally ready to prosecute.

I told her that I would respect her decision, but remain available if she ever needed my support. Having had a similar experience at the same age, I found myself wanting to protect and defend her. But -- to tell the truth, I never pressed charges, either.

Statutory Rape
Rape is a charge that can be difficult to prove. If there were witnesses present, in most cases, the rape would not take place. Proving rape can be even more difficult if the victim is a foster child (remember the labels and stigmas discussed in my previous blog entry).

Laws vary widely in their definition of statutory rape and the legal age of consent. In Virginia, for example, carnal knowledge of a 13-14 year old is a Class 4 felony, while carnal knowledge of a 15-17 year old is a class 1 misdemeanor. (Strange distinction).

The rationale behind a statutory rape charge is that a young person, while biologically mature enough to desire intercourse, is not mature enough to make wise sexual decisions. This makes the young person vulnerable to an adult who tries to manipulate, deceive or coerce them.

It's also important to realize that minors are legally, economically and socially unequal to adults. They lack full legal rights. Typically, they are economically dependent wards of their legal guardians. Think of the implications for a young person in foster care.

Promiscuity Defense
The most common defense against a charge of statutory rape is the 'promiscuity defense,' demontrating that the girl has had other sexual partners.

Why would this make a difference?
As Michelle Oberman explains, "At its core, the promiscuity defense reflects a belief that, by virtue of multiple sexual partners, girls become less vulnerable to coercion, and in essence gain the capacity to consent to sex... (as if) there is no longer any compelling need for protective measures for the sexually experienced child."

In contrast, Oberman believes such promiscuity signals a history of vulnerability, rather than worldliness. She argues that, if it were true that girls were powerless until they lost their virginity, society would encourage them to have sex at a younger age.

The promiscuity defense also seems to state that, if a girl is not a virgin, any man alive has the right to have carnal knowledge of her. If she has willingly consented in the past, is she now denied the legal right to say no?

Coming of Age As A Young Woman
Michelle Oberman has asserted that, while both boys and girls share the crisis of adolescence, they experience it in different ways. Young men might seek pleasure and experimentation, while young women might be more motivated by a desire for emotional closeness and attention.

For young women, the physical changes of adolescences often represent a loss of control:
-Their body is changing before their eyes.
-Men around them begin to express desire.
-They begin to see themselves through the eyes of others.
-They measure themselves against impossible ideals.

To experience the physical changes of puberty within the instability of foster care is challenging for a young woman. It makes her vulnerable... emotionally, physically and sexually.

Sadly, there are older men in this world who take advantage of that kind of vulnerability.

Source:
Oberman, Michlle. Turning girls into women: Re-evaluating modern statutory rape law. The Journal of Criminal Law and Criminology, 85 (1994).

Virginia Department of Health website: http://www.vahealth.org/civp/sexualviolence/varapelaws/laws_rape.asp

Sharing the Culture of Foster Care

Much of what I have been sharing lately has been inspired by my time at the FCAA summit, and this is no exception.

As foster alumni, we discussed the stigma of foster care.

Foster Stereotypes:
-Lack of credibility: foster parents /social workers assuming that we were liars
-Assumptions made at school that we were promiscuous
-Labeled as manipulators or troublemakers

Pathologizing Foster Behavior
In terms of mental health, what might be termed 'normal' behavior for a child growing up with family is often pathologized or criminalized for the foster child.

"Normal" Example: A parent dies. Child withdraws, shows grief. Parents take child to see child psychologist. Behavior is termed 'normal grief process." Child is given time to heal.

Foster example: Child loses entire family at once by entering foster care. Expressions of grief such as anger or sorrow are diagnosed as 'rage' and 'depression.' These labels follow the child throughout foster placements, because they are a permanent part of the case file.

Foster children deserve time to heal from entering (or even exiting) foster care. Survivor behavior looks strange, when viewed out of context. However, for many foster children, lack of trust (for example) is logical, rather than an issue of ingratitude.

Danger of Labels
Depending on how much time is spent with a child, or how the adult interacts with the child, their perceptions of that child can be skewed. In that case, the initial assumption is written down in the case file.

It then becomes a permanent stigma, when it comes to finding foster placements for the child. It can also evolve into a self-fulfilling prophecy.

Perception Becomes Reality
“Everyone told me I was bad, so I was bad.”

Actual Foster Care Experience
As foster alumni, we do not view ourselves collectively as victims. We are not, as one commercial portrays us, a cute little unwanted puppy in the window, waiting for a home.

Rather, we are resilient. We are survivors. Our lives have required us to be courageous. When you cannot escape the thing that you fear, you are forced to face that thing you fear.

Part of being a foster alumni means having to prove yourself. A familiar feeling to me, in high school, college and graduate school, was feeling that I had to work twice as hard as everyone else. Things that came easily to other people did not come as easily to me.

Things I Had to Work to Obtain
-A place to stay during the holidays. (Now that I'm married and have two stepchildren, I know I won't be alone. And I know I'll get presents. Those things matter deeply to me).

-Shared memories. (Not having people around to retell childhood and teenage stories together can leave a person feeling rootless and unsure of their own identity).

-Connections with other people. (Part of that was others; part was me. After leaving foster care, it's a process of learning not to view yourself as different. Self-isolation is common).

Consequences and Risks
In general, foster children and foster alumni operate by a different set of rules and consequences. And they have a lot more paperwork!

Here are two examples:

1. Let's say you're in college and you do a poor job of budgeting. Are you:
a.) Now homeless?
b.) Able to call Mom or Dad to bail you out?

2. Let's say you're a teenager and you act out. Will you:
a.) Be transferred to a totally different place to live?
b.) Be grounded for a month?

Foster teens in care learn that their mistakes have powerful ramifications. When they enter the adult world, they often don't know all the resources that are available.

What they do know, and what I knew at that stage in my life, is that there is no safety net for them. That is a scary way to enter the adult world.

Postcards: An FCAA Initiative
-“I reinvent myself daily to deal with my reality”
-“There’s more to me than just my case file.”
-“Group home is the new name for orphanage.”

All of the above soundbytes are quoted from postcards created by foster alumni. This is a creative way to share the culture of foster care. Here is the link to this resource: http://www.fostercarealumni.org/fcaa_postcardgallery.jsp

My favorite one is: http://www.fostercarealumni.org/imgs/4b.jpg

We each have strengths and weaknesses -- and often they boil down to the same quality, viewed in different lights, working for us or against us. What do we choose to call them? It's a question of terminology: strong versus belligerent, emotional versus passionate.

From Fear to Fascination: Polar Reactions to Trauma

Foster Females & Sexual Trauma
A friend of mine wrote me recently. She had been working with two foster teenagers, both of whom had experienced a sexual assault. Their reactions seemed to be polar opposites. One frequently indulged in promiscuous behavior, and the other deeply feared physical intimacy.

My friend observed that, Marital intimacy is so complex; especially when you add in abuse and the foster care culture. I wish there were one simple thing I could tell them (and myself I suppose) to just have a "normal" view of intimacy and sex.

These two extreme reactions are very common.

Forged by Fire
Picture this painful scenario... A child is forever damaged by fire. This same terrible event happens to two young women. One reacts by avoiding fire at all costs. The other becomes inordinately fascinated by fire, leading some to speculate that she might be a pyromaniac.

Both survivors are ruled by their fascination and fear of the force that almost destroyed them. Neither of these two women can see the middle ground between the two extreme reactions. They might even bounce from one extreme to another.

(I apologize for the timing of this analogy. I have wracked my brain, and I cannot come up with any other comparison that captures the essence of sexual damage so aptly. If you think of one - please tell me).

A disruptive, traumatic experience, such as a sexual assault, wrecks double damage upon the adolescent female:

1.) It has the potential to deeply impact their understanding of sexuality, love and relationships.
2.) It has a profound effect on their adult behaviors regarding physical and emotional intimacy.

Fear
One external reaction is fear and avoidance. Sex becomes something to be feared. Sexual situations, and even humor, might trigger post-traumatic stress disorder.

Internally, the young woman is shouldering trauma-related guilt and shame. Was it her fault? Is she 'the sort of person' to whom these things are bound to happen?

Fascination
Upon closer inspection, the 'fascination' response isn't that different than the response born of fear.

Sexual addiction also involves guilt and shame. By acting out sexually, the young woman might be reliving the guilt she experienced after the rape. What is she thinking? "This is how I can have power." "This is what I deserve."

Acting out in itself can be a form of emotion-avoidance. The fear can be experienced as a rush or a high. Sexuality can become a drug to escape painful thoughts or feelings.

Healing & Balance
What then? Is there hope for the female survivor of rape, sexual assault or sexual abuse? Can sex ever be a way to connect with another human being, rather than to 'numb out'? Can that sort of intimacy be experienced, or will it forever be overshadowed by fear?

From my personal experience, I believe that progress in this area is possible.

It's not short and simple. It's not quick and easy. It requires time, hard work, honesty, and discernment in choosing trustworthy friends.

Here are some of the strategies that researchers (and I) have found to be the most effective:

Personal choices: Taking responsibility for unwise decisions. Choosing self-protection, rather than self-destruction. Finding liberation through forgiveness (of self and others), self-respect, self-control and by seeking insights and awareness.

Involvement with others: Seeking out a healthy group of people who can provide validation and acceptance. Experiencing love and nurturing. Having friends to encourage progress and celebrate accomplishments.

Seeking accurate perceptions of self and others: "As a man thinks in his heart, so he is."
-Self-perception: Having a sane, healthy view of self.
-Perception of men: I could write an entire blog entry on this issue.
-Perception of sexuality.
-Perception of relationships.

Some people might find what they need to heal in a support group. Others might work through painful issues with a trusted counselor. Still others find a church group or a close-knit community that meets at least some of their needs.

As my friend observed, foster care exacerbates the wounds from this type of traumatic experience. Repetitive abandonment and displacement increases self-blame. She, I and several of our fellow foster alumni would like to see more research and therapeutic progress in this area. In the meantime, we are committed to supporting those within our circle of influence and seeking health and balance for both them and ourselves.

Sources:
Kaltman, Stacey, et al. Psychological impact of types of sexual trauma among college
women. Journal of Traumatic Stress; Oct2005, Vol. 18 Issue 5, p547-555.

Street, Amy, et al. Impact of childhood traumatic events, trauma-related guilt, and
avoidant coping strategies on PTSD symptoms in female survivors of
domestic violence. Journal of Traumatic Stress; Jun2005, Vol. 18 Issue 3, p245-252.

Woodward, Clare, et al. Positive change processes and post-traumatic growth in people
who have experienced childhood abuse: Understanding vehicles of change. Psychology & Psychotherapy: Theory, Research & Practice; Sep2003, Vol. 76 Issue 3, p267-283.

Erikson & Foster Care

While I was at the Foster Care Alumni of America's May Summit, I mentioned the challenges inherent in trying to establish a movement by foster care alumni.

Specifically, we are asking people who have learned distrust, independence and isolation to trust, connect and commit. As foster alumni members discussed policies, strategies and best practices for FCAA, we had to learn to listen to one another with an attitude of openness.

It was a difficult transition from being the "Lone Ranger."

This applies also in the area of marriage. By making a 'lifetime commitment,' a former foster child who has learned not to trust is required to entrust their very soul to another person. A person who might betray them, abandon them or abuse them, as their parents did...

Erikson's '8 stages of man' has significant relevance to foster care:
Stage 1, Trust vs. Mistrust
Stage 2, Autonomy vs. Shame and Doubt
Stage 3, Initiative vs. Guilt
Stage 4, Industry vs. Inferiority
Stage 5, Identity vs. Role Confusion
Stage 6, Intimacy vs. Isolation
Stage 7, Generativity vs. Stagnation
Stage 8, Integrity vs. Despair

Regarding foster alumni, I am going to focus on the sixth stage: "intimacy vs. isolation." Several participants at the Seattle FCAA summit, including myself, agreed that this stage is particularly challenging.

Several of us mentioned that, after experiencing problems early in our marriage, the simplest option appeared to be, "Why not just leave?" Leaving is what we know; what we are familiar with; what we have experienced throughout our entire lives. So, why stick around?

One participant confided to me that on her ten-year anniversary, she told her husband, "I've finally decided that I'm in this for keeps." He was quite relieved to hear it. I have a similar story of my own.

Can marital intimacy be enjoyed by the former foster child?
Many barriers often impede this:

1.) Fear and confusion regarding physical intimacy. If the person has experienced abuse, particularly sexual abuse or rape, physical intimacy can be overshadowed by fear or a deep sense of shame.

Or, the person might try to face their fears by heading in the opposite direction: sexual addiction; using sex to "numb out" rather than to connect with another person.

2.) Fragile sense of self. Foster alumni are often plagued with a sense of self-doubt. We truly haven't had the freedom to make mistakes because the consequences for those mistakes were often blown out of proportion. What might be viewed as 'normal' teenage risk-taking for other teens often sent us reeling into a different foster placement.

In addition, moving around frequently makes it difficult to build a rock-solid identity. To please foster placement #5 might require different tactics than pleasing foster placements #2, 3 and 4. Staff or foster parents might perceive you differently, and you find your behavior changing as a result.

In foster care, adapting to each new placement is vital to survival. But, along the way, you might wonder, "Who am I, anyway?" And, as we know, dating someone else when you don't know who you are is fertile ground for codependence.

3.) No roots or safety net. Let's say a young woman ages out of foster care. She's confused about intimacy. She has a fragile sense of self-worth. The first guy she attracts turns out to be abusive. They enter into a codependent relationship. What then?

Will she leave? What if she has become emotionally or financially dependent on him? If she summons up the courage to leave him, where will she live? If she is isolated, who is there in her life to give her wise counsel and say, "Leave this jerk. You deserve better - whether you believe it or not."

Not her father, she doesn't have one. Not her brother, they were separated. If she is very lucky, she might have established a safety net of trustworthy friends. If not, she is on her own.

Foster alumni are at a disadvantage due to their lack of roots. If you were uprooted from living with your parents, separated from your siblings and shuttled from one placement to another, with whom can you share your stories?

Even now, listening to my husband and stepdaughters, I am amazed at the shared history between them. It is something that I have never had.

4.) Distrusting their partner. If you are a former foster child, must your partner win your trust over and over again? At what point will you stop testing him or her?

Perhaps the distrust comes from something your partner has done. You just found out that the love of your life is imperfect. What if his fallibility leads him to do something horrible - like betraying you?

Maybe you think this person must be crazy for loving you. Over the years in foster care and afterward, you've developed a sense of inferiority about yourself. Perhaps your low sense of self-worth manifests itself in body dysmorphia or eating disorders. Or, maybe you just dump the other person before they get the chance to disappoint you.

Intimacy versus Isolation for Foster Alumni
Foster children grow up feeling powerless. After aging out of foster care, independence offers us power. Think of what first comes to mind when you hear the word "emancipation." No one can hurt us anymore. No one can dump us anymore. We are on our own authority.

To entrust yourself to another person requires a leap of faith that the person will love you. It assumes the fact that you realize that you are loveable. To give that much power to another person, after a lifetime of rejection, is scary.

Remember the scene in the movie "Good Will Hunting" where Matt Damon sabotages his relationship with Minnie Dryver? Where might he have ended up if he hadn't chosen to take that rat-trap of a car and drive out to reconcile with her at the end?

Several of us at the summit could relate with Matt Damon's character. But most of us had one thing in common - we were married. We had taken the risk... and with that leap of faith, we found out that we did have (relational) wings.

Attachment patterns, once developed, tend to persist. Patterns only change if experiences change. One of my follow-up plans from the FCAA summit is collaborate with others to develop and lead presentations on this topic for teenagers and young adults aging out of foster care.

In My Shoes: Assisting Teenagers in Foster Care

Another participant in the FCAA Summit was Christa Drake. She has been part of the alumni movement since 1999, when she was the first former foster child to participate in the Casey Family Programs' community resource council.

In My Shoes
In July 2003, Christa assisted in launching "In My Shoes," the first foster care alumni project in Arizona. This nonprofit organization was created to help foster teenagers (16 and17 years old) successfully transition to adulthood.

Youth in care are matched with foster alumni, who assist them in attaining the skills and information that they need in order to live independently. Participants are empowered to advocate and become leaders within their communities.

To find out more about "In My Shoes," please visit:
http://www.inmyshoesinc.org/

Stones in the Road
Christa Drake is very passionate about her work. From talking with her on a personal level, I was able to ascertain that she has faced concerns and obstacles along the way...

Some of these challenges have included:
-Liability for foster youth behavior when she is transporting them from one location to another. Teenagers in general are prone to risktaking behavior, and foster teens no less so. Christa is very conscientious about this, since one error in judgement could jeopardize the program.

-Feeling that her presence as a foster alumni is desired at meetings, but that her voice is not always welcome.

As I mentioned in a previous post, the credo of foster alumni is "Nothing About Us, Without Us." Including foster alumni in discussions means more than just having them present when decisions are made.

Foster alumni are not "mascots" to represent the existence of foster children. Rather, we are insightful individuals, whose experiences and knowledge can be valuable to social workers, judges, attorneys, educators and behavioral health clinicians.

Talking with Christa affirmed some of the challenges that I have been facing in my state. When I meet with social services representatives, too often I hear the sunshine story:

-"We have no problems finding homes for foster children. Most of our children end up in kinship care."
-"Our foster teenagers are equipped with independent living skills before leaving care."
-"Our social workers are doing a wonderful job."

Yet, when I meet with actual foster parents and communicate with youth-in-care, I hear a different story:

-"My foster son has had five different social workers within the past five months. When the last social worker came to talk with us, he freaked out - because he thought this new stranger was coming to take him away."

-"Our neice was sent to a foster home out of state, rather than allowing her to be adopted by family."

-"We have over 30 teenagers in our school who are getting ready to age out of foster care, and they are unprepared - and scared."

I work at a job myself. I know what it means to "toe the party line." However, because the lives of children are at stake, I am going to have to insist upon hearing more honesty.

Foster Alumna Changing the World Through Film

I recently returned from the FCAA Summit in Seattle, Washington. Sometimes in my life, as a former foster child, I have felt alone. At this summit, I met some amazing people.

Over my next series of blog entries, I plan to share some of their stories, and to explain more about the foster care movement that is taking place. At the FCAA summit, when one alumna was asked, "Why are you here?" she answered, "I'm here for the movement!"

Just as the civil rights movement and women's liberation movement changed American history, when foster care alumni connect, our goal is to transform the world.

Here's how Sasha Isaac-Young is using her gifts and talents to give foster children a voice...

Sasha Isaac-Young graduated USC with an MFA in Film Production. Prior to that, she attended Washington University in St. Louis, where she earned a BFA in Printmaking and a BA in Acting.

I was able to spend time with Sasha during the conference, and we found out that we had a surprising amount of life experiences in common. We've decided to collaborate and share ideas about how to convey the vulnerability and confusion experienced by females coming of age within the foster care system.

I watched two of Sasha's films, a documentary and a fiction film.

Foster Stories
"Foster Stories"is a short documentary Sasha made while still in school. It won best short documentary at the Urbanwide film festival in New York. It opens up with the premise that, "I can't tell you what it's like to live in foster care, but I can tell you stories."

This documentary aired on PBS. After it was shown locally, a viewer commented, This is the kind of documentary that should be shown nationally, on public television as well as all kinds of venues, it is so important.

As far as I know, there has never been any kind of documentary study on this subject, and with the touch of a filmmaker who clearly knows the ins, outs, ups and downs of the system.

This becomes a true masterpiece that could easily become an educational classic, and a work that should be seen by as many people as possible. I can only hope that the filmmaker could get feedback and support enough to allow them to expand it into a feature film; at the least, PBS should add this to it's national broadcasting, so the rest of America can join in the discussion.

To see a portion of "Foster Stories," please visit:
http://www.kcet.org/finecut/episode1.php

Little Valerie
While at USC Sasha directed a second thesis project, a fictional work titled “Little Valerie.”
In this short film, a young girl vys for the attention of the boy who lures her away from her institutional home. Sasha storyboarded the film masterfully, it is the essence of "show, don't tell."

I told Sasha, that I would like to show the film to my husband, but that I know that after I do so, he will start calling me, "Little Valerie."

Full-Length Documentary
Sasha's next step will be a feature film, a full-length documentary examining the American foster care system from the foster children's perspective.

Resources to Assist Social Workers

As I mentioned in a previous posting, in April 2006, New York caseworkers received a memo telling them not to discuss, email or post online anything that might reflect poorly on the agency. At the time, I mentioned my concerns that child welfare agencies, which are rather intrusive by nature when it comes to biological and foster families, might be avoiding accountability themselves.

What makes this directive even more interesting to me now is that in the January/February issue of Child Welfare, in-depth interviews of New York and Chicago social workers were published. A high percentage of New York caseworkers had reported poor morale and described their agencies as inadequate. I have to wonder if this prompted the April directive.

In these interviews, social workers were interviewed and asked their views on the child welfare system.

According to the social workers, the child welfare system:
-Does not meet the basic needs of children in care
-Lacks the necessary resources to appropriately serve clients
-Often sets unrealistic / unattainable goals

One caseworker stated that, "The system abuses the kids just as much as the parents do." Other respondees mentioned that foster children were often lost in the system, because there were not enough placement or adoptive resources.

Their overall responses emphasized the need to reform the child welfare system, and to re-evaluate funding priorities.

What might empower social workers to do the best job possible?

1.) Training. Not just initial, but ongoing training is necessary. Custodial cases are complicated. Laws change, policies adapt, inititiatives are created and research reveals new insights into child development and attachment issues. Investing in ongoing training for social workers is vital.

2.) Support: Caseworkers encounter high levels of stress and burnout. They often feel devalued and unappreciated for the work they do. To be effective, caseworkers need the support of their supervisor and coworkers.

3.) Qualified Supervision: Many caseworkers reported unqualified supervisors, unsupportive supervisors or the absence of supervision altogether. Lack of leadership does not promote effectiveness or morale.

4.) Cooperation with Court Personnel: I've mentioned the PEW Commission's recommendations on court proceedings in previous posts. They had mentioned that the adversarial approach of traditional judicial proceedings was detrimental to children in foster care.

Intrasystem contention: One interesting facet that this study revealed was that an adversarial relationship exists between court and child welfare personnel. It's hard to protect the child and facilitate collective decision-making when this type of antagonism between legal staff and child welfare staff is taking place.

Caseworkers also mentioned their frustration regarding:
-Lawyers who come to cases unprepared
-Certain birthparents and their lawyers were adept at manipulating the legal system
-Courts that were too quick to sever custody
-Courts that were too lenient on abusive birthparents and unwilling to sever custody

5.) Resources for Clients: Caseworkers expressed concern about their ability to provide the necessary services for clients.

Part of the social worker's job is to set clear limits for birth parents and provide them with the resources to overcome destructive behavior. However the instruments used to assess families were viewed as inadequate.

In order to comply with their case plan, birth parents are often required to go to multiple agencies, and if those particular trainings are overbooked, it can take up to six months to find a provider.

Reevaluating the job description

Perhaps it's time to examine the requirements of a social worker position.
-The job demands are high.
-Workers juggle high volume caseloads and redundant paperwork.
-Little time is left over to visit the children, focus on their well-being and determine the best outcome.
-Worker turnover and transition often results in lost information or spotty record keeping.

Even for a social worker with conviction, commitment and experience, the frequent lack of technical, administrative and personnel resources can be quite challenging.

We hand these overworked, underpaid individuals our most vulnerable children. We expect them to work miracles - and we demonize them for any evidence of failure. Rather than blaming the workers, we should reexamine the system as whole. And to do that, child welfare personnel should not be bound by any code of silence.

Source: Zell, Maristela. Child welfare workers: Who they are and how they view the child
welfare system. Child Welfare; Jan/Feb2006, Vol. 85 Issue 1, p83-103, 21p

Foster Children & Attachment

Ironically enough, just as I have been given the opportunity to be a "voice" for foster children in my upcoming trip to Seattle, I now have laryngitis. I am just praying that my voice comes back by the time I arrive on Friday!

Losing the Foster Parent
Because parental rights are prioritized, attachments between children and their foster parents are often ignored. The presumption is that the child can and will reunite with biological parents if at all possible.

Sometimes children who have been raised by birth by foster parents are sent back to biological parents who are effectively strangers to them.

Not only may children not have attached to their biological parents, but they also might have long-standing experiences of trauma with a parent. In these cases, children who have found sanctuary and built trust in a foster home are sent back to biological parents who have neglected and abused them for most of their lives.

Unfortunately, since the bond between foster parent and child is often minimalized, children who return home often do not receive supportive services to cope with the loss of the foster parent.

Meanwhile question remains: Will the biological parents maintain their progress? Or, will they fall back into old behavior patterns? It is vital in these cases to continue to monitor safety plans for the children after they return home. All too often, this does not happen.

Losing the Biological Parent
The reverse is also true. If parental custody is severed and the child is adopted, the child will still need time to grieve the loss of biological parents.

Even in the context of a loving adoptive home, with healthy meals, stimulating activities, support and resources, the child doesn't enter that home with a "blank slate."

Paradoxically, the more safe and secure the home is, the more likely the child is to grieve lost parents. Why? Because grieving is a process. Children can only begin to grieve within a safe and secure relationship.

Only within a safe, secure environment can a child:
-Face their losses
-Confront their anger
-Move past denial
-Emerge from behind a shield of detachment
-Recognize and resign themselves to the fact that any fantasies that they might have had about a reunion will not come true

This painful work usually takes place after a child enters a permanent home -- and at the very time that the social services often terminates services.

For both scenarios, follow-up services are essential. Losing either the foster or biological relationship might be very painful if the child has established a bond.

Source: Rebuilding attachments with traumatized children: Healing from losses,
violence, abuse and neglect by Richard Kagan, PhD.

Foster Children Alumni of America

As Ferris Bueller pointed out, "Sometimes life comes at you fast. If you don't stop and look around around once in a while, you might miss it."

This year, my life has come at me fast. 2006 has been a year of wonderful opportunities. I have been interviewed on the radio, for the first of four tapings. My book is progressing, with my agent eager (but patient) for the final draft. I've prepared and led workshops for foster children and foster parents.

In the meantime, I've also been made exempt (non-hourly) at my day job, which means that I often work 12-hour days. Fortunately, my day job as a children's librarian often intersects with my volunteer work as a child advocate...

Where work and advocacy collide:
-Programming for homeless children and teenagers
-Visiting schools in the inner city and getting to know the teachers and students
-Leading programs for teen moms
-Booktalks at residential facilities

So many of the things I do in my day job have allowed me to meet local resources...

Whom I then contact on my own time, to offer:
-Interviews (so that I can promote their services on the radio)
-Free programming for children and teens, in my spare time
-Workshops more specific to foster care needs
-Bibliographies of resources
-Links to mentoring, including contacts for local organizations

The city where I live seems fragmented. Nonprofit organizations have to compete for dollars, which often means competition between organizations, rather than mutual support. There is an attitude of secrecy; a fear that by sharing ideas with another organization, that group might 'steal' the idea and launch it on their own.

This saddens me, because I've always been a connector. When I was in college, I joined countless college organizations. If I met someone who 'didn't fit' with one group, I would invite them to come with me to visit another group. Many of the college students who were drawn to me as a friend seemed to be looking for a support group, and I really liked helping them find the right place for their needs.

I guess I'm a big picture person. If group A can't meet your needs, why not try group B? If church A isn't right for you, go to church B. We can't be all things to all people, and sometimes the mission and goals of one group will be more in allignment with what you need than another. And, who knows? The right fit for you might change over time.

All this is an introduction to say that...

Hopefully, I will finally be able to impact the big picture. My friend Gayle and I have been chosen as a chapter designee for FCAA, Foster Children Alumni of America. I'm traveling to Seattle, Washington at the end of the month in order to attend a summit, wherein foster alumni from states across the nation will discuss national policy regarding foster care.

The focus of FCAA is national policy, not direct service. Therefore, my plan is to:

- Partner with my friend Gayle and working as a subsidiary of her organization, to provide direct service such as housing for foster alumni, on a local level.

-While also continuing my research and advocacy to impact foster care on a national level, through FCAA.

More information about this new and growing organization can be found at:
www.fostercarealumni.org