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| Respite for Foster Parents |
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| Respite for Foster Parents |
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Contents
Background |
BackgroundRespite, once available only to immediate or extended family members, is now being offered to foster families across the country. Respite can enhance the treatment and care of children in foster care and prevent unnecessary placement disruptions due to foster parent exhaustion and burnout. Foster families are expected to care for one or more children who have experienced abuse, neglect, abandonment, or drug or alcohol exposure. They also care for children who have disabilities, who are medically fragile or HIV positive. Many children in foster care demonstrate a significant amount of emotional disturbance as a result of abuse or neglect which can be very taxing for foster parents and their families. Even though foster parents care for children with numerous emotional and physical needs, these services are usually provided without relief from the caregiving routine. Until recently, foster parents have been precluded from using existing publicly funded respite resources or unable to pay private providers. These factors have sometimes made it difficult for states and counties to recruit and retain foster families at a time when they are in high demand. |
| Respite for foster parents was started as a way
for human service agencies to support and recognize the
outstanding care given by foster parents. In some programs,
respite is a regular part of the family support package offered
to foster families caring for children with multiple needs. Other
agencies have offered respite to foster parents as an incentive
to care for children who are medically fragile, or as an
incentive to accept emergency placements. Although foster
placements are generally temporary, many children in foster care
are adopted by their foster parents. When this occurs, the
respite care established as a support during foster placement
should be continued.
Given the recent financial constraints at all levels of government, it has been difficult to increase foster parent reimbursement rates in any significant way. However, human service agencies recognize respite as a cost-effective way to help ensure the quality of care in foster homes, to reduce multiple placements of children, and to minimize the high costs of recruiting, training, and licensing new foster homes. The new "Family Preservation and Support Services" legislation passed in August, 1993, specifically targets foster and adoptive parents as eligible for respite care and should provide additional funding in this area. Program ConsiderationsOrganizations offering respite to foster families need to consider foster care regulations or other state-approved licensing authorities when developing their programs. For example, children in foster care may only receive care in settings approved by the foster care licensing authority (state, county, city) which acts as a guardian of the foster child. Therefore, the home of the respite provider would need to be licensed as a foster care home. Regulations may also define "temporary" care. After a certain number of consecutive days, care may no longer be considered respite, and transferring the child into a temporary foster home may be required. In many states, foster care regulations also require that anyone caring for children in foster care settings be cleared through a state registry for child abuse allegations, undergo criminal background checks and have a current physical examination on file with the licensing agency. Organizations contemplating a respite program serving foster parents should first obtain copies of state foster care regulations, licensing guidelines and the foster parent handbook. Although foster parents are reimbursed a certain amount each month for the care they provide, establishing an independent fund to pay all or part of respite services for foster parents will encourage them to use the services regularly and will reduce the financial stress on the foster parents. A foster parent advisory board can help respite program designers understand the needs of foster parents and give the foster parents a sense of ownership and investment in the program Later, the advisory board may help promote the service to foster parents. Since the needs of children in foster care are so diverse, it may be difficult to design a program which can serve a broad spectrum of needs. A community needs assessment which includes information about children placed by state child welfare agencies will help narrow the targeted population. In the beginning, trying to serve too many needs may decrease the quality of care and strain the program’s financial and provider capabilities. For example, a program wishing to serve foster families with children who have chronic illnesses may initially need to decide to serve only children who are affected by HIV/AIDS. One of the reasons for this decision is largely a training issue. Both group and individual training can then be focused on the needs and condition of children affected by HIV/AIDS and their families to ensure a high quality of care. As the program becomes established, the target population can be broadened. It is important for the respite program to pay particular attention to the match between the respite provider, the foster parent and the child(ren). The matching process should include face-to-face meetings with all three. Although there may be frequent changes in the foster family composition, providers with an appropriate skill level should be matched consistently with the same foster parents when possible. Consistent matching is helpful both for the foster parents and the child(ren), who may be in respite care for successive visits and will value the comfort and consistency of care providers. The parents will begin to build trust in the respite provider by reviewing the general routine of the day, the child(ren)’s care needs, and the location of needed items in the foster home. When a respite provider is introduced to a foster family, an initial visit is desirable so the provider learns as accurately as possible the specific needs of the family. It is also important that the family understand what the respite provider can and cannot do. A supervisor should accompany the provider on this visit to act as a liaison between the family and the provider and between the family and the respite program. Foster Parent ConcernsFoster parents may have some initial concerns about using respite services. They may feel that they should not need respite, since they knowingly and willingly took on the role of foster parent. Some foster parents may fear that if they use respite, it will be viewed as an admission that they are "stressed out" and unfit as foster parents. They may also worry about handling additional paperwork or other administrative tasks associated with using the respite service. Others may fear that if a problem occurs during a respite stay, their reputation as foster parents, or even their licensing, could be threatened. Foster parents may be concerned that respite providers will not be able to care for the children adequately. For example, those who care for children affected by HIV/AIDS may fear that other providers will not offer the children the love and attention they need and have grown to expect. Foster parents of children with behavioral issues may worry if the children spend time in someone else’s care, their hard work with the child on correcting behaviors and stabilizing the child’s life will be undone. To address the concerns of foster parents, the following strategies might be helpful:
Respite for foster parents is a preventive service. Foster families are often composed of single parents who are caring for a combination of their own children, children who have been adopted, children of family members and children in foster placement. It is not unusual for a foster parent to be caring for six or more children at a time, if licensing permits. The physical and emotional demands of caring for children with special needs create added stress. For example, in addition to the complex home care requirements of a child with special needs, there may be medical appointments, periodic hospitalizations, or any number of daily emergencies. Without a break, any parent can be taxed to the point of losing the ability to provide high quality care. This also places the children at risk. Providing respite enhances the quality of care for the child, gives foster parents a deserved and necessary break, and ensures healthy and stable placements for all children. Respite Provider Recruitment, Screening, Training, and RetentionProvider recruitment strategies need to be tailored to the needs of children and families served. For example, if the program serves foster parents of infants and toddlers there will be a different pattern of usage from programs serving school-aged children which have a greater volume of weekday and daytime requests. To meet service needs, programs may need to hire individuals for whom being a respite provider is their primary occupation, rather than those for whom respite is a secondary job. This may require higher salaries and/or benefits. Applicants for respite provider positions must be carefully screened about their motivations for providing respite. Some applicants may be interested in working with children in foster care because of their own personal experiences with foster care or with abusive or neglectful situations. While these experiences may sensitize the applicant to the trauma the children may be experiencing, they must be screened to ensure that they have processed any unresolved feelings. Potential providers need to understand that each child’s experience is unique and cannot be compared to their own. Care must also be taken to inform respite applicants that they are not expected to initiate or promote a therapeutic counseling relationship with the children. Foster parents are often trained to offer therapeutic care and would certainly want the respite offered to them to support any programs they have initiated with children in their care. Respite providers must be willing to bring serious concerns to the attention of the foster parents, who in turn can arrange for an ongoing relationship with a mental health professional. Training for respite care providers should include the following topics:
The supervision of respite providers can be done in a group setting. Scheduling regular meetings as forums for support as well as feedback sessions, can increase the cohesiveness and commitment of the providers. Initially, a supervisor or trainer needs to help a provider learn the care requirements of each family for whom the provider works. Later, the supervisor may conduct periodic reviews of the provider’s work. Regularly scheduled interviews between a supervisor and a provider can also offer opportunities for feedback and performance evaluation. Retaining quality respite providers is a challenge to any program. Some incentives that can be offered to providers are: continued educational opportunities, a variety of care assignments for an individual provider, higher wages, benefit packages, frequent verbal and written praise and recognition, opportunities for rest and relaxation. High provider retention serves a number of positive purposes for the respite program:
Unique Challenges in Serving Foster ParentsFoster parents experience frequent and dramatic changes in the number and needs of the children in their care, and even trained respite providers may be caught off guard by these situations. Providers may be unprepared to handle the numbers of children in a foster home at a particular time, or they may be unable to care for the needs of certain children. Respite providers need to know when and who to call for assistance. Another challenge is that the foster parents who provide short term care for children may have little information to share with the respite provider about the child just placed in their home. Respite provider training should prepare them to enter each home for a respite visit knowing there may have been changes in the composition of the household. Providers must be flexible and prepared for unexpected emotional, medical and/or behavioral problems in the children, of which the foster parent may not yet be aware. When necessary, thorough telephone assessments of children newly placed in foster care may replace face-to-face meetings of the respite provider with the family. Respite providers may also need to learn to handle the sometimes sudden departure of children. Providers may feel they did not have an opportunity for closure with a child or that a promised activity was left unfinished. Providers, like foster parents, may worry about a child’s transition and future car. These issues can be addressed at staff support meetings, since most respite providers will experience similar situations. The respite program may also provide bereavement support groups to help providers understand and better handle the losses inherent in their work. SummaryFoster parents and the children in their care benefit from the regular availability of respite. By providing a needed break from the responsibilities of caregiving, respite offers foster parents another incentive to continue doing the important work of caring for children. Respite providers working with foster families may become essential members of a needed support system for those families, but may require some additional training in topics such as loss, grief and attachment. ResourcesNational Foster Care Resource Center, Eastern Michigan University, Ypsilanti, MI 48197, (313) 487-0372. ReferencesProject HARP Manual, Brookwood Child Care, 25 Washington Street, Brooklyn, New York 11201, (718) 596-5555 About the Collaborators/Authors Marilyn Barney is the director of Project HARP, a program in Brooklyn, New York which provides respite care to foster families who care for children affected by HIV/AIDS. Judy Levin is a program supervisor for the Family Support Services of the Bay Area in Oakland, California. The program offers a range of services, including respite to foster families. Nancy Smith is a regional coordinator for the ARCH National Resource Center for Crisis Nurseries and Respite Care Programs in Chapel Hill, North Carolina. ARCH Factsheet Number 32, January, 1994
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