PRIDE 5 - SLIDES - Strengthening Family Relationships

Welcome to Session 5!
Strengthening Family
Remember the Core Competencies of PRIDE:
1. Protecting and Nurturing Children
2. Meeting Children’s Developmental Needs and
Addressing Developmental Delays
3. Supporting Relationships Between Children
and Their Families
4. Connecting Children to Safe, Nurturing
Relationships Intended to Last a Lifetime
5. Working as a Member of a Professional
Supplemental Handouts for This Session
• Copy of Ecomap Diagram Exercise for your
• Resources to bolster your community support:
– List of Medicaid HMOs
– List of WIC Office Locations
What is the connection between family
relationships and a child’s self-esteem?
• How children feel about themselves is
related to their sense of family and
• How children feel about themselves is
related to the respect and dignity they feel
about their cultural and ethnic affiliation
Why Are Children In Foster Care At Risk Regarding
Developing Positive Self-esteem and Personal and
Cultural Identity?
• Children may feel they are responsible for bad
things happening to them because they are not
loveable or valuable
• Cultural identity can be negatively affected if
placed out of their own culture and heritage
• Foster parents cannot provide children with a
legal status, social status, continuity of parenting
and commitment that comes from being with
one’s own family
Your role as a resource family is
to ensure that the children in
your care have the opportunity to
develop to their fullest potential!
The Bluest Eye by Toni Morrison
“Each night, without fail, she prayed for blue eyes.
Fervently, for a year she had prayed. Although
somewhat discouraged, she was not without hope. To
have something as wonderful as that happen would
take a long time.
Thrown, in this way, into the binding conviction that
only a miracle could relieve her, she would never
know her beauty. She would see only what there was
to see: the eyes of other people.”
Can You Help Me Know Who I Am?
• Much of the way in which our identity
forms has to do with how others see us,
react to us and provide feedback to us.
We tend to pick up cues about who we are
from other people.
• We begin to form our sense of who we are
from the messages we receive from those
who surround us.
Cultural vs. Racial Identity
• Cultural identity is a part of every child’s
development. Race is only one aspect of a
child’s cultural identity.
• Through cultural identity, children develop
values, life routines, communication patterns
and religious beliefs, as well as a taste for
certain foods and a knowledge of how life is
celebrated and honored.
• Children of the same race may still have
differences in their cultural identity.
Development of Racial Identity
• Racial identity may challenge resource
families when working with children
• We ask ourselves, “When do children
begin to notice that skin colors differ?”
• PRIDEBook Page 163 describes one
model of how racial identity develops
Development of Racial Identity
• From birth to age 3, toddlers become
aware of physical race and skin color
difference and learn names for specific
groups. They do not comprehend the real
meanings of these labels.
Development of Racial Identity
• With young toddlers, how would you promote a
sense of positive racial identity?
– Have dolls, toys and books that reflect the child’s
racial and cultural identity
– Ensure that children learn appropriate names for
specific groups
– Acknowledge differences in skin colors if the child
asks or seems to notice
– Avoid long explanations- indicate acceptance of
differences through smiles, physical gestures and
positive comments.
Development of Racial Identity
• From ages 4 to 6, preschoolers can
usually identify their own racial or ethnic
group and may place a positive or
negative value on their own and other
Development of Racial Identity
• With preschoolers, how would you promote a
sense of positive racial identity?
– Continue to have dolls, toys and books that reflect the
child’s racial and cultural identity
– Model positive feelings about the cultural affiliations
– Closely monitor television and other media to ensure
that the child is receiving positive messages about
his/ her identity
– Ensure that the child sees other people who look like
him/ her
– Acknowledge differences in a positive way and
encourage the child to begin to talk about how he or
she views differences
Development of Racial Identity
• From ages 7 to 11, children usually have a
firmer understanding of their own racial
and ethnic identity and- given the
opportunity- will explore what it means to
be a member of this group.
Development of Racial Identity
• With children of this age, how would you
promote a sense of positive racial identity?
– Continue to have dolls, toys and books that reflect the
child’s racial and cultural identity
– Be prepared to talk honestly about the differences
and how the child experiences the differences
– Help the child to find a positive role model who
reflects the child’s racial identity and is willing to
spend time with the child
– Get the child involved in organizations and groups
with a cultural focus
– Participate in activities that support the child’s cultural
identity (cook special foods together, attend festivals,
parades or events that promote the child’s culture)
Development of Racial Identity
• From the ages 12 to 18, adolescents do a
lot of exploration related to identity
including determining the significance of
race, ethnicity, culture, adoption and
examining how these apply to the
Development of Racial Identity
• With teenagers, how would you promote a sense
of positive racial identity?
– Many teens will enjoy some of the activities discussed
for latency age children- festivals, groups, music, etc.
– They may adopt traditional dress and hair styles and
seek to become immersed in the culture
– There is a critical need to talk honestly and deal with
the concerns that teens present
– Do not become defensive and try to refrain from
minimizing or denying racial and cultural concerns
Challenges of Cultural and Racial Identity
• What are some of the challenges you may face
regarding a child’s cultural or racial identity?
– School projects that involve family history
– Other children may make cruel or inappropriate
– Children may feel embarrassed that they look
different than your family
– Lack of historical photos/videos of the child’s life
– Lack of historical photos/videos of the child’s family
How Do You Respond to Racial Bias?
• I can go shopping alone most of the time, fairly well
assured that I will not be followed or harassed by store
• I can turn on the television or open to the front page of
the newspaper and see people of my race widely and
positively represented.
• I can go into a bookshop and count on finding the writing
of my race represented; into a supermarket and find the
staple foods that fit with my cultural traditions; into a
hairdresser’s shop and find someone who can deal with
my hair style.
• I can do well in a challenging situation without being
called a credit to my race.
How Do You Respond to Racial Bias?
• I am never asked to speak for all the people of my racial
• I can be reasonably sure that if I ask to talk to “the
person in charge,” I will be facing a person of my race.
• I can easily buy posters, postcards, picture books,
greeting cards, dolls, toys and children’s magazines
featuring people of my race.
• If a traffic cop pulls me over, I can be sure that I wasn’t
singled out because of my race.
• I can choose blemish cover or bandages in “flesh” color
and have them more or less match my skin.
Situations You May Experience
Your family has known the Smiths for years and you consider them to
be good friends. The children in your families grew up together. They
played often, participated in activities together and were close friends.
Your minority son is now 16 years old, as is the Smith's oldest
daughter. Your son asks their daughter to go to the prom with him as
his date. She tells your son she can't go with him because he is not
white. Your son comes to you questioning why he could be her friend
all these years but can't take her to the prom.
• What would you tell your son?
• As a parent, how would you feel?
• How would this affect your relationship with the Smiths?
Situations You May Experience
Your adopted daughter, Tina, who is twelve years old and of mixed
race, comes home from school visibly upset. When questioned, she
begins to cry and tells you that her friend, Joyce, told her that the Bible
says it's a "sin" to mix the races. She was also told that Joyce's mother
said that, not only is your family a sin, but because Tina is mixed race,
her birth was a sin. Tina loves to go to church and religion is becoming
important to her. She is very troubled about what Joyce told her and
wants to know if this is true.
• What is your initial reaction?
• What will you tell Tina?
• Will you approach Joyce’s mother?
Situations You May Experience
You are grocery shopping with your 6-year-old adopted
daughter, who is of a minority race. A woman approaches
you in the aisle, smiles at you and asks, "Is your child
adopted?" You reply that she is. She comments, "What a
wonderful person you are! God will certainly reward you in
heaven. What a lucky little girl she is!"
• How would you feel?
• How would you respond to the woman?
• What concerns might you have about the way that your
child might interpret the woman’s comments?
Challenges of Cultural and Racial Identity
• What kinds of things can you do as a family to
help deal with some of these challenges?
– Immerse yourself in school projects with your child – it
will be an educational experience for you as well
– Reassure your child that the hurtful comments of their
peers are probably because they don’t understand
– Participate in foster/adoptive family association
functions – children see other similar families
– Take as many pictures/videos of the child as you can
– include their photos with your family’s
Multiethnic Placement Act of 1994 (MEPA)
• Federal law enacted as part of the Improving America's
Schools Act
• Designed to:
– Decrease the time children wait for adoption
– Prevent discrimination in the placement of children
– Facilitate the identification and recruitment of foster
and adoptive families that can meet children's needs
Multiethnic Placement Act of 1994 (MEPA)
Prohibits foster care and adoption agencies from delaying or
denying or otherwise discriminating in making a placement decision
on the basis of race, color or national origin
Prohibits agencies and entities from categorically denying the
opportunity for any person to become an adoptive or foster parent
solely on the basis of the race, color, or national origin of the
adoptive or foster parent or the child
Requires states to develop plans for the diligent recruitment of
potential foster and adoptive families that reflect the ethnic and
racial diversity of children in the state for whom foster and adoptive
homes are needed
In What Ways Can You Work With the
Team to Support Family Relationships?
• Support family visits
• Talk positively to children about birth families
• Encourage birth parents’ participation in decision making
for the child
• Obtain pictures of the birth family
• Take the child back to visit community/church/school
• Plan for telephone calls or letters
• Have the child draw pictures/artwork for birth family
• Include birth family in child’s prayers at bedtime
In What Ways Can You Work With the
Team to Support Family Relationships?
• Ensure that items given to the child by their birth family
are respected
• Reassure the child that the birth family cares for him/her
despite the difficulties the family has had in meeting
child’s needs
• Be courteous and respectful to the birth family in front of
the child
• Help birth family cope with their losses
• Do not talk negatively about birth family in front of or to
the child
• Ask for birth parents’ input or assistance on a parenting
Bridging the Gap
Remember …
Foster care is a support for families
Your role is to ensure that the children in
your care have the opportunity to
develop to their fullest potential
The Ecomap Diagram
The Ecomap diagram, along with the
Genogram that we discussed in Session 2,
are tools that can help us understand our
family relationships, and how these
relationships contribute to our self-esteem,
personal identity and cultural identity.
Ecomap Diagram – Conventions
• Strong relationship
• Weak relationship
• Stressful relationship
Ecomap Diagram – The Basics
• Members of my family include _______.
• Important friends of our family include _______.
• The network to meet my family’s developmental
needs includes _______.
• My family’s employment and income is met
through __________.
• The teams and voluntary networks in which my
family is involved include ________.
• Changes or transitions in my life, some of which
are positive and some negative include ______.
Ecomap Diagram
As an example of an Ecomap, either use
Bud’s Ecomap or the Hanson Family
Ecomap from the PRIDEBook (redundant to
use both). Both sets of slides are included
here. Just omit the exercise that isn’t used.
Cannaveno Family Ecomap
(Before Becoming a Resource Family)
Friends & Neighbors
Bud’s sister
having 1st baby
Joy H.
Dr. Ed
Andrea classified
in school
Needs Providers
At Home
Aunts &
Sports &
Cannaveno Family Ecomap
Friends & Neighbors
- John’s career
- Bud’s job uncertain
- Shania may go home
- Andrea will be driving
Aunts &
Needs Providers
At Home
Sports &
The Hanson Family Ecomap
• PRIDEBook Pages 168-169 show the
Hanson Family ecomap both before they
became resource parents and after.
• What are some of the most notable
changes you can identify?
The Hanson Family Ecomap
• The “after” ecomap is much more complicated and
• There are many more people and agencies that were
• There are new relationships with birth families.
• Other resource families appear to be the friends in the
support network.
• The strength of some connections had to decrease in
order to make room for all of the new connections (like
Emma no longer working outside the home).
• Some of the connections have become stressful (like
Carlton’s union) because the family has less free time.
Ecomap Diagram
Changes and
Please complete your family’s
Ecomap Diagram as homework.
Your Family Circle
Voluntary Networks
The Child Health Program
• Partnership between the UMDNJ School of Nursing
(Francois-Xavier Bagnoud Center) and DCF/DYFS,
established in 2008
• The purpose of the Child Health Program (CHP) is to
support DCF/DYFS to ensure that the
medical/dental/mental health needs of children in out-ofhome placement are met
• The CHP develops child-specific health care plans
• The CHP adheres to recommendations of the American
Academy of Pediatrics (AAP)
The Child Health Program
“Health Care Management is the responsibility the of the
child welfare agency, but it is a function that requires
medical expertise.” 1
• Numerous studies indicate that children and adolescents
in foster care have multiple physical, emotional and
developmental needs
• Health Care Management is provided by the CHP to
overcome barriers to ensure that children & adolescents
receive high-quality, comprehensive and coordinated
health care
Fostering Health: 2nd Edition, Task Force on Health Care for Children in Foster Care, AAP, 2005
The Child Health Program
• Responsible for managing the health care needs of
children in out-of-home placement through Health
Care Case Management
• Ongoing interaction with DYFS staff regarding health
and medical needs of children in placement
• Provide nursing summary and Individualized Health Care
Plan for children
Components of Health Care Services
• The American Academy of Pediatrics indicates there are
four primary components to health care services:
An initial health screening (pre-placement exam) within 24
hours of placement
A comprehensive medical and dental assessment (CHEC or
CME) within 30 days of placement
A developmental and mental health evaluation (part of CHEC)
Ongoing primary care and monitoring with the child’s Medical
• Continuity of care for children in out-of-home placement
is paramount!
Initial Health Screening
• Pre-placement or re-placement physicals are completed
within 24 hours of placement/re-placement
• Physicals are to be completed by CHU nurse, Urgent
Care Center or Medical Home
• DYFS policy prohibits pre-placement and re-placement
physicals in hospital emergency rooms unless deemed
necessary by the Local Office Manager
Comprehensive Medical Exam
• Comprehensive Health Examination for Children (CHEC)
includes a mental health assessment (detailed interview
and evaluation)
• Comprehensive Medical Examination (CME) includes a
mental health screening (just a few general questions)
• CHU Staff Assistant will coordinate and schedule – must
be completed within 30 days of placement
Developmental & Mental Health Evaluation
• If during CHEC/CME needs are identified, CHU will
follow up to assure that appropriate follow-up is obtained
• Children under age 3 should have an evaluation by the
Early Intervention Program (EIP)
Ongoing Primary Care and Monitoring with
Medical Home
• Medical Home refers to child’s primary care physician
• Medicaid HMO must be selected
• Continue with prior Medical Home when feasible
(continuity of care)
• Early Periodic Screening, Diagnosis and Treatment
(EPSDT) exams at specified intervals as per Bright
• Immunizations per Centers for Disease Control (CDC)
• Routine dental exam and care every 6 months, starting
at age 3*.
How It Works: The Child Health Unit
• Group of child health care staff (nurses and assistants),
dedicated to serving DYFS children in a given area:
Ensure that children receive their immunizations, dental and
medical appointments according to the American Academy of
Pediatrics and Bright FuturesTM
Access immunizations records
Obtain medical records and medical information
Assist Resource Parents with advocating for a child’s health
care needs
Manage the health care needs of children in out of home
How It Works: The Child Health Unit
• Group of child health care staff (nurses and assistants),
dedicated to serving DYFS children in a given area:
Health care resources, support, and education for Resource
A “bridge” to the healthcare community
Communicates with those involved in care of child, keeping
them informed of child’s health status and participating in key
case conferences concerning the child
May attend regional placement conferences, family team
meetings, court hearings, etc.
The Child Health Unit
Ensuring That A Child’s Health Care Needs Are Met
• Physical Health Needs
– Children receive Early and Periodic Screening Diagnostic and
Treatment (EPSDT) examinations in accordance with the
periodicity schedule
– Children receive timely immunizations
– Children receive appropriate follow-up care to address their
health needs (includes follow-up of the recommendations of
health care providers)
The Child Health Unit
Ensuring That A Child’s Health Care Needs Are Met
• Mental Health Needs
– Children receive mental health assessments
– Child Health Unit will work with DYFS to ensure referrals that
service are in place
• Dental Health Needs
– Children 3 years and older receive semi-annual dental
examinations- unless indicated otherwise. New
recommendations began screening at age 1.
The Child Health Unit
Communication is KEY!
• In-Person Contact:
– The Child Health Nurse will contact Resource Parents and make
a home visit within 2-3 weeks of placement and visit about every
2-4 months depending on the child’s healthcare needs.
• Phone Contact:
– Resource Parents are expected to contact their child health
nurse to inform them of any changes in health care status of the
children in their care, doctor visits, new medications, etc.
The Child Health Unit
• In the Beginning …
– Ensure pre-placement and re-placement physicals for children in
placement are completed within 24 hours of initial placement or
a change in placement.
– The child health nurse will complete a DYFS form that is the
child’s Health Passport. This is mailed or given to the Resource
– The nurse may be calling you to discuss significant health care
issues before receipt of the Health Passport.
The Child Health Unit
• Ongoing care…
– A child health care plan is developed by the Child Health Nurse
which will include their nursing plan and recommendations from
health care providers and other community sources as well (e.g.
– The Health Care Plan is a living document and so it changes as
the health care of your child changes. The Child Health Unit
staff and Resource Parents will be communicating often.
Child Health: YOUR Responsibilities
• Maintenance of a “Medical Log” by the Resource Parent
is expected and will be reviewed by the nurse at visits.
The Medical Log should include all health care visits
(well & sick), medications, illnesses, injuries, appetite.
• According to DYFS policy, if a child has a fever of
100.4°F, you must contact your child’s primary doctor.
• The Resource Parent must maintain a copy of the child’s
immunization record.
• Psychotropic medications require DYFS approval
• CPR Certification is recommended for all Resource
Parents and caregivers.
The Child Health Unit
How Visits Support Family Connections
• The most significant way in which family
connections are supported is through family
• Research has consistently shown that visits are
the key to reunifying families, because the
relationship and bond are maintained!
Goals for Family Visits
• Different members of the team may have
different goals for the visit:
– The child needs to know he or she is loved and lovable and that
parents are all right
– The birth family needs to know that the child is being well cared
for and that the child has not forgotten them
– The resource family needs to understand the family
relationships/dynamics in order to support the child in his or her
attempt to understand the birth family and their situation
– The Caseworker needs to provide direct input into the parentchild relationship, observe parenting skills and obtain data to
make decisions
Common Concerns About Family Visits and
How They Are Addressed
• Contact
is parents
think that
birth parents
have guidelines
might try to
to harm
kidnap the children.
• Parents
not informed
may beofafraid
the child’s
that birth
will find
it is authorized
out where
by the
and create
a disturbance.
to do so.
• Parents
a legal
right to
their children
who have
rights have
see them.
• Resource
shows may
that observe
sibling ties
with not
each other
of sibling
more when
rivalry.parents are not available.
• The
team should
may observe
which kin
the children
are important
do not enjoy
to maintain.
with their relatives.
• Adoptive
is a complicated
may be afraid
that it could
It is possible
slow down
to build
the process of
people at the same time.
More on Visits
• PRIDEBook Pages 171-174 provide
information about how to prepare for visits
and what to expect about their location,
frequency and length
• NOTE: DYFS policy mandates that the
birth family be provided with a visit within 5
working days of placement.
What are some things that a child needs in
order to be well prepared for a visit?
A clear understanding of the visiting
As much information as possible about the visit
ahead of time
To be prepared for the parent’s reaction
To be prepared for his/her feelings and reactions
To understand that emotions are complicated
and unpredictable, and that the visit may bring
up a range of these feelings
In what ways can we help children at the end of
a visit or after a visit?
• After saying goodbye, remove the child as quickly and as
calmly as possible from the visiting location
• Let the child know that you are there to listen, but do not
question them about the visit
• Tell the child when the next visit will be
• Make a statement that allows the child to know that he or
she can express feelings
• After visits, be prepared to pick up the child’s cues –
some children want to be left alone, others need to be
with someone, many children need to sleep
• Don’t force the child to eat or push them to be
Promoting Family Continuity
• Think about how a lack of family history
might be a problem for someone …
– Unable to answer medical history questions
– Unable to give mother’s name for
– Unable to tell children about their ancestors
– May cause someone to experience a grieving
reaction or trigger an identity crisis
• Lack of family history can be an issue for
children in foster care or who are adopted
Bridging the Gap
(group home,
Tasks or Activities to Bridge the Gap
• The families can meet and get to know one
another, plan for transition, and share
• There should be pre-placement visits for
• Families can maintain contact after the child is
placed or moved
• Share pictures and letters
• Talk to the child about the transition
• A Lifebook is a tool that can be used to build a sense of
history and continuity
• It is a child’s record of families and connections, both
past and present
• A Lifebook can be a photo album, a loose-leaf binder,
folder or composition book, a scrapbook, or even a video
• The collection should include information about why the
child came into care, pictures of where he/she has been,
names of significant people and important life events
• Contributions to Lifebooks can be from you, the child, the
birth family, the caseworker or any other person in the
child’s life
• Maintaining a Lifebook is a DYFS licensing requirement.
Review Key Points, PRIDEBook Pages 183-188
Review You Need to Know!, PRIDEBook Pages 189-192
Read Birth Parent’s Perspective, PRIDEBook Page 193
Complete the PRIDE Connection exercise on
PRIDEBook Pages 194-195 (copy in packet)
• Read Making A Difference!, PRIDEBook Page 196-197
• Session 6: Meeting Developmental Needs: Discipline
Supporting Family Connections and Continuity
Will’s World
• PRIDEBook Page 152 tells the story of
Will as he enters foster care
• What connections are at risk for Will?
Supporting Family Connections and Continuity
Will’s World
• His family (mother, grandmother, uncle)
• His friends (Jim, other neighbors, couple
• His mother’s former boyfriend
• His teachers and school (gym teacher)
• His school counselor
• Little League
• The neighborhood health clinic
How Can The Team Work to Maintain These
Connections for Will?
Support regular visits with his mother
Support regular visits with his grandmother
Explain to him that his uncle is sick
Allow him to continue playing on his little league team
Encourage him to write letters to his family, friends, teachers, etc.
Continue his health care at the neighborhood clinic
Allow him opportunity to say good-bye to his teachers and school
adjustment counselor
• Ensure that he is connected to a new school adjustment counselor
• Provide him with as much information as possible about his new
family, school and community
• Discuss his history with him so that he will be more able to
understand how his foster family fits within his life
What message are we sending to Will when
we work to maintain these connections?
• We demonstrate unconditional acceptance of
who he is
• We show respect for his personal connections
• We help him to be more self-accepting
• We bolster his self-esteem and assure him that
his circumstances are not his fault
What message would we be sending to Will
if we did not support these connections?
• We would send a message that there is
something bad about him
• We would be rejecting his family, friends and
community, and therefore be rejecting him
• He would learn that he cannot trust his new
caregivers, who have already failed to meet his
needs for connection and belonging
What Would You Do If … ?
• Four video vignettes:
– Norma, age 15
– Mike, age 5
− Michele, age 9
− Charlie, age 10
• For each vignette, think about these questions:
– Why might the child behave this way or feel this way?
– How can you handle the immediate situation?
– What long-term tasks might you identify for the foster
care team?
Preparing Annie for a Visit
As you watch the video think about the
1. What concerns does Annie seem to have as
she approaches the visit with her mother?
2. In what ways does the resource parent
address these concerns and/or help to
prepare Annie for the visit?
Preparing Annie for a Visit
Annie’s Visit Experience
Think about the goals we talked about for
the different members of the team. In
what ways were some of these goals
accomplished during the visit?
For Annie?
For her mother?
For the resource family?
For the caseworker?
Annie’s Visit Experience
What were some of the issues or challenges
that came up during the course of the visit?
• The mother was late for the visit
• The mother seemed to be questioning
Annie’s care
• The mother was unable to support Annie’s
efforts in school
Annie’s Reaction to the Visit
As you watch this last video clip,
consider the following:
– Why do you think Annie is behaving this
– What strategies might you use to help Annie
with her behaviors?
– How might you feel about handling a child’s
behavior after a visit?

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