Walking the Thin Line: How to Transition a Suicidal Foster Child into Your Home

by John and Diane

I recently posted a blog with some information on working with foster kids who threaten to hurt themselves or are suicidal.  I have been working with a child like this and it has been a delicate balance that I have been struggling with.  I wanted to share my journey with all of you, in hopes that you might give some advice, or perhaps learn something from my struggles.

I got this foster child we will refer to as Mary as a young teen, with a history of self- abuse and a recent suicide attempt.

After release from the hospital Mary came to my home in a delicate mental state. Although she was receiving some counseling, after a few days in my care, she seemed to be adjusting well to my home and the other children. She had a "boyfriend" at the time, whom she relied on heavily, but there was no physical intimacy between them.  I allowed continued, monitored interaction as I felt it was necessary for Mary to have some support and a sense of continuity in spite of the new living situation.

I admit, I was nervous about Mary's history and although I usually go into "Jesus Mode" with my incoming foster kids, learning their history and gaining their trust, ( Read more about Jesus Mode in " Tantrums and Trust Disorders" )  I just didn't know how hard I could push Mary, how strict I could be with her regarding following house rules and how much I needed to restrict her.  I felt like I needed to coddle her a bit more at the beginning, as she had extreme self-worth and self-esteem issues, was extremely sensitive to redirection or correction and quickly fell into "dark moods" and depression that worried me.

I spent a few weeks attempting to build Mary's self-esteem, confidence and self-worth.  I gave her opportunities to feel part of a family unit, to express her self and feel safe within boundaries. I spent a great deal of time counseling Mary and building a trust bond with her.

During this time however, I saw Mary becoming more manipulative, using her depression as a way to get her way.  I was worried about this. Was I seeing this correctly? Could I correct this behavior? If I began to set stricter boundaries, what would happen? Would she retreat into self-harm?

I had a heart-to-heart with Mary one day when she was trying to push her limits. I told her that it didn't seem like I could make her happy in my home. No matter how much I did for her, it seemed like she needed more and more to make her happy. That was not going to work for me. We talked about all of the things I felt, the manipulative behavior, and I was straight with her, outrightly telling her I felt manipulated. I am not one to beat around the bush. She didn't have much to say.

Diane, my co-author and I consulted on all of this and came to the conclusion that it was a good time to start setting some boundaries and making trust a two-way street.  A common practice amongst therapists is to make a contract with patients who have suicidal tendencies.  The contract is a promise from the patient to the counselor that the patient will not harm themselves.  Creating a contract like this between Mary and me would be a great start in building trust between us and removing part of my fear. It would also give me an opening to discuss how I would need to begin putting some boundaries on Mary, and begin treating her like more of the family. During this discussion Mary officially moved from her "Jesus Mode" status to a more regular member of the household.

It's difficult to know when it's right to move a child forward, but I guess instinct and experience must be relied upon, as well as consulting with your treatment team. You, as primary caregiver though, know the child the best, and must do what is best of the child and the family unit.

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How Do I Deal With: Kids Who Hurt Pets

Hi Friends,

We have talked a lot about kids and pets here on FPR, and we have mentioned many times about how necessary it is to supervise foster kids with pets during pet therapy or as you are just getting to know your "new" kids, as many times abused or traumatized children will act out, or children with RAD or attachment disorders may need coaching when interacting with animals.   Yes, we have kind of danced around the topic, but we aren't dancing anymore.

We recently got an email from a friend and reader asking a very straightforward question, and although we have a lot of information on the topic, we didn't have a straight-enough answer for her.  We thought we should go ahead and talk about the topic of kids who hurt or abuse pets or animals and what you should do about it.  (imagine us shifting uncomfortably in our chair.)

First, the question from our reader:

Q:  Recently our little guy has really been picking on our dog. He's getting worse and worse little by little. We have a no touching animals rule in the house, but he disregards that rule despite the consequences. Any ideas?  [ the child has shown evidence of RAD or an attachment disorder.]

A: FPR:   This is basically what is happening:  RAD kids don't know how to show love, and so when they try to show the dog affection, they try to control the dog (which is the only way the child knows how to deal with people and animals..thru control) and so eventually the dog revolts against it and struggles against it, so the child gets rough.  Now the relationship between pet and child is damaged.

 So, you have to show the child how to rebuild the relationship with the dog.  Give him treats to give the dog and teach him how to interact properly with the dog.   Also, only supervised play with the dog until you are sure that the child has learned how to interact with the animal.

The no- touching the animals rule isn't going to work. You have to spend time teaching them how to play with the dog and have only supervised time with the animals.  A No touching rule is impossible, you might have a "no picking up rule," "no hitting the dog rule" is okay, but you have to take control of the dog and keep them separate.

 Let me know how it goes and keep up with it even if you think that they have learned it...
sometimes they can trick you and revert to the bad behavior. 


Now, my advice comes from my own experience working with RAD kids and my families own pets.  I have had the same issues with kids being too rough with pets, mistreating them, and I have cameras in my house, I feel like I supervise the kids as well as anyone can.  And I lost a pet. A small breed dog under unfortunate circumstances- most likely from one of the kids hugging the struggling dog too roughly.   It was devastating.  The RAD child then acted as if nothing bad had happened. He had to learn to allow others in the house to grieve the loss of the pet, I had to accept it, and counsel the child through the event, to try to discover what had happened, without allowing my own personal feelings to come out, or to take them out on the child, ... it was terribly, terribly difficult.

In the end, I guess it helped build trust between this boy and myself. He was sure he'd be kicked out of the house for the incident, and I didn't kick him out.  I tried to get to the bottom of the situation, and we continued to work on his skills with pets, and worked and worked on it.  He has come a long way and I do believe he will be a success story yet.  Time will tell.

Here are some other resources for you. Some very interesting articles here I encourage you to read if you are dealing with this problem. 

 IF YOUR CHILD HAS TORTURED OR KILLED AN ANIMAL PURPOSEFULLY... TALK TO A PROFESSIONAL IMMEDIATELY.

Children Who are Cruel to Animals: When to Worry

Children Abusing Animals

 Cruelty to animals a sign that heeds attention

When Children Abuse Animals

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Dialectical Behavioral Therapy: Sounds Scary, but You Are Probably Doing It Already...

by John and Diane

Dialectical Behavioral Therapy (DBT) is a cognitive/behavioral therapy and a term you might hear being thrown around if your child deals (and your family) deals with obsessive compulsive disorders, borderline personality, or bi polar personality disorder (to name a few.) 

It sounds intimidating, but a lot of the principles it uses are most likely things you are doing already with your foster, adopted or bio. kids who have behavioral issues that stem from wrong-self perceptions and exagerrated sense-of selves and importance.  

Basically, this type of therapeutic approach is used on people who have extreme emotional reactions to situations that most people would not, and would take more time to "level out." 

Now, I realize the below information may seem overwhelming, or you may think to yourself, "well, I won't be able to get this kind of therapy for my child..." 

I get that.

However, I wanted to bring you all this information so that you can either, mention it to your team, if you think it's applicable to your child, OR, put some of the principles into use on your own if you think some of the approaches might help your child, no matter what his or her diagnosis.  Any therapeutic intervention is basically a way of interacting and talking with your child... you can do that.  Just read through the material and read  more about it.  You can do it. 

As always, we encourage you to run your ideas past your counselors, physicians or social workers if you have those people at your disposal.  

Here is an overview from PsychCentral: 

People who are sometimes diagnosed with borderline personality disorder experience extreme swings in their emotions, see the world in black-and-white shades, and seem to always be jumping from one crisis to another. Because few people understand such reactions — most of all their own family and a childhood that emphasized invalidation — they don’t have any methods for coping with these sudden, intense surges of emotion. DBT is a method for teaching skills that will help in this task.

Characteristics of DBT

• Support-oriented: It helps a person identify their strengths and builds on them so that the person can feel better about him/herself and their life.
• Cognitive-based: DBT helps identify thoughts, beliefs, and assumptions that make life harder: “I have to be perfect at everything.” “If I get angry, I’m a terrible person” & helps people to learn different ways of thinking that will make life more bearable: “I don’t need to be perfect at things for people to care about me”, “Everyone gets angry, it’s a normal emotion.
• Collaborative: It requires constant attention to relationships between clients and staff. In DBT people are encouraged to work out problems in their relationships with their therapist and the therapists to do the same with them. DBT asks people to complete homework assignments, to role-play new ways of interacting with others, and to practice skills such as soothing yourself when upset. These skills, a crucial part of DBT, are taught in weekly lectures, reviewed in weekly homework groups, and referred to in nearly every group. The individual therapist helps the person to learn, apply and master the DBT skills.

Generally, dialectical behavior therapy (DBT) may be seen as having two main components: Weekly individual sessions and weekly group sessions.

The Four Modules of Dialectical Behavior Therapy

1. Mindfulness
The essential part of all skills taught in skills group are the core mindfulness skills.
Observe, Describe, and Participate are the core mindfulness “what” skills. They answer the question, “What do I do to practice core mindfulness skills?”
Non-judgmentally, One-mindfully, and Effectively are the “how” skills and answer the question, “How do I practice core mindfulness skills?”
2. Interpersonal Effectiveness
Interpersonal response patterns taught in DBT skills training are very similar to those taught in many assertiveness and interpersonal problem-solving classes. They include effective strategies for asking for what one needs, saying no, and coping with interpersonal conflict.
Borderline individuals frequently possess good interpersonal skills in a general sense. The problems arise in the application of these skills to specific situations. An individual may be able to describe effective behavioral sequences when discussing another person encountering a problematic situation, but may be completely incapable of generating or carrying out a similar behavioral sequence when analyzing her own situation.
This module focuses on situations where the objective is to change something (e.g., requesting someone to do something) or to resist changes someone else is trying to make (e.g., saying no). The skills taught are intended to maximize the chances that a person’s goals in a specific situation will be met, while at the same time not damaging either the relationship or the person’s self-respect.
3. Distress Tolerance
Most approaches to mental health treatment focus on changing distressing events and circumstances. They have paid little attention to accepting, finding meaning for, and tolerating distress. This task has generally been tackled by religious and spiritual communities and leaders. Dialectical behavior therapy emphasizes learning to bear pain skillfully.
Distress tolerance skills constitute a natural development from mindfulness skills. They have to do with the ability to accept, in a non-evaluative and nonjudgmental fashion, both oneself and the current situation. Although the stance advocated here is a nonjudgmental one, this does not mean that it is one of approval: acceptance of reality is not approval of reality.
Distress tolerance behaviors are concerned with tolerating and surviving crises and with accepting life as it is in the moment. Four sets of crisis survival strategies are taught: distracting, self-soothing, improving the moment, and thinking of pros and cons. Acceptance skills include radical acceptance, turning the mind toward acceptance, and willingness versus willfulness.
4. Emotion Regulation
Borderline and suicidal individuals are emotionally intense and labile – frequently angry, intensely frustrated, depressed, and anxious. This suggests that borderline clients might benefit from help in learning to regulate their emotions. Dialectical behavior therapy skills for emotion regulation include:

• Identifying and labeling emotions
• Identifying obstacles to changing emotions
• Reducing vulnerability to “emotion mind”
• Increasing positive emotional events
• Increasing mindfulness to current emotions
• Taking opposite action
• Applying distress tolerance techniques

If you are working, living or loving a person with borderline personality disorder, check out this website,  http://familiesontheline.com/index.html  

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How Do I Deal With: Foster Kids Who Threaten or Talk About Suicide

Is Suicide too tough for foster parents to deal with?  It is a difficult subject to be certain, frightening for many to be sure. If a foster parent hears that a incoming child has attempted or threatened suicide in the past, would they or should they consider not taking the child?

Of course they'd be afraid the child would attempt suicide again "on their watch." Its a natural fear. But, isnt this the type of child you got into foster care to help? OR, is it okay to know your own limits and be okay with that?

Whether you know it or not, many children in foster care, who have suffered abuse or trauma, may be suicidal at one point in their lives. Whether you are ready to deal with it or not, if you are doing foster care, you should be prepared and ready to address self-harm or suicidal behavior in your foster children.

Here are some facts from:  Suicide and the Foster Child  By Helen Ramaglia, July 11, 2013

• Adolescents who had been in foster care were nearly two and a half times more likely to seriously consider suicide than other youth (Pilowsky & Wu, 2006).
• Adolescents who had been in foster care were nearly four times more likely to have attempted suicide than other youth (Pilowsky & Wu, 2006).
• Experiencing childhood abuse or trauma increased the risk of attempted suicide 2- to 5-fold (Dube et al., 2001).
• Among 8-year-olds who were maltreated or at risk for maltreatment, nearly 10% reported wanting to kill themselves (Thompson, 2005).
• Adverse childhood experiences play a major role in suicide attempts. One study found that approximately two thirds of suicide attempts may be attributable to abusive or traumatic childhood experiences (Dube et al., 2001).

Ramaglia goes on to say:  "Foster children can benefit from programs that bring together other like-minded children where they can share their pain, share their stories and heal from the inside out. If such programs existed, and were led by foster alumni, this would aid them even more of ridding themselves of turmoil that can often become debilitating.

There are few, if any programs encouraging the foster child to rid themselves of the pain and darkness that often consumes their lives outside of a therapeutic setting."
(read full article here:  Suicide and the Foster Child)

So... What can a foster parent do? Educate yourself. Ask for training from your therapeutic staff and avail yourself from materials offered through foster parent training.  

Know the warning signs.
According to The Role of Foster Parents in Suicide Prevention the warning signs include: 

 ■■ Talking about wanting to die or kill oneself
■■ Looking for a way to kill oneself, such as searching online or buying a gun
■■ Talking about feeling hopeless or having no reason to live
■■ Talking about feeling trapped or in unbearable pain
■■ Talking about being a burden to others
■■ Increasing the use of alcohol or drugs
■■ Acting anxious or agitated; behaving recklessly
■■ Sleeping too little or too much
■■ Withdrawing or feeling isolated
■■ Showing rage or talking about seeking revenge
■■ Displaying extreme mood swings

Another excellent point made in this same booklet says: 

 Encourage your child to talk with you. Your comfort in speaking with a foster child about suicide (and his or her willingness to talk with you about these issues) may depend on many issues: your experience as a foster parent, howlong the youth has been with you, his or her family’s cultural background, and whether the child is used to talking with adults about difficult topics.

 For example, some families talk things over, while other families are reluctant to discuss personal issues. Some families have a tradition of mutual support, while others encourage their members to
be self-reliant. A family is shaped not only by its own history, but by the cultures the family belongs to. All of this affects the approach you select when initiating a conversation with your foster child about how he or she feels.
 
■■ Another factor unique to foster children is the possible fear that sharing their suicidal thoughts will result in being removed from your home. This may influence whether a foster child will admit to feeling suicidal.
It is important to let foster children know that they can talk to you about their problems and that you will make every effort to keep them with you. Foster parents can help by not automatically moving a child who expresses suicidal feelings.

Finally, get professional help.  Know that this is a difficult psychological situation and your foster child needs professional intervention. Contact their case worker or counselor and or take them to emergency health services if necessary to keep them safe. 

There are many published materials and resources for foster parents on this subject. Be familiar with them so you know what to do when the situation arises. 
Here are some links:

The Role of Foster Parents in Preventing Suicide

http://www.sprc.org/sites/sprc.org/files/FosterParents.pdf

Suicide Prevention and Intervention for Foster Families

http://www.helppromotehope.com/documents/FosterParentsPrevention.pdf

preventing suicidal behavior among youth in foster care - American ...

http://www.suicidology.org/c/document_library/get_file?folderId=261&name=DLFE-557.pdf

Childhood Suicide: Learning to Assess Risk - Focus On Youth

http://www.focusonyouth.com/pdfs/Childhood%20Suicide.pdf

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How Do I Deal With: Kids Who Cut Themselves

by Diane and John

Cutting behavior is not uncommon among teens and pre-teens in general populations and among foster kids, who have suffered trauma of some kind, it may be even more prevalent.

Cutting behavior refers to the act of cutting into the skin, deeply scratching or any self-harm activity done usually on a child's arms or legs with some kind of sharp implement.  It is not an indicator of a suicide attempt, but is an attempt by the child to deal with emotional pain that they cannot express any other way.

Recognized most often in girls, it does happen in children of both sexes. It often starts as a response to a self-esteem issue (body hatred, response to molestation etc) but once it becomes a habit, it is turned to as a release of any kind of stresser.

If you receive a child in foster care who is a "cutter," hopefully the issue is already being addressed through counseling and therapy. Be sure to talk about it with your team to be sure, as the behavior is ofter well-hidden by the child. 

Dealing with the issue in your foster home should be part of your open conversation. Just as we recommend with sexual issues, it should be part of the family conversation, and if the child is willing to work on the behavior, a plan can be developed. 

Cutting releases endorphins which releases the stress the child feels when under pressure. Although counseling works long term, in your home, you want to provide ways to help your foster child deal with emotional pressure.

If the child is not in school, try running, basketball or any sport the child enjoys. It should be something enjoyable, and not seen as a punishment.  Since the issue is something that the family will talk about openly, when you notice the child is under stress, you can initiate the conversation: "Honey, do you feel okay, do you need to burn off some pressure? Why don't you and your brother go for a bike ride?"   Afterwards, you can talk about how the physical exercise is a way to substitute for the cutting.

If the child is in school, start with a simple behavioral modification technique, a rubber band around her wrist. A quick snap can relieve building emotional pressure and can be just a first step to learning to deal with angst.  Deep breathing should follow.  Then a program where he or she can simply snap her fingers, squeeze her earlobe or take other measures to trigger her decompression.

Coach your pre-teen or teen to know that the issues that trigger these events, perceived failures at school or in sports, feelings of rejection etc, are all part of life, are part of growth and can be accepted and moved through.  Build self-esteem through other therapeutic process and exercises as well.

Check out the WebMD information on Cutting for more information. 

Cutting and Self-Harm: Warning Signs and Treatment

Do you have experience with "Cutters" in your home? Share your stories here please.

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Is Neurofeedback the Solution for Your Child? Follow Our Journey: Part 5 The First Report Card Since NeuroFeedback

 The below post is from our friend “Marie.” She is sharing her story with us as she tries a brain-retraining program (neurofeedback) with her daughter who has ADD and severe memory issues.  This will be an ongoing series following their progress and success.  We hope you find it helpful as you search for solutions for your own children.

If you missed the first four parts of the series, read them here: 
Is Neurofeedback the Solution for Your Child? Follow Our Journey: Part 1.

Is Neurofeedback the Solution for Your Child? Follow Our Journey: Part 2 The First 3 Sessions

Part 3:  Seeing Signs of Success and Positive Changes!

Part 4: The Importance of Breathing and a Progress Report

Part 5: The First Report Card Since Neuro-Feedback Started

My daughter received her yearend report card. I was curious to look back at the comments from the first semester pre-Neurocore. 

They said things like “She is very capable when she challenges herself and doesn’t let herself get distracted. “

Then I read and compared her last semester post-Neurocore comments.

 They were as follows: “The last 6 weeks of class have been great for ___ in math. She is on task, and using her problem solving skills to figure out problems she wouldn’t have tried before without a teachers help.” 

Fabulous! I was so thankful to hear the official feedback.

As I have discovered, she does have the ability to remember. She may daydream while she is listening to instruction, but if you can get her to stop the habit of daydreaming AND hold her accountable then wallah! 

This has taken a combination of Neurocore - neurofeedback and regular home spun behavior modification.   

Before, I think I felt a little squeamish about holding her accountable to a task.  Mainly because, in my gut, I felt she wasn’t grasping the information fully. Unfortunately, my attitude enabled her to become undisciplined and lazy.  

 I am so thankful that I know what I am dealing with now. With this information under my belt, I feel confident she has all the capability and NOW it is time to tackle the laziness, etc.

And we still have 12 sessions to complete…

Have you tried Neuro-feedback and have a story to share? Please comment here or on our Facebook page.  We have no personal interest with NeuroCore - we are only bringing you the true and unbiased findings in hopes of giving parents some information from another parent.

 

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The Use of Art Therapy with Kids with Attachment Disorders

Art therapy is a natural tool to use with children, and when used with children with attachment disorders or RAD (reactive attachment disorder) it can help to unlock the doors of communication between the child and caregivers.

We have talked about art therapy with RAD kids before, (The Safety Fort: An Art Therapy Intervention for RAD and Trust Disorder kids,  Great Conversations: Letter Writing and Art Therapy with the Introverted RAD Child , Art Therapy with Trouble Foster Kids: Addressing Defiance, Detachment and Behavioral Issues, Helping Foster Kids Understand Change and the Foster Process Through Art) and have encouraged use of the arts with all kids, foster, adopted and your biological kids, especially when trauma is present.

We found this article which discusses the use of art therapy with children with attachment disorders which features some case studies that we thought you might find interesting.  Read on, and consider asking for art therapy with your kids if it is a tool you think might help.

The following is an excerpt from: 

The Use of Art Therapy in Treatment of Attachment Disorder

Marilyn Magnuson MSW, RSW

The Use of Art Therapy in Treatment

 

Children often have difficulty speaking about their concerns, feelings and past trauma, but they can draw and paint these images through art therapy. Art Therapy makes use of symbols and images as an alternative language.  Memories, emotions, desires and concerns are externalized and released from body tissue through the art.  Once a therapeutic environment has been set, art therapists 'get out of the way' while art makers relax and use their intuition to guide their artmaking.  Art materials such as clay, paints, pastels, and markers provide visceral stimulation, brining body memories to the conscious.  These images from the unconscious reveal hidden aspects of Self.  By tapping into right brain activity through spontaneous artmaking we by-pass the judging, censoring and rationale left-brain.  Art therapy is useful for children who experienced trauma prior to speech, as they do not have words to express the trauma, but the symbolic memories remain in the old brain.  For example, this girl drew her hospital experience as an infant. Through the doorway (left vertical line) she saw the nursing station and the emptiness of the experience (sparse lines), and her separation anxiety (where's mom?).  These Limbic memories do not appear during talk therapy.  

 Family involvement in treatment is essential.  This usually begins with family art therapy assessment exercises, as well tools to uncover intergenerational history (Genogram) and community supports (Ecomap), and a behavioural questionnaire.  The Kinetic Family Drawing (KFD - Landgarten, 1987) requires all family members to draw on the same page without speaking.  They then draw together on a separate page while speaking to one another.  The resulting drawings reveal family dynamics that assist in developing therapeutic interventions (Gil, 1994).   

This six-year old boy, Billy, was brought to therapy for aggression, nightmares, learning problems, and lack of social skills.  Family history disclosed that Mom gave birth at age 16 while living with the father and his parents.  Although they moved out of the grandparent's home when Billy was 2 years old, Billy often stayed with Grandma, and learned to phone Grandma when there were domestic problems.  Grandma then would rescue him.  Mom and dad were emotionally, verbally and physically abusive to Billy.  Mom was overwhelmed and Dad was in need of psychiatric care for depression and anxiety. Billy appeared insecurely attached and was afraid of his parents during stressful times.  Neither Mom nor Dad had a history of secure childhood attachment and found it difficult to nurture him physically and emotionally.

The non-verbal family drawing was started by Grandma who took up much of the space on the page with her sun and tree.  She encapsulated herself and Billy in a tree.  Billy drew dad with rabbit ears, possibly a symbol of dad's ineffectiveness.  He drew mom with hair on her legs and a large razor, possibly symbolizing mom's aggressiveness.  He drew a sun in the upper right corner, copying Grandma, and pushing dad over to the middle of the page next to mom.  It appeared that his desire was for his parents to get along.  Dad drew a sword stuck in a rock, possibly symbolizing his emotional state.  Mom drew herself and dad as separated from the two boys.  

The verbal family drawing began with Grandma taking over mom's space, pushing her out of the activity, possibly symbolizing Grandma's rivalry with Mom, and Mom's disempowerment within the family.  Billy again demonstrated his anger with mom by giving her a bat that resembled a knife.  Dad drew his brother as a humorous character  Grandma drew Grandpa as small and stated he was rather uninvolved.  The black oval object is a garbage can that Billy included, possibly symbolizing his view of family nurturance. Mom was left with no room to draw and solved this problem by placing grass under the feet of each figure.  The family drawings demonstrated triangulation and coalitions.  Grandma appeared to be matriarchal and protective, triangulated with Billy.  The couple relationship appeared to be stressed, and Billy appeared to be both angry and afraid.  Within an hour family dynamics were revealed through art images and the processing of these images.

Read the entire article here: http://www.expressyourselfarttherapy.com/id20.htm




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