June 4, 2012

Growing Relationships A Child at a Time

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Joseph V. Madia, MD By:

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A Home Within pairs therapists with foster children for long term relationships

It's a staple of mental and emotional health that you must know how to build and maintain healthy relationships with others. But foster students lack this luxury.

After all, if the only relationships you ever knew ended in under a year, how would you ever learn the skill of forming lasting relationships and keeping them going even when the going gets tough?

This dilemma is just one of the many challenges that face foster kids, some of whom may move homes more times than the number of years they've been alive.

A Home Within, a nonprofit organization with 50 chapters spread across 22 states, is aiming to change that cycle of broken relationships, one child-and-therapist pairing at a time.

For the past ten years, A Home Within has sought therapists who are willing to take on a single foster child for no fee as a long-term client, meeting them once a week to help them with the various emotional troubles that come with being in the foster system while simultaneously providing them at least one relationship that will last longer than a few months.

Dr. Toni Heineman, the executive director of A Home Within, recently shared with dailyRx the mission and the rewards of being a therapist for A Home Within.

She hopes other mental health professionals across the U.S. will be inspired to commit some of their time and expertise to the organization.

How does A Home Within work?
A Home Within is a very simple model. We have clinicians that understand the importance of a consistent relationship and they agree to see one foster child for as long as it takes. The average length of treatment is three and a half years, but we have kids who have stayed in touch with their therapists for over 10 years.

We know the relationship makes a huge difference in the lives of these kids. They usually don't get long-term relationships. They usually get interns, who leave after six months or a year, so these kids do not have the stability of relationships that all kids need to thrive. On the one hand, it's a big "ask." On the other hand, it's just one kid and it can make a difference in the life of that child.

Describe the big picture of foster children's lives.
By and large, their relationships are kind of like quicksand. They aren't really stable. They're usually separated from their biological parents, and they become separated from their foster parents. According to some surveys, most [non-foster] kids don't become financially independent until age 26, and those are kids who are raised by parents so they're pretty well-positioned for adulthood. In foster care, kids haven't had the kind of stable childhood that prepares them to go into successful, productive adult lives. You need a lot of stability in your life to grow up.

Why kinds of mental health issues and challenges do foster children face?
They find it understandably incredibly difficult to trust people because people have let them down again and again and again - which makes it hard for them to get close to people. They often suffer from low self-esteem because it's human nature to blame ourselves when things go wrong, and so they think they're not lovable. We see a lot of depression and anxiety.

The biggest thing is that they find it hard to form relationships, and we all need relationships. We need people to turn to when we're sad and need a shoulder to cry on. We need people to turn to when we're happy and have good things to share. With their difficulties in trusting and building relationships, foster children often don't have the opportunity to mourn all the losses they've experienced.

In foster care, we keep teaching kids how to start over. We don't teach them how to stick around, and that doesn't make for very good long-term relationships. Sticking around is what builds relationships. How do you go through the hard part of being in a relationship? How do you stick it out?

There are 500,000 kids in the system at any given time. About 800,000 pass through the system in a given year. They're a vulnerable population, and they can really make use of psychotherapy. We have kids who have been in five or thirty different homes. I have one child who's been with a therapist with five years, but she's 9 and she's had 14 different foster placements. We have moral responsibility to make things better for these kids.

What kinds of volunteer mental health professionals do you need?
We need three kinds of people: therapists, consultation group leaders and clinical directors. A therapist commits to seeing one foster child, teen or young adult once a week in therapy free of charge. Therapists also participate in a consultation group that connects them with colleagues. It's hard work, and you need a lot of support. You might watch a webinar at these meetings, talk about the work or read relevant literature.

Consultation group leaders are people who are willing to lead weekly meetings for therapists to get professional development. It's a learning community with continuing education credits free of charge, and it's a great way to build a referral basis and network with people in the community. One of the things we hear over and over again is that the consultation group is one of the highlights of their week and an incredibly important part of the therapists' development and network.

Clinical directors are the point persons of each community who become Fellows for us and establish and maintain a chapter of A Home Within, and that's a three-year commitment of four hours a week and an annual training and retreat in San Francisco. The fellowships are also volunteer - we pay for the retreat, but we don't pay any stipend. The retreat is a fabulous experience. People love it.

How do you match clinicians with children?
We have a pretty extensive process. We do a screening to make sure the therapists are qualified and know what they're doing. We also find out what they're more interested in - a little kid, a teenager, a young adult. Then when we have a child or adolescent or young adult that seems to match, we let the clinical director know and he or she is responsible for actually making the connection.

What if there's not a local chapter?
If someone really wants to help out a foster kid, we want to do everything we can to make that happen, so we have a conversation with that person and see what we can do to make it work. We ask if they can help us find a clinical director, or maybe they could be part of an electronic consultation group. We have the technology, so let's use it. We've had people call in by Skype, and we do board meetings electronically.

How does helping these children affect society?
It means that instead of having over 50 percent of the kids who spent time in the foster system in homeless shelters, unemployed or incarcerated or sending their children back into the foster care at a rate six times higher than the general population, they are finishing high school, attending college, getting educated, holding down jobs, paying taxes and becoming productive, satisfied members of society. That's good for them, and that's good for us.

What are your goals for the future?
We would like for therapists to think of A Home Within when they're wanting to do pro bono work. I would love to have clinicians who are interested in providing mental health services to foster children and therapists who are in the communities we are currently not in if they are interested in helping us establish a community for A Home Within.

We're also trying to reach out to the non-therapeutic community, like caseworkers or staff in group homes, to give them tools they can use. We have a web-based platform with materials for working with pregnant and parenting teens and aimed at staff working with a range of foster kids.

We can provide them with the resources to help with these populations even if they're not mental health professionals. Often they're asked to do the work without any training or education or support. Sometimes there are no therapists geographically or the culture doesn't support psychotherapy, but that doesn't mean they can't have access to best practices in theory to be helpful. We're translating best practices into curriculum that's useful for non-mental health professionals.

How can non-clinicians become involved with A Home Within?
If people can, they can help spread the word. They can help with media, they can do a small fundraising or awareness event. They can bring people over, share the materials, let them know what the needs of foster kids are, and if someone has an idea, we'd love to hear it. When I say we want to hear ideas, I really mean it. We know we have not cornered the market on ideas, and there may be something about spreading the word that we're not doing. If anybody has any thoughts, they should be in touch.

The website for A Home Within is www.ahomewithin.org.

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Reviewed by: 
Joseph V. Madia, MD
Review Date: 
May 30, 2012

Citation: 
A Home Within
Last Updated:
August 21, 2012