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Table of Contents for Nurturing Adoptions: Creating Resilience after Neglect and Trauma |
Part One: Issues of Neglect and Trauma into Today�s Adoptions
Part Two: Putting the Pieces Together�Restoration after Traumatic Stress and Neglect This book is a guide for the parents and professionals charged with the task of helping children affected by neglect and trauma. Research with people who have suffered neglect and trauma confirms that those who have grown up without appropriate professional and family interventions continue to exhibit trauma in adulthood. Nurturing Adoptions details interventions that create hope and resiliency in children post neglect/trauma. The challenge for the adoption and foster care communities is to first identify the symptom clusters of neglect and trauma, and then select home and professional practices that move children onto healthier developmental arcs. When I first presented material on trauma and neglect, an adoption professional friend of mine said, �I had a visceral reaction to what you were talking about. My daughter�s struggles played as a mental slide show as you talked. I realized how many problems were related to maltreatment. But how do I get a therapist to understand what she needs? I went home feeling sick�for my family and for so many others. We have to get help to families and also to therapists who relate to our children.� This experience compelled me to begin my journey of organizing the information into a user-friendly format. This book provides a practical manual for professionals, reflecting advances in brain processes shaped by early stress, neglect, trauma, and exposure to substance. It applies theory and research to professional protocols in both therapy and casework. Parents can also use this information to understand the effects of neglect/trauma and employ in-home processes to create a hopeful future for their children. Neglect and abuse are commonplace terms in the histories of children being adopted through domestic foster care programs or from overseas institutions. As adoption has changed, and these terms appear more frequently, there has been a tendency for professionals to treat these potent words as if they were insignificant�almost innocuous. Abuse and neglect are far from innocuous. The truth is that, by itself, placement into stable, loving families cannot be sufficient treatment for problems stemming from chronic maltreatment. Routinely, children who have been maltreated suffer from high rates of traumatic stress symptoms, anxiety, social problems, aggression, and hopelessness. They will need professional treatment in order to recover. Traumatic stress is best understood as a health condition, needing early treatment for best results. It stands in the way of a person�s ability to develop close personal relationships. It becomes the silent shaper of everyday life, a lens that superimposes the helplessness of trauma on the meaning and pleasures of life. It leaches away life�s joys. In addition to the emotional costs, a study by V.J. Feletti and colleagues demonstrates the relationship of childhood maltreatment to many of the leading causes of illness or death in adults. People who had been maltreated in childhood had a four to twelve times greater risk of developing alcoholism, depression, and drug abuse and of attempting suicide than people who had not been abused or neglected in childhood a two to four times greater risk of smoking, of having at least fifty sexual partners, and of acquiring sexually transmitted disease; a 1.4 to 1.6 times greater risk for physical inactivity and obesity; and 1.6 to 2.9 times greater risk for ischemic heart disease, cancer, chronic lung disease, skeletal fractures, hepatitis, stroke, diabetes, and liver disease (1998). Secure attachments act as vehicles for the transmission of healthy stress regulation systems. Without healthy stress regulation systems, children are especially vulnerable to the shocking biological effects of trauma on their memories, attention, concentration, anxiety levels, and social responses. Children who lack secure attachments during the time of trauma are particularly at risk for developing traumatic stress disorders. The type of traumatic stress that they are prone to develop is the type that is particularly hard to treat�complex post traumatic stress disorder. With the exception of newborns carried and delivered out of healthy pregnancies, children coming into placement rarely have secure attachment histories. But these children are placed as if the trauma has not shaped their brains or their lives, or as if their rates of distress post-trauma are the same as distress rates in children who have had continuous, secure-base attachment histories. Neglect has even more misunderstood implications than does trauma. The effects of neglect on mood, empathy, and emotional understanding of others can be long-term. As a group, children who have been neglected show distinct vulnerability in developing empathy and/or the ability to balance their own points of view with the interests of others. This balance is essential in social relationships. Laurie Miller, M.D. has conducted studies of children adopted from Eastern Europe. These children, ages 8 through 11, are notably quite similar in characteristics to children adopted from the North American and Western European foster care systems. One-half of the children in Miller�s study were identified by schools or parents as requiring social skills classes. Yet, the group�s average age at adoption was just 21 months, with 66% of the children adopted at under 8 months old (2005). It is remarkably common for new adoptive parents to be sent home with good information on adoption as a lifelong process, but with no information at all about the dangers of untreated traumatic stress�a potentially serious long-term threat to their children�s mental and physical health. No specific plan is being made for post-placement treatment of traumatic stress. Far too often, placement professionals themselves are unaware of its potentially lifelong repercussions. Furthermore, placement professionals who know that therapy is essential often have difficulty finding therapists who understand the simultaneous treatment of attachment, trauma, and grief. The result is, in my opinion, a growing public health disaster. For the treatment community, Nurturing Adoptions provides treatment outlines and case examples for therapists who are treating the related issues of traumatic stress, attachment, and neglect issues for children. Therapists who look at their cases strictly through a trauma lens describe having treatment failures when children in treatment have never developed a beginning attachment that permits the emotional stability to begin doing trauma work. They recognize that play therapy alone is not helping these children resolve issues. Instead, the trauma themes are played out, over and over and over again. No mastery or de-sensitization seems to occur. Therapists who focus only on attachment describe the frustration of continuing to treat for attachment issues for long periods of time, making gains and then seeing them erode. They have never included trauma work in their treatment models. Trauma keeps eroding attachment relationships until the trauma is treated. This book reflects the growth in the field in terms of understanding the interrelationship between trauma, neglect, and attachment. It gives detailed case descriptions of updated treatment processes. This book includes the theory and the practicalities of therapy for children who are coming into families after maltreatment. I have a specialty practice in adoption and foster care, and, as a result, children and their families have taught me to adapt my therapy processes to fit their specific needs. I have incorporated these lessons into this book. Additionally, I have liberally cited the beautiful research that has been done by workers in the trauma and neglect field to assist the understanding of how best to help children. The vignettes in the therapy section should also help parent readers recognize the process of change in families like theirs. Nurturing Adoptions describes therapeutic techniques and case examples for children who have early neglect. Many neglected children have difficulties later with anxiety, emotional regulation, emotional attunement, and reflective thought. Ways to stretch brittle emotional states and to develop reciprocity are detailed. This book describes ways to understand how neglect has altered the development of such children. Then it describes ways to remediate this. Attaching in Adoption (Gray, 2002) was written for parents, with the understanding that professionals could also use and enjoy it. This material in All too often individual parents are forging trails to services, feeling like lonely pioneers, burdened with finding appropriate services in a timely way. All the trail markers are written in a different language, i.e. psychobabble. Many commonalities shared between parents in terms of problems and resource needs are described in this book, as well as the professional supports necessary to undergird success in these families. Child welfare workers have not been left out. Nurturing Adoptions covers not only the issues of neglect/trauma, but also goes on to discuss how to move children, prepare parents for placement, and make assessments during home studies. Templates are provided for community mental health workers who may be seeing children from the foster care system who will be adopted by their foster parents. The methods suggested in this book fit well into typical outpatient mental health practices. There is no question that an increase in adoptions of maltreated children is a societal advance. Nurturing Adoptions assists the child welfare field�s trend by updating practices in therapy and casework that respond to the changing adoption population. For placement professionals, this book identifies capacities needed by adoptive parents who will be parenting children with trauma and neglect and methods of assessing those capacities in home studies. It provides parent preparation guidance for placement professionals as they help families to identify and use capabilities that provide long-term benefits for children. Theoretically, psychodynamic and cognitive behavioral approaches co-exist. Family systems approaches are used with families. Developmentalists will see approaches best described as applied developmental psychology. Evidenced-based practices are used as the preferred treatments throughout the book. Readers familiar with coercive techniques will find them singularly absent from Nurturing Adoptions. The reasons go beyond widely shared ethical concerns. Coercive techniques are contraindicated due to the effects that neglect and trauma have had on the brains of the children about whom this book was written. Vignettes and case examples are used throughout the book to capture the flavor of the successful parent-professional teamwork that makes for best practices for children. The stories give a voice to children who are on a healing path. Their voices give encouragement to all of us in the field, reminding us to give them not just a good start in their families, but an excellent future. |