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Jun 26, 2018

Interview with Hannah Strauel, Supervisor, Domestic Foster Care, Grand Rapids, Michigan

Kenita (a pseudonym) was 6 when she entered foster care. Because of the complex trauma and abuse she’d experienced, she had developed difficult coping skills, including running away when she was triggered. In one instance, she took off from her foster home and made it two miles before her foster parents caught up with her. In her first year in foster care, she moved five times as foster parents struggled to manage her escalating behaviors.

As we’ve posted here, here, and here, children who enter foster care have experienced trauma, whether abuse, neglect, and/or being removed from their familiar home environment. We’ve posted here and here about interventions foster parents can use to respond to trauma-related behaviors.

But sometimes children with prolonged exposure to abuse or neglect have escalated behavioral, emotional, or mental health concerns. These children need specialized therapy, counseling, and/or medication as part of their treatment plan. Children with elevated needs were once only referred to residential treatment facilities for care, but some Bethany offices are equipped to train families to provide an alternative: enhanced foster care (also known as “treatment foster care”) allows children to receive the intervention they need in a family setting. 

Below, Hannah Strauel explains how Bethany is helping children in Grand Rapids who need additional services.

Why is treatment foster care needed?

Trauma rewires how a child’s brain works. The body and brain’s response to trauma is fight, freeze, or flight. When children stay in a high-stress, high-alert mode for long periods, their brains learn to respond to environmental cues (triggers) and go directly to fight, freeze, or flight responses as a coping skill. Most adults and typically developing children have the capacity to step back and evaluate their environment from a rational perspective, assessing what is actually a threat and what isn’t. Traumatized children often don’t have those neural pathways in their brains, so they may experience anything unknown in their environment as a threat.  

With treatment foster care, we want to help kids self-regulate, or learn how to calm themselves when they are triggered. In the meantime, we’re working to identify what external prompts or sensory cues will help. When kids are escalated, and they are operating only in that emotional “fight, freeze, or flight” part of the brain, they have trouble responding to external cues. It takes some practice to identify what works well and what doesn’t for each child. The time to talk about triggers is after the child is calm and regulated again. They still may not know what triggered their emotional response, but with guidance, they can start to recognize triggers—and it doesn’t take much to trigger children who have survived complex traumas.

Think about how you might react if you were in a car accident. For a time, you might have an emotional reaction when you approach that intersection. Your body might tense up, and your brain might replay sounds or images of that event.

If your mind and body can respond that way to one event, imagine how it might respond to multiple, repeated traumatic events, and you have a clearer idea of what some children experience every day. They’ve been conditioned to see the world as an unsafe place; things around them may hurt them, so they are always on high alert.

When foster parents see triggered behavior unfold, they often say, “It was like she went from 0–60 in a second!” More accurately, her baseline is 60, and she went to 80. 

Who qualifies for treatment foster care?

Every child who is in foster care has experienced trauma and may exhibit occasional escalated behaviors. Treatment foster care is designed for:

  • Children who struggle with escalated behaviors multiple times a month, or the behavior is more extreme than what is typical for a child with a trauma history.
  • Children whose behavior is unsafe or creates an unsafe environment for others.
  • Children who have experienced numerous placement breaks, whether foster placements or adoptive placements.
  • Children who may have a mental health diagnosis or trauma and/or attachment diagnoses.
  • Children on the autism spectrum who have also experienced trauma and have a hard time self-regulating.
  • Children stepping down from residential treatment and transitioning back to family-based care.

Treatment foster care equips families to keep children safe and stable as they work through their treatment plans.

Who is helping the children and families?  

Beyond the typical foster care case manager who works with families, they also have a clinical case manager who works with the foster parents and the child. They meet weekly with the family in their home to develop the child’s treatment plan. We offer additional training and monthly support groups specifically for parents providing treatment foster care.

Children see a counselor or therapist, usually weekly, whether in an office or at their foster home. The family and child also work with a behavioral specialist (in addition to other recommended counseling or therapy). Along with teaching coping skills, the behavioral specialist teaches the child how to put these skills into practice in various environments, such as home, school, and public places. 

Treatment foster parents also receive behavior-specific training (beyond typical training on trauma-informed parenting) based on the child’s specific diagnoses.

What qualities/skills are you looking for in treatment foster parents?

  • Two or more years of foster parenting experience
  • Parents without foster care experience are considered if they have specific professional experience and positive history working with children who have difficult behaviors, e.g. teachers, coaches, social workers, therapists, etc.
  • Better than average patience
  • Ability to provide stability, structure, and safety
  • Honesty and vulnerability
  • Lots of grace (for yourself and for the child)
  • Ability to absorb a child’s big emotions
  • Willingness to take one day at a time

How did treatment foster care help Kenita?  

Kenita entered a treatment foster home for just over a year. During that time, her mother’s parental rights were terminated, and she became available for adoption. Her grandmother could provide a stable home and was interested in adopting her. We began involving her grandmother in Kenita’s treatment plan with her treatment foster family to prepare her for the stability of her grandmother’s home.

Once her mother’s rights were terminated, and she knew she wasn’t going home, Kenita’s behaviors calmed some; but she still needed resolution: where was she going to live? She began having visits with her grandmother, and once she learned she would be transitioning to her grandmother’s home for good, it was like she was a whole different child. Once she had a plan, her baseline was much calmer. Her world went from chaotic, dangerous, and uncertain to stable, safe, and permanent. She’s 10 now and thriving. Treatment foster care helped her learn how to self-regulate and mange her behaviors and emotions, which helped prepare her for her permanent home with her grandmother.

Bethany in Grand Rapids is one of 20 agencies in Michigan to offer treatment foster care.


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