Foster Care Trauma and Adoptions

On a prior post, I said I’d do one on the foster care system at a later date. Well, this is that later date. For the last 11 years I’ve been the social worker with Wasatch International Adoptions’ Second Chance program.

WIAA Ogden

What does Second Chance do? We do secondary placements of international and domestic foster care adopted children who are victims of trauma. The behaviors of most of these children are extremely difficult to handle.

We’ve all heard that the United States’ foster care systems are all broke. About every couple of months, there is an article about what’s wrong with foster care. I have yet to see any real progress in fixing the systems.

The boy is angry or sick

It’s like a nightmare that repeats itself day after day, month after month and year after year. Back in 1998 when I spent 6 months reviewing foster care files for the Department of Human Services, the problems kept repeating for file after file.

The problems were often considered standard procedures. Young children between the ages of newborn to 16 years old were removed from their biological home for reasons of neglect (physical and educational), physical abuse and mental abuse.

The social workers and/or police removed the child if they felt the child was endangered. They would place the child in a short term foster home and then move the child back home or to a more long-term foster home depending on the outcome of their investigation.

The child’s mental health concerns were not even considered. They still aren’t! And, this social worker is still angry. I see the results of multiple placements all the time in our Second Chance kids.

The following article excerpt, even though it’s old, explains what happens when a child gets multiple placements while young.

Committee on Early Childhood, Adoption and Dependent Care

Pediatrics November 2000, 106 (5) 1145-1150; DOI:

Greater numbers of young children with complicated, serious physical health, mental health, or developmental problems are entering foster care during the early years when brain growth is most active. Every effort should be made to make foster care a positive experience and a healing process for the child.

Threats to a child’s development from abuse and neglect should be understood by all participants in the child welfare system. Pediatricians have an important role in assessing the child’s needs, providing comprehensive services, and advocating on the child’s behalf.

The developmental issues important for young children in foster care are:

1) the implications and consequences of abuse, neglect, and placement in foster care on early brain development;

2) the importance and challenges of establishing a child’s attachment to caregivers;

3) the importance of considering a child’s changing sense of time in all aspects of the foster care experience; and

4) the child’s response to stress.

Additional topics that should be addressed relate to parental roles and kinship care, parent-child contact, permanency decision-making, and the components of comprehensive assessment and treatment of a child’s development and mental health needs.

Children in foster care in the United States have been the victims of repeated abuse and prolonged neglect and have not experienced a nurturing, stable environment during the early years of life. Such experiences are critical in the short- and long-term development of a child’s brain and the ability to subsequently participate fully in society.

Children in foster care have disproportionately high rates of physical, developmental, and mental health problems and often have many unmet medical and mental health care needs.

Pediatricians, as advocates for children and their families, have a special responsibility to evaluate and help address these needs. Legal responsibility for establishing where foster children live and which adults have custody rests jointly with the child welfare and judiciary systems.

Decisions about assessment, care, and planning should be made with sufficient information about the particular strengths and challenges of each child. Pediatricians have an important role in helping to develop an accurate, comprehensive profile of the child.

To create a useful assessment, it is imperative that complete health and developmental histories are available to the pediatrician at the time of these evaluations. Pediatricians and other professionals with expertise in child development should be proactive advisors to child protection workers and judges regarding the child’s needs and best interests, particularly regarding issues of placement, permanency planning, and medical, developmental, and mental health treatment plans.

For example, maintaining contact between children and their birth families is generally in the best interest of the child, and such efforts require adequate support services to improve the integrity of distressed families.

However, when keeping a family together may not be in the best interest of the child, alternative placement should be based on social, medical, psychological, and developmental assessments of each child and the capabilities of the caregivers to meet those needs.

Health care systems, social services systems, and judicial systems are frequently overwhelmed by their responsibilities and caseloads. Pediatricians can serve as advocates to ensure each child’s conditions and needs are evaluated and treated properly and to improve the overall operation of these systems.

Availability and full utilization of resources ensure comprehensive assessment, planning, and provision of health care. Adequate knowledge about each child’s development supports better placement, custody, and treatment decisions. Improved programs for all children enhance the therapeutic effects of government-sponsored protective services that is foster care and/or family maintenance.

The thing is that the foster care systems don’t always follow this advice.  How do I know that? One of the most diagnosed problems of children in foster care is ADHD. Now with true ADHD, the medications work very well, but with the majority of foster care kids, those meds may not be very effective. So what do the docs do? They either increase or try a different medication.

Angry Kids

Most pediatricians do not have a working knowledge of Reactive Attachment Disorder (RAD for short.) Exactly what is RAD or the behaviors attached to it.  RAD kids have had to survive in unnatural situations. International kids have what we call orphanage trauma. American kids’ trauma has to do with lack of or poor parenting.

RAD behaviors are really difficult to analyze. Some kids have screaming tantrums. Others steal and lie for any reason. The kids can be manipulative. They can set parent against parent. Or they can be totally passive-aggressive.  However it manifests itself, RAD is the most misunderstood diagnosis that childcare workers have to deal with.

Kara Lamphere

I lived with a RAD child. That was the toughest time of my life. She was a traumatized child. She was abused as a young child by her father. She ran away from home and was picked up for stealing food. She was placed in a jail cell and repeatedly raped by the jailers.

By the time my daughter arrived, she had experienced many years of trauma. Foster children, depending on their ages, have also experienced many years of trauma. Even newborns can experience trauma when removed from their biological mother.

I might get some flak for that last statement, but Second Chance has had some children that have acted out in a family even though they were adopted at birth or a young age. Most infant adoptions go well and the adoptive family feels there are no issues, but the issues lie just under the surface.

Just the other day, I was contacted by an adult adoptee who wanted to find her birthmother. Her adoptive parents had died and she wanted to know about her birth family. Adopted children almost always feel something is missing in their lives.

One of the things that bothers me the most is the thing the legal system calls reunification. Adoption is never the first plan for a foster child. In fact many legal ploys have to be tried before adoption is even considered.

By the time the courts decide adoption should be considered, a child can be older than 12 years. There aren’t many families available for kids going on 13. In fact, most foster kids older than age 10 age out of the system. If they are lucky they have a foster family who loves them for themselves, not just the money they bring in.

As an editorial, I feel that biological parents are given way too many chances to parent their child.  Permanency should be the objective for the child’s wellbeing, not the parents. I am an active “best interests of the child” believer.

I think the courts and foster care social workers should change their way of thinking. Children should be the #1 consideration. Let’s quit adding more trauma to an already hurting child.

Adoption agencies in Utah that I support:

Wasatch International Adoptions

Children’s Service Society

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2 responses to “Foster Care Trauma and Adoptions”

  1. Thanks, Ann.

  2. I would like to do a post on RAD and Second Chance someday.

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