Case 3:
Chronic, moderate stress and a ‘trigger’
incident: Clinical work with maltreated and
traumatized children.
The ChildTrauma Academy’s interdisciplinary team
has worked day after day
with high-risk children: children living in
foster care after being neglected or abused
by their biological families; child
witnesses to violence, children living
through car accidents, cancer treatment,
fires, and tornadoes. For many of these
children and families there are no resources
or services available to act on the
recommendations of the clinical team. Child
mental health services are scant and, all
too often, sub-standard. Enrichment or
special educational opportunities for
high-risk children are difficult to arrange.
Optimal adult to child supervision ratios in
foster care are almost unheard of (in Texas
as many as 10 children can be in one foster
home). Very young children with profound
developmental delays requiring one on one caregiving
will be placed in ‘therapeutic’ foster homes
where there are five other children under
the age of five – with only one adult
caregiver during the day. This can lead to a
sense of frustration and futility. In other
cases, children in foster care will be moved
from placements against our better
recommendations. The decisions regarding the
health and welfare of these children are
often out of the hands of the clinical team.
And when hours of clinical work seem to be
ignored by a judge, caseworker or
supervisor, the sense of hopelessness can
eat away at effectiveness and motivation.
Against this background,
a child protection worker referred Brenda, a
four-year-old child to our clinic. This
young girl was the third in a sibship of
five. The other siblings were in other
placements. Following severe emotional and
physical neglect, Brenda was chronologically
age four at time of removal but was
functioning like a two year old –
undersocialized and developmentally delayed.
She was placed in the home of an experienced
and caring foster family who, at that time,
had no other children in their home aside
from their two teenage biological children.
Within the first nine months, with lots of
attention, consistency, nurturing and
predictability, Brenda blossomed. She erased
many of her developmental delays and was
approaching age-appropriate motor and
behavioral functioning. The foster family
was seriously considering adopting her.
Things looked great for Brenda and the
clinical team felt they needed to see her
only once a month – to track her progress.
And then, somewhere,
someone made the decision that the family
should not be broken up. The caseworker
could either move Brenda into a new
placement with all of the other sibs or ask
the foster family to take in the siblings.
The siblings were moved into the foster
family. The clinical team knew nothing of
this move until a month later at the next
visit when the foster family reported a
plateau in her progress and, some tantrums
and new behavioral problems. The next month,
Brenda regressed. She had much less
attention in this new situation. Her
siblings, older and younger, demanded the
attentions of the foster family. The
dilution in attention and the increase in
the chaos in the foster home just
exacerbated her already considerable
situation.
The team tried to get the
foster family or caseworker or supervisor to
understand how Brenda’s condition – indeed
the capacity of any of these five children
to improve – was dependent upon the amount
of consistent, predictable and nurturing
attention they received. But none of the
team’s efforts could change the harsh
reality of the situation. The system says
the siblings must remain together. Ultimately,
the situation deteriorated to the point
where the foster family asked the caseworker
to take all these children. And, for the
fourth time in a year, these children were
moved to another placement. They were
together, but as a group, their needs were too much for any
single foster family. Each of these children needed
more attention, more consistency, more
predictability and more nurturing than could
possibly be provided by a single overwhelmed
foster family. With the move, Brenda was
"lost to follow-up." The tantalizing
progress she made and the recaptured
potential she demonstrated only made the
situation feel worse to the clinical team.
Frustration, anger and a sense of
hopelessness about the system permeated the
discussions of this girl – the poster child
of an ailing foster care/child protective
system.
