Therapeutic Foster Care

Please understand that I am not a doctor, counselor, or therapist. I am simply a parent who has been fostering for 6 years now and I am giving my own personal opinions on things. The names of the children in this article have been replaced with: Child X, Y, and Z.

Introduction

            The one thing to remember with therapeutic foster care (sometimes called "Intensive Foster Care", IFC for short), is that you must always expect the unexpected. We were unprepared for all the trials and all the joy that we would experience while taking care of children with special needs.

            In 2004 our youngest son (Child Y) was born with Autism. This was not something we were expecting so when we finally discovered this it hit our family pretty hard. I was in denial for a long time thinking that he was just delayed or that the arm flapping was just some idiosyncrasy of his. (Child Y) did not do many of the things that typical children do such as cooing, babbling, ect. The diagnosis of autism impacted my wife much more than myself. The reason for this was due to the fact that she knew much more about autism than I did. In fact, I knew nothing at all about it. You might say for those first few years the statement "Ignorance is bliss" described me. After a few years of struggling through (Child Y)'s diagnosis and wrestling with God over it, we learned, by God's grace and mercy and by his power, how to handle it. Do we still have times of frustration and anger over it? Absolutely, but for the most part we have learned to rely on God and live with the diagnosis.

            The reason I mention (Child Y) and his diagnosis is because it was through (Child Y) that we decided to do therapeutic foster care. It was my wife who had the brilliant idea. She said that maybe we should look into helping other children with special needs, after all God, we felt, had been preparing us for this kind of work. After a time of prayer and discussion, we took the plunge and the adventure began.

Short-term vs. long-term placements

            One of the first things to understand when preparing to do therapeutic foster care is the difference between short-term placements and those that are long-term. The reason this is important is because there are different challenges to be faced with each type of placement.

            Short-term placements are typically anywhere from a day to a few weeks in length. These children can often be well behaved, showing little or no signs of behavioral issues. Your home, family, and environment are all new and exciting for some children. You may be pouring out gifts and making them feel special. You have not yet had to discipline bad behaviors and so the child might see your home more as a vacation of sorts. You may not run into many behavioral issues if you chose to do short-term and/or respite care.

            There are of course children that are hard to handle even when they are staying with you for a short time. They may simply have been in the system so long that they have become bitter and feel like they are being passed from one place to another or it may be that a child has just been removed from their home because their parents (or the living environment) have been found to be unfit for some reason. These children can feel that you and your home are strange and that you are in some way responsible for taking them away from their family. As a defense mechanism they may be distant, difficult, or unresponsive.

            Long-term placements can be anywhere from a few months to a few years or event until the child ages out of the system. Children that are placed in your home on a long-term basis are more likely to become attached emotionally to your family. It is also very likely that your family will become emotionally attached as well. As with many short-term placements, long-term placements may, at first, feel like your home is a vacation. The same feelings of newness are often there. This period is sometimes referred to as the "honeymoon period". There can be a temptation for new foster parents to overdo things. Going out to eat more often than normal and always giving the child the choice of where you will eat. Buying lots of presents, toys, clothing and over doing praise (not that helping your foster child with self esteem is a bad thing). In short, spoiling the child. This only contributes to the feeling that your home is a holiday. This kind of thing happens to many first time parents as well. You want to give your child more than you had but in the end this kind of parenting often backfires and the child can become spoiled. Once the "honeymoon period" is over and you have to start disciplining bad behavior your foster child might swing in the opposite direction. At first they were the picture of sweetness, very much like Annie (the foster child from the movie Annie) but now that there are rules and consequences for breaking those rules the child can become almost uncontrollable. This can certainly happen, and does, even if you have not spoiled the child for the first few weeks or months during the "honeymoon" phase.

            Something else to consider when taking in long-term children is that they become a part of your family, which is a good thing in one sense because having a permanent home can often help to stabilize a child, but can also be a cause of pain and loss if that child is reunited with their biological parents, move to another foster home, or are adopted. This kind of attachment is not a bad thing as long as you and the child understand that although this is a fairly permanent placement there is probably coming a day when they will leave your home. It is also very helpful for the child because they have learned how to trust, love, and form appropriate attachments. These lessons will often follow the child wherever they go.

Physically demanding

            Taking care of children is a physically demanding job. You run around trying to catch them, clean them, feed them, and play with them. That is true for all kids, but once you add a child that has special needs into the mix, you have other challenges to face as well. For example, you may have a child with hyperactivity. That means they run like the energizer bunny. They keep going, and going, and going. They simply don't stop. For children with this disorder, it becomes important to keep them busy. Signing them up for sports or taking them for walks, ect. helps give that child a positive outlet for all that energy. If the child does not have that outlet they will very likely display behavioral issues (Possibly hurting themselves and/or others) or simply be very loud and fidgety. One of our children, who has ADHD (Attention Deficit Hyperactivity Disorder) will sometimes speak very loud in a very high pitch voice. He is trying to release some of that built up energy. These kinds of things can be helpful clues that your child may need to go for a walk or play a game, something to use up that energy.

            There are also lots of doctors visits and specialist visits to go along with all the other activities. Every child has to go to the doctors for shots and physicals, but when your child also has special needs there are all kinds of other visits that come up. You may have family counseling to go to. The child may have their own therapy as well. You need to take them to medication visits. That is, there are special doctors who prescribe and monitor the child and their medications. These are often different doctors than the family doctor or the pediatrician. With our son (Child Y) he not only has Autism but has a form of epilepsy and, you guessed it, he has a special doctor that we have to go and see every so often to check the medication he is on as well as check blood levels.

            So you have the family doctor and the regular visits as well as therapy and possibly medication doctors, but we are not done yet; you also need to bring your children to the dentist. Not too many children like going to the dentist, in fact, not many adults like to either. But when you have a child that has autism, anxiety, or some other disorder, it can be an absolute train wreck. Our son would yell and scream and tremble in fear when the dentist would come close to him with all those strange tools. It took us years to get him a full dental examination and it only happened once we found a specialist who treated autistic children. Here is where you may need to do some research. The local dentist may not be trained to deal with children who have special needs. That means you will need to ask other foster parents or parents with special needs children where they go. You may need to ask your foster care agency if they have a list of dentists/doctors who deal with these issues. This is simply one more thing to add to the list. So add another doctor to the already long list. Mom and Dad go to one dentist and our son goes to another one that is an hour away.

            Because of all the doctors, therapists, and other appointments it becomes imperative that you have some kind of event planner. My wife uses a plain calendar and we write all the appointments and which child the appointment is for. Here organization is key. When you take in foster children you are expected to make and keep all these appointments.

            At other times you have those emergency visits to the hospital or doctor's office. E.R. visits can certainly be a normal occurrence for parents in general. Some parents have that "accident prone child" but with special needs children the visits can also be fairly regular.

            One of our foster sons, (Child X), was born addicted to drugs which resulted in all kinds of medical issues, from being born premature and having a very low birth weight to being extremely fussy. Today he has ADHD (Attention Deficit Hyperactivity Disorder) but he also has asthma, both are the result of being born addicted to drugs. With (Child X) there have been frequent visits to the E.R. because of his asthma. Waking up in the middle of the night to the sound of a child coughing and who is unable to catch their breath is scary, both for the child and for you, the parent. We have spent many a night with him in the E.R. or up giving him breathing treatments.

            Another one of our foster sons, (Child Z), woke up one night acting strange and telling us that he was hearing voices in his head. Off to the E.R. we went to spend the next five hours waiting for the Crisis team to come and check him out to see if he would be returning to our home or be moving to an institution.

            Not only do you have lots of doctors visits and other kinds of visits to attend you also have lots of people coming into your home. When you do therapeutic foster care you have a worker who visits each and every week to check on you and the child. They make sure you have everything you need and that child is not being abused or going without, as well as other things. You also have monthly meetings and quarterly check-ins where a worker will come and inspect your home to make sure you are up to code (the home is safe; fire extinguishers, smoke detectors, ect). That doesn't include the visiting mentors that some children need or the lawyers that some children have if they are an award of the state. That also doesn't include the child's adoption worker (if they are going up for adoption). It also doesn't include that therapist that you may need to work with your child on a daily basis. We have a wonderful ABA (Applied Behavioral Analysis) therapist who comes into our home most days of the week to work with our son (Child Y). As you can see, this kind of work is physically demanding.

            There are two keys to managing these demands in a proper way. The first it to make sure you stay organized. Things are already physically demanding, but when you are unorganized they become chaotic as well. And the second thing is to make sure you and your spouse communicate. You will need a break, some time off. It may be to simply get a coffee or go to the park by yourself. Whatever that break is you will need to work as a team and give each other the time you need to relax and recharge. My wife and I simply say to each other, "I need a moment". Being open and honest and being able to communicate with each other is imperative.

Emotionally demanding

            When doing therapeutic foster care it is physically demanding, as already mentioned above and your home is often overrun with people coming and going constantly. Life is full of appointments as well as doctor visits, therapy visits, and Emergency room visits. These all add up to create a very physically demanding life.

            Once the body becomes tired the mind and emotions soon follow. All the activities, lots of sleepless nights and long days can drain you physically. Once that happens, you can become emotionally drained as well. Special needs children are often harder to care for and depending on their mental functionality and capacity they may do things that are simply dangerous without understanding that what they are doing could lead to injury or death.

            (Child Y) wandered away from home on three separate occasions. He isn't trying to run away he's trying to go visit his Nana. He knows where she lives and could certainly find it, but she lives about 20 minutes away when driving in a car. Not only that, but there are major roads that have lots of fast moving traffic. (Child Y) has opened the front door and tried to go to his Nana's house, but he doesn't put on his shoes so he is walking barefoot. He doesn't speak much so he isn't going to interact with people. The first time he did this the police found him and were asking him where he lives. (Child Y) would not tell the officer, not because he was being fresh, but because (Child Y) only knows how to respond to certain questions. The officer would have needed to ask him what is his address not where do you live.

            After that episode we took (Child Y) to the local police station and had him photographed and gave them the needed information. But that event was extremely emotional. Since then we have placed alarms on our doors and windows. We have also placed locks on the doors, but that hasn't stopped (Child Y) from wandering away.

            The last time (Child Y) wandered away was about four weeks ago. The door was opened because we were getting ready to leave for a birthday party and we were going in and out. (Child Y) saw the door opened and decided he would take a walk. We don't know why, but (Child Y) ended up going into a strangers house and turning on their TV and using their computer. The owner of the house was home and obviously a little shocked when he saw a strange child in his home who, believe it or not, demanded something to eat. Thank God almighty that this man was not a child predator or some kind of dangerous person. This man simply called the police. I was on the phone with the Police at the same time and my wife was off in the car trying to find him. Again he was returned safe, but these kinds of things are extremely emotionally draining.

            It is highly recommended that if you have a child such as (Child Y), who does not speak or speak much, that you take them to the local police station and have them photographed  and also let them know if there are certain questions that they would need to ask your child in order for them to give the appropriate answers.

            Another area where fostering children becomes emotionally draining is when the child you have been caring for is removed from your home for some reason. It could be that the child is being reunited with his or her biological parents or it could be that the child has become too difficult to work with and the agency decided that child needs to be moved to a residential facility. No matter the reason, when that child that you have cared for, loved, mentored, and shared good times as well as difficult times with leaves, there are deep emotions that are difficult to deal with. It doesn't matter how often you remind yourself that this child is only with you for a short period of time, if that period of time is anything more than a few weeks (ours were always years), it is as if someone is taking your children away, because in reality they are. You have loved and cared for these kids, nursed them back to health when they have been sick and held them in your arms when they have been hurt or gotten upset. You have been there for the victories and for the defeats.

            Here a strong relationship with God and your spouse is, again, key. You want to share your struggles and your heartache with God and with your spouse. You may also need someone to talk to about your feeling of loss like a good Christian counselor or a close brother or sister in Christ (someone you can trust). There are lots of foster parent support groups on Facebook and other online sites but there may also be a group that meets in your local area. These support groups can often be a great place to meet other foster parents who understand what you are going through and will be there to give helpful suggestions. These kinds of networks are also great for researching doctors or dentists that specialize in working with special needs children.

Adaptability

            It is important to keep in mind that you will need to constantly be adapting to each new situation. Each child brings their own set of challenges and issues. Each child responds differently to the demands of family life, school life, and social environments. Each child responds differently to discipline. What works for one child doesn't always work for another.

            Some children thrive with one-on-one attention. They need those personal interactions (Of course all children need some amount of one-on-one attention, but certain children need more of it than others). If you have other children in the home, you may need to make plans to have some alone time with each child, paying attention to those that really thrive in that situation. Other children thrive in a group environment. That means that if there are no other children in your home you will need to make arrangements with other parents for play dates or regularly bring that child to the park to play with other children or sign them up for various sports. Again, each child is different and each situation is different. Adapt and change is the name of the game.

            Some children are impulsive, not thinking through the consequences of their actions. One of our foster children is like that. Before he came to live with us he was in a group home. One day, without thinking, he decided he would hang from the fire suppression pipes. As he did the pipe broke and flooded the building. If you have a child who is impulsive then you may want to walk around your house and your yard looking for potential problem areas and either making them safe or simply keep that child out of those areas.

Medications

            Many children in therapeutic foster care are on medications for different reasons. Some are on anti-psychotic medications, others are on ADHD medications, still others may be on multiple medications for multiple diagnoses. As a foster parent one of your many jobs is to administer these medications. Keeping track of a child's medication(s) is of utmost importance. As you can imagine if a child skips a medication or is given the wrong one at the wrong time it can cause all kinds of problems. Reactions can be anything from erratic behavior to suicidal thoughts and more. Diligence is needed when administering medications. One way to help keep track of the proper medications and the proper times to give them is to use medication organizers (Pill organizers). There are a variety of kinds and sizes. If you chose to use this kind of organizer make sure the agency you work for allows you to use them. Some agencies do not allow parents to use these organizers, but instead demand that the pills stay in the original bottles with the original labels on them. They see this as a way of making sure your foster child is given the correct pills at the correct times because the bottles will have all that information on them.

            If you are unable to use a pill organizer you can always use a reminder on your phone or computer to tell you when the medication is needed and what dosage, ect. Most phones and computers have programs that allow you to set up reminders with notes. In the notes field type in what child receives which medications and then set that reminder to go off at the appropriate time during the day, then simply do the same for all of your children that are on medications. Again, this is an area of extreme importance and organization is key.

Extremely Rewarding

            It may appear from what I've written so far that there are more difficulties and challenges than there are joys. That is simply not true at all! The joys really do out weight the stress and the struggles. The struggles are real, this is real life with real children who have real needs, but the joys are every bit as real as well and in my opinion simply out weight the difficulties (So long as you are doing it for the right reasons).

            When you watch your foster child or your child who has special needs, play soccer and score their first goal there is joy there. When you watch as they practice Karate and get their first belt, you rejoice with them in their achievement. And when your child who has special needs crosses the finish line after running in the Special Olympics and shows you their "proud face", you feel that joy deep inside.

            It is also extremely rewarding to know that you are working for God. James tells us that "Religion that is pure and undefiled before God, the Father, is this: to visit orphans and widows in their affliction... (James 1:27, ESV)". Jesus made it clear that what we do for others, we do for him and so keeping that in mind, we are blessed to be able to serve Christ by taking care of these children.

Some Lessons Learned

            Throughout all the pain, difficulties, and joys we have learned so much. I can only share a few of the things we're learned because time would simply not allow me to go into detail.

            One of the things we have learned though our experience working with special needs children and foster care is patience. We are much more patient now than we were before having (Child Y) and fostering. Are we perfectly patient all the time? Not at all, but have we grown? You better believe we have. It takes patience to work with your child who doesn't speak. It took (Child Y) a very long time before he spoke one word. During that time we learned patience as we used PECK boards and sign language in order to communicate with him.

            When (Child X), who runs non-stop like the energizer bunny, tries to tell you something, but he is going all over the place, that takes patience and when the agency you work for or the State continually wants to do things that you know would be the wrong thing for your child, that takes patience.

            My wife and I have also learned to rely on each other more. We simply know when the other one is getting worn down and needs a break. She will say to me "I think you need to go out for a while" or I might say to her "I think it's time for you to go get a massage". We have learned to work together better and have learned to rely on each other.

            Probably the biggest thing we've learned in the 7 years we have been doing foster care and the 11 years we've been raising (Child Y), is to lean on Christ for our strength. There is simply no way we could have done any of this on our own, maybe others could have but we couldn't. Our prayer life is stronger as we daily ask him for strength. We are always asking him for wisdom and guidance and always asking him to give us the ability to love and care for these children. We of course pray for them and thank God that he has blessed us by placing these children in our home.

What is needed

            This was mentioned briefly above, but let me take some time to elaborate here. There are two major things that are needed when doing Therapeutic Foster Care/Taking Care of Children with Special Needs.

            The first and most important thing is that you and your spouse have a strong walk with God. You will need to rely on him and his strength on a daily and many times and hourly basis. It is no good to have a superficial relationship with God. One where you say hi to him once or twice a week at the worship service or Bible study. Of course, this should be the normal life for a Christian any ways, but sadly it is not always the case. It is important to keep in mind that God is the Creator and Sustainer or life. He is able and willing to help you through the good times and the bad.

            The second thing that is needed is a strong marriage. You will be tested in all kinds of ways. You will be stressed and tired. You will get angry and frustrated (Not always with the children, but many times with the system). You will need to be able to communicate with your spouse and let them know when you need some time or when you feel overwhelmed. If your marriage is not strong adding a special needs child into the mix is really a recipe for disaster. That does not mean that there have not been couples whose marriages were weak and they took in a child with special needs and their marriage survived or was even strengthened through the process, but that is more of the exception than the rule.

            Make sure you talk things over before you jump into Therapeutic Foster Care and make sure the lines of communication are open. There will always be surprises, but try to talk over some of the anticipated difficulties and obstacles you imagine might come. It is far better to talk things over before you have a child placed with you and while things are clam than to try and do it in the midst of a torrent of emotions and frustrations.

            Be honest as well. If you do not think you can handle a special needs child or simply do not feel called to do Therapeutic Foster Care, make your feelings known. If you do not want to do this and you end up taking in a child it will not be long before you start to resent your spouse and become bitter over the whole situation. You want this to be a positive experience for you and these children. So be honest!

Know why you are doing foster care

            It is also important to know why you are doing foster care in the first place. If it is simply for the money there are plenty of other jobs you could do. Please do yourself a favor and the children in foster care a favor, do not move forward. If you are only in this for the money, it will not be long before the money is not enough of a reason to keep you lovingly motivated. You are likely to get burnt out faster and give up if your sole reason is because you think this might be an easy way to make a living. If you do get burnt out and give up that will mean sending that child away to another home or institution. So please think carefully before you go forward.

            Doing it to serve Christ by serving these children was why my wife and I got started. We believed that God had been preparing us to do this kind of work. It is my conviction that the main reason a Christian should do foster care is to serve God almighty, to be his hands. When foster care becomes hard and difficulties arise, and they will, knowing that you are working for God helps to keep you focused and motivated.

Conclusion

            There are certainly lots of challenges and struggles when taking care of children with special needs but there is something extremely rewarding as well. I am always reminded of the passage of scripture that says: "Religion that is pure and undefiled before God, the Father, is this: to visit orphans and widows in their affliction... (James 1:27, ESV)". We are here to work and serve our Great God and Savior, Jesus Christ and one way we have done that is by taking care of children with special needs. It has been a privilege and a joy, even in the midst of trials and heartache.

            If you have the ability and the desire, therapeutic foster care is a great way to serve God by serving children in need.