Hey everybody.

I'm a Hope Bristol.

I'm sure of Florida's dependency Court Improvement panel.

I'm also the administrative judge for our unified Family

Court here in Broward.

I wanted to also welcome everybody to part 2 of our ask the

expert webinar with the fabulous.

Dr.

Charles Inna from Tulane University.

This seminar is going to pick up where we left off from part

one where we learned about bonding and attachment now, we're

going to learn how to apply bonding and attachment to our

Only court cases.

This is meant to be an interactive webinar.

There will be times where you can email your questions or

send them to the great Folks at USF, and they will facilitate

those questions, and we have a live audience here as well

and will participate in asking questions from this area to

all right, so dr.

Xena, it's off to you now.

Happy holidays.

I don't know what it's like in Florida but it feels like

Chicago and New Orleans this morning and I think in Chicago,

it feels like Antarctica.

So I don't know if you guys have gotten any of this lovely

cold weather or not.

But anyway, so what I wanted to do is just briefly review

some of the things the key points that we talked about last

time and then move into applying those to various aspects

of Foster care in for young children, there will be plenty

of opportunities.

I'm sure for questions and discussions and I would encourage

you to be thinking of case scenarios or vignettes that you

would like to discuss because I think that will be the most

useful way for us to spend our time.

So just to begin with A Brief Review we talked about the

fact that human infants are born with a very very strong

biological predisposition to form attachments to caregiving

adults and when they experience caregiving from adult caregivers,

they tend to over the course of the first year of Life begin

to form a selective or preferred attachment to the individuals

who care for them adults similarly are born with a strong

biological predisposition to be attracted to interested in

and motivated to care.

We're young children and that helps a lot in the first few

months of life.

When babies are beginning to figure out how to make distinctions

amongst different people and then figure out who it is who's

providing care for them and respond to those people attachment

as a construct develops gradually over the first year of

life. But remember we say that the onset of attachment is

somewhere in the seven eight nine month range and and we

know that attachment is present when infants begin to exhibit

protest separation protest from their familiar attachment

figures. And also when they show evidence of a wariness around

strangers when those two things happen, we say that infants

have formed attachments and remember that they they form

attachments to a relatively small number of adults who spend

substantial amounts of time with them because the way that

it works is the Infant experiences pain or distress or hunger

or some kind of discomfort?

Which activates their attachment need and then the caregivers

who satisfy those needs for Comfort support nurturance and

protection through repeated experiences of that happening

the babies begin to say.

Okay.

This is the person that I go to when I'm distressed or unhappy

or upset or needing support or reassurance in order for attachment

to occur for very young children.

Adult caregivers involved have to spend substantial amounts

of regular and predictable contact with infants.

It's not something that happens with weekly contact or a

couple of times a week.

It's something that really requires very substantial amounts

of time and attachment is important because the experiences

that the young child has with attachment figures begins to

guide it creates expectations for them about what Ins when

they're in need is there someone there for me consistently

reliably or not?

And it begins to guide their behavior in Intimate Relationships.

So not surprisingly given that the quality of the young child's

early attachments the quality because the quantity means

the attachments always almost always present, but the quality

of the attachment relationship is strongly predictive of

the child's subsequent adaptation psychologically and socially

Usually a key point for considering foster care.

Is that very young children the first three years of life

and to some extent even four and five-year-olds have a very

difficult time sustaining attachments over time and space

what that means is that although older children adolescents

and adults can sustain attachments to individuals with whom

they're not having direct physical contact through phone

calls through knowing someone as their older individuals

are able to maintain attachments, even if they're separated

for long periods of time and even if they live in different

places, but for very young children in order to sustain attachments,

they have to have regular ongoing and substantial amounts

of contact.

So The first point is that I'm not going to present a lot

of data about this, but I'm going to ask you to accept my

assertion which is backed by Decades of research that secure

attachment which is a type of attachment.

It's a pattern of attachment or one of the qualitatively

different categories of attachment secure attachment is a

very strong predictor of the child subsequent outcome and

especially in Risk environments young children who are growing

up in environments that pose risks to their development If

the child forms a secure attachment, it's enormously protective.

It's not a hundred percent protective, but it's enormously

protect protective and what we know from studies of young

children who have been maltreated is that 80% have the most

worrisome pattern of attachment called disorganized and we

saw a little girl last time who exhibited characteristics

of disorganized attachment.

So up to 80% have disorganized attachment and very very few

have secure attachments to the individuals who are responsible

for their maltreatment.

So having the child develop a secure attachment is a critical

issue for those of us concerned about child well-being for

young children involved in the child protection system.

So talk about foster care.

First of all, the basic premise is that foster care is an

intervention. It's a societal intervention for young children

who are in dangerous or very risky situations and it's an

intervention that's designed to protect children who have

been maltreated.

We know that interventions can be helpful not very helpful

or actually even harmful.

So the point of this is that we want to invest as much as

we possibly can to make sure that the quality of the foster

care experience for young children is of as high quality

as possible because this is this is in fact our intervention.

So we really should be thinking about what are the things

that we can do to enhance the quality of foster care.

It's provided to young children.

I often describe to Layton models of foster care and what

I mean by Leighton mottos is this isn't something that someone

has written up in and and advocated.

This is just if you go out into the world of foster care

and you make observations, this is what you see and the first

is a model that I call Extended respite.

This is kind of the babysitting model safety is the critical

thing the child has to In a safe environment, they have to

be provided food clothing and shelter but essentially the

foster parents simply acts as a placeholder for the child's

biological parents and the child's just being their kind

of on hold until they can be returned to their biological

parent the second model.

That one sees is a what I call a child centered model in

which the foster parent loves the child as if it's their

own child and makes a full psychological commitment to that

child in their care and I would argue that what young children

need is the child centered model not the extended respite

model. We cannot simply put children's developmental needs

on hold while their biological parents were case plans and

get themselves together and put themselves in a position

to become safe and effective parents.

It just doesn't work that way for young children, okay.

So young children where I am and I realized this varies a

lot in different parts of the country.

And so I'm not sure what it's like in your particular area.

But in our area once young with a very high threshold for

kids coming into care and once they're in they're typically

in for 18 months or so somewhere in the 15 to 18 month range.

So that's not a very that's not a matter of a few days or

even a few weeks.

That's a very Amount of time if you're six months old when

you come into care and you're in care for 18 months, that's

three times as long as you've been alive.

So and you remember from last time that the first three years

of life are a critical period for brain development.

So the quality of the child's relationships, which are the

most important factor influencing their brain development

is occurring during this period of time.

It is simply impossible in my opinion the vast majority of

the time for biological parents to be the child's primary

attachment figure once the child's been separated from them.

And that's because the way that attachment develops remember

is when the child is activated someone responds and makes

them feel better and the biological parent just cannot have

enough time with the child to sustain the child's attachment

to them while they're in care.

To develop an attachment until we get to the transition time

and I'll talk about that later on.

So therefore the child's primary attachment figure during

the time that the child is in foster care is the foster parent.

And so we need to remember that and think about that in all

aspects of the things that we do with young kids while they're

in care now one question that maybe asks is is our Aaron

who have been severely maltreated severely neglected or physically

abused or and and seriously traumatized are they capable

the as a result of their traumatic experiences or deprivation

experiences of even forming secure attachments and this is

actually been studied reasonably well, and it turns out when

foster parents provide sensitive and responsive care that's

necessary to facilitate the formation.

Of healthy and secure attachments children can definitely

develop secure attachments at almost the same rate as if

they'd never been maltreated.

So we need to remember that when we're recruiting and training

foster parents that that needs to be a critical part of the

equation. This next slide is just a series of five studies

the first three of which are looking at assessments of the

child that tell us something about their quality of attachment

to their foster parents and you see that the range is somewhere

between 49 percent and 66% of these maltreated kids form

secure attachments to their foster parents.

Now the typical figure for low-risk samples of children is

somewhere between 55 and 60 percent develop secure attachments.

So we're definitely very close to that range in the first

Three and the last two studies are studies in which we're

looking at attachment from the perspective of the foster

parent fostering a particular child.

And again the on the parent side of the equation substantial

number of foster parents are able to function as double to

develop secure attachments to the children young children

in their care.

So the answer is yes, even though they've been severely maltreated

and traumatized the vast majority of young children.

Are capable of forming secure attachments to their foster

parents? Okay, the next issue is disruptions and by disruption,

I mean the child is removed from one caregiving environment

and placed in another so by definition young children in

foster care have already experienced one disruption and I

want to come back and talk about that.

in a minute, but the issue is that disruptions of the child's

caregiving environment necessarily disrupt their attachment

relationships and that happening increases the child's risk

for long-term difficulties and all you have to do to think

about this before even get to the data is just imagine that

you're a young child and someone comes over and picks you

up and takes you somewhere else and drops you off how you

feel. You have no way of understanding why this happened

you have no understanding of where you are or what this is

about and so this is a very stressful and potentially challenging

experience for young children and when it happens repeatedly

it clearly begins to substantially increase the risk.

For long-term harm.

So disrupting is of placements is something that we should

do very thoughtfully planned for Ali and for very very good

reasons and we can talk about that some perhaps with some

examples. These are just some of the studies that have examined

the effects of disruptions on children's later development.

This is a study that our group just published last year.

Year looking at kids who experience very substantial levels

of early deprivation neglect and those who maintain stable

placements over time.

We're substantially less likely at the age of 12 to have

serious levels of Psychopathology.

Now, you can argue that kids who have more severe problems

may cause A disruption in placement by being impossible for

the foster parents to manage.

We went back because was a longitudinal study and we went

back and looked at the kids between the ages of 3 and 5 on

just many many many measures and they're absolutely no differences

in the children at that age who had subsequent stable placements

and the children who had subsequent unstable placements and

yet at age 12 their vast differences significant differences

in their Psychopathology suggesting that it's the disruption.

It's self that causes problems rather than problems causing

the disruption at least in that particular study.

Okay, I'm going to stop here for a minute and see if anyone

wants to talk about disruptions has questions or comments.

We have a question here in Broward from one of our parents

attorneys. Is there a natural attachment with the biological

mother at the time of birth and fitting into that canopy

more harmful to remove a child from a mother even with substance

exposed children when Services can be put in place.

To preserve that attachment with the newborn mother and child.

Okay.

Thanks for the question.

So remember that attachment forms not on the basis of genetics,

but on the basis of the child's experiences, so the child's

experiences in the first seven eight.

Nine months is going to determine to whom the child forms

an attachment.

So there's no particular Advantage for any one person over.

Or another whether that person is the child's biological

mother biological relative or anything else.

It's who's responding to the child when the child is in need

and when that happens repeatedly with one or two or three

or four particular people.

Those are the people to whom the child is going to form attachments

as to the second question.

If Services can be put in place to keep a child with a biological

parent ID.

And safely and effectively then I think everyone can agree

that that's a real totally reasonable thing and even a desirable

thing to do, but the question is with services in place can

the parent provides safe and effective treatment or not.

And so the question of removing the child at as a newborn

from the parent really hinges on things like what's the history?

What's the social situation?

What are the services that are available?

Abel what's the potential harm to the child?

Those are the factors that would be considered attachment

the child can can form an attachment to the biological parent

If the child is living with that parent and and developing

with that parent over the first year of life or if the child

is removed the child can form an attachment to the foster

parent. And remember this is a point will come back to when

we get into visits here, but once the child develops the

capacity to form attachments around 7 and 9 months and when

I say seven and nine months I'm not talking about chronological

age I'm talking about cognitive age so if the child has some

cognitive delays the child may be chronologically a little

bit older but generally speaking of cognitive age of seven

and nine months once the child has reached that point the

child can form attachments to anyone subsequently if if they

have a sufficient number of regular experiences of being

comforted and nurtured and protected by that person that's

why adoptions happen in older kids all the time and the child

can adapt and form attachments to the to the adoptive family

so once they've reached that age they have the capacity and

can infect format a chance to anyone so even for kids who

initially have the foster parent as they're We figure they

can have an attachment relationship with their biological

parent reconstructed at some point in the future when the

biological parent is ready for that to occur.

And as I said, I'll talk more about that as we get into the

visits discussion.

This is Judge Bristol.

I had a question talking about moving children and two different

placements or multiple placements.

If a child is placed in foster care, and I'm asking this

to somebody that has to make these decisions but this is

certainly for attorneys and case workers also in bringing

forth these motions and parents want the child moved to a

relative or a non-relative what things should be taken into

consideration. Raishin, if a child is in foster care based

on the age of the child and then subsequently moving the

child to a placement that is more favored by the parent.

Right?

So I'm going to just completely ignore the law because that's

not my area and just talked about from the standpoint of

what does developmental science tell us about what's in the

child's best interest.

What it tells us is that decisions about placement with relative

should happen at the time of removal not down the road because

if you're going to move a child down the road you are going

to disrupt an attachment and if you can't do that make that

decision very quickly.

Then the longer the time goes on the more you increase the

risk to the child now can children survive that of course

they can but each Subsequent disruption increases risk for

the child most children can survive a broken leg, but that

doesn't mean we're going to break their leg because we think

they can survive it.

So my recommendation on the basis of what science tells us

is that a decision to place with the relative is a decision

that should be made very very early at the time of removal

of possible or very very soon after that.

I'm talking about kids in the first three years of life in

particular and to some degree kidnapping.

Kids age four and five if there are reasons other than what's

in the child's best interest for moving the child then that's

where we'll talk about that a little bit later under the

topic of transitions how to transition from one placement

to another and how to do that in a way that is least likely

not guaranteed, but at least least likely to cause harm to

the child.

Okay, we have some some questions from from online viewers.

If you're ready to take that the first question I think was

was partially what you answered but it says the first statutory

hearing after removal and shelter hearing is usually arraignment

often. The initial placement is an emergency respite placement

while we search for a Have what kind of damage are we doing

to the ability of the child to bond during that period of

time? How what's the time from removal to or you know emergency

removal to this hearing they didn't indicate that in the

question? No, but I'm probably the judge can tell us.

Okay 21.

Yeah, so that's not great.

You know the 21 minutes would be better 21 hours would be

better than 21 days.

You know, the sooner the better just imagine that you're

a child who's experienced something significant enough that

you've been removed.

So you've already experienced maltreatment which increases

your risk for harm and then you get taken somewhere where

you don't know.

'well, you get dropped off there.

They begin to be the people who look after you and then after

three or four weeks you get removed from them again and place

somewhere else.

You begin to think that at some point someone is going to

come and take you away from wherever you are because that's

how the world works.

So, you know, I don't think that's I think that's a very

long time and I think the longer that that decision Asian

about placing the child is made from the time of removal

the more probability of harm to the child.

So I would encourage you to do it as quickly as possible.

Okay.

We have another question here.

It says do you believe that attachment to foster parents

adversely affects the children long-term once reunified with

the parent just the opposite.

Exactly the opposite.

so young children have a need every single day to have someone

whom they can count on to meet their needs the longer.

They go in some period in which they do not have that the

greater The increased risk for long-term harm.

Okay in this this last question, I received says in light

of the time periods to achieve permanency as provided by

law. Is it realistic that the parents will complete required

case plan tasks and have time to re-establish a secure bond

with the child within 12 months.

Absolutely, this happens routinely, you know, I spent two

days a week working in an intervention program for kids many

of whom are in foster care.

If parents are success have successfully worked their case

planner are successfully working their case plan.

Then you move into a mode of beginning to increase the frequency

and length of visits that they have with their biological

parents. So I'm going to postpone the Rest of my answer until

we get through visits and transitions, which I think maybe

we should move into right now if that's okay.

Yes.

We Have No Further online questions.

Okay, so visits between parents and their young children

in foster care represent a great opportunity to work on repairing

relationship problems that existed prior to the Removal it's

an opportunity to be together to enjoy one another to have

support to have a nice time together, but I'll just speak

for around here very often.

There's very little planning that's involved.

There's very little thought that is given to the visit and

there's very little support provided and oftentimes.

It's just a chaotic sort of mess.

It doesn't have to be that way but That's often times what

happens in the absence of careful thought and planning sometimes

it's quite a bit less optimal than we would like.

It can be a very stressful time for parents.

It can be an enormously stressful time for young children.

Sometimes young children who have been severely maltreated

the parent represents a threatening figure for them and something

has to be done to allow them to feel safe because they're

not in a position.

Position to understand the visit in the same way that the

adults involved are and we don't want the last thing we want

is for visits between the biological parent and the child

whom were trying to reunify to be harmful or even traumatic

for the young child.

So all of that needs to be thought through very carefully

in my opinion young children in the first three years of

life and maybe even the first five years of life should be

a Company to and from the visit by an attachment figure and

that means for young children in foster care their foster

parents. This is not something where you pop a three-year-old

on a van with a driver and drive them over to a visit and

have a visit and then have the van driver driving back home.

This is a critical role for the foster parent to play is

to accompany the child and preferably to be with them during

the Visit now that often requires some work and some negotiation

between child protective services and the biological parent

and the foster parent, but it can be done.

There are models where in fact this is the norm.

This is what's expected to be done biological parents need

preparation for the visit and they need debriefing after

the visit so in my Recommendation of how this should go.

Each visit should have a goal and the initial goals in the

early phase just after removal should just be having the

parent and child has an enjoyable time together in a supportive

environment. The foster parent is there to make the child

feel more comfortable because the foster parent relationship

with the child is the one that we're trying to construct.

Struct into a secure attachment we're not concerned initially

with the child's attachment to the biological parent because

we've already said that developmentally it's not going to

be possible for the young child to sustain an attachment

in the vast majority of cases to the biological parent because

they simply aren't going to have enough time with them.

So the goal can be reviewed with the biological parent before

the visit and then the visit happens.

And then reviewed with the biological parent after the visit.

How did it go?

This is what we were trying.

How did you think that went that kind of thing?

The goal for the the initial phase of parent-child visits

as far as I'm concerned as I said is just to be comfortable

and enjoy one another and I'm going to talk more about that

in a minute as the parent is working your case plan in your

six months nine months in whatever and they've gotten on

top of the problems that led to the removal in the first

place and you're beginning to work on reunification.

Then you change the frequency and length Could that visits

at that point but initially you're not so concerned about

having several times a week visits.

In fact, we've seen situations where that really works against

biological parents because they're supposed to go to Parenting.

They're supposed to go to substance abuse intervention.

They're supposed to see a psychiatrist or supposed to get

a job.

They're supposed to work on housing.

They're supposed to do all these things and if you then add

on to that several times a week visits, then that becomes

a problem so from the And Point again of what's in the child's

best interest.

I think initially the goal is to get the child feeling comfortable

and to be able to enjoy some time with the biological parent

hopefully receiving support from the foster parent in order

to make that happen.

This this slide is really important because I myself used

to think of attachment is either present or not, and we've

now Had some really carefully conducted research that's demonstrated

that it's not all or nothing that there's a whole spectrum

of closeness.

If you will between over on the far left-hand side just recognizing

someone as okay.

This is someone I recognized over to the far right-hand side,

which is attachment.

So the child Begins by recognizing the individual and then

that individual becomes familiar to them.

Them then once they become familiar to them that the next

thing that happens is the child can begin to feel comfortable

around this person.

Okay.

It's a familiar person and I feel comfortable around them

and then not only do I feel comfortable around them.

I also enjoy being with them.

It's fun.

It's pleasurable.

Whatever.

Not only after that happens.

Not only is it pleasurable and enjoyable to be with the person?

a Time beginning I'm showing some early moves towards beginning

to rely on the person to help me with this or that or the

other thing and then finally it moves from Reliance to actually

this person is someone I prefer and it's only when you get

all the way over here to preference that we're really talking

about attachment of fully formed and well-developed attachment

in my opinion visits between Parents and children biological

parents and children in the early phases of foster care all

you're trying to get to is this comfort and pleasurable point

in the Spectrum.

So you want the child to feel comfortable with a parent and

you want the child to enjoy being with the parent later as

the parent begins to work their case plan and you're increasing

the frequency and length of visits.

You can begin to move further along here, but if you can

get here rather Then starting way over here, you're much

better off and will be much easier to transition here.

If instead of comfortable and pleasurable if the child's

uncomfortable stressed out or experiencing significant amount

of stress and unhappiness being with the parent.

And for those of you who heard the very the first presentation

that I did.

I began with the case vignette of the 11 month old child

who just cried miserably during every visit with her mother.

In part because she was separated from the Foster mother

and in part because she found the visit with her mother stressful.

Well her endless crying and lack of being comforted by her

mother made her very stressed out and uncomfortable which

the child picked up on and that exacerbated the child's discomfort

and unhappiness it as well.

The problem is not all children show distress as overtly

as that childhood.

It's a useful Teaching the yet because the child so obvious

about her distress, but it turns out if you physiologically

monitor young children when separated from their attachment

figures, even those who behaviourally look like they're doing

okay internally, their physiology is highly aroused and they're

experiencing significant amounts of stress, even though they're

not showing that distress.

So let me stop here for a minute and and open it up to questions

and comments about about visits.

Can we have one question from an online viewer doctor Xena,

it says in regards to parent-child times visitations.

Is there a recommended evidence-based model?

Well, that's a great question.

There's a model that I'm very excited about which is undergoing

evaluation in a randomized control trial and unfortunately,

it's changed names and I only remember the old name but Mary

Dozier at the University of Delaware developed an intervention

for young children who have been maltreated that she's used

both with foster parents and with biological parents called

attachment and biobehavioral catch up.

Known as ABC and this is an in the home intervention 10 sessions

lots of video review with parents.

But essentially it involves training the parent to follow

the child's lead and to understand what the child is queuing

the parent to do and to overcome what might be their natural

aversion to problematic behaviors that the child exhibits

so that's attachment by A behavioral catch up that mod that

intervention has been modified for visits between biological

parents and their children.

And essentially what what happens is the foster parent gets

trained to complement and praised the biological parent when

during the visit the biological parent follows, the child's

lead. So the biological parent is met with before the visit.

Someone helps them.

There's gold.

That for the visit they have this time with the child and

the foster parent is there to provide support to the child

but also to craze the parent for following the child's lead

and then there's a debriefing afterwards now when I first

heard about this, I thought well that's never going to work

because bio parents not going to go for this.

In fact, what is clear we already have feasibility results

in the feasibility results are that this goes very well that

biological Parents really like this.

They feel good that the foster parents.

He's positive things in them and there was a site in Nevada.

That was one of the original sites for this that agreed to

provide 10 cases for what's a multicenter randomized control

trial, they finish their 10 cases and the investigators asked

them if they would agree to do 10 more because it had gone

so well and they said absolutely not we're going to give

this to everyone we're Not waiting for the results of the

randomized control trial.

So the results are not in their pending, but I'm very excited

about this as something that could be a model that could

really make a huge difference in this issue.

Dr.

Zeno.

We have a question here in Broward from one of our parents

attorneys. Sure.

Yes.

Hello.

Does this analysis apply to children on the strong attachment

to their parents and then remove say it too?

Three or four years old.

Yeah, then when I say Kinder three, I mean kids under three

when I say kids under five.

I'm talking about under five.

It does not apply to kids and and these ages are approximate.

These are not laws of the universe about age cutoff.

So I just want to be clear about that.

But when kids get to be six seven eight nine years old, they

can in fact sustain attachments over time and space but kids

under 3 and sometimes kids between And five that's very difficult

for them.

So these recommendations apply absolutely two kids in the

first three years of life and often applied to kids who are

four and five years old.

They do not necessarily apply to kids older than that.

Okay.

We have another question from an online viewer.

Dr.

Xena says, what would you suggest as the best visitation

time in the beginning of the case for parents and child and

is It different based on the child's age.

Right, so I don't think there's any formula that necessary

applies in every case.

But as a starting point, I think once a week is reasonable

there may be reasons for making it more frequent than that.

There may be reasons in rare cases for making it less than

that. It needs to be enough.

It needs to be frequently enough that from the child's point

of view.

The child can begin to get comfortable with the person.

Ian and I'm not I'm not unaware that parents can get very

discouraged if they're not allowed visits with their kids

and we don't want the parents getting so discouraged that

they give up so taking into account all the often complicated

logistical issues that are involved in arranging these things

the parents current psychiatric substance use and and general

psychological situation.

They you know functioning adequately and I mean, you know

an overtly psychotic parent or a parent who's high on drugs

or you know hungover or whatever those those parents are

not in reasonable shape to be visiting with their children.

So if the parent is able to visit then I think once a week

often is a reasonable starting point and you can tweak that

one way depending on circumstances.

That one additional question here.

It says during the first six months or so of Life how important

is consistent caregiving for attachment particularly when

the infant is experiencing substance withdrawal, right?

I don't know of any evidence that substance withdrawal is

a factor one way or the other.

Consistent caregiving should always be the goal and I don't

want to be misunderstood about this but the effects of disrupting

placements and relationships after seven and nine months

is significantly greater than disrupting them in the first

six or seven months of life.

So if a consideration is being made about a move for example

The evidence suggests that kids who are moved or have relationships

or placements disrupted in the first six months are going

to handle that far better than kids after 6 months.

And in fact, there's more harm and kids older than 12 months

than kids younger than 12 months.

So that's not to say that we should be having multiple moves

in the first six months of life.

I don't think anyone thinks that's a good idea but Based

on the evidence we have today ate after seven and nine months

becomes problematic and after 12 months becomes even more

problematic. Okay, that's our last question.

We've received from online viewers.

Okay, so I'm going to move into the last part of this which

is about Transitions and this is thinking about okay we have

this child in foster care and now we want to transition them

back home and we want to do this in a way because we know

disruptions are harmful.

We want to do this in a way that is least likely to cause

harm to the child.

So what do we do?

Well, what we do is I'll just tell the story about a study

that was done in the early 1950s.

So this is not you know, brand new evidence.

This is something that we've known for very long time.

There was a study done in London in the early 1950s.

And at that time when women had a baby they would go into

the hospital and often spend three or four weeks in what

was called confinement.

So the latter part of their Seeing in the first couple of

weeks or so of the postpartum period they were in confinement.

So oftentimes mothers had young toddlers say 24 months old

20 months old something like that.

And the mother was going to be in the hospital for a month

and dad in many cases was working.

And so these kids would be put into what were called residential

nurseries. So it's like a daycare except that the kids their

T 4 hours a day 7 days a week during the time that the mothers

away and there were a group of a couple of social workers

a husband and wife team who were very concerned about the

harmful effects of those kinds of separations on young children

and based on their observations of children in these settings

decided that they wanted to do a study about this.

And so what they did was they had mrs.

Joyce Robertson who was Wife in the couple would go over

to the pregnant woman's home and in before she went into

the hospital and visit with the child on a daily basis for

a couple of weeks.

And then the mother would go into the hospital and the child

would be placed with mrs.

Robertson and mrs.

Robertson would care for the child.

And then after the child's mother got out of the hospital

and the child was returned back to the mother.

Mrs.

Robertson would spend several hours a day over the first

few weeks that the child.

It was back there and you know kind of staying in touch with

the child and that was compared to the usual way of doing

things, which is that the mother would drop the child off

in the residential Nursery.

Leave the child there for three or four weeks pick the child

up when when she got out of the hospital and take the child

home and not surprisingly the kids who had this gradual transition

to mrs.

Robertson and the gradual transition from mrs.

Robertson back to their parents did far better than the To

had the sudden drop offs and pick up and that is the kind

of transition that seems to minimize the probability of harm

to the young child.

So when we get to the point when we're ready to begin thinking

seriously about reunification, we increase the frequency

of visits to several times a week the length of visits to

hopefully several hours.

Ideally, we would have the foster parent with the biological

parent for the first few of these and then gradually wean

them off of being with the child.

And then once the child is returned home.

We'd have the foster parent making some visits to the biological

home to spend some time with the child oftentimes.

We have to have less than ideal, but nevertheless that's

the sort of Standard that we strive for and we can get reasonably

close most of the time.

So the point is the child is perfectly capable at that point

of reconstructing an attachment relationship with their parent.

So we give them a few weeks and this has to be individualized

it really I'm really concerned when these things are court-ordered

in a very rigid way.

It really makes sense to have some flexibility because sometimes

you want to Speed up the process.

Sometimes you want to slow down the process with younger

kids. You may take a little bit longer with older kids.

You may go a little bit faster.

But as a ballpark, I would say typically transitions would

be in the three to four week range.

But again, those are not laws of the universe those are just

rough guidelines and they can be tweaked and managed in individualized

based on how the young child is reacting how old the child

is what the circumstances are.

In terms of feasibility and Logistics and all that kind of

stuff but a gradual transition over a period of several weeks

is going to be far better for a young child than a sudden

thing. And one of the worst things that happens around here

is we have situations in which the child is brought into

foster care.

The father's not around and it goes through the legal process

and gets to the adjudication hearing which around Here is

around 80 days after the removal of the child and functions

as a sort of trial to determine if the child needs to be

in care not if the father was not named on the petition originally

and he shows up the child's hand it off to him.

Even though the child may have never seen him before and

I'm sure from a legal standpoint that makes perfect sense,

but from a psychological standpoint and a child's best interest

child's best interest and point.

That's a terrible way to do business.

It would be much Better if there were a way to gradually

transition the child to that father spending increasing amounts

of time and getting support from foster parents as that occurs.

So I'll stop and open it up to questions and discussions

the sky.

She's one of our she runs one of our provider agencies.

Hi doctor.

I was just wondering as far as you know foster care placement

or relative placement.

Would it be fair to say that even after the child has you

and I've had with the bio parents.

They the child could benefit from some kind of contact with

the foster parents like being cut off that abruptly seems

to I've seen it really harm the child.

Absolutely.

Absolutely.

It's not good for kids to have.

It's just disappear from them suddenly with no way of understanding

why that happened because they begin to think that's how

the world works that people who are important to you can

just suddenly drop out of your life.

Hi, we have stopped burger and of our parents attorneys coming

up to ask a question doctor.

Good morning.

What do we look for to see if that has been identified?

Okay.

So those are two very different things separation anxiety

is developmentally normal.

So that kids between seven and nine months and maybe three

four five years when they're separated from their attachment

figures will experience separation anxiety or separation

protest depending on if you focus on the feeling or the behavior,

so that's a developmentally expectable thing and and basically

a good thing to see because it means the child has an Management

attachment disorder are a whole different thing.

There are two types of what's typically called attachment

disorders one is called reactive attachment disorder and

essentially reactive attachment disorder represents the absence

of an attachment to an adult caregiver.

So a child who's been severely neglected fails to form an

attachment and it takes really substantial.

Neglect or deprivation for that to occur and then becomes

emotionally withdrawn and unresponsive etcetera.

And once that child is placed in a normative caregiving environment

and has a responsive caregiver the signs of reactive attachment

disorder attended this year.

The other type of attachment disorder is something I'll disinhibited

social engagement disorder or sometimes indiscriminate behavior.

And these are kids who don't have the developmentally expected.

Ranger weariness and are engaging and willing to go off with

people they've never seen before so they don't have the sort

of break that developmentally we expect to come in around

seven to nine months.

So apart from separation anxiety and attachment disorders

in terms of what to monitor during the visit.

I think signs of obvious signs of distress and the child

obvious signs of fear in the child obvious signs of withdrawal

in the child.

Ow, signs of changes in Behavior.

So a child who's Super Hyper in the visit but not hyper at

other times that would be an issue to be aware of but also

paying attention to how the child reacts in the days after

the visit.

So we like to draw a distinction between a visit experience

that stressful and a visit experience that heart that is

harmful if it's stressful then we want to be looking and

thinking carefully about what can we do?

To reduce the stress level for the child and often for the

parent during the visit if it's frankly harmful, then we

often recommend suspending the visits until we can get things

under better control so that the child and the child's relationship

with the parent is not harmed by the visit and those are

unusual. Those are not typical things that happen but there

are situations in which parents have problems that are so

serious and so severe that they spill out in the visit.

And potentially cause harm to the child.

So those are the kind of things that we'd be monitoring and

pay attention to I appreciate that.

Thank you Doctor.

Sure.

Thank you.

Thank you.

We have a question that just came in from an online viewer

and it says I'm a guardian ad litem whose child children

have been reunified and will be out of the system in January

after more than a year of one or two visits a month.

Should I continue to see the Children occasionally If the

parents agree the children are ages 4 and 14 with developmental

delay. So for years and 14 years.

Yeah, and this is the guardian ad litem in this case who's

asking if she should visit with the kids.

Yes.

Well, I think it's a great question.

But I think it doesn't have anything to do with attachment

unless she believes that the children have formed an attachment

to her.

I mean, I think those kind of decisions would be made based

on something other than thinking about attachment in early

childhood and and Foster Care Okay, great.

We have another couple questions here one says any recommendations

for children who have been removed and returned twice.

Well, that's an open-ended.

So they've been removed and returned twice.

So I assume there's still at home with the biological parents.

The fact that they were removed twice is a concern because

as far as I'm concerned one of the absolute worst things

that can happen to a young child who comes into foster care.

Here is recidivism.

I mean that these are these are kids who already just from

that initial fact that they were maltreated so severely that

they had to be removed and placed in foster care and who

knows what the foster care experience was like those kids

are at enormously increased risk for long-term harm.

So the fact that it happened a second time is clearly a system

failure. And so if they're back home for a second time I'm

then I would hope that there are extensive efforts to provide

support and whatever else is necessary to make sure that

the parents can provide safe and effective care for the kids

so that whatever has happened in the past isn't going to

happen in the future.

Okay, great.

And we have a question from dr.

Neil Boris.

He wants to know what you are suggesting about the role of

foster parents both in visitation and transition is so important.

It's also kind of disruptive sort of like uber in a sense

as the old way of doing things is to have strict lines between

Foster carers and bio parents.

Can you talk about a bit about why going in a new?

Direction is so critical.

Well, thank you for the question you I really hadn't thought

about this as being like uber but in in the Contemporary

models that are just beginning to roll out and have very

encouraging preliminary results.

The foster parents role is change quite dramatically from

being this babysitter who often feels unsupported and Bonded

to by child protective services and not included in legal

proceedings to being a legitimate professional team member

and the foster parents the demands on that foster parent

are much greater than the demands that we make have made

traditionally. So they're expected as I said to make a full

commitment to the child to treat them as if it's their own

child to attend doctors appointments with the child.

Old to including Mental Health appointments to advocate for

the child in school to advocate for the child everywhere

but also to facilitate visits between the biological parent

and the child.

So the team becomes the biological parent the foster parent

the child protective services worker and any Community providers

who are involved and that team is supposed to be working

together. Gather in what's in the child's best interest and

I understand that there are situations in which that kind

of teamwork is not possible.

But it turns out that kind of teamwork is possible far more

often than we realize because we don't ever try and if we

try it turns out in places where they do try this it can

happen much more and I don't know how many people who are

on this webinar or familiar with the quality parenting and

initiative, but essentially that's what I'm describing is

what the quality parenting initiative is really all about

is elevating the stature of the foster parent, but also increasing

the demands on the foster parent and expecting much more

from them making a full psychological commitment and What

Child in foster care as if it's your own child at the same

time developing a relationship with the biological parent

and trying to facilitate the child's.

With that biological parent, that's a tough order, but it

turns out it can work and it can be very very effective.

Okay, great.

Thank you so much.

I know we're running out of time.

We have another question that just came in which is what

about the role of foster parents with pre-adoptive or adoptive

parents is their presence welcome can it be continued our

their negatives if it's abruptly stopped?

I don't think you know from The Young child's perspective

those kind of distinctions of adoptive parent biological

parent phosphorus those don't apply for very young kids.

So all the Things that we've talked about this afternoon

apply in the situation of children who are moving from a

foster placement to an adoptive placement.

So, you know doing the transition in a gradual thoughtful

planning planful way having a relationship between the foster

parent and the adoptive parent.

All those things are in the child's best interest.

Okay.

Well that that concludes the the questions that we have from

online viewers.

Well, I take that back because we do have one more question

that just came in.

Let me know when you want to cut this off any suggestions

regarding children who have an attachment to foster parents

and no three of the children who are siblings placed their

only one of them will be able to stay and be adopted by The

Fosters. Their parents because of the different fathers in

this case any concern regarding the attachment between the

children sibling attachment?

Yeah.

So that's a good question.

I'm glad we got it when the way that I have been talking

about attachment today.

Is that an adult caregiver provides Comfort support nurturance

and protection to a young child who through repeated experiences

of having nurturance support comfort and protection provided

to them begins to look to that person as someone they can

count on to provide that The relationship between siblings

though. It may be extremely important isn't or should not

be an attachment relationship.

So I know that sometimes older children kind of sometimes

out of necessity begin to function as attachment figures

for young children, but there's a reason why we don't think

eight-year-olds ten-year-olds 12 year olds, maybe even 14

year olds should be parents because Is there the demands

of parenting are so complex that it really requires adult

thinking and children in that age range are not capable of

it. But in terms of maintaining sibling relationships when

children are separated because of various placement issues.

I think it's always a good idea to advocate for continued

sibling contact and I don't necessarily support court-ordered

things for the long term, I think adoptive parents or biological

parents if they have the child back have to be in a position

to make a decision about what's in their child's best interest,

but I certainly encourage adoptive parents or foster parents

or biological parents when siblings are separated to think

about the importance of the relationship between the siblings

and trying to encourage Regular contact, so the siblings

can be in touch with one another whenever that's possible.

Well, thank you everybody so much for joining us for our

part 2 of our ask the expert webinar and many thanks to dr.

Xena and the folks at USF for all the technical support and

all of the great information that you gave us.

I know we're very happy here in Broward with the information

that we got and we hope our viewing audience as well had

some great takeaways.

So thank you very much.

from the 17th