Forensic Medical Exams

Sometimes a doctor needs to examine foster kids to gather evidence to be used in court when allegations of abuse or neglect are made.  This is called a forensic  medical exam.  Here’s what one is like.

Child Protective Services will request that a particular doctor examine a particular child.  Where we live, the county uses a special unit at a children’s hospital.  The foster parent takes the child to that clinic.

The waiting room is small, but has lots of toys to keep kids busy.  While the foster parent fills out paperwork, someone comes to explain to the child what the exam will be like.  I forget what the exact title for that person, but it’s a child specialist whose job is to keep a child calm during a medical exam.  She does this by first showing the child different medical instruments and showing him/her what they are for.  Then she talks about the exam, using easy-to-understand terms.  “You will wear a hospital gown that opens in the back.  It’s like putting on a jacket backwards.”  “The doctor will look at your skin from head to toe.”

During the exam, the doctor begins at the head and works his way down, documenting any injuries, such as bruises, cuts, burns, scars, etc.  He will set a ruler next to the injury and take a photo to document the size and severity of the injury.  He will also use the stage of healing to determine how frequently injuries are occurring.  If physical abuse is particularly severe, the doctor may take x-rays to see if there is evidence of previous broken bones.  If sexual assault is suspected, the exam may include swabbing genitals for evidence of semen or hairs.  If severe neglect is suspected, weight and blood work showing nutritional deficiencies may be ordered.

During the exam, the foster parent can be present if the child feels comfortable with them in the room.  The child specialist will be charged with distracting the child during the exam.  At our clinic, she uses an iPad with games on it.  And if a child becomes anxious during a particular part of the exam, she will redirect their attention to the game or ask them a question or otherwise distract them.

At the end of the appointment, the child gets to pick out a toy to take home.

The forensics doctor usually only gives the foster parent a cursory read out – something really general like diagnosis suspected child, bruises and burns.  You can get a fuller report from the social worker, who may say something like the number of injuries, what may have caused them (e.g. cigarettes).

The medical report will be used by the county to substantiate their claims of abuse or neglect.  This helps the judge determine whether the county was justified in removing the child from his/her home.  The medical report may also be used to prosecute a criminal case, if the county decides to file charges against parents for the maltreatment of their child.

We really like our local forensics pediatrician.  You would be surprised, but kids actually kinda have fun.  They get to play video games and get a nice toy (think remote control car, teddy bear, etc.).  The exam doesn’t include any vaccinations, so no shots – a bonus in most kids’ minds.

Bottom line:  It may seem scary to take a child to a forensics pediatrician to have their injuries documented, but really it’s not bad at all.  I recommend foster parents go along and keep calm, lending their strength to these young children in need.

Should I Believe in Reuniting Foster Kids with Their Parent?

Here is what I believe in.  Reunifying parents with their kids who are in foster care.  Helping families who are going through hard times get past their troubles .  So why do I catch myself hoping for quick termination of parental rights?

Today, 4-year-old Jumping Jack came to visit our 8-year-old foster son Watchful and 10-year-old foster daughter Joyful.  Jumping Jack is their biological brother who is placed with another foster family.  Jumping Jack’s foster mom and I took a quick break to have an adult conversation out on the patio, and she confessed to the same feeling.  She had gotten into foster care to help families heal and reunite, but she is doubting the wisdom of reunification in this case.

As I mentioned in Too Early for the Adoption Word, our social worker and guardian ad litem think there’s a good chance the case will move to termination of parental rights.  At court yesterday, it was made clear that the county will definitely be seeking to terminate mom’s rights later this year.  They are giving dad his chance to fix things, but they are not optimistic that he will be able to turn things around.

Dad diligently shows up for every visit, but then ignores Watchful and Joyful.  He expresses concern about the children’s eating habits, but denies that the trauma has negatively impacted the kids.  He’s says he’s interested in reunification, but chooses not to call the children.  He says he would protect the kids, but blames the children for the abuse and blames the school system for not teaching children how to defend themselves.

This is the kids second time in foster care, and dad received a year’s worth of training back then.  Counseling and parenting classes didn’t fix the problem last time, though. Why would counseling and parenting classes work this time?

And so, I am left in a quandary.  When I see dad make efforts to turn things around, I want to cheer him on.  Yet, when I am reminded of the horrible trauma that happened under his watch and observe some of his current poor choices, I want to help the children move on to a life without him so they can lead safe, healthy, and eventually happy lives.

Every time I have the fleeting thought that maybe Joyful and Watchful would be better off if adoption becomes the plan, a little part of me dies.  Those very thoughts violate one of my most deeply held beliefs.  But apparently, I have a belief that is stronger than my belief that families should stay together.  My most powerful belief, apparently, is that children deserve safety and  love above all else.

Too Early for the Adoption Word?

Joyful and Watchful have only been with us for a little over month.  Officially, the plan is return to parents or return to other family members.  But people are hinting that this fall the plan could change to adoption…

You never know what a person will do.  Will their dad work the plan to get his kids back?  Our social worker and the guardian ad litem both think he won’t.  They hope he will, but don’t see evidence that he will do what it takes to regain custody.  Because he isn’t calling the children.  Because of comments he has made.  Because of some initial non-compliance.  Because the bar is higher now that it is the second time Joyful and Watchful have needed to come into foster care.

All of the known extended family members have been ruled out as potential homes for Joyful and Watchful.  The county is now searching for other extended family to step up and take the kids, if need be.  But the other extended family would not know the children at all, wouldn’t know their parents either, and they live outside the United States.  The odds are stacked against finding a relative to adopt them.

So, where does that bring us?  The unspoken question is “would you consider adoption?”  Would we?

We planned on being just foster parents, a temporary home as we worked to reunite families going through tough times.  We thought we’d be empty-nesters in the next few years.  Our children already have one step out the door, being teenagers.  Permanently taking on a 10-year-old and 8-year-old means another ten years of daily parenting!  And what about their little, 4-year-old brother  Jumping Jack?  Would we adopt him, too?  Financially, can we take on three more kids?

We adore Joyful and Watchful.  They are so wonderful.  They have blended with our family so beautifully.  My heart aches just thinking about not having them in our lives.  I can imagine them as our forever daughter and son.

But there’s at a lot of time between now and this fall, the earliest time that the plan could change to adoption.

And I want to work as hard as possible to reunite them with their dad.  I’m scared to let the kernel of hope grow that they could be ours forever, and develop conflicting feelings about reunification.  Like I said, we got in this to help families stay together.

So, too soon I say.  Too soon to say the word “adoption.”

This post is part of Adoption Talk Link Up, where people interested in learning about adoption discuss a new topic every two weeks.  Check it out!

No Bohns About It

Parenting to Stop Self Harming Behavior

Ok.  I promised I’d tell you how Maude, Watchful’s new therapist, wants us to handle his self harming.  It seems pretty strange, but it’s working so far.

To recap, 8-year-old Watchful has been hitting himself, injuring himself by throwing himself against hard objects, and discussing his plans for killing himself.

Maude says we need to demonstrate to Watchful that we can keep him safe, even from himself.  Easier said than done, was my first thought, thinking of a panicking child who is intent on hurting himself.

But actually, her method isn’t super hard.

1)  Project Calm and Confident Vibes.  When Watchful is hurting himself, the first step is to avoid showing we’re upset, worried, scared, or angry.  We are to remain calm.  We are to project confidence that we will be able to keep Watchful safe, even from himself.  Being calmly confident is probably the hardest part, but Maude suggests that continuing to repeat confident statements (see #3) will help us develop that inner calm during the most tense moments.

2)  Do Not Verbalize Undesired Behaviors.  If Watchful is punching himself, we should NOT say “don’t hit yourself” or “don’t hurt yourself.”  Why?  When a child is an agitated mental state, hearing the word “hit” or “hurt” can trigger the child to continue doing that action.

3)  Confidently State What Behavior  You Expect to See.  If Watchful is bending his fingers backwards, we should say “I am waiting to see safe hands” or “I am confident you will start being kind to your hands.”  If Watchful says he will kill himself, we should say “I am here to help keep you safe and I know we are going to get through these big feelings safely” or “I am really good at keeping kids safe and I am confident that you will soon calm down and choose to be kind to your body.”

Three steps to reducing self-harm.  Seems quite doable.  And so far, we’ve had occasion to try it out twice and it’s worked both times.  Yay!