Paper
Meeting the needs of foster children with (complex) trauma and their foster families: A recent initiative in the Netherlands
- issue: Issue 1-2013 / 2013
- authors: Hans Grietens
- keywords: trauma, training, trauma-focused care
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- downloaded: 0
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abstract
Introduction. Several studies show that large numbers of foster children have a history of trauma. In the United States, for instance, Greeson et al. (2012) reported complex trauma (this means, having been victim of at least two different types of violence within the family) to be present in more than 70% of foster children between 0 and 21 years old. In the Netherlands, Grietens et al. (2012) studied trauma in children in short-term foster care aged 6-to-12-years old. On average, children had experienced eight stressful life events (including loss, separation, interpersonal violence), before entering their foster family. There was a significant correlation between the number of stressful life events experienced and scores on a trauma symptom checklist.
Histories of trauma and stressful life events have great impact. Many foster children suffer from posttraumatic stress or related problems. Behavioral and emotional problems following unacknowledged trauma may be a risk factor for breakdowns of foster care placements and re-traumatisation in care (Eggertsen, 2008). The unmet needs of foster children may also impact their foster carers, who have to be protected against secondary traumatisation. Professionals and researchers agree that making foster care more trauma-informed is a major challenge for the future.
Aim. In the Netherlands, trauma therapists recently introduced a training programme for foster carers: «Caring for children who have experienced trauma: A workshop for resource parents» (Coppens & van Kregten, 2012). This two-month group training has been developed in the United States by experts from the National Child Traumatic Stress Network (www.nctsnet.org 2010). The training consists of eight two-hour sessions. A maximum number of 20 foster carers can be included in a group. Core of the training is to provide information on trauma and its impact on children and relationships. Foster carers learn to identify (behavioural) signs of trauma in children and react appropriately. A module «Caring for yourself» is included to anticipate to secondary traumatisation. Case material is used to illustrate theory and foster carers can bring in case material.
Although the training is based on cutting-edge theories of trauma and trauma intervention in children, it has never been evaluated by empirical research. In collaboration with the trauma therapists and colleagues from the VU University Amsterdam we have set up an evaluation study, using a quasi-experimental design with a waiting list and three measurements. The study will start in December 2013. By means of self-reports and observations changes in foster carer-foster child interactions will be studied, together with changes in foster children's trauma symptoms and emotion regulation.
Prior to this evaluation study, a small exploratory study has been conducted. The focus of this study was on goal attainment and satisfaction with the training (Kobes, van Proosdij, & Sluiter 2013).
Method. Foster carers who had recently finished the training were asked to complete an e-questionnaire. The questionnaire contained 64 items (46 closed and 18 open questions). With regard to goal attainment statements, for instance «I can describe how children may react to traumatic events», had to be rated on a five-point scale, going from «fully disagree» to «fully agree». As there was only one measurement (after training), foster carers were asked to evaluate retrospectively how the situation with regard to the goals was before the training. Items regarding satisfaction with the training had to be rated on three-point or four-point scales. There were items on satisfaction with structure and content of the training, trainers, group characteristics and dynamics, and training material. In open questions, participants could give remarks as well as suggestions to optimize the training. Results were analysed using SPSS Statistics 20. In addition to descriptive statistics, t-tests and correlation analyses were performed. Answers to the open questions were coded.
Findings. Fifteen foster carers completed the questionnaire (response rate: 34.9%). The majority were mothers. Age varied from 35 to 68 years (average: 48 yrs.). All participants were non-kinship carers, except one. Experience as foster carer varied from 1 to 21 years (average: 9 years). The majority of the carers (about 60%) had a bachelor degree (University College). None of the participants had ever followed training on trauma in children. The age of the «target» foster children with trauma varied from 3 to 17 years (average age: 10 years). There were 8 girls and 7 boys. All but 5 children received professional help. On average, the children were living for 5 years in the foster family.
Results were diverse, but mainly positive and confirming expectations. Foster carers reported that they had attained 15 of the 17 goals. Two goals, «Creating a safe environment for the child» and «Giving the child the care that she/he needs» were not reached. About 70% of the foster carers were moderately to highly satisfied with the training. Participants were mostly satisfied with the training materials and the content of the modules and somewhat less with the trainers. A positive correlation (Spearman's rho = .54) was found between general satisfaction scores and general goal attainment. This correlation was significant at the .10 level. Participants suggested that the training could be improved by presenting less theory, making sessions more interactive and giving more time and space for foster carers to bring in case material. Finally, participants wanted the module on «Caring for yourself» to be more in the beginning of the training.
Conclusion. There is a high need to make foster care more trauma-informed. The training «Caring for children who have experienced trauma: A workshop for resource parents» which has recently been introduced in foster care practice in the Netherlands is a promising tool. Foster carers who followed the training were satisfied and reported to have attained many goals. More research on the effects of this training is needed, however, before it can be implemented in practice.
Key references
Coppens, L., and van Kregten, C. (2012). Zorgen voor getraumatiseerde kinderen: Een training voor opvoeders. Handboek voor trainers. [Caring for traumatized children: A training manual]. Houten: Bohn Stafleu van Loghum.
Eggertsen, L. (2008). Primary factors related to multiple placements for children in out-of-home care. Child Welfare, 87, 71-90.
Greeson, J.K.P., Briggs, E.C., Kisiel, C.L., Layne, C.M., Ake III, G.S., Ko, S.J., Gerrity, E.T., Steinberg, A.M., Howard, M.L., Pynoos, R.S. and Fairbank, J.A. (2012). Complex trauma and mental health in children and adolescents placed in foster care: Findings from the National Child Traumatic Stress Network. Child Welfare, 90, 91-108.
Grietens, H., Van Oijen, S. and ter Huizen, M. (2012). Ingrijpende levensgebeurtenissen en traumasymptomen bij pleegkinderen: Een verkennend onderzoek in Noord-Nederland. [Stressful life events and trauma symptoms in foster children: An exploratory study in North Netherlands]. Orthopedagogiek: Onderzoek en Praktijk, 51, 16-27.
Kobes, G.B., van Proosdij, L.I. and Sluiter, M.N. (2013). Traumatraining onder de loep. Korte termijn uitkomsten van de interventie «Zorgen voor getraumatiseerde kinderen: Een training voor opvoeders». [Trauma training, a closer look. Short term results of the intervention «Caring for children who have experienced trauma: A workshop for resource parents»] (Bachelor thesis). Groningen: University of Groningen.