Alternative vs. Traditional Therapeutic Methods and Interventions Used to Treat Children in Foster Care

Alternative and Traditional Therapeutic Methods and Interventions:

The Treatment of Children in Foster Care

Children who live in a foster care environment often have emotional difficulties that must be dealt with by their caregivers. It is true that some of these children also have physical disabilities and ailments, but most of these physical problems can be handled more easily than some of the emotional scars that these children carry. Many of these emotional scars run very deeply, and they deal with issues and topics that no child should have to face, especially from their families.

Because of the difficult times that many of these children experienced before they came to foster care, and because of the pain and scars that they now carry from their previous conflicts and experiences, many of these children are involved in different kinds of therapy and intervention strategies. These strategies are designed to help children overcome some of the bad experiences they have seen in their past, and learn how to adjust to a new life in their foster home.

Many of these interventions and therapy sessions also deal with how to prepare the child for being adopted out to another family, especially if there is little to no chance of the child returning to live with his biological parents. The idea of adoption can be particularly troubling for many foster children, and this is especially true of foster children who have been with their foster parents for quite some time. They become comfortable with their foster parents, and may feel somewhat secure in the belief that they will not be parted from them. This is especially true of children who have been faced with a particularly traumatic separation from their biological parents.

These children may feel like they belong to a "real" family, and therefore not wish to be separated from the individuals who have opened their home and their heart to raise a child that no one seemed to either want or be able to take care of. All foster children should have some intervention in order to hopefully repair some of the emotional, and sometimes physical, damage that the traumatic removal from their biological parents may have caused. Often, even when children are abused or neglected by their biological parents, they are still reluctant to leave the only parents that they have ever known and loved. Even if they do not understand their parents' behavior toward them, they become used to it and even believe that all children are treated this way.

These children will also sometimes blame their parents' actions on themselves, assuming that they have been bad children, or have done something wrong, or their parents would treat them better than they do. Some children obviously need more therapy and other intervention methods than other children will need, simply because of the degree of trauma they have faced in the past.

The purpose of this paper is to discuss both traditional and alternative therapeutic methods and intervention strategies as they pertain to children in foster care. The goal is not to determine whether traditional methods are better than alternative methods, or vice versa. Instead, a comprehensive review of recent literature will be used to compare and contrast these two different intervention strategies, in order to come to a better understanding of what they both involve.

This will aid not only in the understanding of traditional and alternative intervention strategies, but also in the realization that some children need a particular kind of strategy based on the hardships they have faced in their life. An understanding of the different types of therapeutic methods and intervention strategies can help caregivers and other individuals who work with foster children determine what course of action will best help the child. It is possible that, for many children, a mixture of traditional and alternative methods will be the most likely to help the child make progress.

In the course of the literature review, more emphasis will be placed on alternative intervention strategies for two reasons. Alternative intervention is showing more potential to help foster care children learn to handle their emotional and behavioral problems, and it is an up-and-coming field in which a great deal of research has been done. These two reasons make it worthy of more attention than the traditional methods of foster care intervention, but that is not to discount the impact that traditional intervention strategies have had on children who have grown up in foster care.

Literature Review

Traditional Therapeutic Methods & Interventions

One of the most traditional intervention approaches for foster care children is placing them in a special education class. This has been done largely because many children who come into foster care have behavioral, physical, and emotional problems that do not allow them to function normally in a standard classroom setting. These difficulties can come from many things, but abuse and neglect by biological parents are the two most common reasons behind the problems that foster children face in their lives. Because of these behavioral and emotional difficulties, many foster children are not able to function to the best of their abilities in a typical classroom environment (Smucker, et.al., 1996).

Many studies have shown that, when the population of foster care children is examined in this country and compared to the population of children who are still with their biological parents, the prevalence of special education classes in the foster care population is about 30%. This is approximately double the percentage when compared to children who come from "normal" households, and may be indicative of the traditional view of foster care children, which is that they all have problems that cannot be dealt with in a 'normal' classroom (Sawyer & Dubowitz, 1994).

Further studies show that approximately 10% of children nationwide receive special education services in the classroom, and 1% of these children have a severe behavioral or emotional disorder that causes them to require these services. This shows that children who are being raised in foster care homes end up in special education classes about three times as often as children in the country's population as a whole (U.S. Department of Education, 1994).

While these studies are very important, it is difficult to say for certain whether they are an accurate representation of the actual percentage of foster care children receiving special education services. This is due to the fact that many things affect the amount of children in special education services at a given time, and a representative sample of foster care children might include a group who had suffered less, or possibly more, neglect than a group that might be studied the following year.

In other words, while these studies are certainly representative of the growing problem of foster care children entering into special education classrooms, there is no guarantee that the representation is completely valid. However, the chief concern is not how many children are entering special education classrooms, but what other interventions and therapeutic methods are being used to help these children adapt and learn to thrive (Keefe, 1996). It is to these issues that attention now turns.

Some states have begun programs for foster children that deal with specific traditional intervention strategies. Many of these programs look at the children and try to assess their comprehensive needs. By comprehensive, the program looks at both the emotional and physical needs of the children. This can be a significant intervention strategy, because many children who enter foster care are in need of physical care for routine issues such as dental hygiene. These children are also at risk for more serious diseases and other physical problems due to abuse and neglect in the past. The problem with many of the traditional intervention strategies such as this one is that the states often do not have the funds to treat all of the children who are in foster care (O'Hara, 1998).

Screening for physical disabilities and other health problems is another traditional intervention for many foster children. Because of the abuse and neglect that many of these children have suffered at the hands of their biological parents, they often have significant health problems that have gone untreated. Even those who do not have any health problems at the time they enter foster care are still in need of basic well-child checkups and other physical interventions that parents have often neglected to provide for their children, either from a lack of adequate income or insurance to do so, or from a lack of concern about their child's welfare (O'Hara, 1998).

Developmental and psychological assessments by licensed professionals are often performed on these children as well. In order to have effective therapeutic and intervention strategies, one must know where the child's development is at the time they enter the foster care environment. This will be used to judge their progress in foster care, and can be compared with assessments taken at a later date. Without this information, it becomes difficult for her caregivers, pediatricians, psychologists, and others who are attempting to help these children (Horwitz, et.al, 1994; Halfon, et.al., 1993).

Often, these professionals are uncertain of where to begin with a child who has recently entered foster care, and therefore these assessments play a vital role in determining the course of treatment. This has long been a traditional method of determining how best to help foster care children, as they often have trouble with basic issues such as socialization, communication, and motor skills (Horwitz, et.al, 1994).

Unfortunately, different professionals often assess these foster care children in different ways. This is part of human nature and cannot be helped, but because of this, some children do not get the proper diagnosis of their problems, which can make treatment difficult. Children are done a disservice when they are treated for things that they don't really have, or when their problems go undiagnosed and therefore untreated because there are not enough professionals available to help them.

The needs of foster care children are very complex, and traditional therapeutic methods and interventions do not work for every child. However, if they were not helpful to a significant number of children in the foster care system, they would have likely disappeared long ago. The problem with the previous statement is that children are entering foster care more often and at a younger age than they were in the past. They are also often staying in foster care longer than they were in the past (Kools, 2003).

This is indicative of the fact that, at least to some extent, the traditional methods of intervention for these children are not doing all that they could do to protect them from harm. Especially where health care is concerned, the intervention strategies utilized for children in foster care still fall terribly short of what is actually needed (Carlson, 1996; Blatt, 1997). A need to correct this problem has been shown by many researchers through countless studies of foster care children over the years.

Many of the children who are currently living in foster care are not in settings that seem very much like what would be assumed to be a typical family. For example, some foster care settings have up to 12 foster children, and there are also group shelters and other residential facilities that some of these children reside in when more typical home settings are not available. Because of this, they are not getting the one-on-one attention that they would get in a typical family setting, and this is not helping them prepare for what their life will be like when they leave foster care (Clark, et.al., 1994).

Another problem with traditional foster care systems is that they do not always make sure that the law is being followed (Jenkins, 1994). For example, many states say that foster care children cannot be in this type of care for longer than 18 months. Many children remain in foster care for years, and since nothing has been done about this, it can only be assumed that these states either don't care or are simply allowing it to go on because they do not know what else to do with these foster care children (VanDenBerg, 1993).

Much of the problem with the traditional foster care system lies in the fact that it is funded by the individual states, which do not have money for all of the things that foster care children actually need. Basic needs for food, shelter, and medical care are met, but there is often not additional money to help the children that need it most (General Accounting Office, 1993). While this is not the fault of any one particular group or government, it becomes everyone's problem as the numbers of foster care children continue to grow (Clark, et.al., 1994).

This money would provide therapy and other important interventions that would help children adapt not only to the foster care environment, but independent living when they reached the age where this would be an option for them (Blumberg, et.al., 1996). Lack of funds is the main contributor to the lack of traditional intervention programs available for foster care children, and showcases the need for the alternative intervention programs that have become popular in recent years (Clark, et.al., 1994).

Alternative Therapeutic Methods & Interventions

Because the problems of children who enter foster care are often profound and difficult to address, many of the intervention strategies have not changed over the years. Health screenings, psychological screenings and therapy, and providing medication for those who are severely emotionally disturbed has been most of what foster children could expect from the medical system (Chernoff, 1994).

Whether this is right or wrong is largely a matter of opinion. However, as time goes on and the problems of foster care children do not show any great improvement, alternative ideas begin to make their way to the forefront of thinking for those who are involved with foster care children.

One of these alternative ideas is to expand the primary care and community-based care for these children, so that they can receive proper healthcare when and where they need it instead of only receiving what Medicaid will grudgingly pay for (Clausen, et.al., 1998). While better health care may not sound like an innovative idea, it is a welcome change from the Medicaid-based life that many of these children live. That is not to say that Medicaid in itself is bad. It is much better than nothing at all when it comes to providing health care for children (Children's Defense Fund, 1993).

However, many foster care children need much more than the services that Medicaid is willing to pay for, and because many of these children and their caregivers survive in low-income households, they are not able to pay for insurance other than Medicaid, nor are they able to pay for doctor visits and other health-care needs that the child may have (Children's Defense Fund, 1993).

The idea behind the primary care and community-based initiative for health care for these children would give them better access to the health care that they actually need for whatever condition or problem they may have, instead of only providing the basic necessities and forcing the child to do without medical care for other problems they may have simply because their caregivers' income is not high enough to help them out. This would be a tremendous boost to the foster care system (Children's Defense Fund, 1993).

Another alternative intervention that has recently appeared on the foster care scene is the idea of using role models and mentors to help these children adjust to their new lives. While the idea of a child having a role model or a mentor is not a new one, many of the children in foster care deal with feelings of worthlessness and depression. Because of this, they often do not look up to people that they wish to emulate, because they have come to believe that they will never amount to anything (Yancey, 1998).

Some of these children were told this information by their parents, and others came to believe it because of the way that they were treated. Still others have emotional and developmental problems that make them feel they cannot compete in society and make something important and worthwhile of themselves (Dubow & Ippolito, 1994).

It is true that some of these children have developmental problems that will truly hold them back and not allow them to participate fully in all that society has to offer. Unfortunately, many of these children are convinced that they will remain this way when, in fact, their problems lie not in the inability to perform the tasks required of them, but in the inability to believe in themselves and their value as members of society (Kauffman, 1993).

These children must learn that they are all-important human beings simply by being who they are, and they must be made aware that their goals, desires, and dreams can come true if they are willing to be realistic, work hard, and do the very best that they can to make the right things happen in their lives. They must be taught to make the right choices, and many of them must be taught how to know what the right choices are (Duncan, et.al., 1995).

Quite a few children in foster care have trouble distinguishing good choices from bad when it comes to food, friends, school, and other important issues that many people take for granted. Some of these children do not even really know right from wrong, except in the most fundamental sense (Yancey, 1998).

At this point, it is important to note that role models and mentors are not the same thing. Role models are celebrities and others of influence either in the community or on a larger scale that children look up to and want to emulate as they grow up. Often, these people are not accessible to foster children, or any other children outside the circle of people that they associate with. While these people may be seemingly very important in a child's life, they are not people that these children can go to for support and advice.

Mentors, however, are people in the community that can work specifically with these children on a one-on-one basis. They are often people who have been through hardships in their own childhood. Some of them come from abusive homes, some of them come from the foster care system, and others come from various other hardships and tragedies that they endured as children and young adults.

The reason that this is so important for foster children is that these mentors have experiences and problems that they have made it through, and many of these experiences and difficulties are similar to what foster children either will go through or are going through right now (Yancey, 1998).

Because of the fact that many of these people have been through the difficulties that these foster children are now facing, they are able to give advice and help in a way that many others would not be able to. They have "been there," and they know what many of the pains that a foster child goes through feel like. This makes them uniquely qualified to give advice and to help these foster children.

There is evidence that mentoring works with many foster children, especially those who really need the extra help and guidance that they may not be getting in their foster care home. Children who live in foster care can benefit from mentoring programs no matter what their age or disability levels, as mentors can be found that are willing and able to work with children who have many different needs (Yancey, 1998).

Really, all children can be helped by having a mentor that they look up to, but this need is especially important for foster children, as they often do not have any way of making contact with these individuals outside of a specific mentoring program, and their daily lives do not bring them in contact with individuals who have been in their situation, then grown up and gone on to have full and complete lives. Mentoring helps these children to realize that they can make something out of themselves and their lives, and it shows them that they are worthwhile and important.

Children may be somewhat skeptical of their mentor at first, but when they began to realize that these people really understand what they are going through they often open up to them. This is one of the best forms of therapy, and these children feel safe in knowing that they can talk to their mentor on a level that both will be able to understand. It is helpful for the children to learn that they have potential, and it is helpful for the mentors to give something back to the community and help children that are in the same place the mentors were not very many years ago.

Ideally, to aid in this understanding mentors should be from the same ethnic group that the foster children come from. This is not always possible, but it should be strived for in any intervention program because children, and many adults, respond better to those that they feel they have the most in common with. Ethnicity is a strong bond between a mentor and a child, and this bond can be used to its fullest advantage when common experiences, dreams, and fears can be shared (Yancey, 1998).

That is not to say that programs that pair mentors with children of different ethnic backgrounds are not helpful, or will not work. The only difficulty with this is that children may not relate as well to someone who shares a different cultural background. For example, a young black boy with a white female mentor may feel like he is incapable of doing some of the things that his mentor tells him he can do, simply because he may be of the opinion that black individuals have less chance of making it in society than white individuals do. Debates and opinions as to whether or not he would be right must be left for another time, but there is evidence that many people of minority ethnic groups hold the opinion that they cannot compete with those of the white race.

However, if this same black boy had a mentor who was also black, regardless of the mentor's gender, he would have more confidence in his abilities to perform up to the mentor's expectations. In other words, if he sees that his mentor has excelled in a particular job or field of study, he would be more confident that he would be able to do the same, because differing ethnicity would not be an issue.

Caution must be exercised with role models, however, because foster children often latch onto them rather strongly, and they want to do the same things that their mentor does. If, for example, their mentor smokes cigarettes or drinks alcohol, the child in question will often see this as acceptable behavior.

This does not mean that anyone who has an occasional drink of alcohol or chooses to smokes cigarettes should not be allowed to mentor a child. It does, however, mean that those behaviors should be absent when the child is around, and they should not be mentioned or discussed as something that is acceptable, or something that is encouraged by either the mentor or society in general (Yancey, 1998).

Besides role models and mentors, there are other alternative programs in place for foster care children, and more are on the way as child advocates work to improve the current, traditional, and somewhat flawed foster care system. One of the other programs being utilized today involves professional foster care that is often intense, professionally run, and family-oriented (Sobel & Healy, 2001).

While this sounds similar to some of the traditional models, it is actually very different and much more involved, as it requires more commitment not only from the adults involved, but from the children as well. It came about because many critics were suggesting that these foster care children should be placed into orphanages like they used to be several decades ago (Terpstra & McFadden, 1993).

Instead of placing these abused and neglected children in orphanages where they would spend their days dreaming of adoption, or of the families that they were taken away from, advocates of foster care decided that the current system just needed some changes to bring it into line with what foster children really need to grow and thrive in their environment. The main goal of this project was to preserve or reunite families through intense counseling and services designed to help the entire family, not just the child, learn to work with others for a common goal (Clark, et.al., 1994).

When it was not possible to keep the child in the home with the biological parents, or reunite the child with the biological parents after a short foster care absence, the program then switched its goals to determining what the best interests of the child would be, and finding the best ways to provide for and protect those interests (McLoyd, 1998). This required intense commitment, and often also required more money than states were traditionally willing to provide under the normal foster care system. More than just the immediate, basic needs of the child were assessed (Clark, et.al., 1994).

A study done of foster care children approximately ten years ago stated that these children were getting their basic needs met under the traditional system, but were not getting other, sometimes more important, needs met, such as learning about their strengths and abilities that would allow them to build stronger futures for themselves and be more productive members of society when they were either adopted out, reunited with their families, or reached the legal age of majority where they could move out and live independently (Duchnowski & Kutash, 1993).

These strengths and abilities are some of the same issues that mentors use when they work with foster care children, but mentors are not always available, so those wishing to help these children as much as possible needed to look for other ways to provide help. This desire to help foster care children excel and thrive in their homes as well as society as a whole brought about some of the most innovative and comprehensive intervention strategies in the field (Duchnowski & Kutash, 1993).

One of the more basic goals of some of these programs is to provide children with many of the therapeutic and other interventions that the state will not, or is not able to, pay for. While the state is required to take care of children in foster care, on welfare, and in other state run programs, the basics are the only things that are required for these children. As has been mentioned previously, many of these children need much more than just the basics. Many of them have emotional and behavioral problems that are deep enough and serious enough to require professional intervention in the line of therapists, psychologists, or other mental health professionals (Clark, et.al., 1994).

Some of the problem lies with the foster care workers and foster care parents as well. Many of these individuals do what they need to do to stay in compliance with the state laws, and they do not worry about anything beyond that. This does not mean that they are lazy, or that they do not care about the children. What it does mean is that there is not enough money and not enough people to properly handle and treat all of the children that are currently in the foster care system (Klee, et.al., 1997).

The lack of available funds, and the lack of available individuals, makes it difficult for advocates of the foster care system that are trying to make sure all children get fair and equal treatment. Many times, the treatment that these children need is available, but they have no access to it either because there is no state-given money to pay for it, or because there is no professional individual in their local area that is willing to work was foster care children for little or no money (Clark, et.al., 1994).

Those who advocate this new intensive program are looking at the child not just in the foster care setting, but it all of their interactions with different individuals. An effort is made to view the child while they are with the foster parents were in an emergency shelter where they live. Efforts are also made to spend some time observing the child while they are with their biological parents, while they are in school, and while they are interacting with their peers and others (Smith, et.al., 2001).

It is not always possible or feasible, of course, to see each child in each one of the settings because of the extenuating circumstances foster children sometimes have. However, for the purposes of the study that Clark, et al. (1994) performed, the foster care children were divided into two groups; one group was studied in this manner and given additional supportive services, while the other group was left to the traditional interventions and therapeutic methods that foster care provides.

Even though the study showcased a rather small sample of children when looked at in the context of how many children are in foster care in this country, the preliminary results indicate that many of the children who received the traditional foster care plus the extra benefits that the program provided fared better on emotional and behavioral testing that was performed after the program was complete. These test results were compared to the results that the children had when they first came to foster care, and they were also compared with the results of the children, both before and after the program has implemented, who did not have the extra intervention (Clark, et.al., 1994).