Foster care and line of sight supervision

Two boys in foster care just visited our home to help prepare them to stay with us in about a week.  Harry Potter, age 6, and his little brother, Explorer, age 5, are pretty gosh darn adorable… and overflowing with energy!

These sweet boys have lived in four – yes four! – foster homes since they came into care just six months ago.  I’m sure their excessive energy, tantrums, and other behaviors have been challenging, but my guess is that the need for constant, line-of-sight supervision is what really tired out the foster parents.  We’re super happy that the current foster family has asked us to do respite so that they can re-charge their batteries and continue on with the placement.  These boys need stability in their lives!

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Children can need line-of-sight supervision for a variety of reasons.  They may get rowdy and knock over lamps, use the couch as a trampoline, and accidentally launch projectiles at the tv – in other words they have not yet developed safe indoor playing skills.  When toddlers engage in this behavior, it’s age appropriate and fairly easy to redirect.  My friend who has an older, developmentally-delayed son who gets too exuberant says she feels like they are always five minutes from an emergency room visit.  Whew!  Imagine constantly being on edge, feeling disaster is lurking just out of sight.

Other children need help with social skills and need adult intervention to help them have good interactions with other kids.  They might be prone to fighting or hitting or saying mean things when they get irritated.  As foster parents, our job is to see when a child is beginning to become agitated and either help them calm down, think through their actions, or remove them from situations.

Another reason for line-of-sight parenting is sexualized behavior, which can occur if a child has been sexually abused and hasn’t yet learned the rules of appropriate sexual behavior for children.  Children may masturbate or try to touch other children.  A child who is masturbating can be given a choice of going to their room as sexual self-touching is a private activity or the child can play in the living room without touching their privates.  A child who tries to touch another child is reminded to keep their hands to themselves.  The trick is to not shame them while ensuring no other kids are touched in appropriately.

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When we are parenting kids who need line-of-sight supervision, we use a tag team approach.  My hubby, teenaged kids, and I take turns watching the little ones and ensure the adults get some down time.  Why?  Frazzled parents have a harder time keeping calm and being a good role model.  We never have our teens watch more than one, and usually only if we’re near by.  For example, 15-year-old Savvy might do a craft project with a child while I prepare dinner.  If an issue comes up, I can easily intervene.  Such a method teaches the teens how to interact with others without putting too much responsibility on their shoulders.  At the same time, the little ones see a “cool,” older kid practicing good behavior and they naturally want to emulate them.

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.

Reuniting Children with their Sexually Abusive Parents

Is it ever safe to reunite children with the parents who sexually abused them?  I decided to do some research.  Here’s what I’ve found.

Pedophiles and Sexual Offenders are Not the Same
Weirdly enough, being a pedophile does not mean you sexually abuse children, according to Harvard Health Publications.  Pedophilia means that you are sexually attracted to children age 11 and under.  You could be attracted to children and never abuse them (think of how you have been attracted to your cute co-worker but you never acted on it).  The reverse is true, too.  You could sexually abuse children and not be sexually attracted to them.  Think of the influence of drugs, mental illness, sadism, etc. that may lead you to inflict harm without feeling sexually attracted to the victim.  Harvard says researchers cannot agree what percent of child molesters are pedophiles.

 Pedophilia is Not Curable
Just like you can’t “cure” someone who is heterosexual or someone who is homosexual, you cannot cure someone who is sexually attracted to children.  Treatment for pedophiles consists of keeping them away from kids and sometimes giving them medication to lower their sex drive, that same Harvard report says.

MAYBE a Child Molester Can be Rehabilitated
Sexual attraction can’t be cured, but can the child molesting behavior be cured?  The jury is out.   The Prevention of Childhood Sexual Abuse by David Finkelhor systematically looks at a variety of ways to treat perpetrators.  Mental health services, particularly cognitive behavioral therapy, may help reduce a child molester’s likelihood of committing another sexual offense.  Some meta-studies say a child molester may be one third less likely to sexually abuse a child again.  But no experimental studies have been conducted to prove this, mainly because psychologists are reluctant to set up an experiment where only some sex offenders receive treatment while others serve as the control group and don’t receive treatment.


 So What is the Risk of a Child Molester Abusing a Kid Again?  7%-50%
(Figuring out How Likely a Child Molester is to Abuse Again is Complicated)

So, let’s say that cognitive behavioral therapy reduces a person’s likelihood of sexually abusing a child again by one third.  What is the risk now?

First, let’s look at the risk of a child molester re-offending overall.  Recently, The Atlantic wrote that all child molesters have a 10-15% chance of committing another sexual offense against a child.  But that figure may be TOO LOW.

When someone commits another sexual offense, that’s called recidivism.  A study on how recidivism is calculated reveals that the 10-15% figure grossly underestimates how likely a child molester is to hurt a child again.  Most studies only follow child molesters for 2-5 years after they have been released from jail.  A study that only follows the child molesters for 3 years misses 75% of the sexual offenses the child molesters commit.  But if you look at a study of 25 years, there is a greater than 50% chance that the child molester will commit another sex crime.

Studies on recidivism further underestimate sexual re-offending depending on they whether they count “re-offending” as when the child molester is charged with another sex crime, is arrested, convicted or sentenced.  An easy way to understand this is a person may be caught committing a sexual offense, but plead down to a different charge.   Furthermore, child molesters commit multiple sexual offenses before being caught.  So I am not entirely clear if any statistics can be relied upon, because if a person was able to molest a child without detection for a period of time prior to be arrested, what’s to say they aren’t molesting again without anyone knowing?

Ok.  Back to our question.  If a parent molests their child, goes through therapy and is reunited with their child, how likely are they to sexually abuse again?  If we believe the general rate for child molesters committing abuse again is 10-15% and we choose to believe the non-empirical data on the effectiveness of therapy, that abusive parent has a 7-10% chance of sexually assaulting their child again.  However, if we believe the general rate is 50% and believe in the effectiveness of treatment,  that parent’s likelihood of molesting again is 35%.   If we don’t believe in the effectiveness of treatment, then there’s  a 10-50% chance of that parent abusing again.

Educating Children About Sexual Abuse Helps
In foster care, the sexually abusive parent wouldn’t be the only one receiving therapy.  Kids would be educated that adults should not be molesting them.  There is no conclusive data that teaching kids about good touch and bad touch will PREVENT child sexual abuse.  Maybe education does prevent child sexual abuse, but no one is studying this topic.  However, there is evidence that children are learning the concepts of refusing to cooperate with a molester, seeking help, and telling a trusted adult if abuse does occur.  And there is evidence that educated children who are victimized will feel that it is not their fault.  So, maybe the education will help kids protect themselves.  Sadly, though, once a child has been sexually abused, they are 6.9 times more likely to be sexually abused in the future.

Reuniting
Sigh.  Sending a foster child back to a parent who was sexually abusive will be absolutely gut wrenching.  For me, a reasonable assumption of risk of re-abusing seems to be about 20% or a 1 in 5 chance.  And that sucks.

I was super hoping that my research would reveal something that would make me feel better about reuniting families in a situation like this.  And a 20% risk is a lot lower probability than I originally thought (I was thinking that the odds were more like 100%).  But I am not feeling better.

Should Survivors of Abuse be Foster Parents or Adoptive Parents?

Our social worker said that adult survivors of abuse, neglect, sexual assault and other forms of trauma often make the best foster/adoptive parents.  However, she said there is a big “but” that can disqualify people from adopting or becoming foster parents.  Read on…

Survivors Can Make Fantastic Parents – Adoptive or Foster

Empathy:  Adult survivors can truly empathize and understand what foster kids are going through.  They can easily love traumatized children as the child’s difficult circumstances don’t scare them away, and similar histories may actually be something that bonds them together as a family.  Survivors almost instinctually get that an outburst is due to fear of abandonment or that a tantrum is about anger over not having control of one’s life, which means these parents can see and address the root cause of their children’s less than desirable behaviors.  They may even have an innate sense of what to do to calm a child who’s acting out or feeling blue.

Vision:  These parents truly believe in a bright future for their hurt kids, even when those kids are struggling in school or are having a hard time making friends or even just being part of a family.  They know that hurt kids can heal and turn their lives around, because survivors know from their own experience of healing themselves that it can be done.

Dedication:  Parenting kids who may exhibit difficult behaviors can be exhausting.  Imagine handling a child who hits, who wets the bed, and yells a lot.  Now add time for doctor appointments, counseling sessions, teacher conferences, and visits with birth family.  And kids typically don’t thank parents.  Survivors can be tenacious, though, holding onto the vision of a healed child.  Perhaps they vowed that they wouldn’t give up on children like adults gave up on them when they were younger.  Perhaps they’ve vowed to make their own suffering mean something.  Perhaps they promised God that if God got them out of their previous bad situation, they would help others in the future.  Or maybe simply reflecting on how hard their journey of healing was will give them strength to stay the course.  Regardless, survivors tend to be dedicated to helping kids, even when the going gets tough.

Believing It:  Foster children’s stories can be horrific.  Their mother sold them to a pedophile in order to get drug money, their father tried to strangle them with a belt, or they have been eating carpet since their parents haven’t brought home food for weeks.  If you lived a typical childhood, it can be really hard to believe your new children’s stories of what happened.  You can be shocked by the tragedy and may have a hard time coping when your view of the world “as a good place” is turned upside down.  Survivors, however, know from experience that terrible things can and do happen; it’s not really that shocking when it happens to others, too.  Abused children benefit when parents validate their experiences, when parents trust that the children are telling the truth.  Traumatize children also benefit when their parents aren’t bowled over by their histories. They sense that their new parents are strong enough to handle their darkest experiences – giving them confidence that in time they will be able to cope, too.

When Survivors Should NOT Adopt or be Foster Parents

Triggers:  Your children’s troubles can trigger your own personal memories or emotional turmoil.  For example, imagine that your child reveals to you that he or she was sexually abused, and you were raped previously.  You may relive those experiences, and/or become sad, angry or depressed.  It’s already challenging to parent a traumatized child, but it can be incredibly tough to parent a child when you’re in your own emotional tailspin.  Will you still be able to work towards reuniting your foster kid with their family?  Will you have enough emotional energy to heal yourself and your children simultaneously?  If you haven’t healed from your trauma, now is not the time to take on responsibility for an abused or neglected child.

What’s Changed?:  Are those people who hurt you still in your life?  Sadly, the perpetrator who hurt you when you were younger may be a family member, such as a parent, aunt/uncle, or sibling.  You may have jumped from one bad previous relationship into another bad relationship.  How will you protect your children from abusive or neglectful relatives, significant others or friends?

How Social Workers Decide

Resolution? Counseling?:  Social workers will ask you about all of the losses in your life, how you handled them, and assess whether you seem to have resolved any trauma.  If you have gone through therapy and successfully addressed your own trauma, social workers will recognize this.  Be honest with them about what has happened in your life, and what you’ve done and continue to do to compensate.  For example, if you know bed wetting reminds you of being beaten as child and triggers big emotions, but you’ve made arrangements for your spouse to handle changing bed sheets if your child has an accident, then you’ve shown an understanding of yourself and the ability to handle that particular situation.  However, if social workers think you may have unresolved issues, they will ask you to seek counseling (on your dime) and then come back afterwards to finish your home study.  Your willingness to seek help will demonstrate to social workers that you’ll do what’s necessary to keep your family healthy.

Lifestyle:  Social workers use something called a genogram to dig through your family relationships.  In short, it maps out your relationships and acts as a guide for your social worker to talk with you about how well you get along with relatives.  If you had abusive or neglectful relatives, it gives you an opportunity to discuss how you’ve either resolved the situation, whether you have terminated the relationship, or how you would otherwise protect your foster or adoptive children.

Footnote

A 17 year old liked Should Foster Teens Seek Adoption?, so I checked out her site and saw a young woman in a lot of pain.  But I have faith that she can grow up to be a tremendous power for good.  (You can do it, C!)  She already inspired me to write this post (thanks, C!).  If you’re going through hell, keep going… and then consider how you can take something horrible and make it into something wonderful.

So, what do you think? Should adult survivors of abuse or neglect be able to foster or adopt?