The Role of Race and Diversity in Work with Children in Child Welfare

Editor's note: This text-based course is a transcript of the webinar, The Role of Race and Diversity in Work with Children in Child Welfare, presented by Alison D. Peak, MSW, LCSW, IMH-E.

Learning Outcomes 

After this course learners will be able to:

• Identify the role of culture, implicit bias, intergenerational trauma, and historical trauma in manifestations of trauma.
• Identify treatment considerations for children, biological parents, and adoptive parents when issues of race and diversity arise.
• Describe the role of privilege in the therapeutic power dynamic.

Introduction

My background or clinical specialty is in children who have experienced early childhood trauma. In other words, infant mental health. We examine what trauma looks like for children between birth and six years old. It is often my privilege to be able to serve children and families who are in the child welfare system. I also help families who have come together by adoption, whether it be private, international, or children who have been adopted outside of DCS custody. What I will share with you today comes from real-life examples walking alongside these children and families. When beginning a conversation around race and diversity, I want to discuss from a clinician's standpoint and perspective. I hope to come from a place of increasing our awareness that our privilege as highly-educated, potentially licensed providers carries with it additional weight to be observant. There is an inherent responsibility to recognize that it plays a role. When we are talking about families and children engaged with child welfare, it has an added layer of importance. 

Early Childhood Trauma and Child Welfare

I want to begin by laying a foundation of early childhood trauma and the child welfare system. Children come into contact with the child welfare system as a result of some form of physical, emotional, sexual abuse, or neglect. That may be drug use within biological parents that resulted in neglect, homelessness, or intense amounts of inter partner violence. I am based out of Tennessee, and we will also see children come in for truancy. We find that often when children are brought into custody, even for issues around truancy, some underlying dynamics are indicative of medical neglect or some form of physical or emotional abuse. 

Foster care numbers. Annually, somewhere between 450,000 and 690,000 children are in the foster care system at any one time. That is a broad range number because children do come into and exit custody often. There are also periods throughout the year where children tend to go into custody, and numbers will spike considerably. We see a large number of children come into custody shortly after the school year begins. Often that is because children have been in a position over the summer where there were not people observing what was going on within a family situation. Children are registered for kindergarten, and cases that had never been on a professional's radar before, are now glaringly obvious. Then we also see a lot of children exit custody right around the holidays. The court systems try to get children home before the holidays, if it all possible. They also like to finalize adoptions right around the holidays. We see general swings based on trends of other kinds of social factors. 

Child trends data. ChildTrends data is the national clearinghouse for all data related to child welfare. From the most recent year available, ChildTrends identifies that about 23% of all children in foster care are African American. In comparison, only 14% of the population of all children in the US are African American. For Hispanic children, that is 21% in foster care versus 25% of the general population, and about 7% of the foster care population is biracial. In contrast, biracial children only make up 4% of the greater population. We do see an over-representation of children of color in the child welfare system when compared to children outside of the child welfare system.

Child Welfare and Risk Factors

Poverty. What are those risk factors that lead to children being removed? It is often complicated by poverty. Poverty has a significant role to play in the reasons that children are removed and placed in foster care. We hear so often about the frustrations that biological parents have around this issue with poverty. Foster families often receive food stamps, clothing, a child care certificate, and per diem for their children. Biological parents will say if they received such provisions, they would not be struggling as much. Those issues around socioeconomic status do complicate the factors that bring children into custody as well as caregivers with mental health, substance abuse concerns, and neighborhood safety are often seen. We will often see children come into custody that have been wandering around the neighborhood without supervision. They were in some kind of housing like a single room occupancy hotel and were found in the parking lot, where there may have been gang violence, drug deals, other types of illicit and illegal behavior. When the police arrived for whatever other purposes, then there were these children that no one seemed to know who they belonged to. 

Child Welfare Placement

Foster care. Placement changes in foster care are considered to be their own traumas and delay development by six months for every move. Children frequently have three or more placements, delaying their development by 1.5-2 years. Anywhere between one foster child to multiple foster children are placed in a home with caregivers. Whether it be one caregiver, two caregivers, caregivers who are married, or family situations where two generations have foster children together. There are situations where biological children present, or children adopted from the child welfare system in addition to foster children exist. 

Group homes. Children sometimes are also placed into group homes. These are considered to be a next-level step up. Group homes consist of some type of staff who are on-site at all times, 24/7 with a lower level in security, and also fewer number of children. There may be six to eight children and two to three staff on a shift. Typically, they are homes in a neighborhood. If you didn't know that it was a group home, then you could not pick it out because it somehow looks different. They are generally not identified and do not have signage. They do offer additional services for children in child welfare, and also provide some other supervision and accountability.

Residential treatment. Then there's also the option that children would go into a residential treatment facility. Those can look anything from a summer camp, or dorm room with bunk beds.

Within this broad spectrum of options for placement, there is also a broad spectrum of outcomes. Within the child welfare system, the first goal is always, unless there has been severe and heinous abuse, that those children will return to the biological family. Parents get that opportunity to work a permanency plan to see if they can rectify the mistakes that brought children into custody, and that those children will hopefully be able to return home to a parent. Sometimes that happens, and sometimes it doesn't. In the situations where it doesn't, the option becomes that those children return to a kinship placement. Somebody else who they're still biologically related to, but maybe wasn't the primary caregiver, who really couldn't take care of those children in the first place. Or, there's going to be a process of termination of parental rights and subsequent adoption. 

Child Welfare and Child Development

Placement changes. Placement changes also occur fairly frequently within the child welfare system. Most states are working to decrease the number of placements that children experience. Placements can be changed for a multitude of purposes. A family may decide that the foster child placed with them has behaviors that they cannot manage. There may be a home that is open closer to the county where the child was removed from biological family, which is always a priority that they remain as close as possible. Children change placements. We know scientifically that changes in placement are each individually their trauma and will delay development by about six months at every move. For children who have received three or more placements, we're talking about delaying their development on average one and a half to two years. Yesterday, we did a consultation on a five-year-old who's had 11 placements in the last two years. The number of traumas and the delays associated with that is longer than his life in total. We have to consider how the child welfare system is set up. Trauma symptomatology for the children who do rely on the system for their basic needs and caregiving in relationships. 

Trauma-specific services. It is also important to note that out of the 450,000 to 690,000 children in the child welfare system, only about 10% of them ever receive trauma-specific services. 10% is not a high number. What are the motivations that the 10% are seen as needing services? Also, what is the conjoining factor that the other 90% are seen as not needing services? There is a multitude of barriers that prevent access to mental health and trauma services for children in child welfare. One of them is the recognition of child welfare as their trauma. That being removed from your parents, regardless of the situation that brought children into child welfare, is in and of itself a traumatic experience.

Early childhood trauma associated with foster care placement is inexplicably linked to increased symptomatology of PTSD. We know that the rate of PTSD in children outside of the child welfare system is a much smaller percentage than if we isolate the population of child welfare, and we test for PTSD just in children in foster care. The rate of PTSD is much higher. Children who have had early childhood trauma are more irritable, and they have a lot more difficulties in relationships throughout their life span. Relationships have not been easy for them. They have often not been productive or supportive, and they have often been places that create and result in fear. We know that there are neurological changes around emotional regulation for children who have been in foster care and have had early childhood trauma. There are also observable (e.g., EEG PET) scan level changes within the brain when we have had chronic exposure to trauma and stress. If children have been in child welfare, we also know there's an increased rate of mental health and substance abuse concerns. There's also an increased rate for academic difficulties. 

Defining Trauma

Types of Trauma

We had a 12-year-old come in for an intake, and I asked if there was any history of mental health concerns in the family? The 12-year-old said, "well, my grandfather killed himself, and my great grandfather killed himself, and let me tell you how". There's this heightened anxiety that this intergenerational trauma has been passed down over and over again. Trauma has a broad spectrum definition. Here are the various types of trauma:

• Single Incident
  • Occurs on one occasion. May require services. Generally, well treated quickly in the presence of supportive, consistent, caregivers.
• Chronic Trauma
  • Trauma is a consistent piece of life. Treatment is prolonged due to the depth and tangled nature of the trauma
• Intergenerational Trauma
  • Trauma that is passed down through generations by mechanisms such as secrecy about the horrors of the trauma or, on the contrary, telling and retelling of the traumatic events and through heightened levels of stress

Forms of Trauma

Historical trauma. A cumulative emotional and psychological wounding over the lifespan and across generations, emanating from massive group trauma experiences. Historical traumas have been perpetuated. This results in a dynamic where, those same people who have had this historical trauma in their background, who feel that historical trauma in their epigenetics, are then confronted by an individual in a place of power, are going to have a biologically based response. Historical trauma is going to create and manifest in modern-day, interactions, and because our DNA tells us this has been a scary, horrible thing that has happened to people who look like me, perpetuated by people who look like me.

Neurobiology of historical trauma. We know that trauma changes the epigenetics and the DNA makeup of individuals. That there's somehow a response within our DNA, by an outside presence. We see this quite clearly within identical twins. As identical twins grow up, they increasingly look less and less alike because the events that have occurred to them individually have been processed differently by their epigenetics and have shifted things. It's also the place where we see the biomarkers for family histories of cancer, or heart disease, or even alcoholism and substance abuse. It is generally an external event that will flip a switch within epigenetics that causes it to be displayed in some individuals, or maybe recessive in others. Historical trauma, systemic racism, intergenerational trauma will create these epigenetic shifts that then get passed down through generations. 

A research study in which they took a section of mice and elicited a smell that the mice liked. The mice would wander over to the scent, and when they would get close to where the smell was coming from, the scientists would shock the mice. They did this repeatedly for some time, and then they took semen from the generation one of the mice and created a second generation of mice. Put the mice in the cage, elicited the smell, and the mice all panicked. They all had a biologically based response. They had a body-based, completely observable response to this smell, even though they had never been shocked, and there was no actual behavioral association with what was happening. It is not until the fourth generation that we begin to see some shift in response to what is now a neutral stimulus.

When we think about this in the context of what epigenetics and our neurobiology have to do with our historical trauma, we are not four generations removed from many of the massive horrors that have happened to people in our country, and many, many other countries. There's still this inherit a body-based epigenetic response to what these historical traumas mean for our safety in the modern-day. It's a curious thing to think about that in the application of what it looks like in the context of therapy. What does that then look like for the people who come through our doors? What does that look like for those individuals when they walk back out onto the streets and live their own lives? How have those historical traumas and intergenerational traumas shown up within their own families? How did those things get addressed? It's a curious point of consideration. 

Colorism. One of the other traumas that we also frequently see is this idea of colorism, which occurs in minority populations of valuing some skin tones over others. For example, groups of individuals with darker or lighter skin or certain hair textures in certain cultures, that there's a likelihood that you will be safer, in more danger, picked on, or preferred over the other. I had a set of twins in an African American family, where one of the children was much lighter skin than the other one. There were often comments from the biological mom about, "this is my white baby. Did you see my white baby?" They would often go back and forth, and say things to each other, about the color and tone of their skins, and that one was good, or one was bad as a result of that. When we think about this piece of trauma, and that trauma in early childhood is also quite frequently marked by this real internalized sense that children have caused trauma. In that place of hearing those messages and seeing evidence of these things, then this becomes a real place of formation of identity. If I had been lighter, darker, had different hair, somehow spoke differently, then maybe all of these things would not have happened to me. 

Role of Trauma and Culture

Culture is an inherent part of human development. Culture is embedded in our child-rearing practices, holidays, food, and the way we understand our world, etc. Cultural expectations can be broad (e.g., religious beliefs) or seemingly minor (e.g., cleaning your plate). Traumatic experiences influence cultural beliefs and expectations. Culture has a lot to do with how we understand death and dying, how we understand celebrations of life, of birthdays, of how and who we identify as family. It also really engages in this place of both culture and behavior. Different cultures demonstrate healthy relationships and bonding, through a variety of different behaviors, that it's not all the same, and it can't be observed the same. Often, the nuances of placement go to the back burner, because what is essential at the moment is that these children have a place to sleep. What does that mean for these children to be then placed in homes where there are reminders of these forms of trauma? How is that then internalized and received from that child and questioned? Cultural expectations can be vast. Sometimes the things that we identify as clear markers of culture such as religion and language are there, but they're not the only representations of what it means to have internalized a culture in our early years. We know that traumatic experiences influence cultural beliefs and expectations. When we look at research in international populations where trauma has occurred to a community, then we will see that those attachment and bonding relationships in early childhood shift. That there's an expectation that children stay closer to caregivers because it's going to keep them safe. That children don't wander into certain types of areas because that's going to keep them safe. That children become independent very quickly, because parents may not live, and we need you to be able to take care of yourself. Cultural belief and the experience is shared by our culture rather than influence how that relationship develops. 

Culture and Symptomological Presentation

There are also real interplays between culture and symptomological presentation within the Hispanic community. We see increased rates of anxiety within the Hispanic community. My agency serves a fair number of children who were detained at the border in detention facilities and then placed into federal foster care. We have consistently seen similar presentations in their trauma: high anxiety and intense manifestations of nightmares. We will also see a variety of cultures talk about demon possession. A few years ago, we had a refugee come in from Iraq. The child was 13, and the family was quite insistent that he was demon-possessed. He was having intense nightmares frequently and would have visualizations of seeing the trauma. He was having a hard time regulating and cried a lot. In a westernized or American-centric view, we would have said this child had PTSD. As providers, we have an assumption of how trauma should present itself.

Interestingly, the reason that the child from Iraq was referred to me was because the physician was incredibly concerned that the family thought he was demon-possessed. The physician was worried that he had schizophrenia. We make this leap rather than hearing through the culture, maybe what our translation would be, or how we might see it or approach it. We might not be right.

We have this assumption from a majority perspective that we are right that our language is correct. In the beginning, I mentioned as social workers; we have a responsibility to ask questions and to check our own implicit bias. Be able to acknowledge that we have our personal implicit bias and assumptions, and to check in with those clients and ensure that we are hearing their individual story and not our assumption of what it must be like. 

Culture within Adoption

Transracial Foster/Adoption

Transracial foster and adoptive families are typical in child welfare. Consider a time where you traveled to a foreign country or a state in a different region of the US. What emotions did you experience? What questions did you have? Consider the experience of a child placed into a home that is not their own with caregivers who do not look, sound, or interact like they are accustomed to. We talked about how responses to trauma are also cultural. That all cultures have a way of responding to trauma, of coming together of addressing things. There are several LGBTQ families with foster and adoptive children in the child welfare system specifically. Also, a large number of white families have African American children, vice versa, and everything in between. When we think about taking especially young children and then placing them in families from a variety of backgrounds, there is also that piece of culture shock.

Working with Transracial Foster/Adoption

The Multi-Ethnic Placement Act of 1996-and its amendments-made it a violation of federal law to consider race as a factor in placement decisions. It was intended to decrease the capacity of foster parents to refuse children for placement due to a child's race and ethnicity. With this act in place, you could no longer consider race as a factor of placement. Before that, not only did federal law permit it, but it was common practice that race was a consideration in the placement of children within the child welfare system, which means that an agency could decide that they were only going to place African American children in African American homes, or that they were only going to place white children in white homes, etc. What often happened as a result of that was that agencies would only recruit for specific populations of foster parents. They would recruit in highly Caucasian neighborhoods and highly Caucasian churches. Then they would have all of these Caucasian foster parents where placement just wasn't possible because they wanted to ensure that children of color were with foster parents of color. The federal government came in and said; you can't do that anymore. Simply put, children need homes.

At that time, the National Association of Black Social Workers also said we could not forget that children have come from a place of culture, regardless of what their culture is. That we cannot usher them into families where they are absorbed into majority culture, and their culture of origin is completely forgotten. The NABSW still maintains that this piece around race is not an option of any type of factor in a placement decision. When we think about transracial foster and adoption, it does bring up implications for interactions between children and foster parents. Often, this will foster great conversation between children and foster parents. Still, it does call for there to be a necessity that providers can discuss race with children and families in child welfare. We have to be able to acknowledge that. Providers need to be able to discuss race with children and families in child welfare.

Good enough attachment refers to quality, healthy, parent-child relationships, in children who are adopted. When we think about that gold standard, and then interlay it with the idea of transracial foster and adoption. Again, it is not perfect, but good enough. We can engage in that dance of attachment. Good enough attachment of children in transracial foster/adoption is often predicted by:

• Child's formation of cultural identity
• The cultural background and awareness of this background of the foster/adoptive family
• Child's experiences with members of their race

Betrayal trauma. Experiences of trauma and colorism can result in betrayal trauma. Betrayal trauma is implying that an individual feels as though others who looked like them betrayed them in creating safe, predictable spaces (Jobson, Moradi, Rahimi-Movaghar, Conway & Dalgleish, 2014). An article was written about When I Grow Up I Want to be White (Lewis, Noroña, McConnico & Thomas, 2013) is this story of a little girl who was African American in New Orleans, placed into a biracial family. One of the parents was white, and the other one I think was Hispanic. An individual from CPS who removed her was also African American. The first foster home in this situation had been incredibly physically abusive, was also African American. This child had grown up with this experience of the people who looked like her, had perpetuated traumatic events.

Understanding the experience. When working with transracial and foster and adoption, we must understand and own our own implicit bias. That we know what those blind spots are, and that we can recognize them at the moment when they come up. That's hard work. It's a lot of digging into ourselves and recognizing the places where we didn't even realize that we were holding some nasty, ugly things. Research demonstrates that African American clients and parents often identify that white providers understand their culture from the perspective of cultural activities, but rarely realize that their experience in the day-to-day world is different. As a provider for transracial foster and adoptive families, it is essential to speak to the issue of race as it impacts the family. Acknowledge privilege and often and make race a common part of the conversation. Assist families in acknowledging the differences and unity of their transracial foster and adoptive family. There are great things that all families share, but the experience of being a minority is one to be acknowledged as uniquely it's own. We want to facilitate a connection with groups that share similarities to the child's culture of origin and be able to recognize the child's readiness for this. Assess possible connections between cultural events and traumatic connections. Ultimately, we want to be able to put these families and children whom we serve in connection with cultural events, groups or youth groups, to be able to build a positive sense of identity around who they are. 

References

Buhmann, C. B., Nordentoft, M., Ekstroem, M., Carlsson, J., & Mortensen, E. L. (2018). Long-term treatment effect of trauma-affected refugees with flexible cognitive behavioral therapy and antidepressants. Psychiatry Research, 264, 217-223.

Chakawa, A., Frye, W., Travis, J., & Brestan-Knight, E. (2020). Parent-child interaction therapy: Tailoring treatment to meet the sociocultural needs of an adoptive foster child and family. Journal of Family Social Work, 23(1), 53-70.

Cohen, J. A., Scheid, J., & Gerson, R. (2014).Transforming trajectories for traumatized children. Journal of the American Academy of Child & Adolescent Psychiatry, 53(1), 9-13.

Cromer, L. D., Gray, M. E., Vasquez L., & Freyd, J. (2018) The relationship of acculturation to historical loss awareness, institutional betrayal, and the intergenerational transmission of trauma in the American Indian experience. Journal of Cross-Cultural Psychology, 49(1), 99-114.

Fortuna, L.R., Norona, C.R., Porche, M. V., Tillman, C., Patil, P. A., Wang, Y., Markel, S. L., & Alegria, M. (2019). Trauma, immigration, and sexual health among Latina women: Implications for maternal-child well-being and reproductive justice. Infant Mental Health Journal, 40(5), 640-658.

Jobson, L., Moradi, A. R., Rahimi-Movaghar, V., Conway, M. A., & Dalgleish, T. (2014). Culture and the remembering of trauma. Clinical Psychological Science, 2(6) 696-713.

Kim, J. & Tucker, A. (2020). The inclusive family support model: Facilitating openness for post-adoptive families. Child & Family Social Work, 25(1), 173-181.

Lewis, M. L. (1999). Hair combing Interactions: A new paradigm for research with African-American mothers. Journal of Orthopsychiatry, 69(4), 501-514.

Lewis, M. L., Noroña, C. R., McConnico, N., & Thomas, K. (2013). Colorism, a legacy of historical trauma in parent-child relationships: Clinical, research, and personal perspectives. Zero to Three, 34(2), 11-23.

Lewis, M.L., & Norwood, R. G. (2019) "When I go to heaven, I'll be white": The ethics of transracial adoption within the context of childhood trauma and identity development. Zero to Three,12- 21.

Mancoske, R. J., Lewis, M. L., Bowers-Stephens, C., & Ford, A.  (2012). Cultural competence and children's mental health service outcomes. Journal of Ethnic & Cultural Diversity in Social Work, 21(3), 195-211.

Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.

Zhen, P., & Gray, M. J. (2015). Posttraumatic coping and distress: An evaluation of western conceptualization of trauma and its applicability to Chinese culture. Journal of Cross-Cultural Psychology, 46(5), 723-736.