Using Theraplay to Support Transitions from Fostering to Adoption - December 2015

THIS MONTH'S REVIEW IS A LITTLE DIFFERENT -
A POSTER AND PRACTICE NOTES FROM THE FAMILY PLACE
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Using Theraplay to support transitions from fostering to adoption by Dr Vivien Norris and Sally Twigger.

Dr Norris begins the practice notes by stating “Although it is widely recognised that support over the transition from fostering to adoption is essential, many are uncertain how best to do this in practice”.

We recognise that transition is a complex process which carries with it many hopes and expectations for all involved.  It can be a tense and emotional time for the child the adopters, the foster carers and professionals.

Prospective adoptive parents will all have had their own particular journey to adoption, they will have attended preparation groups, have under taken an intensive home study , been to an approval panel and will have known the details of the child they have been matched with for a number of weeks, and will be desperate to meet and claim the child.  The adopters will want to begin to get to know the child to establish a relationship as soon as possible.  They may also feel nervous about being surrounded by other people who know the child well.  This can result in adopters feeling vulnerable and intimidated by an experienced foster carer who has effectively built up and managed a relationship with their child. 

The co-ordination process can be emotionally painful for foster carers who have cared for the child for a long time sometimes from birth.  Foster carers will have supported the child through some difficult experiences.  They will have integrated the child into their family and will have developed empathy for the child’s experience.  They will have supported the child to meet their developmental milestones and will have established rhythms’ and routines that the child will be familiar with.  Many foster carers can experience difficult feelings about the imminent separation from a child in their care.  This can be even more complicated and sensitive if the foster carers have previously expressed an interest in caring for the child on a permanent basis.

The workers have also known the child and supported the child through difficult and distressing times.  They will have contact with the birth family and will have facilitated family contact which is often fraught.  They will have been instrumental in removing birth parents parental rights and responsibilities and are invested in securing a good outcome for the child parents who will meet the child’s life long needs and offer the child an opportunity to heal, grow and develop.  In my experience everyone comes to co-ordination with hopes, dreams and high expectations, and it is possible to lose sight of the child’s needs when so many conflicting adult needs are at the forefront.

In her piece Dr Norris reminds us that children who are transitioning from one family to another, and who have a history of developmental trauma face complex difficulties.  They are likely to have a fragile sense of trust in adults and sensitivity to being triggered into a survival state, or to regress to earlier ways of relating which means they may move away from rather than towards their main attachment figure (the foster carer) at times of significant stress.  They are also likely to hide their fear and miscue; that is to give signals that they are fine and self-sufficient when they are feeling frightened.  In addition their capacity to think and make sense of what is happening to them is likely to be highly compromised and exacerbated by fear.  They may not be able to process and retain information or respond to logic and their sense of time may be distorted. Foster carers will often report that things have been explained clearly to a child but ‘they act as if they haven’t heard it’.  Alongside age related development and a child’s concept of time, children who are highly anxious may be able only to think in minutes or seconds and any discussion of the future beyond that may be meaningless.  This obviously presents challenges in terms of how to be of most help to children who are moving family.

The purpose of a transition is to move a child from their foster carers to their  adoptive parents.  This is usually achieved.  In my opinion that makes how we do the co-ordination even more important as we should be child focussed and protective of the child recognising their distress as described by Dr Norris.
The co-ordination plan focuses on practical arrangements but these arrangements should be put in place to support the child to transfer their sense of trust from his primary care giver to their adoptive parents. 
Dr Norris’s approach helps us to put the child in the centre and supports the child to make use of their main attachment figure.

With my colleagues I have put into practice Dr Norris’s approach to good effect. The use of theraplay in transition has made everyone more aware of the importance of transferring established loving ritual.  We are more conscious of need to know more about the child’s rhythms and to transfer these from the foster carer to the adopters. We are more conscious of putting in place a co-ordination plan aims minimise the trauma that the child will experience during the transition.  We want to know what soothes and what excites the child.  We pay greater attention to the continuity of the sensory environment and to the non verbal means of communication such as touch, play, music and transitional objects.

I have found the poster helpful, as it supports us to think about the impact of developmental trauma and the implication for the child when they are experiencing another move.  It is helpful to think about potential issues, the implications and goals that underpin the transition process.

This model recognises the foster carer as central in supporting the child throughout coordination and it is essential that they are well prepared for and well supported throughout this process.  Their social worker has a crucial role in relation to this and needs to be available to the foster carer during the co-ordination process.  Foster carers need to be enabled to undertake this piece of work and it is important that other departmental demands are kept to a minimum where possible (e.g. additional foster placements, LAC Reviews for the child).

As Dr Norris points out even children who are well prepared for moving placements can find the experience confusing and anxiety provoking.  This model recognises and accepts the child’s experience and helps us all to remain child focused throughout this difficult and challenging process.

I would recommend that all workers, foster carers and adopters read Dr Norris’s piece alongside her chapter in "Healing the Hidden Hurts".

Anne MacKenzie 
Senior Practitioner at City of Edinburgh Council

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