- » Substitute Care Providers: Helping Abused and Neglected Children
- » Substitute Care Providers: Helping Abused and Neglected Children: The Needs Of Abused And Neglected Children
The Needs Of Abused And Neglected Children
Being a successful parent to any child is a challenging task, and caring for children in substitute care can be truly complicated and demanding. Foster and adoptive parents assume responsibility for meeting the needs of the children they accept into their homes. To parent a child in foster care or in adoption is more challenging, especially when the child comes into care as a result of neglect or abuse. In order to meet the needs of these children, substitute parents must clearly understand the following:
- Abused and neglected children have the same basic needs as all children.
- As members of a group of children who are being cared for outside the home, abused and neglected children also bring a special group of needs.
- The needs of children in foster care are different from those of children in adoption.
- The effects of abuse and neglect usually create additional needs that may require special therapeutic interventions.
- Each child brings into care a unique set of individual needs that are a result of that child's genetic heritage, birth experiences, cultural identity, and past life experiences.
Basic Needs of All Children
Early childhood developmental theorists speculate that newborn infants, protected and nurtured in utero, enter the world with the expectation that this kind of care and protection will continue. Birth brings about a sudden change in environment. Because humans are born virtually helpless, they require a longer period of dependent caretaking than do the young of any other species. Very quickly, the infant begins to develop an awareness that the meeting of its needs depends on someone independent from him/herself. If its basic needs are not met by its caretakers, the infant soon becomes anxious about what will happen to him/her.
If a child is to survive and achieve satisfaction during adulthood, the following six basic needs must be met during infancy and childhood:
- reciprocity, and
- value orientation.
It is critical that the child has all of these needs met. Although it is difficult to arrange these needs hierarchically, the need for security is clearly the most important.
Abraham Maslow, one of the first of the humanistic psychologists, is perhaps best remembered for his theory of the hierarchy of human needs. He postulated that people could not focus on meeting their important individual growth needs until after their more basic universal needs were met. Maslow diagrammed his theory as a pyramid, with the most fundamental needs as a base supporting all the other needs.18 On the lowermost level of the pyramid, he placed the physiological needs—air, water, food, shelter, sleep, and sex. At the second level, he put safety and security; at the third level, he included love and belongingness; and at the fourth level, he placed self-esteem as reflected by others. At the top of these four levels, he placed all of the individual growth needs.
Although having his/her nurturing needs met is essential to a child's survival, it is noteworthy that a child who is in care or at imminent risk of placement, and who is old enough to be conscious of his/her needs, is often more concerned about protection and security than about any of the basic physiological needs. Whether he/she will be fed, clothed, or sheltered is frequently of less immediate concern than whether or not the child feels safe. Positive caretaking during infancy and early childhood not only meets the child's physiological needs but also serves as the medium through which caretakers transmit the message that other needs will be met.
Infants need stimulation as well as protection and good nurturing. Those babies who are adequately nurtured but insufficiently stimulated may suffer from infant marasmus (i.e., infantile atrophy) and die. As the child grows and attempts to master appropriate developmental tasks, the need for stimulation continues rather than dissipates.
Consistent caretaking is another basic need. From birth to age 3, if a sound level of care and stimulation is missing, provided intermittently, or offered by a number of different caretakers, the child's capacity to trust may develop inadequately or be seriously damaged. This sense of trust forms the basis for learning to make attachments, and it is not unusual that children who suffer a loss of consistent caretaking usually demonstrate attachment disorders.
Reciprocity is yet another basic need. In this context, reciprocity means caretaker-child relationships that are characterized by mutual give and take and that are significant to both individuals. It is important, that as he/she grows up, the young child should realize that not only are adults important in meeting his/her needs, but the child is also important in meeting the needs of the adults. Because of the transitory nature of foster care, all too often children feel that they are interchangeable pieces in the lives of caretaking adults. Children who are adopted, often after the couple's prolonged attempts to achieve pregnancy, may view themselves as just one of any number of children who could have easily fulfilled the adult's need to be a parent.
Lastly, children need a value system to anchor and guide them. An important function of a family in any society is the acculturation of its children. Adults pass along values and beliefs by setting rules that reflect expectations of behavior, by determining what children come to view as important in terms of relationships to others and to their environment, and by reflecting their own values and modeling for children what they consider important. The value base established for children in their families is extremely difficult to alter or change in adulthood.
The Special Needs of Children in Substitute Care
Foster and adoptive children are in care because they have lost, at least on a temporary basis, the family that gave them birth. A child comes into substitute care because of his/her parents' inability to meet some of these basic needs, or because of the wish of the birth parents to have someone else meet those needs. Because he/she is a foster or adopted child, a child in substitute care has special needs in addition to the basic needs of all children. Substitute parents must not only meet the normal developmental needs of the child placed in their care, but these other special needs as well.
These needs originate from the fact that every child in family foster care or adoption is a member of at least two families. The child belongs to its family of origin. No other family can ever take the place of the birth family. Through substitute care, however, the child has become a member of another family. This second family provides everyday care and meets the child's ongoing developmental needs for as long as the child lives with the new family. It is not unusual for a child in care to have lived in several families. In this case, the child may feel that he/she belongs to many families, including relatives, family friends, or other strangers who have provided care before the child was placed in his/her current home.
Whether coming into care for the first time or moving to yet another substitute family, the child arrives suffering the pain of a devastating loss, the loss of being taken away from his/her birth family. Placement away from the birth family means more than the physical loss of living with the family, it also means having to deal with the loss of relationships and the sense of loss of control over one's own life. There can be no greater blow to a child's self-esteem than to be abandoned or rejected by the people who brought him/her into the world. "Why did my parents give me away?" is a question that haunts all children in care.
Children coming into care suffer from the loss of their families and from damaged self-images. They are under a great deal of stress. Like anyone under stress, they try to find ways to behave that are easier for them and that relieve some of the stress. Generally, that means they regress and function in ways inappropriate for their age. They defend against their emotional pain, usually through denial or projection, or they consciously use learned behaviors to protect themselves, attempting to manipulate their environment without investing in new relationships.
The Special Needs of Foster Children
Normally, foster care is viewed as temporary, while a more permanent plan for the care of the child is being developed. Thus, all children in foster care suffer from a system-derived tension about where they are going to live and whether their needs are going to be met tomorrow. No matter how good or loving the foster family, the child is aware that the stay is usually for a limited duration. Although the child has usually been told and retold that planning is underway to assure long-range security and well-being, most children in foster care are aware that a move is imminent. For most foster children, there is little opportunity for planned input or control over where and when that move will occur. Therefore, it is not unusual for the child to feel anxious and helpless; he/she may resort to behavior that, from his/her perspective, will have some influence on the decision to change placement. The child may somatize illness, run away, or act out in some other way.
Children in foster care are usually ambivalent about leaving their foster homes. Their individual histories, the current case plans, and the tie to their birth families all affect their feelings. Regardless of the family's past behavior or the quality of relationships with family members, it is the fantasy of every child in foster care to return to his/her birth family and grow up safely in his/her original home. Even children who clearly state a preference for continuing in foster care or moving into adoption harbor the fantasy that they will "go home." Because it is a fantasy, the foster child often imagines that everything will work out at home, despite the circumstances that first brought him/her into care. If the parents were abusive, the child may imagine that the parents have changed, will never abuse him/her again, and will somehow make up for the past.
Foster parents must meet their child's basic needs, yet be sensitive and responsive to the special anxieties that are inherent in foster care. A child in foster care is often anxious about being a foster child. He/she is, after all, trying to cope with a new situation and the loss of the birth family while struggling to learn how to fit into a family of strangers, and worrying about the plans that are being made for "permanent" care. Although the foster parents must try to help the child manage his/her behaviors, attempts to reduce the child's anxiety may not be in his/her best interest. It is natural for the foster child to be anxious—his/her status is unsettled, and unfortunately, foster parents cannot offer any promises or reassurances about the future.
The Special Needs of Adopted Children
An adopted child does not have to deal with the fantasy about returning home. The good news is that if he/she is adopted, the future seems secure, and the child will not have to move again. The bad news is that if the child is adopted, and the future secured with the adoptive family, the child will not be able to move again. That means that the hidden fantasy of returning to a reconstructed, now perfectly functioning birth family is no longer viable. The cost of the security and permanence of an adoptive family is the permanent loss of the birth family as possible nurturing parents. This is similar to what happens to children of divorced parents. Until the final decree, it is not unusual for the child to fantasize that the parents will reconcile and that the family will be reunited. Even after the decree is granted, the fantasy may persist. The child knows it is still possible for the parents to get back together and remarry. If either parent marries someone else, however, the child must acknowledge that it is highly unlikely that the birth family will ever be reconstructed. For an adopted child, the adoption conveys the same messagethe birth family will never be reconstructed. Adoptive parents must help their adopted children deal with the death of the dream that they will ever go home again.
Increasingly, open adoptions are making it possible for children to have ongoing access to information and, in some instances, contact with their birth parents. Open adoptions can help resolve many of the conflicts that adopted children have about their status and the reasons for their adoption.
The Special Needs of Abused and Neglected Children
Today, most children entering substitute care have been abused or neglected. The majority of these children have suffered deprivation or trauma in having even their basic needs met. It is especially important that child welfare professionals and substitute care providers understand the following:
- Abused and neglected children have not been kept safe; thus their capacity to trust and form meaningful relationships has been jeopardized.
- In almost all instances, abused and neglected children have not had their basic physical needs adequately met.
- Abused and neglected children may have been ignored and understimulated, or they may have been stimulated inappropriately through sexual abuse.
- Many abused and neglected children have experienced multiple, inadequate caretakers prior to, or perhaps while in, the formal child welfare system.
- Abused and neglected children have not been valued in their own rightthey have been ignored, used for adult gratification, or treated as pawns in dysfunctional adult relationships.
- Abused and neglected children have often been exposed to values that society does not accept or hold in high esteem and that will not help them cope successfully in adulthood.
Most children with histories of abuse and neglect enter foster care at regressed developmental levels. Infants who are born addicted or with medical problems may come into care with physical and neurological problems and developmental lags. Older abused and neglected children enter care because their environment has failed to meet their needs. Because critical basic needs were not met, the children have been unable to master age-appropriate developmental tasks. These children may have had to expend considerable emotional energy surviving hostile or withholding environments, leaving little time to invest in routine developmental growth.
In addition to the trauma of the events that brought them into care, all foster children are subjected to the pain of separation from and the possible permanent loss of their birth families. This is more difficult for children who have been abused or neglected as well as for their foster and adoptive parents. Although society sees the separation of a child from abusing or seriously neglectful parents as an act of protection that is clearly in the best interests of the child involved, the child may perceive the placement as just one more traumatic event in his/her sad life. As one child arriving at her first foster home said through her tears, "Don't leave me here. I'd rather be beaten by my mamma than by strangers."
As the abused or neglected child adapts and begins to feel more secure and comfortable in his/her foster home, new issues arise. The child is caught between the longing to return to the birth parents and the fear of what could happen if this actually occurred. The ache of separation from the family of birth is especially intense because of the relative comfort and security of the foster home in which the child now lives.
An abused or neglected child placed in adoption has a more difficult time integrating the two families than do other adopted children. All children in adoption struggle to bring into their lives with their adoptive families the parts of themselves that belong to their pasts. For a child who has been abused or neglected, that includes the history and trauma of those experiences. It is also difficult for adoptive families to allow the child to "bring in" the abusive parents by responding to the child's questions or by sharing the child's earlier experiences. Adoptive families want to deny the impact of those experiences to protect the child from painful memories and to protect themselves from facing the reality of those experiences.
One of the paradoxes of adoption, however, is that the more the adoptive family allows the child to bring in memories of experiences with the birth family, the more the adopted child will belong to the adoptive family. By accepting the whole child, including an abusive or neglectful past, the adoptive family reaffirms acceptance and love of the child.
It is not unusual for an abused and neglected child in substitute care to have problems in school. The placement circumstances and the energy needed to cope with feelings of loss, a poor self-image, and the trauma that brought the child into care leave limited energy for learning. In addition, many children in care have learning disabilities, often the result of deprivations that occurred prenatally or in earlier childhood. Many abused and neglected children also choose school as the arena in which to act out their feelings. Misbehaving at school puts the child in less jeopardy than misbehaving at home.
Sexually Abused Children
It is estimated that from 75 to 85 percent of the children currently in foster care have experienced some form of sexual abuse.19 Although many children may enter care because of known sexual abuse, increasing numbers are disclosing sexual abuse after entering care for other reasons. Once secure in the foster or adoptive home, it is not unusual for a child to reveal his/her earlier victimization.
Both statutory definitions and public perception vary about what constitutes sexual abuse of children.20 For the purposes of this manual, sexual abuse is defined as "any activity or interaction where the intent is to arouse and/or control the child sexually."21 One researcher identifies the following three differential factors that can help to distinguish abusive from nonabusive acts and that can provide some guidelines for assessment and treatment:22
- a power differential that implies that one party exerts some control over the other and that the encounter is not mutually conceived and undertaken;
- a knowledge differential that stems from the fact that the offender is chronologically older, more developmentally advanced, or more intelligent than the victim; and
- a gratification differential that recognizes that the purpose of the encounter is the satisfaction of the offender and that any gratification of the victim is in the interests of, or incidental to, the offender's pleasure.
Although there are several categories of sexual abuse, incest and systemic family sexual abuse are the most common. Most of the sexually abused children coming into substitute care report having experienced either or both of these forms of abuse. Other types of sexual abuse include rape, ritualistic sexual abuse, and sexual exploitation for profit (e.g., prostitution, sex rings, and pornography).
In both incest and systemic family abuse, there is some relationship between the abuser and the victim, and the abuse can be viewed as fulfilling some dynamic function within the family system.
- Incest. This is the best known type of abuse. It usually involves an immediate family member or paramour as the abuser, generally lasts for a period of time within an established trust relationship, and often occurs with the knowledge and covert approval of other family members.
- Systemic Family Sexual Abuse. This is probably the most prevalent type of sexual abuse among children coming into foster care. It is usually only one symptom of family dysfunction that may also include alcohol and drug abuse and the physical neglect and abuse of the child. The family system casts the child in the role of victim; the abuse takes place within the family; and there may be multiple abusers. Usually, the parents participate in or encourage the abuse; at a minimum, they fail to offer the necessary supervision and protection and allow the abuse to continue. Sexual activity is often initiated in infancy, and the child may grow into adulthood without recognizing the behavior as abusive. Such abuse is often not disclosed by the foster or adopted child until after he/she is safely in care.
The Impact of Sexual Abuse on the Abused Child
Sexual abuse makes most people very uncomfortable. It upsets them to think that adults inflict physical and psychological pain on a child to gratify their own pleasures, especially when the adults are trusted family members or friends.
Although the reactions of family and society surely have some impact on the long-term impact of sexual abuse, especially of very young children, research findings from 40 studies clearly indicate that sexual abuse causes real and profound problems for most abused children and their families.23
These problems can be classified as falling into one of the following four major areas:
- Sexual abuse can undermine the child's ability to trust adults.
- Sexual abuse can lead to an altered view of sexuality.
- Sexual abuse can cause reactive or protracted emotional states (such as depression, anxiety, fear).
- Sexual abuse can generate behavioral problems reflecting the above (e.g., poor adult relationships, sexual dysfunction, substance abuse, or suicide).
In their review of the current literature, Minshew and Hooper add to the list of possible problemsthe weakening of the child's will as a result of a sense of powerlessness, the negative connotations that may be incorporated into the developing self-image of the abused child, and role confusion as a result of unclear parental boundaries.24
The Impact of Sexual Abuse on Foster and Adoptive Parents
Sexual abuse brings to the surface strong feelings on the part of those who care about the well-being of children. Most prospective foster and adoptive parents are shocked that such terrible things can happen to a child and are enraged at the parents who participated in the abuse or allowed it to happen. Foster and adoptive parents must reconcile their own feelings before they can help the child victim. The foster and adoptive parents cannot, of course, condone the behavior of the abusive parents, and they must generate an environment in which the sexually abused child is not only safe from harm, but also feels secure enough to share and recover from the trauma of the abusive experience. Neither the foster and adoptive parents nor the abuse victim can ever forget that the parents who sexually abused the child (or allowed the abuse to take place) are still the birth parents of that child. A sexually abused child must come to terms with that reality. The child can only do so if the foster or adoptive parents are able to accept that part of their child's previous life experiences.
Because most sexual abusers are intrafamily perpetrators,25 helping the child overcome the effects of the abuse within a family setting seems to be the best approach. Therefore, a child welfare agency has an especially important responsibility in recruiting and developing appropriate and caring foster and adoptive homes for children. That responsibility is threefold:
- To ensure that prospective substitute parents understand and confront the likelihood that most children coming into foster care and most special needs children available for adoption have suffered from sexual abuse.
- To assist prospective foster and adoptive parents in clarifying and understanding their own feelings about child sexual abuse and the impact of those feelings on their capacity to be effective parents to a sexually abused child.
- To provide the training and support that foster and adoptive parents need to deal with the implications and problems of rearing a sexually abused child.
Medically Fragile Children
A growing number of children are beginning life already the victims of parental neglect. Because their mothers have not obtained proper prenatal care, these infants are born suffering from the effects of their mothers' addictions, illnesses, youth, or poor general health. Included in this group are low-birth weight babies; alcohol or other drug-affected babies; and babies whose mothers may have transmitted infectious diseases to the babies in utero (e.g., mothers who have AIDS or who are HIV-positive).
These children, as well as children who suffer from genetic difficulties or birth injuries, are medically fragile. Whatever the nature of the medical problem, these children make great demands on their caretakers and on all of the members of the families in which they live. Many medically fragile children come into foster care, and some are available for adoption. Most of these children have special medical needs that complicate their care and place increased stress and responsibility on their caretakers. Many medically fragile children are developmentally delayed because of their physical condition, and all are suffering from the impact of the placement itself. Thus, the foster and adoptive families who will be caring for these children must be selected carefully. Social service agencies must also be prepared to provide the additional training and support that these families will require.
Prenatal Substance Abuse
There are a number of unanswered questions about the impact of a mother's use of drugs on a developing fetus. In some instances, such as in fetal alcohol syndrome, the problems the child will face have been clinically determined. The long-term impact of other drugs, such as crack cocaine or "ice," is not fully understood. The full extent of possible neurological damage cannot be assessed until the child reaches later developmental stages. This problem is further compounded because newer "designer drugs" are constantly appearing and because many mothers are polyaddicted.
Within broad limits, however, there are some behaviors of infants associated with prenatal substance abuse. For instance, infants prenatally exposed to drugs may alternate between periods of irritability and lethargy, may frantically suck their hands, become tremulous, or engage in prolonged or high-pitched crying.26 They may suffer seizures, fever, sweating, diarrhea, or excessive regurgitation. If their mothers have abused stimulants, these infants tend to be easily overstimulated, and they may move from periods of sleep to loud crying within seconds. Whatever the specific symptoms, these children prenatally exposed to drugs will require patience and special nurturing skills; they often need close medical supervision and monitoring. Thus, these children require a special kind of foster or adoptive parent.
In addition to the usual qualities required for foster or adoptive parenting, individuals who accept a medically fragile child must cope with the following:
- a greater number of unknowns (e.g., unpredictable behaviors resulting from the uncertainty of the prenatal drugs involved, lack of knowledge about the developmental impact of newer drugs, and uncertainty about whether an HIV-positive child will develop AIDS, etc.);
- a new focal point in their lives that will assuredly alter their lifestyle and limit their mobility;
- multiple appointments with medical and rehabilitative personnel;
- working with a complex interdisciplinary team;
- the use of medical techniques and equipment that are essential for the monitoring or caretaking of the infants (e.g., apnea monitors, cardiopulmonary resuscitation, suctioning, etc.);
- advocating for the services the child may need;
- stress on all family members because of the amount of caretaking that the fragile child demands; and
- the possibility of deterioration or death after heroic efforts to maintain the child's life.
The Individual Needs of Children
In addition to commonly shared needs, each foster or adopted child also brings into care his/her own unique earlier traumas and unmet needs, and foster or adoptive parents must meet the specific needs of each child for whom they care. Sound substitute care can provide the opportunity for the foster or adoptive child to overcome much of the impact of earlier painful experiences. The child can recover many earlier missed developmental opportunities and get back on his/her own developmental track. Although some children may require professional help, substitute caretakers are often in the best position to act as "primary therapists" and to provide the kind of therapeutic input that the child needs most. Child welfare staff have the task of helping identify the specific needs of each child, of assisting the parents learn to deal effectively with those needs, and of making additional professional services available when necessary.
This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway.