Objectives
Studies demonstrate that a majority (68%) of children have experienced exposure to traumatic events; however, among children in foster care, the rate approaches 100 percent. Serving the needs of this profoundly affected population requires vigilance to their unique situation and context. Although strategies to address trauma are emerging, adaptations for children involved with child welfare need to be considered. This presentation will review the needs of traumatized children in foster care and appropriate clinical response, including diagnosis, treatment planning, and follow-up.
Methods
Review of pre-placement exposures and familial factors to be identified will be discussed. The issues with the system that impact identification, diagnosis, and treatment and how they must be managed will be covered. Consideration of how to address trauma in the context of various caregiver relationships and how a treatment can impact safety and stability will be addressed.
Results
Pre-placement issues include traumas within the familial context, familial history of trauma, and system's trauma of placement. Trauma-sensitive attunement therapy with families demonstrates better outcomes than routine parenting supports. Multiple traumas occurring across the age and developmental spectrum can present variously and impact multiple domains of function, resulting in diagnostic challenges. Unique to these children, trauma-reactive behaviors may further threaten the child’s permanency and safety. These factors increase the pressure to provide pharmacotherapy, yet make management and monitoring of medications more difficult. Caregiver involvement in trauma care must be approached creatively, as caregivers may be unavailable and nontraditional caregivers may be considered. Finally, the impact of caregiver trauma history and secondary trauma on the clinician can influence care.
Conclusions
The unique issues of children in foster care need to be considered when addressing trauma for this population, informing the presentation, diagnosis, treatment, and ongoing clinical monitoring of these children. Appropriately addressing the trauma of these children with attention to their biologic and foster caregivers has implications, not just for mental health but also for safety and stability before, during, and after placement.