Mental health articles

Issues for infants and children in foster-care
There are many issues for babies and toddlers who enter the care of the welfare
system, which are often unrecognised by the system, the carers or the
community at large. They often experience three to four placements in their
experience of care, which is the antithesis of what is considered necessary for the
healthy development of babies and toddlers, that is, consistent, reliable care.
Babies, in particular, are more vulnerable to abuse and neglect, which will
influence their presentation into care (Wulczyn & Hislop, 2002).
At the more extreme end of the continuum of early childhood abuse and
neglect, the effect on brain development is wide ranging and may permanently modify an individual’s vulnerability to disorganised attachment and psychiatric
disorder (Perry, 1997, 2001) and affect his long-term capacity for intimate,
satisfying relationships.
A cautionary note is given to carefully assess the infant described as a ‘good baby’ (Perry, 2001). It may indicate what he describes as ‘dissociative continuum’
for children exposed to protracted neglect and/or abuse. Perry states that babies have ‘early alarm stages’ in which they attempt to attract the attention of their
caregivers through facial expressions, body movements and, when necessary,
vocalising and crying. When the caregiver comes to soothe, warm, feed or
protect by flight or fight, the early alarm stages are successful. When the
caregiver does not respond to the early cries, the system is not effective and the baby abandons the early alarm response, appearing ‘good’ or compliant. In the
face of persistent threat to the infant, other neurophysiological and functional
responses will be elicited, which Perry refers to as dissociative adaptations, and which include distraction, avoidance, numbing, daydreaming, fantasy and, in the
extreme, fainting and catatonia.
These children are often reported to be numb or non-reactive, daydreaming
or staring off with a glazed look (Perry, 2001, p. 228). The child has developed
an adaptive strategy that reduces the possibility of abuse (Cousins, 2004).
Common presentations when taken into care include passivity of movement,
limited range of affect, trance-like states and developmental delay in terms of
milestones. Such behaviour on presentation can be interpreted as that of a ‘good’ baby and can be a desirable attribute in terms of management, as the baby does
not make demands, but is not adaptive for the infant in forming a secure
attachment relationship with the new carer, and maximising developmental
experiences.
Given the difficulty of interpreting the behaviour of infants there is a need for
careful selection of foster parents, as well as education, training and ongoing
support for foster parents to help them understand the behaviour of babies and infants entering their care.
The attachment state of mind of the caregiver plays a part in the possibility
of the infant developing a more secure attachment (Dozier, Stovall, Albus &
Bates, 2001). In their sample of 50 foster-family dyads, the authors used the AAI (described in Chapter 2) to assess caregivers and found that children placed with
caregivers with autonomous states of mind formed secure attachments, and most children placed with caregivers with non-autonomous (insecure) states of mind formed insecure attachments. This was found regardless of what age the infants were when placed in care (they had all been in care for at least three months).
The more disturbing result of this research is that the children placed with
carers who had non-autonomous states of mind, either dismissing or unresolved,
were likely to form disorganised attachments (72 per cent), and it is disorganised attachment that is more likely to correlate with concurrent behavioural difficulties and later psychopathology.
Thus, careful selection of foster caregivers is one factor in securing good
foster care, along with training, education, emotional support and infant–parent psychotherapy for carers where appropriate. The reality, however, is that most
child-welfare agencies are under-resourced, have high staff turnover and manage only intermittently to provide adequate practical and emotional support to their
alternative care providers.
If reunification is a possibility, quality access of parent with child is essential
to maintain the possibility of an ongoing relationship. Currently, in some
situations, when reunification is a goal, access of the baby or toddler to his
mother is usually only once or twice a week in a room in the office of the childprotection
services in the presence of a worker, where there are a variety of
people observing what is happening. Obviously, this is not the ideal place for a mother and baby to relax and be together. Meanwhile, the baby is beginning to
form a relationship with and attach to the foster carer, which has to be taken into account as the baby moves between carer and biological mother.
There has to be a constant recognition of grief and loss for all the parties
involved, in particular, for the baby or toddler being separated from mother and
family context, no matter how inadequate that has been. If the infant experiences
several placements, each placement will involve a fresh attempt at relationship
with subsequent grieving and loss on separation. Foster carers need training to understand the effect of these emotional experiences on the infant and the
infant’s subsequent behaviour, and on themselves. They also need recognition
and support as they work through their own emotional experiences of loss and transition.
The importance of establishing stability for the infant as quickly as possible
is obvious, but many care and welfare systems seem unable to put this into
practice. As mentioned above, there may be a conflict or tension between the
infant’s developmental needs and the ideal that he be restored to parental or
family care. The time the legal and welfare systems need to establish more stable arrangements for the child is at odds with the infant’s developmental
imperatives. As a consequence, already vulnerable and traumatised infants are further disrupted during critical and vulnerable periods of their development. In this way risks become cumulative.

Tags: infant