Mental health articles

Alternative care is foster care or adoption In the current social context children are not removed from parents lightly. The
removal of a child into care is a difficult decision that requires thoughtful
consideration of the effect of separation on the infant vis-a-vis careful
assessment of the damaging physical, psychological and developmental impacts
on the child of the abuse and/or neglect being experienced. A thorough
assessment of the infant at the time of going into care is essential to identify
specific areas of need and implement appropriate intervention.
Once a child is removed from parental care there is a break in the
psychological bond between parent and infant—the foundations of the child’s
development have been eroded because the biological parents have not ‘been good enough’. The goal is no longer the best outcome for the child, but ‘the least
detrimental alternative’ (Bemporad, 1995, p. 3). There is a growing awareness that babies and toddlers have specific needs upon entering the alternative care
system (Berrick, Needell, Barth & Jonson-Reid, 1998).
Existing bonds to parents are important to infants, notwithstanding the
inadequacy of nurturance and the distortion in attachment with the parent. In the event of separation or removal of the infant, it is acknowledged that
recognition and time need to be given to mourning the loss of parents and family even though they may have been inadequate.
A review (Dozier, Dozier & Manni, 2002) of the research of the last decade on how children in foster-care cope with disruptions in care noted the difficulties
foster children have in forming secure attachments. The authors noted several factors that increased the infant’s vulnerability. In addition to pre-fostering factors of compromised pre-natal environment, abuse and/or neglect, and
disruption in their primary relationships, there was a tendency for these infants to fail to elicit nurturing from their carers, often behaving in ways that pushed foster parents away. This increased the risk of placement breakdown, adding to
disruption and loss, with a greater risk of developing disorganised attachment with its likely sequela of continual difficulty in later establishing positive supportive relationships.
Alternative care is usually referred to as foster care or adoption. Foster-care arrangements include temporary, emergency or respite care as well as longer term placements, sometimes to age 18 years. Jurisdictions differ in the rules and
processes governing adoption, which can include intercountry as well as local and open adoption arrangements. There is increasing recognition of children’s need for security and permanence, as well as emphasis on the need for contact
with birth family and culture. At times there appears in practice to be tension between these two priorities in decision making about the best interests of the
child. Some children experience repeated breakdown of foster placements and are cared for in group homes or institutions, although in most western countries
the number of large welfare or residential institutions for children is
diminishing.
Once the decision is made to remove a child from parental care, the emphasis needs to be placed on providing the best alternative care situation, preferably
where it will be possible for the infant to form a more secure attachment
relationship with the carer. This has been shown to be a protective factor in the longer term (Shonkoff & Phillips, 2000; Werner, 2000).