RRR V - Interventions That Work

Resilient Rascals V: Interventions That Work

On March 4th & 5th, 2011, we're excited to help present our 5th annual adoption and foster care conference for parents and professionals, with topics and co-presenters near and dear to our heart.

This year's focus is on parenting and therapy approaches that work, either in research testing or our clinical experience, and will happen over a Friday/Saturday at the Community Center at Mercer View, on Mercer Island near Seattle.

Here's the lineup ... conference details and registration details on the Cascadia Training website. Sign up now, and spread the word!

• Fetal Alcohol Spectrum Disorders: Overview of Diagnosis - Julian Davies, MD, University of Washington
  Recent advances in neuro-imaging have brought new insight into the impacts of prenatal alcohol exposure.  The latest round of trials has suggested promising avenues for intervention.  A pediatrician from the longest-running FAS clinic in the country will review the basics of Fetal Alcohol Spectrum Disorders and explore how the brain can be affected by prenatal drinking.
• Insights on FASD Interventions - Heather Carmichael Olson, PhD, University of Washington & Seattle Children's
  The lead investigator for the Families Moving Forward FAS intervention research project will present their promising findings, as well as other evidence-based interventions for the fetal alcohol spectrum.
• Promoting Engagement, Emotional Regulation and Social Play for Young Children and their Families - Gusty-Lee Boulware, PhD, PEERS Play
  In this multimedia presentation, Gusty-Lee will share a variety of developmentally appropriate intervention strategies designed to support young children's social emotional growth and relatedness.  Specifically she will discuss activites to (1) enhance children's comfort with eye to eye gaze and referencing, (2) increase children's success with flexible social problem solving, and (3) help children maintaining a calm alert state.
• Collaborative Engagement between Adoptees and their Birth Countries - Julia Tombari, Adoptee/Student
• Family-Based Interventions for Children with Development Risk - Cynthia Heywood, PhD, Oregon Social Learning Center
  Multidimensional Treatment Foster Care (MFTC) is an evidence-based approach for supporting children with a history of maltreatment, neglect and developmental risk.  The program's aim is to stabilize children in a therapeutic family setting through comprehensive and intensive supports to the child and their caregivers. Dr. Heywood will also present the two innovative programs currently being developed and piloted: a time-limited foster parent training intervention with a therapeutic playgroup component for the foster child, and a strengths-based video feedback intervention for parents and caregivers of infants, toddlers and children with prenatal substance exposure and other high needs children.
• Treating the Whole Child not the Parts: Supporting the Rhythms of Relationships - Rosemary White, OTR
  When engaging in interactions with a child who presents developmental challenges that may be related to medical and or social emotional history prior to adoption, it is essential to constantly think about the "whole child."  This will guide us in our work with families so that we can support the physical, emotional and social development of the child.
• Tying the Interventions Together - Deborah Gray, MSW, MPA, Nurturing Attachments

Refreshments and boxed lunch included each day. We have lowered this year's fee and there is a limited scholarship fund to help reduce costs for those that can't afford the full fee. 

Advocating for Your Child's School Needs

At our recent adoption and foster care conference, Raising Resilient Rascals … Takes Flight, we had a panel discussion that was so full of useful tips that I couldn't resist sharing them here. Thanks so much to our panelists: Julia Bledsoe, Larry Davis (of www.specialeducationadvocacy.org), Lisa Konick-Seese, Gwen Lewis and Kate Molendijk. Some of their "pearls" follow, but first, some basics:

Getting Started

For children under three with developmental concerns, parents can (and should) call their local Early Intervention (also know as "Birth-to-3", or "ITEP") Center. You don't need a referral to start the process. They should do any necessary screening tests, and if your child falls below a certain threshold, they will qualify for subsidized developmental therapies. Increasingly, the center's therapists will meet the child at their home or child care center to provide these services. Find out more here.

For children over 3, your local school district is responsible for developmental screening and providing supports, even if your child isn't in school yet, or is home-schooled, or attends private school. In the latter cases, accessing those supports may not be easy or convenient, but it should be possible. Contact your school district's "Child Find" office to initiate this process.

IEPs and 504 Plans

If your child has a documented disability, which has an impact on your child's education, then your child should be eligible for either 504 Plan accommodations, or an Individualized Educational Plan (IEP).

Generally speaking, if tweaks to general education are deemed adequate to meet your child's needs, a 504 plan will be suggested. One drawback to 504 plans is that the school is not so accountable, oversight being at the federal level.

If your child needs more significant "specially designed instruction," then they should receive an IEP. With an IEP, the school is more accountable (oversight tighter, at the state level).

General School Tips

• It helps to develop an ally or friendly resource at the school that seems to understand and appreciate your child. This person can be invaluable for informal mediation, advocacy, advice about next year's classroom, and so on.
• Invite the teacher to dinner once a year. This used to be common, and some teachers still do it, in the younger grades. It gives them a more holistic sense of your child, and helps build a collaborative relationship.

Tips for IEP Meetings

• IEP meetings, especially your first, can be very stressful for parents, and it's easy to feel powerless, unable to effectively advocate for your child. These tips should help.
• Make sure you "check your own pulse" before the meeting starts. It's natural to feel defensive, or scared, or upset at how things have been going (or not going). You may find that you're in revved-up "mama bear" or "papa bear" mode. That's understandable, but also counter-productive. Make sure you're as calm and centered as possible, and use some of the following strategies to advocate for your child.
• The room may be packed with professionals, but remember that you are the expert in your child.
• Feel free to "stack the deck" in your favor at IEP meetings.
• Bring friends, support, other caregivers, prev. teachers, consultants.
• If you've developed an ally at school, have them there if possible.
• Bring treats. Break bread together. It can't hurt.
• Consider passing around a sign-in sheet (if unfamiliar folks will be there), with phone/email info for later contact.
• School culture can be geared toward "no", especially in these budget crunch times. Build a succession of yes's about your child first, instead of starting with your requests or demands.
• Do that by creating a sense of shared understanding, based on data if possible, about your child's unique background, weaknesses, and strengths. You and the staff should be recognizing your child in what each other has to say: "Yes, that's my child/student." Then the requests should flow more naturally and collaboratively.
• Then again, it may take 3-4 meetings for some staff to "get it." Call followup meetings if need be (it's your right, when you have an IEP), until they do.
• Before a school transition, have a meeting the preceding spring with a representative from the new district/school, to develop the IEP using folks that know your kid, and get a headstart on next year's plan.
• Think carefully about closing out an IEP, even if you decline services. They can be harder to get later.

School Bureaucracy

• School districts have strict timelines for responding to requests around evaluations and special education. Learn them, and keep track. 
• Use email or get copy of letter stamped at school when dropped off. This starts the clock ticking.
• Keep notes, folders for each child, or email folders, to a court-worthy standard (dated, no missing pages from notebooks, etc). Hopefully you won't end up there, but if you do ...

If Things Still Aren't Going Well

• You may consider an independent educational evaluation (IEE), a "second opinion" about your child's abilities.
• An educational advocate may also be useful.
• Consider formal mediation as well.
• Your child has the right to a "Free and Appropriate Public Education"; unfortunately, this does not equal a "Free and Perfect Public Education." We are not funding our schools as we should, and they have limited resources to meet the needs of many students. 
• Trust your instincts about whether this school or program is working for your child (but get some second and third opinions too!). Some families decide that private, parochial, or home-schooling is a better fit for their child's needs. This, of course, can be expensive, especially with added private therapists if those are necessary.

Resources

• WrightsLaw is an excellent resource for special education law, education law, and advocacy for children with disabilities.
• For local info, see the WA State official special education website.
• The WA State Office of the Education Ombudsman (OEO) "helps solve conflict and disputes between Washington families and elementary and secondary public schools so that students have every opportunity to stay in school and succeed." They are part of the Governor’s Office and function independently from the public school system.
• Another excellent source of info in our state is Kristin Hennessey, the Special Education Ombudsman at OSPI, at (360) 725-6075 or kristin.hennessey@k12.wa.us.

Raising Resilient Rascals ... Takes Flight!

We're back for our fourth year! All-new presentations on the most requested topics from previous years! At the Museum of Flight! It's a two-day conference with valuable information for foster/adoptive parents and professionals, presented by experts in the field.

Friday March 5th and Saturday March 6th, 2010

Friday, 9am-4pm:

Welcome - Julian Davies, MD 

Thank you for choosing us today and we hope you have a pleasant flight. Please turn off all electronics during today's flight.

Building Attachment in Infant and Early Childhood Adoptions - Kristie Barber, MSW

Parents traveling with small children may board the plane at this time.

Sleep and Adoption - Julian Davies, MD

The Captain will be turning off the cabin lights. Slides and resources here.

Understanding and Building Childhood Executive Functioning - Gwen Lewis, PhD

This is your Captain speaking, please direct your attention to the front of the cabin.  

Advocating for Your Child's School Needs - Panel Discussion

Please find information about today's flight in the seat packet in front of you. If you have any special needs, please contact a crew-member for assistance.

Saturday, 9am-4pm:

Building Healthy Parent-Child Attachments - Deborah Gray, MSW

Make sure that all baggage you have brought on today's flight is securely stowed. The crew will take you through some safety procedures.

The Importance of Self-Care for Parents - Deborah Gray, MSW

Put on your oxygen mask first before helping others with theirs.  In your in-flight magazine, you will find exercises you can do during the flight.

Emerging Health Issues - Cynthia Kertesz, MD

Upon arrival in customs, travelers should expect a screening for infectious diseases

Parenting the Adopted Adolescent - Paulette Caswell, MSW

We're expecting turbulence, so please keep your seat belt fastened at all times. For your own health and the safety of others, we ask that you observe the no-smoking signs at all times. 

Trans-Racial, Trans-Cultural Adoption Issues - Suzanne Engelberg, PhD

Your flight crew will be passing out entry documents you need to fill out before arrival in this foreign country.

Trans-Racial, Trans-Cultural Adoption - Panel Discussion

Have your passports ready for going through customs.

Details

Cost: $85 for one day; $155 for both days. In-flight lunches will be provided.

Venue: The Museum of Flight
9404 E. Marginal Way S

Seattle, WA  98108

Presented by: Center for Adoption Medicine at the University of Washington, Cascadia Training, Northwest Adoption Exchange, and Nurturing Attachments

CEUs: 7 CEUs per day, 14 total, no additional charge.

For more info or to register: Call 800-298-6515 or 206-441-6892, or visit www.cascadia-training.org

Flyer: Please share this flyer with your friends and colleagues!

Resilient Rascals Grow Up

Save the date! On Friday, March 6, 2009 (please note date change), at the Shoreline Center, we'll be hosting our third "Raising Resilient Rascals" adoption and foster care conference. We're still working on the precise lineup, but the general focus will be on older child and adolescent issues. Possible talks:

• When to worry about mental health issues versus "normal" teen behaviors
• "Parenting Pitfalls" vignettes and open mic, with booby prize for best worst parenting moment
• How adopted adolescents construct their identity, and how to help
• Living with an older child with executive function difficulties - practical tips
• A mother and adopted daughter discuss transracial adoption
• Adult adoptee panel

Details to follow ... stay tuned! And feel free to just go ahead and register.

Raising Resilient Rascals Conference

Raising Resilient Rascals:

Integrative, Brain-Based and Practical Ways
to Nurture Adopted and Fostered Children

 
Save the date! On Feb 2nd we'll be hosting an all-day conference with Deborah Gray and colleagues.  We're aiming to be interesting and informative for both parents and professionals interested in adoption. Check out the topics below, and sign up at the Cascadia Training website.

Topics include:

 

The "Decade of the Brain" Came and Went - What Have We Learned?

The past 10 years brought many advances in neuro-imaging, and better understanding of the effects of prenatal drug and alcohol exposures, malnutrition, maltreatment, lack of attuned care giving, and stress on the developing brain.  What can the latest research tell us about how these all-too-frequent influences affect the neurodevelopment of adopted and foster children?  We will explore different regions of the brain, and aspects of learning and behavior, with an emphasis on avenues for intervention at home and school.

Loving the Child Who Bites You - Disciplining Scared/Aggressive Kids. 

Children who have been maltreated or lost attachment figures desperately need to form secure attachments with their parents.  Often the children are aggressive and/or immature and impulsive.  What strategies are useful when children show limited empathy?  We will look at approaches designed to bring out the best in children whose histories of maltreatment have resulted in dysregulation and behavior problems.

From Snake Oil to Fish Oil - Integrative Medicine and Adoption. 

A lively romp through the wilderness of complementary/alternative therapies commonly used by adoptive families, from an "alterna-friendly" pediatrician.  We'll review the evidence or lack thereof, safety, and cost of interventions ranging from vitamins, minerals, essential fatty acids, and other "nutriceuticals", herbs and homeopathy, elimination diets, chelation therapy, bodywork and chiropractic, developmental movement therapy, sensory and auditory integration, and bio/neurofeedback.  We'll also cover ways to evaluate therapies and practitioners, and the cardinal signs of quackery.

Adderall and Risperdal et al. - Meds and Adoption.  

In this part of our talk, we'll address the use of psychiatric medications with adopted and fostered children.  Stimulants, antidepressants, mood stabilizers, blood-pressure medications, and atypical anti-psychotics are being used more and more with younger and younger children.  Unfortunately, the evidence for safety and efficacy in children for many of these drugs is lacking (as are the child psychiatrists!)  What do we know about these meds and children?  What goes into the decision to medicate a child for specific psychiatric conditions like ADHD, depression, anxiety, and bipolar disorders, as well as less defined emotional and behavioral problems?  What sort of monitoring is important?

Creating Resilience in Children: What areas promote competencies in children?  What are we doing well?  What are we missing?   How should we be doing it? 

The remarkable increase in the number of adoptions of children adopted after trauma and neglect has pushed the need for support.  But, professionals and parents alike need to know when to obtain support.  This talk describes symptom clusters in childhood trauma, neglect's impact on children's functioning,  and best practices in providing help.  We will also discuss what to look for in acquiring help and what to avoid.

Resilience Panel

The day will end with a panel to include all the speakers and a few invited guests.  The panel will discuss resilience factors, resilience gene, adult influences, orphanage interventions, goodness of fit, what can parents do to prepare/promote resilience?  There will be plenty of time to take attendee questions.

About the presenters:

Julia Bledsoe, MD, is a Clinical Associate Professor of Pediatrics at the University of Washington, and a staff pediatrician at the UW Fetal Alcohol Syndrome Diagnostic and Prevention Network in Seattle.  She founded the Center for Adoption Medicine, and has worked in the field of international adoption for ten years, with travels to Russia, Romania, China, and Guatemala.  She has two children adopted from Korea, one of whom has Tourette's Syndrome and ADHD.

Julian Davies, MD, is a Clinical Assistant Professor of Pediatrics at the University of Washington, and the other pediatrician at the UW FAS Clinic.  He is also the Co-Director of the Center for Adoption Medicine, where he provides pre-adoption consultations, post-placement evaluations, and ongoing general pediatric care for adopted children.  He is the primary author for www.adoptmed.org, an online resource for medical and developmental issues in adoption and pediatrics.  He has traveled, clowned, and volunteered extensively in Russia, with an arts rehabilitation program and summer arts camp for Russian orphans.

Deborah Gray, MSW, MPA, is a national trainer, a psychotherapist in private practice, and the author of the well-received book, Attaching in Adoption: Practical Tools for Today’s Parents, Perspectives Press, 2002. Deborah has spent 20 years helping children develop attachments and work through trauma and grief. She teaches in the Trauma Certificate Program at the Univ. of WA School of Social Work and both graduate adoption therapy programs at Portland State University and Northwest Adoption Exchange. Her second book on best practices with children after neglect and trauma is in preparation.

About the particulars:

Location: Tukwila Community Center
When: February 2nd, 2007
Hours: 8:30am-5:00pm
Fee: $65.00 US
CEU info: 7 CEU's 
Cascadia Training is approved by the NASW, Washington State Chapter, to provide continuing education units to Licensed Social Workers, Mental Health Counselors and Marriage and Family Therapists.  Certificates of Completion are awarded to attendees at the end of each workshop.  Provider number #1975-118; Cascadia is an OSPI approved provider of in-service education.  This is a "Washington State Approved Clock Hour Offering Workshop."

Our Post-Placement Evaluations

Here's what we hope to accomplish during our hour-long initial appointments with new arrivals, ideally scheduled 1-2 weeks after you get home. We then like to see children roughly every 2 months until they've been home 6 months, to closely follow adjustment, growth, and developmental catchup. Our Welcome Home Guide is a printable summary of what we usually cover at our first visit, but here is a quick overview.

History and Physical Examination:

• Review any newly acquired medical, educational, or institutional records
• Interview older children, with interpreter
• Discuss family concerns and adjustment issues including sleep, feeding, and attachment
• Assess growth
• Thorough physical examination
• Developmental screening
• Screen hearing and vision - hard to accomplish accurately <4 years old, so ...
• Likely referral for audiology, opthalmology, and/or dental examinations
• If delays are greater than expected, Early Intervention referral

Immunizations:

• Immunizations from Korea (and sometimes Guatemala and Taiwan) are generally trusted
• From other institutional settings, we usually combine checking titers (blood tests of immunity, not reliable <1yo) and repeating immunizations based on the individual child's age and shot record

Lab Workup:

• Newborn screening panel (infants only)
• Complete blood count and ZPPH or ferritin (iron deficiency tests)
• HIV antibody; Hepatitis B panel; hepatitis C antibody (on arrival and 6 months postplacement)
• Hepatitis A titers (asymptomatic in young children, but can make their older contacts quite ill)
• Serologic test for syphilis
• Thyroid function tests
• Lead level
• Stool examination for ova and parasites (three preserved specimens - you'll get vials at the visit to collect and drop off)
• Stool examination for Giardia antigen (one fresh specimen)
• Urinalysis if growth deficient, symptomatic, or any history of issues
• Calcium, phosphorus, and alkaline phosphatase levels, if child has stigmata of rickets
• If height deficiency is profound, further lab evaluation for short stature
• Tuberculin skin test (on arrival and 6 months postplacement - this is crucial)

"Birth-to-Three" Early Intervention

If you have a concern about your infant or toddler's development, discuss it with your pediatrician, but also consider an Early Intervention evaluation. Your pediatrician may be able to reassure you that your child is developing typically, but if you're not convinced, this program can serve as a "second opinion", and provide developmental services if your child is indeed delayed. It's nice to be formally referred by your pediatrician, but you can self-refer if need be.

Early Intervention centers have family resource coordinators, physical therapists, occupational therapists, and speech and feeding therapists, all with expertise in early childhood development. They may draw upon your insurance, but the rest of the costs are typically covered by the state. For families in Washington State, you can get a referral to a nearby center from WithinReach, at 1-800-322-2588. I also recommend "A Family's Guide to Early Intervention in Washington State". Oregon residents can use this brochure.

For international adoptees, who often have multiple prenatal and postnatal risks, and delays from neglect and institutionalization, the decision to involve your child in early intervention is a bit trickier. The major intervention in your child's life is adoption itself, and you should expect rapid developmental catchup by virtue of your love, attention, stimulation, and nutrition. However, if your child is more delayed than other orphanage-raised children on arrival, has other known developmental risks like prenatal alcohol/drug exposures and prematurity, or is not making rapid catchup progress in the first 1-2 months home, then early intervention is recommended. Even if your child is "typically delayed", many parents don't feel comfortable doing this on their own, and want help assessing development, tracking progress, and with practical tools and guidance for their home interventions, as well as direct therapy services.

Mandarin for the Adoptive Parent

These key words and phrases for the adoptive parent, with Pinyin pronunciation and audio links, are invaluable for parents traveling to China and in the first weeks home.

Here's a Guide to Pronouncing Mandarin in Romanized Transcription.

Another nice resource is Zhongwen.com, an in-depth guide to Chinese characters and culture, with spiffy clickable character definitions and language genealogy.

For local parents, Mandarin for Parents offers 6-week classes in Seattle and the Kitsap Peninsula. They also publish study books and CDs.

Some of our families have found the Simple Language for Adoptive Families booklets/CDs helpful as well.

Puget Sound Parenting Calendar

This exhaustive and up-to-date Puget Sound Parenting Calendar is published by PSAS - their description follows ...

"A nonprofit educational organization founded in 1975, the Puget Sound Adlerian Society (PSAS) offers information, referrals, workshops, lectures, courses, and other resources and support to parents, parent educators, teachers, counselors, social workers, workplace managers, and other people who are inter­ested in mutually respectful, cooperative relationships—community-building—in families, classrooms, workplaces, and everywhere else. Parent education has been our primary focus. We help parents choose attitudes and actions of respect for their children and themselves—attitudes and actions that strengthen a child’s sense of belonging and strengthen the family. Kids don’t come with instructions: it is all too easy to put children, family relations, and marriages at risk when parents just need some new skills and attitudes.

... Choosing “kind and firm” attitudes and actions (kind = respecting the child, and firm = respecting the situation) is essential for parents, teachers, and others who live or work with children.

... Democratic parents are still authoritative and set clear limits in matters of safety, health, and morality.  For other matters, we work out guidelines, choices, and solutions, often together in family meetings.  We chose to encourage children and help them learn to solve problems rather than to order, reward, and punish them as in the authoritarian model.  Barbara Coloroso, author of Kids Are Worth It!, calls this “giving your child the gift of inner discipline,” or helping our children learn how to think, not what to think."