Dr. Berrick: Good foster care looks a lot like good parenting, and more. We know a lot about strong, effective parenting from a large body of literature over many decades. We know that children do well when they are raised by parents who are intentional in their parenting, who are proactive, provide prosocial role models for their children, and who are nurturing, loving, responsive, and sensitive. And we know that those same characteristics that lead to better outcomes for children in the general population also are extremely important for children in foster care.
CCPR: But the average child in foster care may be very different than the average child being raised by their parents.
Dr. Berrick: Yes, the average child in foster care is very different than the average American child by a couple of important characteristics. They are more likely than children in the general population to have experienced significant physical abuse, sexual abuse, or neglect (Stambaugh LF et al, Adverse childhood experiences in NSCAW. OPRE Report #2013-26. Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families; 2013). These are deeply traumatic experiences, because children experience these harms from the people who they see as their primary love objects, as their principal caregivers, and as their physical protectors.
CCPR: And does this result in a greater incidence of mental health problems in these children?
Dr. Berrick: Yes, this can result in emotional difficulties, instability, and mental health issues that can go the spectrum from mild to severe. We also know that children in foster care exhibit both internalizing and externalizing problems at much higher rates than we see in the general population. In addition to these emotional and mental health concerns, you also typically see health problems from chronic to acute conditions at rates that are much higher than what you would see in the general population, and foster children are more likely to have developmental delays compared to an average American child population (Vandivere S et al. Children in foster homes: How are they faring? Research Brief, Publication #2003-23. Washington, DC: Child Trends).
CCPR: So all of these concerns mean foster parents have to be able to deal with even more than the average parent.
Dr. Berrick: This accumulation of vulnerabilities makes the parenting challenges associated with these children that much more difficult. It means that you are looking for caregivers who not only have the capacity to parent just as any typical American parent would, but you are also looking for caregivers who have the capacity to parent children effectively who have mental health conditions, sometimes coupled with physical health conditions, sometimes coupled with developmental conditions.
CCPR: Tell us about kinship care. Is this the ideal?
Dr. Berrick: The pros of kinship are that the caregiver is related to the child, and they probably feel a sense of family obligation to care for the child. They are probably known to that child, so moving to that household may not be a traumatic experience. In addition, the child may have already spent a good portion of their life in that household. It means the children get to carry with them their language, their heritage, and their family story. And we know that those are really critical scaffolding for children to use as they grow up and understand who they are in the world.
CCPR: What are the particular challenges to kinship care?
Dr. Berrick: On average, kinship caregivers are more socially disadvantaged than the typical American household (Ehrle J & Geen R, Child Youth Serv Rev 2002:24(1-2):15-35). They may not have a strong educational background and may be very low income. Whereas kin provide children with what we call “social bonding”—meaning they create opportunities for children to have connectivity with their family and with their identity—some kin may not be able to provide children with “social bridging.” This is related to caregivers providing the opportunity point that children need to move into the world with a greater degree of social capital. Kinship caregivers can be very effective, but sometimes they need a lot of additional support from social service providers who can help develop some of those skills and talents that kin may not necessarily have in their existing parenting repertoire.
CCPR: This is where child psychiatrists may come in. Is more parenting coaching and education the best way for us to support kinship care placements?
Dr. Berrick: Absolutely. One of the things that we are learning about foster care is that it is malleable to coaching. I use the word coaching instead of training or education because those look a lot like sitting in a room and listening to somebody. Coaching is one-on-one assistance in the micro-moments of parenting. So the psychiatry community may be able to do coaching in the clinical setting. This can be done by posing parenting challenges and opportunities to caregivers and their children in vivo. And giving coaching opportunities and recommendations in the moment that then caregivers can practice until they develop a new repertoire of skills.