September 2024 Issue 78

Secondary Traumatic Stress in Caregivers

In child welfare circles, we often hear terms like “burnout,” “compassion fatigue,” and “vicarious trauma.” Burnout is a fairly general concept that has been frequently utilized to refer to the worker’s thoughts, feelings, and behaviors associated with their employment position. Compassion fatigue is often referred to as a broader concept to encompass the cumulative personal impacts associated with engaging in a helper role. Vicarious trauma generally is noted to address the internal cognitive changes that occur in an individual’s perception about others and the world as a result of their ongoing work in a helping professional role.

Secondary Traumatic Stress (STS) specifically refers to the notion that an individual, who did not experience a particular traumatic event, has, in the course of secondary exposure to another person’s direct traumatic experience, developed symptoms of post-traumatic stress disorder (PTSD):

• hyper arousal (anxiety, irritability, heavy sense of guilt or shame, difficulties concentrating)
• avoidance (lack of connection or holding back in relationships due to fear of rejection or disapproval)
• emotional numbing/shut down
• fear
• sleep difficulties
• intrusive thoughts/images
• feeling withdrawn and isolated
• Physical indicators can also be present, including headaches, backaches, stomach aches, and exhaustion

Due to the emotionally stressful work and the resultant impacts on workers, the National Child Traumatic Stress Network has indicated that, “The development of secondary traumatic stress is recognized as a common occupational hazard for professionals working with traumatized children.” Though there has not been much formal research into the topic, it is believed that STS impacts the foster caregiver community, as foster caring is a profession where the boundaries between private and professional lives are particularly blurred.

Caregivers may hear firsthand the stories of the traumatic experiences of the children in their care. They may also witness the physical and psychological impacts of those traumatic experiences on the children placed in their homes. Sometimes they can also find themselves helping the child to recover from physical injuries following removal from abusive or neglectful situations. They may have children in their care where they are reminded every day of the trauma the child endured as they see the lasting physical and emotional scars that were inflicted on the child.

They may also experience direct trauma, such as processing losses when foster children leave their homes, dealing with feelings of being overwhelmed with difficult cases and not knowing how to help, and not having someone to talk to who understands from a personal perspective. These were all noted to be personal challenges and impacts of their role, which can contribute to STS or even lead to a separate diagnosis of PTSD.

A study surveyed caregivers in Kent County, Michigan, regarding the Secondary Traumatic Stress Scale. Findings of this study indicated 20% of caregivers reported experiencing moderate to severe levels of STS and 12% of caregivers to be meeting criteria consistent with diagnosis of PTSD as a result of indirect exposure to their foster child’s trauma. Findings support the view that STS is a substantial risk factor in foster caring, however we can work as a team to help mitigate the risk.

Caregivers who perceive having the support they need in their caregiving role experience lower STS outcomes. Though a significant percentage of respondents in the study stated no concerns regarding the level of support received, a larger portion stated that they needed:

• time (i.e. regular breaks, guilt-free respite, time with friends/family)
• specific training (such as trauma-informed care)
• therapeutic support (regular counseling/therapy if needed)
• general professional support (communication, respect, inclusion). If licensed, the Licensing Worker can help to support the family and work to minimize STS. If the family is unlicensed, a Kinship Support Specialist can be a bridge to help the family access resources and support within the community.

Self-care was also noted to have a significant, indirect effect on the STS rate, preventing it from developing into a chronic condition, with activities including hobbies (physical activity: exercise, yoga; outdoor activities: hiking, gardening; creative outlets: crafting, music), reading, and trips. Caregivers should also set boundaries and limits to help prevent feeling overwhelmed and adding to their trauma and stress. The study also found that foster caregivers may find that satisfaction from helping others through their work mitigates the development of STS, possibly through a mentor or volunteer role or by participating in support groups. For more information on these options, reach out to your licensing agency.

Initial Placement Information

When a child initially comes into DCS care, there are often a lot of unknowns. The primary focus is getting the child out of an unsafe situation and locating a safe, stable home. Sometimes, the process moves quickly, but there are procedures in place to ensure that the caregiving family is receiving the tools and resources to best care for the child.

One of those resources is the Initial Placement Information, which includes:

• DCS Contact Information (DCS Specialist and Supervisor);
• Information about the child (which may be minimal);
• Visitation and contacts;
• Health/physical impairments/conditions (if known);
• Behavioral/emotional/psychological/psychiatric information (if known);
• Educational needs (if known);
• Instructions on accessing the Guardian provider portal;
• Notice to Provider (educational, medical);
• Notice of Rights for a Child in Out-of-Home Care; and
• Resource items: Behavioral Health Services for Children in Foster, Kinship, and Adoptive Care; Crisis Services for Children in Foster, Kinship, and Adoptive Care

The complete Placement Packet can be obtained through the Guardian Portal. Additional items that may be found in the Portal include but are not limited to:

• Mercy Care DCS Comprehensive Health Plan New Member Packet;
• Child's (temporary or permanent) Mercy Care DCS CHP member identification card;
• Available immunization record;
• Copy of a minute entry setting future hearings;
• Case plan; and
• Copy of the most recent Foster Care Review Board report.

The DCS Specialist shall follow procedures outlined in Policy to provide:

• a child in the custody of the Department, age 14 years and older, with the child’s social security card within 120 days of receiving a written request from the child
• a youth at least 16 years old in the custody of the Department shall have access to their vital documents within 60 days after coming into care
• a birth certificate for a child in the custody of the Department, in out-of-home care, within 30 days of the child’s removal (unless the child returns to the custody of the parent during the 30-day period)
• a foster or kinship caregiver with the child’s social security number within 90 days of the request if it is for a lawful purpose

When requested for a lawful purpose (such as enrollment in educational or social activities, etc.), the DCS Specialist shall provide the out-of-home caregiver with the social security number of a child placed in their care by the Department within 90 days of receipt of a written or verbal request from the caregiver. (Please keep in mind that children often come into care with no SSN assigned. This process can take at least 60 days for children who already have a birth certificate and much longer for those that do not have one, were not named by their parents, or were not born in a hospital. If you anticipate being eligible to claim the child on your taxes for this year, please reach out to the DCS Specialist as soon as possible so that they can ensure the SSN is received in a timely manner.)

If you are having difficulty obtaining any of these documents or information, there are supports available to assist you. If it is vital information necessary to keep the child safe (Notice to Provider, allergy information, etc.), please reach out to the DCS Specialist and Program Supervisor immediately or the Child Abuse Hotline if it is outside of business hours (M-F 8am-5pm, closed on state holidays). Elevate the issue in the timeframe that you feel is appropriate given the urgency of the situation. If it is a matter that is not urgent, contact the DCS Specialist and allow 24-48 hours for a response. If it is still not resolved, copy the Program Supervisor on your follow-up email. If you do not receive a resolution from either within 24-48 hours, follow up and include the Program Manager on the email. If this does not provide you with a resolution, you can contact the Warmline for assistance with contact information or facilitating communication at 877-543-7633 option 3 or Warmline@azdcs.gov, or you can choose to elevate the issue to the DCS Office of the Ombudsman.

Icebreaker Meetings

When a child is in out-of-home care, there is often a lot of fear and anxiety on the side of both the parents (biological) and caregiver (foster family). The parents don't know who is caring for their child, how they are caring for them, if they are supporting the child's culture, etc. The caregiver doesn't know the child's needs or history, what sort of cultural practices the child has, the child's likes/dislikes, etc. The best way to put everyone at ease is to have them communicate directly through Shared Parenting.

Shared Parenting is a positive, supportive alliance between caregivers and parents who have an open case with DCS. The goal is to keep the parents involved in their child's day-to-day life and to provide the caregiver with important insight about the child. Shared Parenting minimizes the trauma experienced by children when they are removed from their home. It seeks to preserve and nurture the child's relationship with parents, siblings, and extended family. It provides caregivers with necessary information about the child in order to best meet their needs. Relationships and attachments can often be preserved after reunification. Shared Parenting has been shown to increase reunification rates, reduce re-entry into foster care, and improve retention of foster families.

While the Department does encourage Shared Parenting, we understand that getting started can be challenging. It is daunting to reach out blindly, not knowing if the other party is willing to engage. To assist with this, DCS has partnered with Fostering Families AZ, a local non-profit organization, to facilitate Icebreaker Meetings.

An Icebreaker Meeting is a meetup between the parents and caregiver that creates an opportunity to build a bridge between the families and establishes the foundation of Shared Parenting. It allows the parents, caregiver, and facilitator to discuss and work out what is expected of one another in the early stages of the relationship. It gives the caregiver an opportunity to learn about the child's background and discuss the child's care, their routines, likes and dislikes, what gives them comfort, etc. It allows the parents the opportunity to meet the family who is caring for their child in their absence. They can learn about the caregiver's family, their background caring for children, and their plan for caring for their child.

As a result of the Icebreaker Meeting, the child will feel the support and concern from both families working together. The parents are able to remain involved and contribute to the care of their child while outside the home. They can also gain a sense of support in having a connection with the child's caregiver. The caregiver will receive valuable information which will assist them in providing the consistency and care necessary to reduce trauma to the child, as well as create the beginning of a relationship with the parents.

The Icebreaker Meeting is optional for both the parents and caregivers. The information about the program will be provided to the parents, and if they choose to move forward with the Icebreaker Meeting, the caregiver will be contacted by Fostering Families AZ. If the DCS Specialist believes that there are any safety concerns, the Icebreaker Meeting can be held virtually or telephonically, however in-person is preferred when appropriate. Please do not contact your agency or DCS Specialist requesting an Icebreaker Meeting. You will be contacted if the meeting has been requested.

Shared Parenting is part of the Family Foster Home Agreement and Arizona Administrative Code:

FFHA:

2. The Foster Parent(s) agree to:

• 2.1. Abide by state and federal laws, the laws and rules as set forth in Foster Parent Licensing Rules, Arizona Administrative Code, Title 21, and Chapter 6 and 8.
• 2.7. Encourage, support and cooperate with the child’s relationship with their family and important persons in their life, including visitation arrangements, as approved by the child’s DCS Specialist or as ordered by the Court.
• 2.8. Participate as a member of the child’s service team by working cooperatively with DCS and other service providers in planning for the child’s welfare and meeting the child’s needs.

AAC:

R21-6-305. Nurturing Responsibilities - A foster parent shall nurture a foster child by:

• 9. Providing opportunities for the child to contact family members by means of face-to-face contact, mail, telephone, or other modes of communication, unless otherwise directed by the Child Placing Agency.

R21-6-206. Licensing Agency Foster Home Study and Assessment - C. The home study shall include a summary of self-assessments, interviews, and observations evaluating the applicant’s fitness for licensure, including:

• 15. Willingness to share parenting for a foster child with that child’s birth family

For questions or resources regarding Shared Parenting, contact Rhiannon Schaudt-Hobkirk.

Reminder: Social Security Number Requests

Tax season is coming up quicker than any of us want it to, so start preparing now! Ask the DCS Specialist for the social security numbers of the children in your care to ensure that you have the information before taxes are due! See the "Initial Placement Information" article above for more info.

FAS/KSS Provider & Foster/Kinship Caregiver High Five Nomination Form

OLR Supports is focused on the fostering community in the areas of recruitment, retention, and recognition. We believe that it is important to promote an engaged and inspired fostering culture.

We appreciate the fostering community’s dedication to the children and families that are in DCS care, and we want to hear all of the good works so that we can give recognition and thanks for the impact you have on this community every day.

Please complete an FAS/KSS Provider & Foster/Kinship Caregiver High Five Nomination Form when you want to recognize a foster family, a licensing worker or agency, DCS Specialist/Supervisor or other employee, community partner, attorney, CASA, judge, mentor, or other fostering community member.

Sibling Connection Volunteers

Foster Adoptive Kinship Training Series

• September 3, 2024 1:00-3:30 PM TIC09032024
• November 12, 2024 2:00-4:30 PM TIC11122024

As a result of experiencing this course, you can:

• Apply TIC to help build your relationship with children
• Empathize with a child who has experienced trauma
• Describe the importance of relationships in trauma recovery

Swappow Skateboard Workshop Series

Child and Family Advisory Partnership

Foster 5k Family Day

AZ Cardinals Discounted Tickets

The Arizona Cardinals are offering discounted tickets for foster families for these games:

• AZ Cardinals vs. Detroit Lions – Sunday, September 22, 2024
• AZ Cardinals vs. Washington Commanders – Sunday, September 29, 2024

Ser Kallai Shine Symposium 2024

ASA Now

ASA Now is a non-profit organization that ADVOCATES for, SUPPORTS, and ASSISTS children and families impacted by foster care. We are passionate about providing support to families and professionals by restoring hope and empowering them to better serve these children in need.

Warmline Supports Kinship and Foster Families

The Foster Parent Warmline is available for kinship families and licensed foster parents. While not an emergency number, Warmline staff can assist with information, timely communication, and support. It is not intended to discourage or replace direct and regular communication between the DCS Specialist and the out-of-home caregiver. You can reach the Warmline by calling 1-877-KIDSNEEDU (1-877-543-7633) and selecting Option 3. Please leave a message with your name, the child's name, DOB, and dates of placement/departure, as well as an explanation of the issue. You may also send an email to Warmline@azdcs.gov and include the above information.

Children's Heart Gallery

More than 70 percent of the children in need of forever families are adopted by their relatives or foster parents. For the remainder, special recruitment efforts like the Heart Gallery are used to connect them with a forever family.

The children featured in the Heart Gallery represent all ethnic groups and range in age from toddlers to teenagers. Some have special behavioral or medical needs, some are without siblings, and others are in groups of siblings.

Isabella B.