What is therapeutic foster care?

Therapeutic foster care is a term heard often in Australia, and foster care programs around the country are offering additional specialised programs with a strong therapeutic emphasis. I am currently employed in one of those programs.

The title "therapeutic foster care" can lead to misconceptions about the program. Carers often assume that to be part of a therapeutic program they are expected to then function as therapists in their role - a daunting prospect indeed. This can lead to carer reluctance to get involved. Ideally all foster care should be therapeutic, in that the child's experiences in foster care lead to healing for the child. Structured therapy is often an important part of a child's healing, but therapeutic approaches to foster care generally work on the premise that whilst in foster care, the relationship between the child and carer is critical in helping the child to heal.

Therapeutic foster care therefore focuses heavily on the child's relationships, and works closely to develop the relationship with the carer. The carer, as part of a team, is assisted to understand the child's behaviours, underlying emotional needs, and how best to respond in a way that helps the child heal. Where possible, therapeutic foster care should seek to engage the child's birth family also.

All children who come into care experience trauma - the very act of being taken from family is highly traumatic. Many children in care have experienced substantial physical, sexual or emotional abuse and neglect, and may go on to experience multiple placements. Children with this range of experiences develop certain ways of seeing and understanding the world around them. They are highly adaptive, and develop behaviours that protect and bring a degree of control, however small. These behaviours are frequently rather difficult for carers and teachers to manage.

Therapeutic foster parents are supported to understand the underlying needs of the children in their care, and to respond to these needs rather than focussing entirely on the behaviour itself. Therapeutic foster care practice is informed by recent work in understanding the impact of trauma on the developing brain of the child. Trauma can lead to brain atrophy, with significant areas of the brain being far less developed than in non-traumatised peers. For further information on this, I would strongly recommend reading books and articles by Bruce Perry, a doctor and neurological scientist who specialises in this area. His work with children is incredibly insightful, fascinating, and heart warming as he relays stories of healing and restoration. You can read about his work here as a good starting point.

In one of his articles entitled "Neurosequential model of Therapeutics" Bruce Perry states that

"traumatic and neglectful experiences during childhood cause abnormal organisation and function of important neural systems in the brain, compromising the functional capacities mediated by these systems".

Put more simply, the experience of trauma and neglect impacts on how the brain works, especially on higher functions like listening, taking and following instructions, reasoning, planning. Children who are traumatised are more often than not operating with a high level of anxiety, and readily go into a fight or flight state with seemingly little provocation. And during these times, they are not going to hear the instruction to complete a maths sheet, or be able to explain why they did something. Those parts of the brain are in a way, offline.

Therapeutic foster parents care for children within a framework that uses information like this to help them understand what is going on for the children in their care, and how to respond. Sometimes they are required to respond in ways that do not necessarily come naturally - known as counter-intuitive parenting. For example, a school aged child with substantial attachment issues who was severely neglected as an infant, may need to experience the sorts of play and interactions normally reserved for infants - eg rocking and holding. Reparenting enables the neurological pathways in the brain that have not been developed properly to be repaired.

Therapeutic foster parents are not expected to figure this all out by themselves. Training is available, and foster parents work closely with other professionals involved with the child. In the program I work in, a therapist is part of every meeting concerning the child, and the therapist provides direct support and debriefing to the carers. Being a therapeutic foster parent is about being prepared to look at behaviours differently, being willing to try new strategies, and being part of a team. In my opinion, all foster care should operate in this manner, but at this stage funding does not allow it.