As of September 2018, there was 24,235 children in the state of Florida residing in out of home care. Out-of-home care are placements that are outside of a parental home and usually involve court involvement, these placements can be with relatives, non-relatives, group homes, foster homes and residential treatment centers. (“Children In Out-of-Home Care- Statewide”, 2018). Causes for removal from primary caregivers vary, however these can be narrowed to three areas: abuse, abandonment and/or neglect. Cases resulting in out-of-home placement involve children who have either been exposed to domestic violence, parental substance abuse, physical abuse, sexual abuse, abandonment (not due to the above causes), etc. These instances often result in children being exposed to severe trauma early in their lives, hence the need for intensive therapeutic services. In the state of Florida, methodology states that the Department must make considerable efforts to keep children in the home while implementing services or find relatives that are able and willing to care for the child; when these efforts are not successful children often end up in foster care or group homes (can also be considered Foster Care). (The Florida Statues, 2018)
A 2011 study, found that there is a disconnect between children in foster care that often happens when these children feel ashamed of their status, lonely and/or isolated, they often do not disclose these feelings to others. Hence, failing to connect with the other hundreds of children who are also in foster care and may share these similar feelings. In a 1999 memoir by Dr. Francine Cournos, relates her memories and experiences in the foster care system. Dr. Francine Courons explained that there were many children in the foster care system who have “no adequate way of speaking about their experiences.” Studies have shown that children in foster care often experience a variety of behavior problems, developmental delays, and need for psychological intervention services. Some identified issues have been anxiety, attention deficits, and/or posttraumatic stress disorders. Other identified concerns have been aggression, delinquent and withdrawn behaviors.
A study by Mellor and Storer (1995), also attempted to look at if the benefits of group therapy can also be applied for children in foster care. The focus of this pilot study was to allow members of the group to discuss and relate their experiences with others, identify and express their feelings and life stories, create an understanding that these feelings and experiences were not unusual, foster a sense of support within the group, increase the individual’s self-esteem, help the members develop trust in each other and prove a space where they can deal with anger appropriately. There were seven participants in the group, ranging from ages nine to thirteen. The group met weekly on four occasions for 90 minutes. Three additional components were added to the group session, (1) the children were served tea at the beginning of each session which allowed time for the children to work with each other without the therapist’s presence, (2) a box was placed so the children can write letters to other members or group leaders, (3) lastly, a pendulum was placed in the room where the children can mark either a positive or a negative depending “how things were going at any time”. Through the four sessions, the children explored feelings of their past experiences, current feelings about their placements, and were provided with activities that would help the children explore the following with other members. The most noted element that resulted from the group sessions were the children’s ability to share their experiences and form bonds with each other. Overall, the aims of the study were met, and the children were able to form peer relationships with the other group individuals.
Other than the emotional effects caused by the initial separation from biological parents, children who enter the foster care system often experience additional changes in placement while in the system which has proven to cause additional trauma. A 1990 study, explored the children’s feelings about being separated and attempted to find lapses in agency’s practices that often result in multiple placements. There were 46 participants in the following study that were willing to participate in group treatment to address separation conflicts. These treatment groups were led by a pair of the caseworkers who were given six hours of training in separation by a Child Psychiatrist. Data was gathered by questionnaires, child’s shared experiences, and information about the treatment process. There were three, hour and a half session, however some children/workers wished to participate in an additional session. Treatment focus involved the child’s experiences with separation, significant life event, and their feelings and behavior regarding both. Overall, children shared feelings of sadness and anger about being separated from their families and friends. Some shared that they felt relief from separating from abusive families. However, several children indicated that this group was the only place they were able to express the following. Caseworkers reported that the group experience made them more aware and sensitive to the children in foster care and their needs, it was also noted that children were more open to share difficult experiences in group rather than individual settings, and lastly some workers stated that these groups should be mandatory for children involved in the system. Findings of this study revealed that children are open to share their experiences in a group setting, and often did more so than in individual settings. It was also noted that biological family involvement and foster parent involvement would be essential in understanding the child’s experiences and their feelings. (Palmer, 1990)
Wanlass, Moreno & Thomson (2006) developed a case study involving 8-12 girls between the ages of 10-14 who had been sexually abused by a male relative and there was current Child Protective Service involvement. Primary treatment involved Individual Therapy, and Group Therapy was provided in a volunteer basis. Group treatment focused on the sexual trauma, developmental needs, psychoeducation and addressing current involvement with the system. Some concerns brought up by group facilitators/therapists were their ability to accept the dual challenges of being a therapist and a representative for the child when involved in the court system. Therapists must be able to understand the projected roles (parent roles) they may be faced with by the clients, in order to allow the clients to work through these feelings. Despite these areas of improvement, further research should explore how group therapy can be improved to focus on advocacy and group facilitation for children in the system.
Additionally, Joshua Moldonado (2009), developed a study exploring the effectiveness of group therapy for children ages eight to ten in the foster care system. A sample of four children was evaluated through a 12-week program, where meetings were held once a week. The group focus was on teaching individuals social skills, provide counseling and allow for conversation in regard to their experiences in foster care. The SDQ (Strengths and Difficulties Questionnaire) was provided to foster parents to complete at the beginning of treatment and one at the end. The SDQ measures children psychopathology, social behavior strengths and dysfunctional symptoms and behavior. Scores in the pre-SDQ and post-SDQ indicated that at the completion of the program there was a reduction in dysfunctional symptom reduction and increased knowledge in social skill development. Although, these scores did not prove to be statistically significant, there were improvements noted by the researchers, mainly in the reduction of anti-social behavior. Another improvement noted by the SDQ were on peer problems described by the foster parents. Notwithstanding, the post-SDQ score still marked as “abnormal”, however the initial SDQ scored indicated the symptoms were “clinically significant”. Conduct problems decreased from “borderline clinical range” in the pre-test to “normal” on the post test. Conduct problems are associated with criminal activity and dangerous behaviors which are often displayed in children in the foster care system. Lastly, emotional symptoms remained within the normal ranged pre-SDQ and post-SDQ. The following results, although not statistically significant, prove that group therapy can reduce anti-social symptoms and improve psychosocial properties.
In a 2010 study, Craven & Lee gathered an experimental group of eight boys and three girls, and the remainder eight children were assigned to the wait-list group (age ranges were from 6-11). Meetings were scheduled twice a week for a period of 12 weeks. Effectiveness was measured using quantitative and qualitative data. Data was collected through progress notes, videotapes of sessions, demographics of participants, and bio-psychosocial evaluations. To measure quantitative data two checklists were used, The Child Behavior Checklist and the Behavior and Emotional Rating Scale. The purpose of this study was to promote resiliency by using Transitional Group Therapy with children in the Foster Care System. Transitional Group Therapy focuses on a “cocktail” of evidence-based procedures, such as psychoeducation and play therapy, in a group therapy context. Some limitations were noted with the following study as it was a pilot study and there was a limited number of participants. However, the results showed that Transitional Group Therapy has potential as a treatment for children in the foster care system, but further research is needed.
Through the following studies there were some common themes, such as the lack of further research supporting group therapy for children in foster care despite the positive findings with current research. Some limitations to such, involve privacy laws protecting children, resources, individuals who are willing and appropriately trained to work with minors who have suffered severe trauma, and willing participants. Other issues noted were foster parent and case worker involvement in group sessions. Positive outcomes noted in all these studies involved children’s willingness to share their feelings and experiences with others, increased peer support and reports of positive behaviors and feelings at the conclusion of treatment sessions. As the number of children entering the foster care system increases, so does the need for therapeutic services for these children to deal with feelings of separation, confusion, sadness, anger, etc. While there are individual therapy services allotted to work with children in the child welfare system, wait lists are often long and therapists are limited. Hence, the development of further research supporting the inclusion of group therapy in child welfare agencies will establish another evidence-based treatment that will strengthen the abilities of children in foster care, while allowing them with a space to share conflicting emotions with other children who share these same experiences.
Due to the positive findings in current research, a group session should be implemented with current participants. The following will provide an open and safe environment in which all participants will share their experiences, from living with their parents, removal from their custody and current experiences while in foster care. The number of participants in the current group will be 5 or less to assure that each member is addressed and validated through the duration of the group. Groups will vary according to the ages as the children must ideally be on the same developmental level as other group members to allow for a better understanding of each other’s stories. The current group will address children between the ages of 14-18; other groups, in the future, will include children ages 10-13, and children 7-10. Children below the ages of 7 may not be able to comprehend the complexities of their involvement in foster care, therefore it is recommended that they mainly participate in individual counseling. The following also applies to children who are developmentally delayed and have lower comprehension levels.
In order to participate in a group, each child will undergo a thorough evaluation prior to beginning the sessions. This evaluation will be a biopsychosocial model, which addresses the child’s overall environment, their health and mental health. Two assessments used in this evaluation will include the UCLA-PTSD RI (Post-traumatic Stress Disorder Reaction Index) and the BDI (Beck Depression Inventory). The PTSD RI will assess the child for events that have caused trauma and how they are currently experiencing these trauma symptoms, whereas the BDI will assess for current symptoms of depression. The PTSD RI is a self-report assessment that is given to school age children and adolescents and it measures the frequency of trauma related symptoms within the past month. Because as explained above, children engaged in this group often experience trauma related to their upbringing, the following scale will measure how these experiences reflect in the child’s life. Common symptoms in children with PTSD involve avoidance, intrusive thoughts related to the trauma, persistent negative emotional state, decreased involvement in activities, etc. Some of these symptoms are also experienced in children who are suffering from Depression. Hence it is important to also provide the child with the BDI to assess for current feelings of depression. The following will allow the group leader to understand each child’s functioning levels, their likes and dislikes, their cultural backgrounds, concerns, etc. Foster parents, teachers, social workers and other family members should also participate in this evaluation. These evaluations will be conducted by either a Licensed Psychologist, Licensed Social Worker, or Licensed Mental Health Counselor. The evaluation will also include recommendations made for the child, and whether or not the child will benefit from participating in a group session. In future groups, the evaluation will allow for children with similar interests to be assigned to the same group to allow for connections to form and ongoing support between the members.
The group members will meet once a week for an hour. This time frame will allow for enough time for each member to share a bit of their story and provide input to others as well. The meetings will happen at a foster care agency to allow for easy access and common meeting point. Meetings will occur on Thursdays from 6 pm- 7pm. This will allow for the individuals to have time to participate in other activities after school without interrupting their daily schedules. It will also allow for foster parent participation. Groups will have a duration of two months, hence 8 weeks; however, those we may wish to continue are allowed to do so. Groups will be closed per cycle, once a new cycle begins then new members can be added. This will allow for each member to complete the evaluation to determine which therapeutic techniques, activities and personalities will benefit them more.
Group sessions will focus on the variety of experiences children in foster care undergo. Initially there is trauma attached to the removal from their home, their families and the separation between child and parent. Although these relationships are often dysfunctional and harmful, children create a bond from birth and ultimately love their parents. Hence, being placed in an unfamiliar environment can be extremely traumatizing. Therefore topics addressed in goup therapy will involve, (1) child’s feelings about being removed from their parent’s custody (whether positive or negative), (2) current feelings about being in foster care, (3) their emotions about changes due to their involvement with the system, (4) their current relationships with family members, friends, etc. and (5) their hopes for the future. Because this particular group is with children ages 14-18, as emerging adults it is important to address education and enrollment in college, technical programs, etc. Any concerns brought up in therapy should be addressed with social workers and perhaps with the child in an individual setting to allow to process difficult emotions.
Ideally children who successfully complete group therapy, will have an increased level of support, they would have developed healthier coping skills and have gained resources on appropriate ways to share their experiences and emotions. The child will form relationships with same aged peers, that will involve unconditional support and understanding. The child will have a better understanding of their current involvement with the foster care system. The adults involved in the child’s lives will also have better understanding as to the needs of the child and their strengths. Not only will the adults working will the child become more knowledgeable about that particular child, but they will become more conscious of how their actions actively influence how the child behaves and how they feel. Goals will also be assessed through an exit survey and screening. Children will be post-screened using the PTSD-RI to assess for current symptoms related to experienced trauma and the BDI for current levels related to depression. Ideally the child will have decreased levels of symptoms related to PTSD such increased involvement in previously enjoyed activities, better relationships with peers/caregivers, decreased depressive symptoms. The BDI will demonstrate increased positive mood, attitude and self-awareness.