Partnerships in fostering: a newsletter of the Georgia DHR Foster Care Unit, Winter 2003

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A NEWSLETTER OF THE GEORGIA DHR FOSTER CARE UNIT

Preparing Babies d h d
For A U 1t 00

During a child's first year, foster parents can greatly enhance the infant's future mental health, behavior and emotional well being.
"We know babies learn many things from the moment of birth,.and rapid braingrowth occurs from birth to age 5," explained Susan Bertonaschi, Children 1st program coordinator. "Foster parents should know that an early secure, loving relationship with caregivers is a major contributor to a child's ~evel oping self-esteem and, later, with positive peer relationships, self-control, thinking and the ability to be flexible in problem-solving. Loving relationships set the foundation for adulthood."
Interact With Babies
Babies begin developing language skills by making babbling sounds, as well as by hearing language which they eventually begin imitating. Foster parents will bond with the baby and help language development by talking to the baby as much as possible during day-today routines, such as when diapering, taking the baby to the c~, and feeding. While talking, caregivers should make eye contact and imitate some sounds the baby makes. The more babies hear, the more they will imitate, and the more they will be able to use language later in life.
"Smiling at the baby, making eye contact and helping the baby be comfortable are some of the best things a foster parent can do for .an infant," emphasized Bertonaschi. "All infants need to feel loved and wanted in order to grow up to have

positive relationships with others. Many infants enter foster care from neglectful situations, so a foster parent might be the first person in that baby's life to really help her with these needs."

Be Patient

Whether from neglect or other factors such as premature birth or even prenatal drug exposure, infants entering foster care may be especially sensitive. Also these infants in their way are recovering from the grief and sense of loss that comes from being moved from their birth family or previous foster family. Foster parents need to be prepared to be patient, especially in the beginning as they help the infant grow accustomed to them and their home. A good place to start is to get a sense of a child's personal temperament. What is the infant's overall mood and behavior? How calm, intense or active is she? How does she respond to changes in routine? Is she upset by bright lights or loud noise?

ILove guides babies toward well-ad;usted adulthood.

"Foster parents can help a highly sensitive baby by keeping the environment calm, with lights dim and noise levels low," Bertonaschi described. "You may find that soothing music calms her. You may need

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Keeping Kids
From Being

Why do some children who have been maltreated seem almost to seek situations where they will be further maltreated? How can foster parents help them escape this pattern of getting victimized and re-victimized?
Why Victims?
"When children come from families where they were maltreated, they get the maltreatment confusingly tangled with positive aspects of their family," explained Douglas Pratt, licensed clinical social worker with the Child Welfare Policy and Practice Group. "After entering foster care, some of them keep seeking what feels familiar for them, even if it's hurtful. For example, a boy whose father physically abused him might seek out the school bully. He's desperate to be loved, so his motivation is 'I'm going to keep pursuing this person, and, if I tolerate enough of his abuse, maybe he'll love me' - which was exactly what he had been doing with his abusive father. His definition of love includes abuse."

Establish Boundaries
When children were victimized, their personal boundaries were violated, whether through sex, violence or other trauma. When caregivers establish some special household rules, children can regain a sense of boundaries and personal safety, as well as develop intuition for situations to avoid.
Pratt explained, "In some homes, people sometimes dash undressed from bathroom to bedroom, but when a child who was sexually abused sees that, it can be confusing and upsetting - maybe reminding the child of the early stages leading to the abuse. Clear, consistent, strong household rules can help, such as no one leaves the bedroom or bathroom unless fully dressed or wearing a robe. When taking a bath or using the toilet, only one person should be in a bathroom, with the door shut. Undress only with the door shut. Knock on closed doors and wait to be invited in. Even if a bedroom door is open, ask permission before entering. Always keep the door open when visiting in someone's bedroom. Always ask permission to sit on someone's bed while he or she is in it. Never lie in a bed while someone is in it."

Kids can learn not to be victims, says Douglas
Pratt.

Wrestling or rough-housing among children or with caregivers can be innocent play, but can feel upsetting for a child who has been abused. A house rule could be whenever anyone says the other person is doing something that feels uncomfortable, the other person will immediately stop. Also caregivers should emphasize that if anybody in or out of the home does anything that feels "yucky," the child should loudly say no, leave that place, then tell an adult about it.

Openness and Coaching

Similarly, children who were sexually abused might act in sexualized ways they learned from the abuse experience, thus attracting further sexual abuse from older children or adults. Also these children's histories can influence them to become like their former abusers - becoming bullies or people whose definition of love includes sex.
"Foster parents' guidance can help these children develop safer patterns," Pratt said. "While we want to teach these kids to protect themselves, the highest priority is that the adult must take on a strong protecting role. These children lived in chaotic relationships where their adult models might have had few if any clear or sensible rules, so these kids might not know what's appropriate and inappropriate. All children need caregivers to establish protective rules, but these children have special needs for foster parents to do this."

"A rule should be children will tell a caregiver if anyone in the home violates their privacy, and caregivers then should discuss these violations with the one who might have violated privacy," Pratt described. "If this continues happening, caregivers should hold a family meeting to emphasize and clarify house rules. They should also emphasize that children should immediately tell them or another adult if anyone in or out of the home asks them to play any sort of 'secret game' or do anything secret."
Pratt said coaching can help children protect themselves,
noting, "Playing the What If? game can prepare kids so they
aren't taken off guard in the real world. The adult can ask the child to think about possible victimizing situations, like, 'What if some of the boys at school were pushing you around?' or, 'Suppose an adult offers to drive you home.' Then the caregiver can coach the child in thinking of appropriate, safe responses."

Babies (Continuedfrompoge 11

Teaching Children Self-Control

to slow down routines, like feeding and shifting from one activity to the next. It may help in the beginning to limit the number of people who handle her. If she comes from a neglectful situation, she won't be used to having a lot of people pick her up and handle her. For the first week, it might be best for just the foster parents to hold her, then maybe allowing older children in the home to start attaching with her. Just allow some time, and see how the baby reacts. Some cues that the infant wants to engage with you are she opens her eyes, turns her eyes to you, and reaches up. Signs that she's ready for less stimulation are turning her head away, beginning to hiccup or drool, or falling asleep. Soothing techniques such as talking softly, touching, rocking or walking the baby may help calm her."
Feeding time is one of the best opportunities for bonding. Caregivers should not prop up the baby on her own with a bottle, but should hold her during feedings to provide the physical contact she needs to feel secure. This contact also allows the baby to feel the caregiver's heartbeat and breathing, which can help her regulate her own sucking, swallowing and breathing rhythms, as well as to help her feel calm.
Part
I SS UE NUMBER 19
Newsletter Production Supervisor: Jayne Bachman
Editorial Committee Members: Dianne Yearby and Doris Walker
Writer/Editor/Publisher: Dan Corrie
Desktop Design: Dara O'Neil
Do you like this newsletter? Do you have ideas for how it could be better? Send your comments to:
Dianne Yearby DFCS Foster Care Unit, 18th Floor Two Peachtree St., NW Atlanta, GA 30303-3142 404.657.3570

Many children in foster care (especially under age 12) have problems with self-control, including having diagnosed disorders. Foster parents can work with children's case managers and therapists to come up with strategies to help improve their self-control. For example, Michael (age 7) has been diagnosed with attention deficit hyperactivity disorder and sensory integration disorder. With advice from Michael's therapist, his foster parents set out to help him gain more self-control.
Identifying target behavior: The foster parents begin by discussing the various areas where Michael needs better self-control. They realize Michael will only be confused if they try to change too much too quickly, so they narrow their focus to Michael's inappropriate behavior at the store, at parties and when they as caregivers set limits at home.
Planning ahead: The foster parents know Michael often becomes upset when he cannot purchase an item at the store, so they plan to begin giving him some money prior to entering the store. They tell him that if he does not spend the money, he can keep it. They also explain that if he acts up in the store by demanding more money, he will be removed from the store immediately. The parents know Michael becomes overwhelmed in busy stores, so they learn to take him to smaller stores, limit the length of shopping trips (since he has a very short attention span) and bring him to stores at off-peak hours. In the beginning, Michael sometimes has to be left home with a parent/babysitter when the other children go to the store.
Rehearsing: Michael begs to attend a classmate's birthday party, but he has a history of hitting other children. To prepare for the party, the parents ask Michael to role play or pretend that another child is teasing him. The parents can act as the other child, saying some typical teases and letting Michael practice coming up with even-tempered responses, then adding their own suggestions for things he might have said or done. The parents emphasize 1) one of them will remain at the party for Michael to come to for ideas, support or protection at any time and 2) they will leave with him immediately if he does not behave.
Predicting problems: Michael acts out whenever he has to stop a fun activity to take a bath, do homework or clean his room. His parents learn to schedule Michael so he completes such tasks before they will permit a fun activity.
Praising and supporting: The foster parents praise each successful step Michael makes toward improved self-control.
Children with self-control issues learn best from adults with whom they have a positive bond and feel trust, security and safety. Adults should learn to notice warning signs that a child is about to become stressed-out, and they need to be able to remove children from situations immediately without becoming angry or upset. As children begin to develop self-control skills, parents will be able to increase their privileges and activities.

Preventing
Injuries and Deaths

The leading killer of children in the United

dren," Lindemer explained. "Many beginning bik-

deadly mistakes, poisons should never be

may be confused about when to move growing

States is preventable injuries, killing more than all ers think a driveway or hill is great to zoom down

removed from their original containers and

children from car seats to booster seats to safety

diseases combined. This year in the United States, into a street, which leads to many accidents."

should never be placed in a container associated belts. Helpful information about seats and their

Bicycle Helmet Safety Institute www.bhsi.org Georgia Poison Center 1.800.222.1222
Car seat info:
SafetyBeltSafe U.S.A. www.carseat.org National Safe Kids Campaign www.safekids.org
Seat-check event info:

more than 6,000 children will die and 120,000 will become permanently disabled due to preventable injuries. Foster parents can help increase children's safety.
"Caregivers should get in the habit of looking from a child's perspective," emphasized Kristen Lindemer, acting director of the Injury Prevention Section of the Georgia Division of Public Health. "Get down on your hands and knees and think about what's in kids' reach, what could fall on

Children without helmets are 14 times more likely to die from a bike accident than children with helmets. Because they reduce the risk of head and brain injury by 85-88 percent, approved bicycle or multi-sport helmets are required by Georgia law for children under age 16 when riding bikes on public roads, sidewalks and bike paths. A bike helmet should fit properly: approximately two finger-tip widths above the eyebrow and level on the head, not tilting back to expose the forehead or tilting too far forward to cover the eyes. It should fit snugly, so if you move the helmet, the forehead's skin also moves. It should not be so tight as to feel uncomfortable. The chin strap should always be fastened. The Bicycle Helmet Safety Institute's website (www.bhsi.org) provides further information on bike helmets and their proper fit.
Poison

with drinking, such as a soda bottle or milk jug.
Fire
"Most child deaths from fire occur in homes without smoke alarms during the cold-weather months of December through February," Lindemer said. "It's important to have a working smoke alarm outside every bedroom and in the main living quarters. If a family tends to close their bedroom doors at night, they should also have an alarm inside their bedrooms. You can remember to change conventional batteries by replacing them when the time changes. More expensive smoke alarms come with longlife lithium batteries that last seven or more years. Many fires result from cooking, smoking and space heaters. Space heaters should be at least three feet away from anything flammable, like curtains or magazines."
Families need an escape plan which they

installation is available at the SafetyBeltSafe U.S.A. website (www.carseat.org) and the National Safe Kids Campaign website (www.safekids.org), including lists of car seats that have been recalled for being defective and unsafe. Caregivers can also check under "car seats" on the U.S. Consumer Product Safety
Commission website (http:/ /www.cpsc.gov I cgibin/ recalldb I prod.asp) for recalled car seats.
Lindemer advised, "One of the best ways to make sure a seat is properly installed is to drive your car with the seat installed and with the child in the seat to a seat-checking event, where a certified technician will examine how you installed your seat and, if incorrectly installed, will coach you in proper installation. You can find out about free seat-inspection events in your area by calling Safe Kids of Georgia (404.929.8686) or the Governor's Office of Highway Safety (404.656.6996). Sometimes caregivers can receive free child safety seats by attending these events."

Safe Kids of Georgia 404.929.8686 Governor's Office of Highway Safety 404.656.6996
Car seat recall info:
U.S. Consumer Product

Simple precautions can save children's lives, says Kristen Lindemer.

Approximately 150,000 adults and children are poisoned annually in Georgia. More than 50 percent of reported poisonings are children age 6 and under. Poisonings are most common among ages 1 and 2. If caregivers suspect poisoning and the child is showing serious symptoms such as fainting and vomiting, they should call 911. If a situation is less clear, such as the child swallowed something like shampoo and caregivers are unsure whether it is poison and want guidance,

rehearse so everyone knows what to do in case of a fire. Everyone should have two methods of leaving the home, so, if fire blocks one escape route, everyone is ready with an alternative route. No calls to 911 should be made inside a burning home; rather, everyone should focus on escaping, then calling 911 from a neighbor's house. Caregivers with several children should decide ahead of time who will get which children, so they can split up and work separately to save time dur-

Though caregivers understandably look for ways to cut costs, they should not buy a child safety seat they do not know the history of, such as from a thrift shop. They should not use car seats given to them unless they can confirm the seat has never been in a crash or in any way damaged and likely to fail in a crash.

Safety Commission http://www.cpsc.gov/ cgi-bin/recalldb/

them or start a fire or scald them, what's poisonous, what's small enough to swallow, what could suffocate or strangle or electrocute them, what

they can call the 24-hour Georgia Poison Center hotline number, which they should keep near their telephone: 1.800.222.1222. Caregivers also can call

ing a fire. While escaping, family should keep low below smoke, crawling on hands and knees and touching doors before opening them to test

Graphic art provided by the Georgia Division of Public Health.

prod.asp

they could fall from. Think about what they could to request a free booklet or visit the website

whether they are hot from fire on the other side.

drown in. Drowning is the second leading cause (www.georgiapoisoncenter.org) for information

The family should select a meeting point away

of unintentional injuries among children age 14

on such topics as identifying poison plants, treat-

from the home where everyone can be accounted

and under. Most drownings occur in residential swimming pools. Infants drown most often in

p ing insect bites and installing child safety locks on
cabinets.

for, such as a mailbox or a tree that will not be in the way of a fire truck or in harm's way.

bathtubs, toilets and buckets."
Bicycles

Poisonings frequently occur around mealtimes, when children are hungry and caregivers are cooking and may be supervising children less

.I.I Cars
Child safety seats and safety belts can save

"Youngsters are unable to ride bikes safely

closely. Bright labels attract curious children, who

lives, which is why they are required by law.

around any traffic until they develop the abilities might mistake household cleaners for juice or a

However, four out of five safety seats are incor-

4

to gauge speed and distance of cars, which might be age 9 or 10, and could be older for other chil-

soda. They might mistake pills for candy. Poisons should be stored in cabinets with child-proof locks beyond children's reach and sight. To avoid

rectly installed. Caregivers should carefully read instructions that come with the seat. Caregivers

5

Tips for
Teenage Healthcare

Helping Children
with Oral Health

Teenagers' health should be maintained while in foster care. What are some tips for foster parents and case managers?

Monitoring

Carol Miller, a

Douglas County

"Whether in foster

school nurse, checks a teen's blood pressure.

care or not, all teenagers should have annual checkups with

a physician," said

Malaika Hollinger,

prevention specialist

with the Office of

Adolescent Health

and Youth

Development.

"Adolescence is a dra-

matic time for all

young people, but

especially so when

they come from

homes where they

were maltreated. All

- - - - - - - - - - - - - - - - - - - - - - - ' children entering fos-

ter care are thoroughly assessed by professionals

- including medical assessments - and DFCS

makes sure they receive needed services and sup-

ports. Because foster parents see kids daily, their

role is crucial in noticing changes or continued

problems with children's health."

Teen Centers

State Health Check Program 404.463.0183
Health Department
www.ph.dhr.state. ga.us/regional

Teenagers' emerging independence can be particularly challenging for caregivers, and foster parent groups can benefit from inviting the health educator from their local health department to speak on topics such as discouraging kids from smoking, using drugs, drinking or engaging in other high-risk behavior. Health departments also offer classes for youths and have information about other locally offered classes on these and other health-related issues. You can find your local health department's phone number in the phone book, by calling directory assistance or by logging onto www.ph.dhr.state.ga.us/regional then clicking on your county.
"Many health departments have teen centers located in their building or nearby," noted

Carolyn Aidman, director of Adolescent Health and Youth Development. "If youths are sexually active, foster parents or case managers can bring them to a teen center to get a Baby Think It Over doll, which is a computerized doll a girl or boy keeps for 24 to 48 hours to get a sense of the responsibilities of parenting. The doll has a computer that shows how the youth treated the 'baby' during that time, such as whether the youth responded when the doll was crying. If the teen has been involved with drugs, there are Baby Think It Over dolls that act like babies born to a mother whO used crack cocaine - simulating these babies' nervousness and irritating cry."
Health Check
Health Check is a preventive program offered at all county health departments for children from birth to age 21 who are enrolled in Medicaid or PeachCare. All children in foster care are eligible for Health Check services, such as receiving ageappropriate immunizations. Rather than treating illnesses, Health Check exams are "well-child check-ups" to make sure children and teens are developing appropriately for their ages. Once a youth is brought in, Health Check staff will continue scheduling appointments at recommended ages to check on his or her development in a variety of areas. At each visit, Health Check staff set up an appointment for the next recommended visit.
The exam is done by a nurse who spends as much time with the family as needed to understand the youth's physical or emotional issues affecting health. If any problems are suspected or identified, the nurse refers the youth to a physician, dentist or whatever specialist is necessary, locating providers who accept Medicaid. The nurse may be able to refer the youth to other public health programs that would be helpful to the youth. If a youth becomes sick between visits, the nurse will also help foster parents with referrals to a doctor.
You can find your local Health Check location by calling the State Health Check Program at 404.463.0183.

Teeth greatly affect children's self-esteem. Poor dental habits result in pain, expense and inconvenience throughout a lifetime. Children need foster parents' guidance for good oral hygiene, and case managers should ensure children visit dentists regularly.
"Around 50 percent of kids don't have dental problems, while 20-25 percent have 75-80 percent of the problems," noted Joseph Alderman, director of the Oral Health Section of the Georgia Division of Public Health. "This major difference is due to whether kids have good dental routines. If children have good routines of brushing and flossing and good eating habits, they may only need to see a dentist once a year. Others need to go more often, such as every six months. A child's first dental appointment should be at age 1 for a screening, so the dentist can notice, for example, if caregivers need to alter bottle-feeding habits to better preserve the child's teeth."
Alderman added, "It's much better to take kids to the dentist to prevent problems, rather than wait until the child already has a tooth ache, which is both painful and expensive - many children with . poor dental health needing to be hospitalized and put under general anesthesia for their dental work, which is traumatic for the child and can cost Medicaid or Peachcare up to $8,000. Also if children only go to the dentist when they're in pain, they learn to fear and avoid dentists."
Brushing and Flossing
Brushing teeth at least twice a day and flossing at least once help prevent tooth decay and gum problems.
"Be sure children brush correctly, moving the toothbrush in a down-to-up motion on the lower teeth and up-to-down motion on the uppers, using a kind of massaging motion," Alderman advised. "We tell kids to brush teeth in the direction the teeth grow and to brush both the teeth and gums, stimulating gums so they won't become diseased and recede. Get children a childsized toothbrush so they can reach the back teeth where space is tighter. Soft-bristled toothbrushes - usually nylon - don't cut the gums as much. Start them using an adult-sized toothbrush somewhere around age 12, depending on their mouth's

size."
Alderman added, "Flossing should begin at age 1. The adult needs to do it because kids usually don't have the dexterity to do it for themselves until the third or fourth grade. You only have to floss between the teeth that are in contact, so, in a young child, the main teeth to floss are the molars (the very back teeth). Until around the third grade, about age 8, kids need an adult at least to supervise their flossing."
Flouride
For years, fluoride has been added to national water supplies, which has significantly improved the general population's dental health. However, the fluoride in tapwater combined with the fluoride in most toothpastes can be too much for young children, causing brown stains on teeth. For children under 2, caregivers should brush children's teeth only with water, without toothpaste. From ages 2 to 6, children should only use a pea-sized dab of toothpaste on their brush. After age 6, fluoride is healthy without side effects, both in water and toothpaste. In the 2000 census, Georgia was rated as the eighth best state in providing fluoride in water supplies; however, some rural counties do not fluoridate water, and well water has no fluoride, so caregivers in these situations should make sure their household's toothpaste contains fluoride.
Eating Habits
"Eating habits that are healthy for the body are also healthy for the teeth," Alderman remarked. "Kids will usually eat what is available, so caregivers can help with oral health by serving healthy meals and keeping such snacks in the house as oranges, apples, bananas and carrots rather than candy bars and sugared cereal. It's important to limit sodas. Even sugarless sodas and diet soft drinks contain a lot of acid.

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Foster Care
Geo r g ia Dep ar t m en t of H uman Resources D ivisio n o f F am ily an d C h ild r en S erv ic es
Suite 18-222 Two Peachtree Street, NW Atlanta, GA 30303-3180

(Continued from page 7}

Sometimes I place a tooth in a soda to show kids how the tooth soon becomes rubbery. Caregivers sometimes need to settle for tradeoffs with kids. For instance, some children won't drink milk unless it's chocolate. The milk would be better for them without the chocolate, but they need milk, and chocolate milk is much better for them than sodas."
Alderman added, "What we call 'baby bottle decay' is caused when caregivers let babies sleep with a bottle. When children fall asleep, their saliva decreases, so their teeth are bathed in acids and sugars, even from something as normally healthy as formula - or fruit juice which is healthy but has natural sugars, or apple juice which is high in acids."

Attitude
By encouraging positive attitudes toward dentists and oral hygiene, caregivers can have a lasting, beneficial impact on children's lives.
"If a child isn't behaving, some parents will threaten - maybe half jokingly - to take them to a dentist as punishment, but that's very counterproductive," Alderman stressed. "If children ask us what to expect at the dentist's, we should tell the truth but without scaring them, explaining, 'You may sometimes feel a pinch. But not taking care of teeth eventually will cause you more discomfort than that. And we want you to have a nice smile."'