Wednesday, October 15, 2008

Doctors as role models for foster children

Foster kids: in need of connection, and time to grieve
Ryan, Jeff. Contemporary Pediatrics. Oct. 12, 2008.

No one would try to set up a brand new widow or widower on a blind date. It’s too soon: the bereaved spouse needs time to grieve and process the loss before they can try to establish a new bond with someone else.

A child losing the care of parents or guardians, due to death or inability to care, experiences a similar type of loss, and needs a similar time to grieve. But too often they don’t get it, and are expected to immediately start thriving with a pair of foster parents. If they don’t, they get flagged with “oppositional defiant disorder.”

This, according to Francine Cournos, MD, who spoke at Saturday’s plenary session, is one of the few times where the medical establishment overcares for a child going through the foster care system. Cournos is an expert in the system in two ways, as a medical professional and as a child who experienced the system herself.

Cournos’s father died when she was three, and her mother when she was 11. The grandmother she was living with couldn’t provide care for her and her siblings, and her aunts and uncles didn’t want the responsibility either. She entered the foster care system “stunned, then angry” at her remaining family.

She spoke powerfully to the audience, using the voice of “adaptive” children in foster care. “We as foster children need our connection to you,” she said. “We are coming from a world of betrayal, and long for adults who are trustworthy…We may not show it: saying no is the one power of the helpless. But don’t be fooled: we want to connect to you. Our rejection is merely anger.”

She added that “you don’t need to be more than you are,” stressing that foster parents and pediatricians do not have to single-handedly make up for all the deficits of the child’s parents and (sometimes) previous foster parents.

The decades have definitely improved the lives of foster children. When Cournos was in the system, children weren’t considered able to have mood or anxiety disorders, not even depression for how their life had turned out. Still, some pediatricians try to cram in many tests during placement day, when children are already traumatized. This might exacerbate a case of post-traumatic stress disorder.

Cournos recalled a pediatrician ophthalmologist colleague of hers, who realized he was the only constant for some of the foster kids in his practice. She had a similar role model: her own pediatrician growing up. “He was the nicest man in the world,” she recalled, and he was extra nice to foster kids. She said she might be a doctor when she grew up, and he believed her.

All of this despite only seeing him once every six months, for her well visits.

No comments: