The Definition Foster Care Social Work Essay

Published Date: 23 Mar 2015

New World Enclopedia (2012) defines foster care as full-time substitute care of children outside their own home by people other than their biological or adoptive parents or legal guardians.

According to The Adoption Foundation (2012) Foster care means placing a child in the temporary care of a family other than its own as the result of problems or challenges that are taking place within the birth family.

Johnson (2004) defines Foster care as a 24-hour substitute care for children placed away from their parents or guardians and for whom the State Agency has placement and care responsibility.

To summarise the Foster Care aim is to provide the opportunity to children victims of abuse and/or neglect to live in a substitute family on a temporary basis. The role of the foster parents is to give support to the child and help him to grow physically, emotionally, socially and spiritually.

3.2 History of Foster Care

The Children Aid Society (2012) stated that placement of children in foster homes is a concept which goes as far back as the Old Testament, which refers to caring for dependent children as a duty under law. Early Christian church records indicate orphaned children lived with widows who were paid by the church. English Poor Laws in the 1500s allowed the placement of poor children into indentured service until they became adults. This practice was imported to the United States and was the beginning of placing children into foster homes. The most significant record of fostering was in 1853, a child was removed from a workhouse in Cheshire and placed in a foster family under the legal care of the local government. At the beginning of the 1900s only orphaned or abandoned children under the age of 11 years were fostered, and they had to have a demanding psychological profile - well adjusted, obedient and physically normal.

Jeune Guishard-Pine (2007) identified that in 1969 research was carried out on the foster care system and it was found that foster families required training on how to deal with the foster children and make them fill secure in the placement.

3.3 Foster care as a global concept

Johnson (2005) emphasised that foster care is most likely the most widely practised form of substitute care for children world-wide, depending on the needs of the child, the culture and the system in place. According to Askeland (2006) there are many different kinds of fostering and definitions of 'foster care' vary internationally. It can be short -term, a matter of days ,or a child whole childhood. A review of foster care in twenty-two countries found considerable diversity in the way of fostering in both defined and practised.

Mannheim (2002) stated that kinship foster care, which is the most common form of fostering in African countries, is not called 'foster care' in all countries. 'In Ireland for example only children placed with no relatives are said to be fostered'. According to Colton & William (1995) in some countries foster care is only seen as a temporary arrangement.

Johnson (2005) stated that the procedures to be registered as foster parents in different countries such as United Kingdom, Australia, Uganda and South Africa are similar. In some countries foster care programme is managed either by the government or an agency, and each country has their own basic criteria that should be fulfilled, such as; being physically and mentally fit and healthy, having a room for the child ,having time to spend with the child. According to Blatt (2000), the process to be registered as foster families can take approximately six months or more. Individuals who are willing to become foster families must make their applications to the agency. A home study is conducted by a social worker to assess the capability of the applicants for taking care of a child. The assessment form is then forwarded to a panel who gives the approval.

3.4 Placement in Foster care

According to (Blatt 2000; Zuravin & Deponfilis 1997), children are removed from their homes to protect them from abuses. These children have suffered physical, sexual abuse, or neglect at home, before they are transferred to a secure milieu. Some children are abandoned by their parents or legal guardians, or have parents or legal guardians who are unable to take care of them because they have financial difficulties, some are alcoholics, others are irresponsible. These children are then placed into foster care until the parents or guardians are capable of taking the parental responsibility.

Elisa et al (2010), states that in all foster care cases, the child's biological or adoptive parents, or other legal guardians, momentarily gives up legal custody of the child. The guardian gives up custody, but not necessarily legal guardianship. A child may be placed in foster care with the parents' agreement. In a clear case of abuse or neglect, a court can order a child into foster care without the parents' or guardians' consent.

Duncan and Shlonsky (2008) emphasizes that before any placement the foster care family is screened by the Government or agency through a psychologist or social worker that assess the foster care families under certain criteria such as emotional stability, motivation, parental skills and financial capabilities. Elisa et al (2010) states that the government provides foster families with an allocation taking in foster children. The foster parents are required to use the funds to buy the child's food, clothing, school supplies, and other incidentals. Most of the foster parent's responsibilities toward the foster child are clearly set in legal documents.

According to Blatt (2000), foster placements may last for a single day or several weeks; some continue for years. If the parents give up their rights permanently, or their rights to their child are severed by the court, the foster family may adopt the foster child or the child may be placed for adoption by strangers.

3.3.1 The Aim of Foster Care System

According to Hayden (1999), the aim of foster care system is to protect and endorse the security of the child, while providing foster parents and biological parents with the sufficient resources and available services needed to maintain the child's healthy development. Foster care environments are proposed to be places of safety and comfort, and are monitored by several welfare agencies, representatives, and caseworkers. Personal caseworkers assigned to a foster child by the state or county are accountable for supervising the placement of the child into an appropriate foster care system or home. The National Conference of State Legislatures (2006), states that the caseworker also carries out regular visits to the foster care family home to monitor progress. Other agents involved in a child's placement into foster care may include private service providers, welfare agencies, insurance agents, psychologists, and substance abuse counselors.

3.3.2 Types of Foster Care

Ambrosino et al (2008), emphasis that parents may voluntarily place children into foster care for various reasons. Such foster placements are monitored until the biological family can provide appropriate care for the child, or the biological parental rights are terminated and the child is adopted. Legal Guardianship, is a third option which can be used in cases where the child cannot be reunited with their biological family and adoption is not a suitable option. The Guardianship option most commonly occurs for older children aged 10years old onwards, who are strongly bonded to their biological parents.

Geen (2003) mentions that voluntary foster care can be utilised when the parents are unable or unwilling to care of a child; a child may suffer from behavioural or psychological problems and requires specialized treatment. Involuntary foster care is applied when the child is in danger and should be removed from the family to be put in a secure place.

(Blatt 2000; Bath 2010;Moe 2007) mention different types of fostering:

(i) Foster family home, relative - 'A licensed or unlicensed home of the child's relatives regarded by the state as a foster care living arrangement for the child'.

(ii) Foster family home, non-relative - 'A licensed foster family home regarded by the state as a foster care living arrangement'.

(iii)Group home or Institution - 'A group home is a licensed or approved home providing 24-hour care for children in a small group setting that generally has from 7 to twelve children. An Institution is a facility operated by a public or private agency and providing 24-hour care and/or treatment for children who require separation from their own homes and group living experience. These facilities may include child care institutions, residential treatment facilities, or maternity homes'.

Associated Problems with Foster Care System

According to Mannhein (2002) stated that in the United States, placement success rate was 40% and failure rate was 60%.From previous studies carried out, Children and Family Research Center (2004), Proch & Taber (1985), there are many associated problems with the foster care system that leads to the removal of the child from the foster care home such as time of placement in the foster care family, characteristics of home, foster parents characteristics and child characteristics.

According to a study carried by Mannhein (2002) in the United States, placement success rate was 40% and failure rate was 60%. Fernadez and Bath (2010) states,that foster children face a number of problems both within and outside the foster care system. Foster children are more exposed to neglect, abuse, family dysfunction, poverty, and severe psychological conditions. The trauma caused to a child when removed from their home is also severe and may cause depression, anger, and confusion. Psychological conditions of abused and neglected children are required to improve when placed in foster care, however the separation from their biological parents cause traumatic effect on the child.

3.3.4 Time of Placement in Foster Care family

According to Bremner & Wachs ( 2010) many studies which has been carried out show that behaviour of the child is the strongest predictor of placement disruption and is one of the main reasons foster parents request removal the children from Foster Families. Newton et al (2000) confirms that children showing sign of behaviours such as disruptive, aggressive or dangerous behaviour in the foster homes are requested to be removed from Foster Families. Zandberg & Van der Meulen,(2002) study show that behaviour becomes a critical issue for foster placements for children over the age of 4 years.

Webb et al, (2010) states, that children are more prone to experience insecurity in the foster home during the initial phase of placement and the first six months of a placement are crucial as 70 % of removal of foster children occur within this period. According to Whittaker et al (2010) older children experience more placement instability during the initial phase compared to infants and older girls are at the highest risk of placement disruptions than boys.

3.3.5 Characteristics of the Home

Berridge & Cleaver, (1987) stated that children have difficulty to adapt in foster home when they are placed with other children who are roughly the same age or if they are placed in foster homes where the foster parents have children of their own. Foster Children placed with other children may feel insecure and start competing for affection and materialistic objects eventually this leads to conflicts in the foster care family.

3.3.6 Foster Parent Characteristics

According to Walsh & Walsh (1990) to deal with a child's problem behaviour is mostly related to the Foster Parents character and sense of understanding. Doelling and Johnson (1990) states that 'the other most predictive characteristics of foster parents is their "goodness of fit" with a child including a match temperaments and having a relationship that is described as close'. Butler & Charles (1999) also state that a mismatch in temperament between a foster parents who is inflexible and a child with negative mood will eventually lead to disruption.

Walsh and Walsh (1990) study also shows that for a placement to be successful the foster parents should be motivated, they should accept the child, they should feel the desire to parent the child and they should be motivated by their own childhood experience. According to Fine (1993), Social Support in foster family is important to prevent placement disruption and foster parents who have good relationship with their family and friends are more likely to be successful.

3.3.7 Child Characteristics

According to Children and Family Research (2004), the behaviour of a child is closely linked to placement disruptions. As stated by Lindheim & Dozier (2007) foster parents do not understand the behavioural problems of the child and finally they request removal of the child from their custody. The behaviour of the child is a result of the child characteristics i.e the background of the child. Foster children are more exposed to neglect, abuse, family dysfunction, poverty, and severe psychological conditions. The trauma caused to a child when removed from their home is also severe and may cause depression, anger, and confusion.

Psychological Trauma in Children

Psychological trauma is a type of damage to the mind that occurs as a result of a severely distressing experience. When that trauma leads to disorders , damage possibly will involve physical changes inside the brain and to brain chemistry, which modifies the person's reation to future stress.

A traumatic event involves a single experience, or an enduring or recurring event or events, that fully surmount the individual's capacity to deal with or integrate the ideas and emotions involved with that experience. The sense of being overwhelmed can be delayed by weeks, years or even decades, as the person fights back to cope with the abrupt situation. Psychological trauma can lead to serious long-term negative consequences that are often overlooked even by mental health professionals:

Trauma can be caused by a wide range of events, but there are a few general aspects .There is, putting the person in a state of tremendous puzzlement and lack of confidence. Psychological trauma may accompany physical trauma or exist seperately of it. The usual causes and dangers of psychological trauma are sexual abuse , domestic violence, being the victim of an alcoholic parent, particularly in childhood. Long-term exposure to situation such; as extreme poverty or milder forms of abuse, such as verbal abuse, can be traumatic.

Psychological trauma may happen during a single traumatic event or as a result of repeated (chronic) exposure to overwhelming stress (Terr, 1992). Children exposed to chronic trauma normally have considerably worse effect than those exposed to severe accidental traumas. In addition, the failure of caregivers to satisfactorily protect a child may be experienced as betrayal and further supply to the adversity of the experience and effects of trauma. Acute psychological trauma causes impairment of the neuroendocrine systems in the body. excessive stress triggers the fight or flight survival response, which activate the sympathetic and suppresses the parasympathetic nervous system. Fight or flight responses increase cortisol levels in the central nervous system, which enable the individual to take action to survive (either dissociation, hyperarousal or both), but which at extreme levels can cause alterations in brain development and damage of brain cells. In children, high levels of cortisol can disrupt cell differentiation, cell migration and critical aspects of central nervous system integration and functioning. Trauma affects basic regulatory processes in the brain stem, the limbic brain (emotion, memory, regulation of arousal and affect), the neocortex (perception of self and the world) as well as integrative functioning across various systems in the central nervous system.

Traumatic experiences are stored in the child's body/mind, and fear, arousal and dissociation associated with the original trauma may continue after the threat of danger . Development of the capacity to control affect may be destabilized or disrupted by trauma, and children exposed to severe or chronic trauma may demonstrate symptoms of mood swings, impulsivity, emotional irritability, anger and aggression, anxiety, depression and dissociation. Early trauma, mainly trauma at the hands of a caregiver, can distinctly modify a child's perception of self, trust in others and perception of the world.

Children who experience severe early trauma often develop a foreshortened sense of the future. They come to anticipate that life will be dangerous, that they may not survive,and as a result, they give up hope and expectations for themselves that reach into the future (Terr, 1992).

Among the most demoralizing effects of early trauma is the disruption of the child's individuation and differentiation of a separate sense of self. Disintegration of the developing self occurs in response to stress that overwhelms the child's limited capacities for self regulation. Survival becomes the focus of the child's interactions and activities and adapting to the demands of their environment takes priority. Traumatized children lose themselves in the course of handling with ongoing threats to their survival;they cannot afford to trust, relax or fully look at their own feelings, ideas or interests. Characterlogical development is shaped by the child's experiences in early relationships (Johnson, 1987). Young trauma victims often come to believe there is something naturally wrong with them, that they are at fault, unlovable, hateful,helpless and unworthy of protection and love. Such feelings lead to poor selfimage, self abandonment, and self destructiveness. Eventually, these feelings may create a victim state of body mind spirit that leaves the child/adult vulnerable to subsequent trauma and revictimization.

Acute trauma in early childhood affects all area of development, including cognitive, social, emotional, physical, psychological and moral development. The pervasive negative effects of early trauma result in significantly higher levels of behavioral and emotional problems among abused children than non-abused children.In addition, children exposed to early trauma due to abuse or neglect lag behind in school readiness and school performance, they have diminished cognitive abilities, and many go on to develop substance abuse problems, health problems and serious mental health disorders. Serious emotional and behavioral difficulties include depression, anxiety, aggression, conduct disorder, sexualized behavior, eating disorders,somatization and substance abuse. Early childhood trauma contributes to negative outcomes in adolescence, including dropping out of school, substance abuse, and early sexual activity, increasing the occurrence of sexually transmitted diseases, early pregnancies and premature parenting. Early childhood trauma contributes to adverse adult outcomes as well, including depression, posttraumatic stress disorder, substance abuse, health (Harris, Putnam & Fairbank,2004).

Although the effects of child abuse and neglect vs. family environmental and

genetic factors have been debated, recent twin studies confirm a significant causal

relationship between child abuse and major psychopathology (Kendler, Bulik, Silberg,Hettema, Myers & Prescott, 2000). Acute trauma in early childhood seems to set in motion a chain of events , a negative path that places those children who have the highest exposure and a less positive mediating or ameliorating factors at greatest risk of significant debilitating effect on development and increased occurrence of psychopathology (Perry, 1997, 1999, 2001; Eth & Pynoos, 1985; Pynoos, 1994).

The Adverse Childhood Experiences Study (1998)carried a study where researchers mailed questionnaires to over 13,000 people who had freshly had medical workups at the Southern California Permanente Groupin San Diego. These patients were asked about their experiences with any of seven categories of childhood trauma: psychological, physical, or sexual abuse; violence against the mother; or living with household members who had problems with substance abuse, mental illness, were ever imprisoned or committed suicide. Over 9,000 patients responded. Among those who reported even one such exposure, there were substantial increases in a awful range of disorders, together with substance abuse, depression, suicide, and sexual promiscuity, as well as increased incidences of heart disease, cancer, chronic lung disease, extreme obesity, skeletal fractures and liver disease.

In summary, experience to extreme traumatic stress affects people at many levels of functioning; somatic, emotional, cognitive, and behavioral (e.g., vander Kolk, 1988; Kroll, Habenicht, & McKenzie, 1989; Cole & Putnam, 1992; Herman,1992b, van der Kolk et al., 1993). Childhood trauma sets the stage for a variety of disorders, such Post traumatic stress disorders,eating disorder,Attention deficient hyperactivity disorder,oppositional defiant disorder,pervasive disorder,attachment disorder.(Herman, Perry, & van derKolk, 1989; Ogata, Silk, Goodrick, Lohr, Westen & Hill, 1989

3.4 Disorders with the Foster Child

The Northwest Foster Care Alumni Study (2012) on foster care children showed that foster care children, were found to have double the incidence of depression, and were found to have a higher rate of post-traumatic stress disorder (PTSD) than combat veterans. In long term the foster care children suffer from psychopathology and cognitive disorders.

3.4.1 Psychopathology Disorders with Child

According to Barkley and Mash (1996), child psychopathology is the manifestation of psychological disorders in children and adolescents. Some examples of psychopathology are post traumatic stress, attention-deficit hyperactivity disorder, oppositional defiant disorder, and pervasive developmental disorders.

3.4.1.1 Post traumatic stress disorder (PTSD)

Cash (2006) states that posttraumatic stress disorder (PTSD) is an emotional illness that that is classified as an anxiety disorder and usually develops as a result of a terribly frightening, life-threatening, or otherwise highly unsafe experience. PTSD victims re-experience the traumatic event or events in some way, tend to avoid places, people, or other things that remind them of the event , and are exquisitely sensitive to normal life experiences (hyperarousal). According to Dubber (1999) 60% of children in foster care who were sexually abused had post traumatic stress disorder ( PTSD). 18% of children who were not abused faced PTSD just by witnessing violence at home. The symptoms of post traumatic stress disorder are tabulated below

Table 3. 1 Symptoms Post Traumatic Stress Disorder

Re-experiencing the Traumatic event

Avoidance and Numbing

Increased Anxiety and Emotional Arousal

Intrusive, upsetting memories of the event

Avoiding activities, places, thoughts, or feelings that remind you of the trauma

Difficulty falling or staying asleep

Flashbacks (acting or feeling like the event is happening again)

Inability to remember important aspects of the trauma

Irritability or outbursts of anger

Nightmares (either of the event or of other frightening things)

Loss of interest in activities and life in general

Difficulty concentrating

Feelings of intense distress when reminded of the trauma

Feeling detached from others and emotionally numb

Hypervigilance (on constant "red alert")

Intense physical reactions to reminders of the event (e.g. pounding heart, rapid breathing, nausea, muscle tension, sweating

Sense of a limited future (you don't expect to live a normal life span, get married, have a career)

Feeling jumpy and easily startled

Intrusive, upsetting memories of the event

Avoiding activities, places, thoughts, or feelings that remind you of the trauma

3.4.1.2 Attention Deficient Hyper Activity Disorder

Millichap (2010) , defines attention deficit-hyperactivity disorder (ADHD) as a psychiatric disorder and it is characterized by either significant difficulties of inattention or hyperactivity and impulsiveness or a combination of the two. ADHD impacts school-aged children and results in restlessness, acting impulsively, and lack of focus which impairs their ability to learn properly. It is the most commonly studied and diagnosed psychiatric disorder in children, affecting about 3 to 5 percent of children globally.

Robin (1998) has listed some of the symptoms of Attention deficit-hyperactivity disorder are inattention, hyperactivity, disruptive behavior and impulsivity. Academic difficulties are also common signs of ADHD. According to Ramsay et al (2008), the symptom categories yield three potential classifications of ADHD-predominantly inattentive type, predominantly hyperactive-impulsive type, or combined type if criteria for both subtypes are met. The table below shows the Attention Deficient Hyper Activity Disorder Symptoms

Predominantly inattentive Symptoms

Predominantly hyperactive-impulsive Symptoms

Impulsivity Symptoms

Be easily distracted, miss details, forget things,

Fidget and squirm in their seats

Be very impatient

Have difficulty maintaining focus on one task

Talk nonstop

Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences

Become bored with a task after only a few minutes, unless doing something enjoyable

Dash around, touching or playing with anything and everything in sight

Have difficulty waiting for things they want or waiting their turns in games

Have difficulty focusing attention on organizing and completing a task or learning something new or trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities

Have trouble sitting still during dinner, school, and story time

Not seem to listen when spoken to

Be constantly in motion

Daydream, become easily confused, and move slowly

Have difficulty doing quiet tasks or activities

Have difficulty processing information as quickly and accurately as others

Fidget and squirm in their seats

Struggle to follow instructions

3.4.1.3 Oppositional defiant disorder

Matthys W & Lochman J (2010), defines oppositional defiant disorder (ODD) as an ongoing pattern of anger guided disobedience, hostilely defiant behavior toward authority figures which goes beyond the bounds of normal childhood behavior. People may appear very stubborn and often angry.

Freeman et al (2006), also listed some common features of oppositional defiant disorder (ODD) as persistent anger, frequent temper tantrums or angry outbursts and well as disregard for authority. Children and adolescents with ODD often purposely annoy others, blame others for their own mistakes, and are easily disturbed. The table below shows the signs and symptoms of Oppositional Defiant Disorder.

Signs and Symptoms of Oppositional Defiant Disorder (lasting at least 6 months, during which four or more are present)

Symptoms

often loses temper

often argues with adults

often actively defies or refuses to comply with adults' requests or rules

often deliberately annoys people

often blames others for his or her mistakes or misbehavior

is often touchy or easily annoyed by others

is often angry and resentful

is often spiteful or vindictive

3.4.1.4 Pervasive Developmental Disorder

Waltz M (2003), defines "Pervasive developmental disorders,"( PDDP, as a group of conditions that involve delays in the development of many basic skills, most notably the ability to socialize with others, to communicate, and to use imagination.

Malmone & Quinn (2004) also states that these conditions are usually identified in children around 3 years of age -- a critical period in a child's development. Although the condition begins far earlier than 3 years of age, parents often do not notice the problem until the child is a toddler who is not walking, talking, or developing as well as other children of the same age and four types of Pervasive Development Disorders have been identified; Autism, Aperger's Syndrome, Childhood disintegrative disorder and Rett's syndrome.

According to Volkmar (2007), children with autism have problems with social interaction, pretend play, and communication. They also have a limited range of activities and interests. Many (nearly 75%) of children with autism also have some degree of mental retardation.

Malonne & Quinn (2004), stated that children with Asperger's syndrome have difficulty with social interaction and communication, and have a narrow range of interests. However, children with Asperger's have average or above average intelligence, and develop normally in the areas of language and cognition (the mental processes related to thinking and learning). Volkmar (2007) also stated that children with Asperger's often also have difficulty concentrating and may have poor coordination.

Waltz (2003) stated that children with Childhood disintegrative disorder begin their development normally in all areas, physical and mental. At some point, usually between 2 and 10 years of age, a child with this illness loses many of the skills he or she has developed. In addition to the loss of social and language skills, a child with disintegrative disorder may lose control of other functions, including bowel and bladder control.

According to Goldstein & Reynolds (2011), Children suffering from Rett's Syndrome which is a very rare disorder have the symptoms associated with a PDD and also suffer problems with physical development. They generally suffer the loss of many motor or movement skills -- such as walking and use of their hands -- and develop poor coordination. This condition has been linked to a defect on the X chromosome, so it almost always affects girls.

The table below summarises the General Symptoms in Pervasive Developmental Disorders

General Symptoms in Pervasive Developmental Disorders

Difficulty with verbal communication, including problems using and understanding language

Difficulty with non-verbal communication, such as gestures and facial expressions

Difficulty with social interaction, including relating to people and to his or her surroundings

Unusual ways of playing with toys and other objects

Difficulty adjusting to changes in routine or familiar surroundings

Repetitive body movements or patterns of behavior, such as hand flapping, spinning, and head banging

Changing response to sound; the child may be very sensitive to some noises and seem to not hear others.

Temper tantrums

Difficulty sleeping

Aggressive behaviour

Fearfulness or anxiety

Eating Disorders

Hudson et al (2007) defines 'eating disorders refer to a group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health'. According to Hadfield (2008), obesity in all age groups of children has become an increasing concern in recent years. Children in foster care are more prone to become overweight and obese, and in a study done in the United Kingdom, 35% of foster children experienced an increase in Body Mass Index (BMI) once in care.

Hill & Williams (2012), states some children suffer from Food Maintenance Syndrome which is a pattern of excessive eating and food acquisition and maintenance behaviour without obsesity. The syndrome is said to be caused by stress and maltreatment of foster care children.

Tarren-Sweeney (2006) study states that children in foster care also suffer from Food Maintenance Syndrome which is characterized by a set of abnormal eating behaviors of children in foster care. It is "a pattern of excessive eating and food acquisition and maintenance behaviors without concurrent obesity"; it resembles "the behavioral correlates of Hyperphagic Short Stature". It is hypothesised that this syndrome is triggered by the stress and maltreatment foster children are subjected to.Northwest Foster Care Alumini study (2011) reports that Bulimina Nervosa is seven times more prevalent among former foster children than in general population.

The table below summarises Eating Disorders Symptoms

Eating Disorders Symptoms

Repeatedly eating large amounts of food in a short period of time (less than 2 hours).

Frequently getting rid of the calories you've eaten (purging) by making yourself vomit, fasting, exercising too much, or misusing laxatives, diuretics, ipecac syrup, or enemas. Misuse of these medicines can lead to serious health problems and even death.

Feeling a loss of control over how much you eat.

Having binge-purge cycles.

Feeling ashamed of overeating and very fearful of gaining weight.

Basing your self-esteem and value upon your body shape and weight

Repeatedly eating large amounts of food in a short period of time (less than 2 hours).

Frequently getting rid of the calories you've eaten (purging) by making yourself vomit, fasting, exercising too much, or misusing laxatives, diuretics, ipecac syrup, or enemas. Misuse of these medicines can lead to serious health problems and even death.

Feeling a loss of control over how much you eat.

Having binge-purge cycles.

Feeling ashamed of overeating and very fearful of gaining weight.

Attachment Disorders

According to Beckman-Weidmen (2006), histories of pathological care, children in foster care appear to be at increased risk for developing insecure attachment patterns and attachment disorders.Attachment is the result of the bonding process that occurs between a child and caregiver during the first couple years of the child's life. The first year of life is the year of needs. The infant's primary needs are touch, eye contact, movement, smiles, and nourishment. When the infant has a need, he or she expresses the need through crying.

Brisch (2012), also states that through interaction between foster family and child, the child learns that the world is a safe place and they develop emotional connection, the child feels empowered in his or her environment, and develops a secure base from which the child can with assurance and effectively explore the world. The foster child and foster parent creates a deep, nurturing connection together. It is vital for brain development and emotional health, and its effects are felt physiologically, emotionally, cognitively and socially.

Cain (2006), states that when the initial attachment is lacking, children lack the ability to form and maintain loving, intimate relationships. The children grow up with an impaired ability to trust that the world is a safe place and that others will take good care of them.

Attachment Disorders Symptoms

Superficially charming, acts cute to get what he/she wants.

Indiscriminately affectionate with unfamiliar adults.

Lacks genuine affection with primary caregivers (especially mother).

Controlling, bossy, manipulative, defiant, argumentative, demanding, impulsive.

Preoccupation with fire, death, blood, or gore.

Cruelty to animals, destruction of property, aggression toward others or self.

Destructive, accident-prone.

Rages or has long temper tantrums, especially in response to adult authority.

Poor eye contact, except when lying.

Blames others for their problems.

Lacks self-control.

Lacks cause and effect thinking.

Lies, steals, shows no remorse, no conscience, defiant.

Hoards or sneaks food, strange eating habits.

Poor hygiene: wets or soils self.

Has difficulty maintaining friendships.

Underachiever.

Persistent nonsense questions and incessant chatter.

Grandiose sense of self lacks trust in others to care for him/her.

According to Barbell & Freundlich (2001), foster care is a complex service. It serves children who have experienced abuse or neglect by their biological parents. However, associated with the benefits of foster care also shortfalls and one of the methods to tackle the problems related to foster is counselling techniques.

Counselling in the Foster Care System

Definition of counselling

Palmer and McMahon, (2000), has defined Counselling as a 'therapy', which is a process aimed at providing clients with the time and space to explore their problems, understand their problems, and resolve , or come to terms with their problems, in a confidential setting.

The American Psychological Association, Division of Counselling Psychology (1956) defines counselling as a process 'to help individuals towards overcoming obstacles to their personal growth, wherever these may be encountered and towards achieving optimum development of their personal resources'

Ravi (2010), states that 'Counselling involves the development of a relationship between the client and a trained professional that focuses on the client's concerns and difficulties'.

Therefore counselling is a process in which individuals have the opportunity to improve their understanding of themselves, including their patterns of thoughts, behaviours, feelings and the ways in which these may have been problematic in their lives. Counselling also assist the client to identify his/her own resources and capabilities which are sometimes lost or buried in times of confusion and anxiety. Counselling enable the client to see circumstances afresh and with clarity so that necessary changes can be made that will help in particular stages in life. Throughout the process of counselling the client will be encouraged ,supported and empowered to look from a difference perspective. The aim of counselling is not only to help to cope with a current issue or crisis ,but to do such a way that produces learning in the future .

Henderson & Thompson (2011), also states that counselling is a collaborative effort as it involves the client and the counsellor working together to identify goals. Throughout the counselling process the client is encouraged, supported and empowered to look at himself/herself from a different perspective. The objective of counselling is not only to help the client cope with a current issue of crisis ,but to do so in a way that produces learning for the future ,so that the client can feel more in charge of his/her life.

Therapy with foster care child

Blatt (2000), defines 'therapy as an art and science of helping children make sense of their feelings, thoughts, and behavior and learn how to control their behavior and improve interactions with others'. It is an art, because it requires the therapist's creativity, intuition, and spontaneity. It is a science because therapy with abused and neglected children is based on theory, research, and clinical studies. The goals that need to be accomplished and the techniques or interventions that help children address and grow and overcome the experience of abuse and neglect. One of the main purposes of counselling the maltreated child is to provide a safe place and relationship in which the child may try out with new adaptations to a safer world.Counsellors cannot literally substitute the requisite parental bonding which helps children to grow and develop, but have an opportunity to help the child develop a trusting relationship with an adult.

The key to understand the maltreated child is to look at the developmental stage rather than the chronological age. The counsellor will be able to identify adaptations which the child made to the maltreatment and teach the child more appropriate ways of interacting. In the counselling relationship, working with maltreated children requires many techniques other than talking and listening. Using structured or unstructured play situations and artwork, music or clay provide a safe way for children to release tension and express themselves

MacRae & Cara (2013), also states that therapy with abused and neglected children is often demanding and challenging. But it offers the immediate reward to the therapist of knowing that he/she is making every effort to help the child and the family who are struggling to overcome the effects of abuse and neglect. Therapy is a valuable service and a major contributor to the well-being of maltreated children and their family. Munro et al (1989), states that for treatment the therapist uses different techniques such as individual therapy, play therapy and family therapy.

Techniques of therapy

Individual Therapy

According to Munro et al (1989), individual therapy is the child's first introduction to treatment. It is an opportunity for the child to interact with a compassionate and knowledgeable adult and develop a relationship between adult and child. Individual therapy also allows the therapist time to assess and evaluate the child's interpersonal skills and help the child learn appropriate behaviors to interact with peers.

Munro et al (1989) defines the goal of individual therapy as an understanding, integration, and resolution of those experiences that affect development, interaction, and safety. Individual therapy is beneficial in helping children tackle developmental issues of trust, mastery and control, and identity. Individual therapy is also helpful in supporting disclosure of abuse and neglect, helping the child identify issues related to their experience, and in resolving intrapersonal issues.

Play Therapy

Palmer and McMahon, (2000), considers play therapy as an effective modality that helps the child express feelings, act out behaviors, and gain mastery and control over memories and feelings generated by the abusive or neglectful experience. According to Palmer and McMahon, (2000) a child uses play to manage his/her fears and anxieties about the abuse, express his/her feelings about what happened to him/her, and demonstrate their knowledge and understanding about relationships. Play therapy allows the child to represent figuratively those events that generate fear and anxiety and helps the child move toward resolution and integration of the frightening experience.

According to Geldard & Geldard (2008) play therapy is especially effective with children who do not have the verbal or cognitive skills necessary to participate in a more direct approach to discussing their feelings. A child who is developmentally or emotionally unable to express him/herself verbally can benefit from an experience that allows him/her to demonstrate his/her feelings and fears. Themes that are repeated during play therapy should be studied as interventions need to be developed to help the child gain a sense of mastery and control over devastating experiences. The therapist should interpret the play material in a way that adds insight and meaning to the child's experience and facilitates resolution and termination of the traumatic event.

Group Therapy

Jacobs et al (2009), also states that group therapy is helpful for decreasing isolation, improving social skills, and monitoring and intervening in difficult interactional patterns of behavior. Group therapy also allows the child to identify and learn from peers and group leaders and helps the child learn new and possibly more effective ways of interacting and communicating about his/her circumstances. Group therapy can facilitate participation with a supportive and understanding peer group and allow the child to practice many of the skills that will improve his/her ability to affiliate and evaluate relationships. According to Manheim (2002), additional benefits provided by group therapy, include normalization of the experience by hearing similarities in victims' feelings and responses to abuse or neglect, corrective submission of the primary family group, development of socializing techniques and acquisition of the sense of belonging.

MacRae & Cara (2012), also states that group therapy is not justified for a child who is unable to manage his/her impulsive behavior. The child would be disruptive in group or unable to gain acceptance. A child with limited social skills therefore needs individual therapy to prepare him/her for the social experience of group therapy.

Family Therapy

Brisch (2012), states that family therapy is most helpful when the family is willing and able to view the abuse or neglect as an issue that needs to be addressed by all the members in the family. Family therapy is an opportunity to explore roles and relationships, help family members recognize the impact that their behavior has on each other, and increase family cohesion and belonging. Family therapy can facilitate problem solving and improve communication between members. Family therapy seems most helpful after the individual family members have addressed their intrapersonal and developmental issues in individual or group therapy.

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Role of the therapist

According to Betts (2003), the therapist has an important role in helping a child recover from the effects of abuse and neglect. The therapist serves a number of functions, including:

helping the child address issues related to abuse and neglect,

serving as a model for appropriate adultchild relationships,

working to improve family relationships, and

supporting positive and productive peer relationships and support systems.

Freeman et al (2006), also states that the therapist's initial function is to establish rapport and develop a trusting relationship that will help the child address the thoughts, feelings, and behaviors that are generated by abuse and neglect. The therapist promotes the child's awareness and understanding of abuse dynamics, encourages growth and development beyond the role of victim or the inappropriate identification with the offender, and supports the child's individuality and personal integrity. The therapist teaches the child to care for him/herself, think about his/her behavior, and make choices that maximize his/her safety. The therapist also needs to help the child regain trust, faith, and investment in meaningful relationships.

Betts (2003), also states that the therapist models appropriate behavior including nurturing, affection, and the expression of feelings. The therapist gives the foster child the opportunity to explore issues of trust, acceptance, affiliation, and emotional intimacy. The foster child can integrate the therapist as a role model for safe and nurturing relationships. The therapist also shares the child's hope, excitement, and curiosity about life in order to help his/her client reinvest in his/her future.

According to McNair (2000), the therapist models and maintains good clinical boundaries. The therapist understands the vital bond between child and parent and does not attempt to take the place of the parent. The therapist helps the child and parent interact appropriately and offers alternative problem-solving models for parent-child relationships. The therapist also helps the child to be as realistic and practical as possible when relating to parents with problems. It is a difficult task to help a child to be realistic, while not taking away the child's hope for change and improvement in their parents.

Palmer and McMahon, (2000), states that clinical interventions and psychotherapy with parents is vital that every effort be made to improve and maintain the child's relationships with family members. Foster children need to express a full range of feelings regarding their family members. The therapist must remain neutral and empathetic to the child's situation rather than taking angry and punitive stances toward parents and unavailable family members.

Summary of Literature Review

Foster care is most likely the most widely practised form of substitute care for children world-wide. The Foster care system caters for children who have been abused, or neglected by their biological parents. The children are then placed in Foster care families who look after the children until the age of 18 until they become adults, or in some cases they return back to their biological parents. However, with the benefits of the foster care system there are several shortfalls. The children in foster care families were found to have higher rates of post-traumatic stress disorder (PTSD). In long term the foster care children suffer from psychopathology and cognitive disorders. One method to help the foster care families, parents and children is counselling therapy.