Child Welfare System Increasingly Relying on Relatives to Raise Children Exposed to Trauma

According to a new report by Generations United, grandparents and other relatives who step in to care for children, play an important role in mitigating trauma, which children in the child welfare system experience at starkly higher rates than the general population.

Thirty percent (127,819) of children in foster care are being raised by grandparents or other relatives, a six percent increase since 2008. In the wake of the opioid epidemic, that number is even more dramatic in the states hardest hit by the opioid epidemic like Ohio, which saw a 62 percent increase in the number of children placed with relatives in foster care since 2010. For each child in foster care with a relative, there are 20 children outside of the system with a relative.

More than half of the children in the child welfare system have endured four or more adverse childhood experiences (ACEs), leaving them 12 times more likely to have negative health outcomes – substance use disorders, mental health problems, and engaging in aggressive or risky behaviors – than the general child population.

“Growing up with a childhood full of trauma and abuse, there were very few moments where I felt safe and very few people with whom I felt protected. Being put into my uncle’s care was the best decision that could have ever been made for me,” explained Kindra, whose last name is withheld to protect her privacy. “It wasn’t an easy road by any means, but I have no doubt in that it completely saved my life.”

Compared to those in care with non-relatives, children in foster care with relatives have more stable and safe childhoods and a greater likelihood of having a permanent home. The have better mental and behavioral health, and are more likely to report always feeling loved.

“These relatives are the loving and protective arms for babies, children and youth who’ve experience trauma,” said Donna Butts, executive director of Generations United. “They are caring for children with multiple high-level needs and they should get the support required for the families to thrive.”

Unlike parents or foster parents who plan for months or years to care for a child, grandparents or other relative caregivers usually step into their roles unexpectedly. At a moment’s notice, they are forced to navigate complex systems to help meet the physical and cognitive health challenges of the children who come into their care.  Grandfamilies are less likely than foster families to have access to specialized training and support from professionals that have expertise in helping children, who have experienced trauma, heal.

“One thing I know to be true: you can’t love away the effects of trauma from neglect and abuse,” said Jan Wagner, grandparent caregiver, Michigan“Our children need the same amount of intensive therapy and services as a traditional foster placement and we, as their caregiver desperately need the same to help them heal.”

Among the report’s recommendations:

  • Reform federal child welfare financing to provide more trauma-informed support to prevent children from entering or re-entering foster care
  • Increase availability of and access to trauma training and supports designed for grandfamilies
  • Address barriers to licensing relatives as foster parents
  • Ensure grandfamilies not licensed as foster parents can access financial assistance to meet children’s needs

Generations United will release The 2017 State of Grandfamilies in America report Sept. 13 at a reception, from 5:00pm to 7:00pm, in room G-11 of the Dirksen Senate Office Building on Capitol Hill in Washington, DC.

Generations United will honor Senator Susan Collins (Maine) and Senator Bob Casey (Pennsylvania)with its 2017 Grandfamilies Champion Awards at the event.

A Gentle Approach to Dementia for Care Providers

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When I first became a hospice social worker, I was stunned to realize more than half of my patients were diagnosed with advanced dementia. I had been under the assumption that I would be working with mostly people with cancer or other chronic illnesses such as Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF). While many of my patients have suffered from those maladies in the latter category, the prevalence of dementia is rather high. After seven years as a social worker “in the trenches,” I would have to learn a whole new skill set if I was to survive and thrive in hospice.

Most of these patients eventually end up in nursing facilities as the burden of their care becomes too great for family members to keep them at home. In visiting such facilities, I have came to find that many more people than just those in hospice were in various stages of dementia. It is a fascinating phenomenon with several different causes, but I have developed my own way of working with these individuals based on their current level of capability to engage interpersonally. As a result, I have identify several areas of concern regarding the treatment elderly patients receive from care providers and other medical professionals.

Aside from the ways dementia affects different people on a physical level which can include the ability to ambulate, muscle contraction, etc., the mental symptoms can range from extreme forgetfulness to devastating interpersonal impairment. Some of the most pleasant conversations of my day are sincerely answering the same three questions over and over again for an hour with the same patients, but they have little to no short term memory.

I have also spent a lot of time in constant redirection and assurance with people that can no longer recognize relatives with whom they have spent the last eighty years. I have seen these individuals coddling realistic looking baby dolls as part of their care and have played music for people that are nearly catatonic, only to watch their bodies come alive with movement at the faint and automatic memory of their favorite songs, something that blessedly seems to remain long after their ability to speak has faded. I have heard ninety year old patients insist that their mother had just been to visit them or that their young children were running around the facility.

The common thread with which I approach these wounded patients is a measured gentleness that preserves their dignity and, to the greatest possible degree, facilitates their comfort in the immediate moment. For most of these people the present moment is all they have. Thus my preferred method is to redirect them in conversation and to by no means challenge their obviously factually incorrect assertions with harsh reality.

If an elderly woman whose mother has obviously passed insists that she must know when (her mother) will be visiting, I will respond that she’ll probably be around later. I have witnessed facility nurses and aides confronting such patients with the fact that their mother will not be visiting because “she’s dead,” repeating this every time the person asks. I will just as gently take such workers aside and explain that they are effectively breaking the news of the death of a patient’s loved one several times a day, each instance with its own accompanying trauma.

Another of my concerns is when I see people with dementia being treated like children because “they don’t know any better.” Almost every culture in the East has, currently or at some time in their history, had a practice of revering their elders simply for the fact they have lived longer and accrued more life experience than most.

Watching people with little wisdom earned through the kind of adversity their patients have faced treat said individuals as mere nuisances to be quieted makes me sad to say the least. I labor under the belief that my patients are people, whether they be completely lucid and able to participate in conversation or if they are unresponsive. As such, I also believe that each of these persons have the right to my full presence and attention and that, while their minds may have been rendered functionally impaired, their spirits are perfectly intact and engaging with mine. In short, I am no better than these people just because my mind is still functional.

Lastly, watching the pain endured by the family members of such patients is nearly unbearable. They faithfully and dutifully make their regular visits in the vain hope that they will see even the briefest signs of recognition in the eyes of their loved ones, only to inevitably leave disappointed and heartbroken. They deserve to know that their family members are being treated with the highest level of respect and dignity and with a kindliness and gentleness reserved for the most vulnerable amongst us.

Please keep these concerns in mind the next time you encounter a person with dementia. They are locked in a special kind of hell that I hope you and I will never have to experience.

Protecting Vulnerable People: Let’s Get It Right

In the field of social work and particularly with the protection of vulnerable people , we are presented almost daily with the opportunity to make a difference in someone’s life. No matter how small or insignificant this may appear to us, to our Service Users it could mean the world. Not just in Social Work but in Care, Nursing, Healthcare and Education among others, the job you have decided to take on is that of protecting the most vulnerable members of our society. I speak as a UK social worker, but this is the same across the world.

Social Work Week - March 7, 2011
Social Work Week – 3/2011 (Photo credit: BC Gov)

If only it was as simple as hiring people with a view to protect vulnerable people, to work in these positions, thus solving the problem of vulnerability by filing the gap and putting up a defense system for the person in question. The human race is endlessly complex and challenging and as such, those who protect can sometimes become the very opposite- using their powerful position to take advantage of those who cannot look after themselves.

In fact, recently it seems a rather large number of people have chosen a caring role for all of the wrong reasons. It is easy to see why these jobs and this field of work is appealing to those who- for reasons unknown to most of us- wish to cause harm, abuse and torment the disabled, the young, the old, the mentally handicapped. By becoming a Social Worker, a Carer, a Nurse, a Teacher or Assistant, you immediately gain access, often in a private setting, to the very people you wish harm upon.

How this can be avoided is not so simple. We obviously need to introduce barriers in regard to the protection of vulnerable people and checks to these positions to ensure nobody who has previously committed an offense relevant to the role is hired. However the problems arise when the person either has not been caught for an offense, or when it can be hidden.  A DBS (UK Disclosure and Baring Service) check often exposes the majority of incidents, however it is still not 100% effective. People have been employed as teachers, only to reveal they are listed on the Sex Offenders Register. The system means well, but is far from perfect and leads to more questions about the protection of vulnerable people .

Mental Health Social Workers are on occasion working with the most vulnerable people of all and are carrying out safeguards towards the protection of vulnerable people . Just recently, a MH Social Worker was suspended for engaging in and encouraging a sexual relationship with his Service User. For a little over 6 months, Daniel James Bhim-Rao was assigned as her Social Worker yet during this time he pursued a relationship and continued to contact her via text message and calls until he was asked to stop. Prior to this, Bhim-Rao had a completely clean Professional Record and as such was only given a suspension by the GSCC.

Fortunately, the HCPC (Health and Care Professions Council) has proven that it is learning fast as a regulator in regards to unprofessional and damaging behaviour by staff. At a conduct meeting, they reviewed this case, agreeing that Bhim-Rao still posed a risk to the public. The longevity and the relationship he pursued given the time he actually knew the Service User was wholly unprofessional, and for this he neither attended nor engaged with the council at the final hearing. Again at the review he was not present, did not show remorse or provide any evidence to rebuild faith in his character. The HCPC gave him 4 months from the start of February to prove, with evidence, that he is fit to practice, or he will not be allowed to continue.

Of course, the Winterbourne incident and review has left everyone, including the general public, with a sense of dismay and distrust about those people employed to care for their loved ones. What if they are secretly hurting them, and they can’t explain? A recent survey carried out in the UK showed that an alarming number of people state they don’t wish to go into care when they are no longer capable of looking after themselves, the main reason being they were afraid of being abused or receiving inadequate care. Winterbourne is a stark example of what can be lost when power is given to the wrong people.

Another interesting perspective concerning the protection of vulnerable people is the difference between abuse and simply, inaction. What constitutes abuse? Is it only when a person comes under attack? Or can you abuse someone by not meeting their needs? Of course, abuse and inaction are the same. How many stories have the media picked up regarding a Social Worker who didn’t protect the child from the parents or guardians and whom subsequently died?

There are obvious grey areas, nothing is black and white, especially in our field and the protection of vulnerable people . But there are cases where Social Workers and carers, nurses and doctors, made a choice to restrict their actions or assistance. Is that as horrific as someone who physically attacks and maims a vulnerable person? Fortunately the courts decide on a case-to-case basis what level of crime has been committed. However, if you work in a caring position and cannot see abuse and inaction as essentially the same problem, then maybe you should consider a different career!

Restriction, restraint and inaction can all be used as part of a care plan, however these are important decisions concerning the protection of vulnerable people and you will need to be able to explain the use, and extent of use of these methods, to your colleagues and supervisors, and to the family and friends of the person who have made this decision for. It is sometimes difficult to know when you are acting on your personal feelings, within the law or for the Service Users feelings. Those who callously and deceitfully abuse vulnerable people will never be eradicated entirely from a filed where they can gain access. Being mindful of your own actions and being able to justify them at all times is very important for Social Work. We may not be able to protect everyone in a world that can sometimes be crooked, but we can do our bit and work hard to provide the best service for our clients.

Practical Palliative Care Resources for Patients and Family Caregivers

Caritas House headquarters of Harris HospisCare (Photo credit: Wikipedia)

Does your practice’s website include local or national resources that complement the professional medical services they provide?  One way to add value to the services and increase the efficiency of medical office visits is to provide palliative care resources that your patients and their caregivers can use to inform care decisions.

Many people are starting to hear the term palliative care in the media from care managers and from people they know.  Yet, national research indicates that most people are unfamiliar with the term or confuse it with only one type of palliative care – hospice. Unlike hospice, palliative care is available to anyone, regardless of his/her illness or condition or life expectancy.  Palliative care can be offered in conjunction with curative or life-extending care and is available in all care settings.

The California State University Institute for Palliative Care defines palliative care as care that improves quality of life for patients and families facing serious or chronic illness — whatever the diagnosis or prognosis. It prevents and relieves suffering by addressing pain as well as the physical, emotional, psychosocial and spiritual problems associated with serious and chronic conditions.

Palliative care complements the care that your patients receive from you and acute care providers and can help with care transitions and prevent costly ER visits or (re)hospitalizations, by holistically addressing pain and symptoms while supporting family caregivers. Simply adding some or all of these resources can help to educate your patients about palliative care and communicate your support for this emerging aspect of healthcare.

Palliative Care Resources:

  • CSU Institute for Palliative Care –
  • Get Palliative Care –
  • Center to Advance Palliative Care –
  • Caring Connections – 
  • WebMD –
  • Department of Veterans Affairs –
  • Mayo Clinic –
  • National Cancer Institute –
  • Next Step in Care –

The CSU Institute for Palliative Care at California State University San Marcos

Want to Work With Children: 5 Skills and Qualities You Should Be Working On

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Most people love the idea of working with children but not everybody has the skills or the personality for it. Kids, contrary to what you might have been told or brought up to believe, are not simply “regular people in miniature form.” They are unique beings who are still developing into the people you’re used to dealing with in the adult world which means they haven’t yet learned most of the skills, coping mechanisms, and boundaries that you take for granted as being inherent.

Working with children is much different from working with adults. And furthermore, working with little kids is much different from working with older kids. If you’ve got your heart set on working with children (whether as an educator, an entertainer or in human services), here are five skills you need to hone.

Patience

Patience is listed first because it is the most important. Remember: children are not adults. They process things differently than adults do and bridging the gap between what you know and what they understand can be frustrating. You’re going to have to repeat yourself a lot. You’re going to have to explain a lot. You’re going to have to deal with distractions and a bunch of other focus-grabbers. You are going to need a deep well of patience to keep from getting frustrated.

Note: Kid time is much different than grown-up time. If you have ever played “house” with a young child, you’ll know what we’re talking about.

The Ability to Hide Frustration or Annoyance

Kids can pick up on even the slightest shift in your demeanor. It is important that you learn how to hide tiredness, frustration, etc. You don’t have to be happy all the time and it is okay to let a child know that you are not happy with him when he or she misbehaves. Groaning when they insist on a twelfth read through of The Hungry Caterpillar, however, can be demoralizing for them. Learn how to hide your boredom, frustration and exhaustion.

Hint: Movie night wasn’t invented out of thin air!

Keeping Calm in an Emergency

Kids freak out when adults freak out. This can make a stressful situation infinitely worse. It is important, then, to learn how to keep your cool when things go awry—even if your heart is pounding and things around you are chaotic. Working with children—especially in large groups—means maintaining a calm presence even when everything else is overwhelming. Remember—your kids will look to you for how to act and deal with everything.

Pro Tip: The best way to develop this sense of calm is to learn how to deal with difficult situations yourself. For example, going through first aid training and child and infant CPR classes will help keep you calm when emergencies happen because you’ll know what to do.

Communication

A lot of adults think that, to work with kids, they need to be able to “dumb down” the information they’re sharing. This is an unnecessarily burdensome misconception. There’s a difference between “dumbing down” information and using examples children can relate to when you need to illustrate an idea. Children learn primarily through examples and stories, so talking about situations they can relate to is the best way to teach them new skills and explain new concepts.

Enthusiasm

You have to actually like and enjoy spending time with kids if you ever want to work with them successfully. Kids know when an adult is uncomfortable and many get a kick out of exploiting that discomfort. You also have to have enthusiasm for the things you’re trying to teach the kids you’re working with. Kids aren’t going to want to do or learn anything that you talk about with a frown.

These are just five skills and qualities that you need to master if you want to successfully work with children. Most of the more technical skills, you’ll find, will fall under one of these umbrella traits.

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