Marty Beyer, Ph.D.
Family visits with children in out-of-home care are an underutilized service which can be the most significant assistance the child welfare agency provides for safe reunification. Although research correlates visits with return home and shorter foster care placement, in most child welfare systems visits are rarely more than an encounter in an office, often less frequently than once a week. As caseloads get larger and paperwork demands increase, the time available for a caseworker to arrange visits becomes even more limited.
Traditional visits seem pointless to many caseworkers. Families can have "okay" visits for months and be no closer to demonstrating that they can keep their children safe. Services are seldom designed to help families learn more about what their children need. Drug and alcohol programs and domestic violence counseling focus on adult treatment, not parent responsiveness to children. Parenting classes are not specifically designed to help a parent clarify what he/she could do differently to meet the unique developmental needs of his/her particular child. Parents can be clean and sober, or determined to stay out of battering relationships, or graduates of parenting class and still not be able to demonstrate that they will protect their children from risks that brought them into care.
Unfortunately, the message sent to parents is that agency visits are another hoop to jump through in order to get their children back. Parents’ unrealistic hopes for a short timeframe for reunification contribute to this misunderstanding of visits. The agency, the judge and the lawyers, believing that the reason for quality visits is obvious, typically do not make sure the family comprehends the purposes of visits. Visiting would be dramatically different if soon after removal parents could articulate that the purposes of visits are to make their children happy and to demonstrate their best parenting.
Visits typically do not attempt to build on a parent's strengths or guide improved parenting. Throughout the time the case is open, parents' concepts of their children's needs may remain different from the worker, foster parent, parenting teacher, or therapist. The parent’s grief, anger, and preoccupation with complying with court-ordered treatment, employment and/or housing may obscure their child's needs. Accustomed to the way office-based visits have always been done, it is difficult to see how—unintentionally-- visit practices alienate parents, children and foster parents. Coming to the agency reminds the parent of their child’s removal and the anger, loss and hopelessness associated with it. In most agencies the visiting space is not family-friendly: typically there are not toys, books, games or crafts for all ages or clean floor space to play together; visits often occur in a large public area where many families visit. Parents report that being watched by someone taking notes during visits makes them uncomfortable and less likely to do anything with their children for fear of making a mistake. Children often have to travel long distances to visit at a time when they would normally be napping or eating. Children’s behavior reflects their feelings about being separated from family members, about the neglect or abuse that preceded placement, and their confusion about living with a new family. As a result, unsupported visits bring out the worst in the parent and child, who react to each other’s sadness and anger.
Child welfare agencies can improve visit practices somewhat by enhancing visit rooms, ensuring that visits are at least weekly, providing evening and weekend visits, encouraging visits outside the office, and freeing families from supervision unless there are safety concerns during the visit. Sometimes agencies open or contract with a provider to operate a visiting house for a homelike environment that is more accessible to families. Unfortunately, traditional supervised visits often are the practice in these visit houses.
Families are required to make significant changes in a short timeframe in order to meet their children's needs. They are expected to stop their dependence on substances and their involvement in domestic violence and to overcome emotional problems, immaturity and cognitive limitations. To make major life alterations within a year and meet their children’s needs necessitates intensive visit support beginning soon after removal.
Visit coaching is fundamentally different from supervised visits. Instead of watching the family, the coach is actively involved in supporting them to demonstrate their best parenting skills and make each visit fun for the children. Visit coaching includes:
• Helping parents articulate their children's needs to be met in visits
• Preparing parents for their children's reactions
• Helping parents plan to give their children their full attention at each visit
• Appreciating the parent's strengths in responding to each child needs
• Helping parents cope with their feelings in order to (a) visit consistently and (b) keep their anger and depression out of the visit
Some agencies initially react to the idea of visit coaching with: "Caseworkers already give parents pointers while supervising visits." For the parent who has been removed from the parenting role and feels guilt and anger about what has happened to their child, it is unlikely that direction to interact with their child or discipline in a certain way, for example, will make visits productive (despite the good intentions of the worker or parenting teacher). Other agencies consider visit coaching "ideal but impossible to do because of caseload size." When staff are trained to coach visits, agencies find that it is completely different than supervised visits--although coaching makes each visit more time-consuming, cases close more quickly and it is so effective that staff want visit coaching for most families.
HELPING PARENTS TAKE CHARGE OF VISITS
One of the challenges of visit coaching is helping parents not get discouraged--change takes time, time when they feel they are losing their children. They get frustrated that "the system" is so slow. They feel helpless and hopeless. Many parents have been debilitated themselves by trauma, learning disabilities, and poverty, and they are fragile as they "start their lives over" in alcohol and drug treatment and domestic violence programs. Finding housing, going to or looking for work, and attending treatment are time-consuming and draining.
Separating from their child in visit after visit is so painful that it is remarkable families do not give up. The loss of their children and the resulting instability and sense of guilt take a toll on parents. When they come for visits, parents may be overwhelmed by their mixed feelings of pleasure, sadness, awkwardness and defensiveness as well as their competitiveness with the foster parent. Parents often feel more inadequate after visits. Even though they enjoy their children, visits make most parents feel worse.
Coaches help make the pain of visits tolerable for parents so they will return. If coached visits start immediately after removal and parents are helped to visit consistently for several months, safe reunification may be able to occur. But progress may not be that rapid, and in subsequent months the parent may require continuing encouragement not to give up.
When they arrive at the agency, parents are often flooded by their anger and sadness about the removal, as well as discomfort about the unnatural setting of visits. The parent benefits from the visit coach's validation of their complicated feelings about visits. But the visit coach's primary goal is to help the parent stand in the child's shoes. Coaches support them to put their reactions aside in order to concentrate on meeting their child’s needs during the visit.
Empowering parents to plan their visits builds on their strengths. Instead of viewing the agency as owning the visit (setting the time, place, frequency and conditions), families are coached to take charge of visits and make them as homelike as possible. The coach guides while appreciating the unique ways the family shows love for their children. Parents are encouraged to make visits a celebration of the family by taking pictures, making a family scrapbook, and telling family stories.
Parents are helped to manage competition between the children for the parent’s attention in visits. Coaches help parents spend a little special time with each child during the visit. Many parents lament that their children seem so different in visits than before they came into care, and coaches help them not take the child’s behavior personally. By confirming that meeting their children's needs can be frustrating and exhausting, the visit coach gives the parent valuable support.
While it might be tempting to skip the formal step of planning each visit around the specific needs of the children, it is the key to helping parents demonstrate they can keep their children safe in the future Families may come to visits without having the opportunity to think about how to make them happy for their children. The lasting benefit of visit coaching is the parent saying to him/herself as the child develops, years after the foster care placement, “What does my child need?”
SUPPORTING PARENT RESPONSIVENESS TO THEIR CHILDREN'S NEEDS
Children enter care because their parents are not attentive enough, often as a result of substance abuse. Being clean and sober does not make parents responsive to their children, especially if their chemical dependency started in adolescence and continued when they became parents. For infants, the parent may not be aware of the child's need for touch and stimulation, for preschool children the parent may not see the child's need for play, and for the elementary school child the parent may not tune in to the child's need to have his/her interests valued. Much of what the visit coach does is to help parents learn how to see their children's needs. The parent who sits on the couch while their child plays with toys is encouraged to play actively with their child. The parent who sits silently while their child munches on a snack is encouraged to ask about school friends and activities and make their child feel listened to.
Attuning to children's needs requires being able to focus and follow through. Some parents have disabilities which include limited "executive" capacity--they have trouble organizing and completing tasks. They want to nurture their children, but they have difficulty staying focused on several steps to achieve a goal. The coach guides them to organize the visit around the child's needs and not drift off inattentively before completing something with the child.
Some children of inattentive parents are unusually undemanding, which results in the parent overlooking the child's needs. Some children, especially those affected by fetal substance exposure, are irritable and hard to calm from birth and get labeled "difficult"--for neurological reasons they are demanding children, born into overwhelmed families. These children may enter care due to abuse when the parent loses his/her temper at the child's difficult behavior. Both undemanding and difficult children present challenges: visit coaches help parents respond to children with needs that would frustrate the most skilled parents.
Visit coaching helps families learn how their child's behavior is shaped by the adult's words, actions and attitudes. Families are coached to improve the fit between their limit-setting and the child's temperament and behavior. They are helped to see the effect on the child of the adult being too controlling or too passive.
GUIDING PARENTS AND FOSTER PARENTS IN SUPPORTING THE CHILD’S ADJUSTMENT TO FOSTER CARE
Children are placed in foster care to protect them from maltreatment, but removal causes a range of feelings and behaviors in children that are difficult for parents in visits and for foster parents at home. Children who are exposed to disrupted caregiving (from being separated from their families) are at risk for continued difficulty in emotional regulation: irritability, protest, clinginess to foster parents and/or parent, anger at parent and/or foster parent, diminished appetite or food hoarding, disrupted sleep, and withdrawal. Additionally, some children enter foster care with early attachment problems which make it difficult for them to accept comfort, and some show fearfulness, vigilance, and anxiety as a result of trauma. A child’s unique temperament frames his/her response to trauma: reserved children internalize, with fearfulness and withdrawal, and outgoing children externalize, with temper tantrums and aggression. If the child’s trauma is not treated in therapy and the parent and foster parent are not taught to understand the child’s trauma reactions, the child may be delayed in progress in school, social skill development, and learning to regulate emotions in age-appropriate ways.
It is not easy to care for the traumatized child during visits or in the foster home. Parents may minimize the child’s feelings because they think the child is too young to react to trauma or because their child’s insecurity makes them feel guilty. If the child continues to be aggressive or withdrawn, the frustrated parent or foster parent may become less emotionally available although the child desperately needs adults to trust.
It is normal for a child removed from home after neglect or abuse to have reactions to visits, which are usually not a sign that the visit is harmful for the child. Children's reactions to visits typically include a mixture of some or all of the following: (a) happy and relieved to see his/her family because he/she misses them; (b) confused, especially about why he/she cannot go home and has two sets of parents; (c) sad and angry about being separated from his/her family and feeling out-of-control; (d) angry about maltreatment and sometimes fearful;
(e) guilty that being taken away from home is his/her fault; (f) worried about being disloyal to his/her family; and (g) worried about whether his/her parents, siblings, and other family members are okay
Most children do not put these feelings into words; instead, their behaviors reflect their feelings. Regression (being babyish, whining, demanding, or scared), numbing or denying of feelings, depression, nightmares, irritability, aggression, overactivity, and physical pains are common prior to and following visits. The visit coach helps the parent understand the child’s feelings and behaviors during visits, the foster parent understand the child’s feelings and behaviors after visits, and helps both not give up in reaching out to the child.
Coaching helps the parent and foster parent encourage the child to live happily in two different families which relieves painful disloyalty pressures. Without being aware of it, well-intentioned family members and foster parents can contribute to the child's confusion about who to love, who is better, and what to do with negative feelings toward either family. It is important not only for the foster parent and parent to communicate but for the child to see them interact in a friendly way. When caseworkers and visit coaches include parents and foster parents together in regular discussions of how to improve visits, parents and foster parents have a shared understanding of a child's difficult behaviors and use the same approaches in managing them
VISIT COACHING AS AN ALTERNATIVE TO PARENTING CLASS
Typically parents must complete a parenting class prior to reunification, but these classes rarely include their children. Many parents do not connect what is taught in class to how they behave with their children. For some, the problem may be that they learn best from hands-on experience. Others resent being taught the basics of parenting without regard to what they already know. Both of these objections can be addressed by visit coaches being trained to use the teaching moments of visits to do hands-on demonstrations that build on the parent’s strengths while conveying new approaches. Visit coaching as an alternative to parenting class also makes sense because learning any new skill requires repetition and encouragement not to give up. A parent can be taught in a class about the needs of children of different ages, but they appreciate having a visit coach providing encouragement in the real-life visit with their children who compete with each other for attention
For example, if a child is having temper tantrums, the visit coach can introduce ideas about why the behavior is occurring and methods for anticipating and preventing “melt-downs” and how to respond when they are not avoided. If the parent is overly critical, the visit coach can introduce the idea that children respond better to praise than correction and point out how much happier the child is in visits with less criticism. In either situation, the parent will have support to use their new skills repeatedly as they observe their children’s responses.
Although parenting class may emphasize the importance of play in child development, without practice it is unlikely parents will apply this concept. Visit coaching offers a laboratory for a parent to enlarge their repertoire of fun ways to play with their children. Parents may not have played Simon Says, Red Light/Green Light, Pattycake, or marching games before; they may be embarrassed to sing nursery rhymes; they may feel foolish doing dress-up or imaginary play with their children; they may think they are not artistic enough to do crafts. The visit coach will help them learn that play is fun and the child learns problem-solving, achieves a sense of mastery, and develops coordination from play. Some parents unrealistically expect young children to adhere to the rules of games, and some parents do not realize that children learn more when the parent does not control play, both of which can be guided by the visit coach.
BUILDING ATTACHMENT THROUGH VISIT COACHING
Visit coaches help parents tune into their infant: each child, even as an infant, has its own temperament, including unique rhythm of engagement and level of activity. Each parent has his/her own style of responding, attention span, flexibility, and anxieties. Some infants entering care are first children so their parents are more anxious because of their inexperience. Postpartum hormonal states can also reduce mothers' coping skills. Many removals occur when the newborn tests positive for drugs, and not being able to take the infant home from the hospital can be painful for the parent. Parents of infants entering care are likely to be grieving their loss, which may result in holding the infant tightly throughout the visit or distancing themselves from the feelings provoked by not being able to keep the infant. Coaches help parents realize that their infant is communicating with them, and that it is beneficial for the child when the parent responds to the baby's message. This can mean helping the parent talk to and handle the baby quite differently from how they were raised. Coaches support parents in attuning to their infants by emphasizing that reciprocal communication with newborns develops attachment, as in this example:
A 23-year old mother is visiting her newborn, who was removed at the hospital after testing positive for cocaine, and her two preschoolers. She accepts it as "normal" that her 20-month old stays near the foster mother during the visit. The mother spends most of her time watching her 4-year old play with toys, sometimes giving commands to the children from the couch while the baby sleeps in the infant carrier. Otherwise she ignores her 20-month who she says is just like his father; he whines and becomes agitated by the end of each visit. The coach elicited from the mother four of her children’s needs she wanted to meet, leading to the following design for a staggered visit.
VISIT PLAN
CHILDREN'S NEEDS DURING VISITS
THE COACH WILL HELP MOM:
6 week old
• To be happy being close to Mom
Have some visits alone with the infant getting to know what she enjoys; spend time imitating the baby's faces, talking to the baby, trying to lengthen the amount of time the baby can focus her attention
Teach the 20-month and 4-year oldspecial things they can do to entertain their sister
20-month old
• To feel Mom likes him
Find at least one thing to praise him foreach visit
• To have a lot of attention
Have some visits alone with the 20-month old practicing giving him attention and praise to learn what keeps him from getting grumpy
4-year old
• To play with toys and games with Mom
Spend most of the visit on the floor playing, holding and talking to the baby while also moving from the 20- month old to the 4-year old with play that fits their different levels
Plan a music activity and snack they can all enjoy together
Instead of viewing visits as a hoop she has to jump through, with visit coaching this mother appreciates that her precious time with her children is building her relationship with each one.
VISIT COACHING WITH TEENAGERS IN CARE
Teenagers often enter care as a result of parent-child conflict. Some teenagers have grown older in care as a variety of obstacles have prevented permanency. Teens are more likely to become successful, independent adults if they are helped to have stable connections--sometimes with a family member from whom they have been estranged--before they leave care, and visit coaching is a method to achieve this important goal. The teenager and parent may wish for a better relationship, but they may be angry at each other. Some group care providers indicate that parents feel relieved that their teenager is being cared for, and, overwhelmed with other concerns, they do not participate in family counseling. For example, one agency utilizing visit coaching with teenagers reported that many of the teenagers in their group homes had families they might be able to live with, but they had little family contact. The unnatural setting of an office visit was not conducive to improving the relationship between these teenagers and adults with whom they might live.
The goals of visit coaching with teenagers and their families are to (a) help them enjoy something together and (b) improve their communication. Modeling a democratic process by supporting parents and teenagers set simple ground rules and decide on activities is a good beginning. Activities together do not have to be costly, although going to a movie and having a snack afterward can be a very positive visit--the coach can accompany them to facilitate good conversation or can ask for a report from each of them at the next coached visit.
Visit coaches facilitate family meetings to enhance teenagers' day or weekend visits. The family meeting encourages respectful communication and helps the adult and teenager appreciate their different agendas for the visit. This planning prevents weekend visits where the adult feels the teenager is just using their home as a hotel and does not want to spend family time or the teenager who wants to "hang out" with the adult who is exhausted from the week and all the tasks to be done. If each is helped to express openly their wishes for the visit, without blaming, they will be able to compromise on some special "just you, just me" time and also plan separate activities. For example:
"Lamont," a 16-year old, started visiting his paternal aunt who seemed to enjoy being a "weekend parent." He wished his father would drop by to see him at his aunt's home more often. His mother, who had asked the court to place him in the group home, did not respond to staff outreach and seldom talked to Lamont on the phone. The visit coach discussed the idea of a family get together with each family member individually, stressing that the purpose was for all of them to appreciate how well Lamont was doing. The visit coach transported Lamont's mother to his aunt's home where Lamont, his father, his mother, his aunt and coach talked around the kitchen table and had refreshments. Lamont was preparing to sing a solo in his aunt's church choir and sang it for everyone. Lamont also talked about his school program and his plan to remain in the school near the group home for the rest of the year. This initial visit coaching session was not designed to discuss his need for a permanent home--first the adults had to have a tolerable time together and with Lamont. It will take some time to get to the point of deciding whose home he may be able to transition to.
Teenage Parents with Children in Care. While the same principles apply in supporting visits with teen parents as with older parents, the visit coach makes special efforts to engage adolescents who are visiting their children. Teen parents may have difficulty trusting adults. They may feel that they can parent and are being unfairly judged. If the teenager is in foster care, they may be angry about what has happened to them which gets in the way of productive visits. In addition, because of their immaturity, the way teen parents think and behave is different from adults and special coaching is necessary to build on their strengths as parents.
COACHED VISITS & KINSHIP CARE
Traditional office-based visits started when most children removed from their homes were placed in unfamiliar foster homes. Now kinship placements are more common, with individuals familiar, and usually related, to the child. In kinship placements, it is a challenge to design visits to achieve permanency for the child without being too intrusive into the family. When informal visits break down because of family conflict, coached visits (preferably in the relatives’ home) can mediate between the family members while supporting the parent in meeting the children’s needs.
THE LOGISTICS OF VISIT COACHING
To convert from supervised office visits to coached visits requires more staff time. Thus, it is preferable to diversify visit coaching beyond the staff previously supervising visits. Caseworkers, case aides, MSW interns, foster parents, parenting skills teachers, counselors and others can be trained as visit coaches.
Pre/Post Visit Contact with Parents. Coaches meet with parents 15-30 minutes before each visit to review the child's needs to be met during that visit and to practice skills. Coaches meet with parents after each visit to review their notes about how the parent met each child’s needs during the visit and the parent's self-assessment. Post-visit time also supports parents so they are emotionally able to return to the next visit. This essential pre/post visit work with parents presents logistical problems, depending on who transports the children.
The Importance of Communication. If the visit coach is not the caseworker, the two must collaborate to ensure that the needs identified by the parent to be met during visits fit the changes in parenting necessary for reunification in the future. It is not unusual for parents to feel closer to the visit coach and to fear the power of the caseworker and both must work actively to prevent this splitting.
In addition to a brief self-evaluation completed by the parent at the end of each visit, the visit coach writes notes about how the parent met the needs of each child and ideas for the next visit. If requested by the court (when visit coaching is replacing parenting class), the topics covered in parenting class could be a checklist as part of the visit notes. But the coach should ensure that focus of the visit notes remains on the children’s needs, not the imparting of prescribed parenting techniques. It is preferable to share the visit notes with the parent. In addition to becoming part of the family’s record, the visit notes can provide valuable information when they are given, with permission, to the parent’s therapist, substance abuse or domestic violence counselor.
Conducive Visit Environments. When agencies implement visit coaching, one of the first things they change are visit rooms. They move coached visits into private rooms with doors rather than noisy large areas where several families visit at the same time. They get rid of office furniture and clean the rug and floor and put big pillows and sheets in the visit room to make floor play enjoyable. They purchase (or arrange donations of) sturdy, versatile toys, books and craft supplies. Having a camera and portable CD player for music are also valuable tools for coaching.
As visits are tailored to challenge the parent to meet needs that brought the child into care, caseworkers and visit coaches may decide to move coached visits outside the office. Coached visits in the foster home, the family's or extended family's home, school or daycare center and/or in the community (parks, etc.) can enhance the parent's skills. Visit coaches also assist families in getting involved in their child's school, early childhood program, activities, and medical appointments and have coached visits there.
Increased Visit Time. Coached visits more than once a week may be necessary to meet the needs of the children. The coach may recommend staggered visits to allow the parent alone time with each child, as well as time together as a family.
Coaching During Group Visits. An exciting form of visit coaching is a play group for parents and their infants and toddlers in foster care. The first part is a structured playschool format, where the coaches help the parents use music, play, reading, and snack time to appreciate and build their children's skills. The second part is a parent support group where parents and the coaches discuss the children's safety, developmental and permanency needs. Parents report that learning from watching and talking with other parents has been a valuable part of the play group. The play group is more normalized than the unnatural setting of typical visits. Agencies may decide to change the role of the parenting teacher into offering a weekly play group/parent group with active coaching and the integration of parenting topics into these group visits. A video entitled "Baby and Me" describes the formation and shows the success of the play group as a positive form of visit coaching.
Visit Coaching and Extended Visits. As the child begins the process of return home with all-day or weekend visits, the coach can help the parent identify the child’s needs during these longer times in the home.
Training for Visit Coaches. A 20-hour training program for visit coaches includes building on the parents’ strengths, visit planning using the children’s needs, tailoring coaching to fit the parent and children, avoiding overshadowing the passive parent, and working with angry parents. The visit coach has to be knowledgeable not only about children’s needs, the developmental benefits of play, family dynamics, attachment, parenting skills, the variety of cognitive styles shown by parents, and cultural differences, but also must be flexible and able to draw on a variety of intervention approaches to fit a particular visit. Coaches must be ready to use modeling, instruction, and rehearsal, depending on the best fit with the family.