- The Trauma and Adoption Connection
- Foster Care/Adoption/International Trauma
- Before you continue...
- Understanding trauma - AdoptUSKids
Staat and her program through their adoption agency and decided to see if she and her team could help. Looking back, Shelli says that it was one of the best decisions they have made as parents. We do all the screenings that are recommended by the American Pediatric Association. They may not have the feelings that they thought they were going to have and hoped they were going to have, or … be questioning if On rare occasions, she said, families already have been torn apart by the time they arrive at the IAC. I mean I hate to see that child have another loss and I hate to see that family have that loss.
Despite the decline in international adoption by Americans in recent years , Staat is hopeful that programs like the IAC will continue to demonstrate their worth and receive adequate funding. Click here to read the first five stories on re-homing from Reuters. Politics U. Sections U. Follow NBC News. Learn more about our web privacy policies. Tools Print Text. Contact Us. Meeting the Challenges of Foster Care Children in foster care also face special challenges, including poor continuity of care, previous abuse and neglect and repeated disruptions, which can result in emotional and behavioral problems.
Indeed, the third pillar of trauma-informed care, connection, is the foundation for the first two pillars. Felt-safety is derived from trusting relationships Eisenberger et al. Further, self-regulation is also derived from sensitive, trusting relationships, through countless regulatory and attuned caregiver-child interactions Schore Researchers agree that for children suffering multiple or chronic early adversities, interventions targeting attachment are necessary Cook et al.
Improving the quality of the child-caregiver relationship improves physical, mental, social, and emotional development in at-risk children Dozier et al. A high quality caregiver-child relationship, such as that found in a secure attachment dyad, can buffer against the harmful effects of early adverse experiences, including poor behavioral outcomes Audet and Le Mare ; Colonnesia et al.
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TBRI is a trauma-informed intervention grounded in attachment theory that seeks to improve outcomes for vulnerable children by 1 helping caregivers see the needs of children who have experienced relational trauma and 2 helping caregivers do what is necessary to meet those needs. For intervention to be most effective the underlying trauma experienced by children with histories of maltreatment and deprivation must be addressed.
The Trauma and Adoption Connection
In line with the three pillars of trauma-informed care, TBRI consists of three sets of principles that facilitate felt-safety, self-regulation, and connection: Empowering Principles, Connecting Principles, and Correcting Principles. Each set of principles has two associated sets of strategies. The two sets of strategies associated with Empowering Principles are 1 Ecological Strategies, such as recognizing and managing transitions and establishing rituals that structure and connect and 2 Physiological Strategies, such as providing regular physical activity and sensory experiences and meeting nutritional and hydration needs.
The sets of strategies associated with Connecting Principles are 1 Mindful Awareness, such as an awareness of the child, the self, and the environment and 2 Engagement Strategies, such as valuing eye contact, playful interaction, and healthy touch. The Connecting Principles are not only important in their own right, as essential mechanisms for building trusting relationships, but are also the engine that makes both the Empowering and the Correcting Principles work in practice.
The Correcting Principles are used to deliberately shape behavior, but will only be effective to the extent that their practice is based on a firm foundation of Empowering and Connecting. A more detailed explanation of TBRI and how the principles are applied can be found in previous publications e. TBRI has been used in a number of settings to effect change, including intensive home programs McKenzie et al. Consistent with research demonstrating the efficacy of trauma-informed, attachment-based interventions on behavioral outcomes for at-risk children Dozier et al.
Participants consisted of 96 adoptive parents who responded to a recruitment notice for a study for parents interested in learning about the basic relationship and developmental needs of adopted children with histories of early adversities and practical strategies to improve outcomes for these children. Eligible participants included parents of children who were domestically or internationally adopted, were between the ages of 5 and 12 at the beginning of the study, and had resided in the adoptive home for at least 1 year.
In addition, parents or other immediate family members could not have participated in previous training or research studies hosted by the research institute. Parent training was offered free of charge. Of the eligible participants who responded to the recruitment notice, indicated that they were available to travel to the university located in a large metropolitan area in the southern United States to attend 4 days of on-site parent training. Of these potential participants, 85 were randomly assigned to attend parent training treatment group. Participants in the control group were offered online training after the conclusion of the study.
Control group participants were matched to treatment group on child sex, age, adoption type domestic vs. Means and standard deviations for continuous descriptive variables by group control vs. Means and standard deviations for continuous descriptive variables by group for the child. Frequencies and percentage for categorical descriptive variables by group for the child.
Means and standard deviations for continuous descriptive variables by group for the primary caregiver. Frequencies and percentage for categorical descriptive variables by group for the primary caregiver. All participants provided informed consent before participating in research. All participants participated in an online pretest approximately 2 weeks before intervention began, as well as an online posttest approximately 2 weeks after intervention ended.
The questionnaires making up the pre- and posttest assessments were presented in random order at each administration. The SDQ is a item measure of behavior for children age 3 to 16 years old that can be completed by parents, teachers, or adolescents. Added together, scores from these four subscales give a Total Difficulties score.
The SDQ has good reliability and validity Goodman The TSCYC is a item caregiver-report measure of acute and chronic posttraumatic symptomology in children age 3 to 12 years old. The TSCYC also contains two validity scales: Response Level, which indicates a tendency for reporters to over-respond, and Atypical Response, which indicates a tendency to under-respond.
Participants in the treatment group attended a 4-day TBRI parent training 6 h per day designed to teach strategies and skills intended to improve behavioral outcomes for children with histories of complex trauma. The training utilized standardized presentations, presenter manuals, and participant workbooks routinely used in TBRI workshops with various audiences interested in creating changes for children with early adverse histories, including audiences of child welfare professionals, teachers, and adoptive and foster parents.
Each day of training consisted of interactive lectures with small and large group discussions, application activities such as role-plays and therapeutic groups, and video clips used to demonstrate principles and strategies. Trainers each had approximately 2 years experience using the standardized presentations, manuals, and workbooks.
Parents reported that older children had a greater decrease in problem behavior than younger children from pretest to posttest regardless of group. The current study reports on an intervention that is effective at reducing many behavioral problems and trauma symptoms among vulnerable children. In line with the principles of trauma-informed care, the core values of TBRI are felt-safety, self-regulation, and connection.
Although previous research suggests that focusing on these core values will result in behavioral change, this is the first TBRI study to empirically assess change in trauma symptoms. Not surprisingly given their early adverse histories, children in the current sample are at risk for symptoms in line with a Post-Traumatic Stress diagnosis, including arousal, intrusion, and avoidance.
Foster Care/Adoption/International Trauma
That a 4-day parent training could effectively decrease trauma symptomology speaks to the importance of considering trauma in the context of the caregiver-child relationship. These findings are encouraging for the multitude of families seeking help for the behavioral challenges exhibited by their at-risk adopted children every day and are also important for researchers who seek to identify developmental domains that should be targeted for interventions.
Notably, the improvements evident after intervention were not limited to one domain, but appeared in various domains that are addressed by the intervention. Emotional problems are addressed in activities such as creating a clay model representing something the child is afraid of and then smashing the model.
Although one goal of the intervention is behavioral change, it is most effective in the context of the safety, security, and sensitivity of a healthy attachment relationship. Consistent with this perspective, it is important that the intervention target caregivers, with the intention that positive outcomes will be more long-lasting if the caregiver is the medium for change.
Although promising, there are limitations to the current sample.
Participants consisted of volunteers who were interested in learning strategies for improving outcomes for their adopted children. They had to have the means and time to travel to the training and the ability to be available for 4 days; therefore, this sample might not represent the population as a whole. Another possible limitation is the use of parent-report measures of child behavior.
It is possible that problem behaviors decreased in the treatment group after intervention because parents wanted behaviors to decrease.see
Before you continue...
However, the post-intervention improvements in behavior and trauma symptoms are supported by post-intervention improvements found in other studies utilizing different measures for the same intervention principles, including changes in neurochemistry Cross et al. In addition, other studies have found high validity between parent reports of behavior and other behavioral measures, including teacher report Kriebel and Wentzel ; Miller et al.
As is common in studies of adopted children with early adverse histories, especially post-institutionalized children, there was no direct measure of pre-adoption experiences. The current study reports on short-term improvements in behavior and trauma symptoms. Although encouraging, future research should assess long-term follow-up of outcomes following intervention to examine whether behavioral improvements last.
Understanding trauma - AdoptUSKids
If decreases in child behavioral problems and trauma symptoms are the result of changes to parent-child interactions stemming from TBRI parent training, then a central question for future research is to what extent parents continue to use the skills and strategies learned in training. On-site TBRI training conducted face-to-face with TBRI-trained staff is a valuable training model: it allows for a dialogue between participants and trainers during which questions can be answered immediately, skills can be practiced with feedback, participants have a devoted time and space in which to learn and have the context of a supportive environment from trainers and other participants.
However, on-site training also has its caveats: it limits the number of individuals who can attend training and it requires a lot of time and resources on the part of the training staff. Indeed, among the participants who were randomly assigned to the treatment group who had all indicated that they were available to attend training on location during the training dates , the main reason participants withdrew from the study prior to intervention was difficulty making travel arrangements e.
The majority of participants who withdrew from the study expressed regret or frustration at not attending training.
Future research will evaluate alternatives to on-site trainings led by research institute staff. A promising alternative is web-based training, which aims to provide the same content but allows participants to progress through training at their own speed on their own timeframe, no travel required.