Applying a Toxic Stress Lens to Frontline Practice with Parents

Rise Parent leader Jeanette Vega spoke to child welfare leadership at the Council of Family and Child Caring Agencies’ (COFCCA) annual meeting about toxic stress and frontline practice with parents. Here’s the full transcript: 

In the fall when I read Steve Cohen’s paper I was shocked and amazed to think that there was a name— toxic stress— for what I was going through when my son went into foster care.

Life Before My Case

Before my son entered foster care, I was working full time and going to school full time. I was known for multitasking. I never kept a calendar but I could make all appointments and never be late. I was on it. But once child welfare got involved in my life, things went sideways real fast.

After I lost my son, it was like I lost control over my body and mind. I couldn’t focus. I couldn’t get things done the way I used to. I could not keep track of anything anymore. I missed doctor’s appointments. I let my public assistance case close because I missed appointments. It felt like my brain was not working.

Plus, losing my son wasn’t my only challenge. My workers didn’t have the relationship with me to know it, but I lost my apartment because without a child on my case I could not afford the rent anymore. And then I lost my job for getting there late or not showing up.

During the years my son was in foster care, I also lost two family members.

Too Much To Handle

Trying to stay calm was easier said than done. My anger would jump from 100 to 1,000 on a regular basis. I was always the type to have my guard up. I was in defense mode. But when my son went into foster care, I went from defense to attack. Everything felt like a threat to me.

If I got to an appointment late and the receptionist tried to reschedule, I’d flip out and threaten her. In the past I would’ve said, “OK, no problem.”

My biggest trigger was when people would ask me where my son was. I would go on attack so I didn’t have to admit that he was in care.

I never could put words to what happened to me at that time in my life. Was it depression? Was I forgetful just because I had so many thoughts racing through my mind? Did my worry consume me?

All I knew was that it was too much for me to handle, and my “act now, think later” reactions did not help my son come home. No one at the agency understood what was wrong with me, or what I’d been like before. They assumed that I was always an angry, violent person and that itself kept my son in care for longer.

Reading this paper and watching the Harvard Center’s videos to understand toxic stress, I thought back to when I had my case and wondered, “Could the workers have helped me better if they understand what toxic stress was? Could I have helped myself better if I knew the words for what was happening to me?” Not understanding what’s happening to you just makes you feel helpless, powerless.

Setting Parents Up for Success

Today you heard some new ideas on how agencies can focus on toxic stress—and help parents fight that powerless feeling, I want to ask you to think especially about how you can use that knowledge to set parents up for success.

I’m going to focus especially on the beginning of the case, where there’s an opportunity for you as directors to do simple, basic things that can make engagement so much easier.

Think for a moment: Have you ever walked through, or thought about what the process of intake looks like or feels like for parents at your agency?

What does the waiting area look like? How do staff introduce themselves? How are you welcoming, informing, orienting and encouraging the parents?

Imagine being a parent and the first thing you see is the waiting area. There is usually nothing that says: We are here to assist families. One parent at RISE suggested a Family Success Wall in waiting rooms where agencies post photos of families they reunified. This will give a gesture that the system is happy to reunify families.

Having parent-friendly information like RISE or flyers for a support group for parents also sends an important message and helps parents empower themselves as they wait.

The first contact a parent has with the agency in New York City is through the transitional meeting. These meetings feel intense and scary, having all these new authority figures in your life., telling you what you are mandated to do. The hate parents are feeling at this point makes any wrong wording feel like an attack or judgment.

In my experience, these meetings often feel rushed: here is your referral, when you leave here you will go take a random drug test and don’t forget to show up tomorrow evening for your visit, plus sign all these papers so we can get information to report to the courts. Parents’ heads are going in circles on which things to remember.

Toxic stress research shows how parents’ minds and bodies shut down at these moments. They can’t think and plan.

There’s a lot that caseworkers can do to help:

First, caseworkers can emphasize the choices parents do have. For example, even if a parenting class is mandated, parents can choose the type or location. Choices give parents back a sense of control.

Many times the system may think parents don’t know what they need, but I have learned that parents do know what their families need, and if given the chance to understand the options, they will tell the worker what services they think would benefit their family.

When I had my case, they kept sending me to anger management classes. Doing anger management three times did not take away my anger. It made me angrier that I had to keep repeating a service that wasn’t actually servicing me or my family. In reality, I wasn’t an angry person, I was broken for not having my son. What I felt was grief.

Help Us Get Organized

Caseworkers can also help parents organize their thoughts and plan by giving them a calendar and going through their calendar for the week and for the month.

They can discuss transportation time and costs, and try to help parents schedule as many services as possible in one place.

Caseworkers can also find out what’s on the parent’s plate besides child welfare services. Parents have a lot of personal appointments, like with welfare and housing. Steve’s paper suggests that child welfare systems can reduce outside stressors like unpaid bills, or insufficient food. Even if you can’t fix the problem, just asking about appointments can help caseworkers understand other stresses the parent is under.

I know your caseworkers may think, “I should not have to babysit the parents in bettering themselves!”

But parents are not used to navigating so many things and don’t feel they can negotiate about what they should do first. With government systems, we get a piece of paper in the mail telling us, “You’d better come do this!” Parents can use some coaching to prioritize.

Put It On Paper

Another way agencies can help from the beginning is by giving parents written information. Under stress, parents might not even hear what’s being said at their conference.

I’m curious: At your agencies, how many of you give parents a welcome packet?

As a parent who had no written information or guidance throughout my case, I would have loved to have simple things like:

• A calendar, to show me what my schedule would look like.
• A sheet of contact information for the important people on my case, like the caseworker, supervisor, lawyer.
• A handbook introducing me to your agency and the services you provide.
• A copy of RISE magazine to empower by seeing others who faced similar situations and have overcome.
• A flyer for a support group could help me find a place where I was not alone.
• The RISE TIPS handout that explains how I could make my visits a time to bond with my son.
• Rise’s the “Visiting Rooms Do’s and Don’ts” that explains the rules in your visit rooms.

I definitely urge caseworkers to use Rise’s TIPS to explain to parents what’s expected of them in visits. Steve’s paper suggests providing checklists for success. That’s exactly what the TIPS are.

Caseworkers can review the TIPS and help parents understand what can make visits positive with their children.

Parents are usually told what not to do. Tell us what we should be doing, to move our cases forward.

Encouragement Goes a Long Way

 That bring us to encouragement. Steve wrote in the paper that systems can change the way they record service plans to focus on small steps and frequent feedback. Even without that, you have the power to encourage parents every step of the way.

Caseworkers can be trained to notice, acknowledge and document small successes, even when they may seem trivial. For a parent, completing a service is big; a caseworker may have that, “you were supposed to do this” type of feeling. A little acknowledgment of “You did it, good job, you’re moving in the right direction” can go a long way in engaging the parent further.

It’s not easy to build a culture of encouragement when there’s so much in child welfare that’s discouraging but, I believe you can do it.

Parent Advocates Help

If you have parent advocates at your agency, the parent advocates can help you accomplish so much of this. If you don’t, I encourage you to invest in parent advocates and peer support.

When I was a parent advocate, I was following so many of the recommendations about toxic stress to help parents, not because I knew about it but because I was that parent and I felt their confusion and anger.

My parents needed to feel like they could overcome this horrible feeling of losing their children, and feel like they have the power to change the way they are used to living. In support groups, parents opened up with what they really needed to for themselves and their children. Many times it was simple things. I remember one parent had four services in two different places and on different days of the week, plus visits. This gave the mother no time to breathe.

With my parents, I reviewed the service plan and made sure parents understood what they needed to do. I asked if there was any reason a parent could not do any of these things and how could the agency assist her in succeeding. Little things like offering MetroCards for appointments gave the parents a gesture of kindness that I wanted to help them and they were more engaged.

If I was an agency advocate now, I would take another step: I would find a way to explain toxic stress to my parents. Watching the video Intergenerational Mobility can show parents how to take control and take life step by step. I would also explain attachment to parents, using the Rise TIPS and the Harvard videos to explain the importance of serve-and-return moments.

When I visited my son at the foster care agency, the confusion I felt trying to understand his behavior toward me was overwhelming.

My son did not act like he did at home. At home, he usually never got off me. Whether he was sitting, jumping, or playing, he was always interacting with me. During visits, though, he kept his distance and barely looked my way.

I tried to imagine what was going through his little mind, asking myself, “Is my son rejecting me because he hates me? Does he not feel my love for him? Does he think I’m a stranger, like an aunt who visits him weekly?” I also blamed the agency and the foster mother for the change in my son. For so long at visits, I was so upset and angry that I found it hard to even try to engage my son.

Children Experience Stress, too

If I had read Steve’s paper at that time—or something simpler, like the TIPS—I could have realized that my son was experiencing stress because of the change in environment, change of caregiver, and maybe he thought I abandoned him. I also could have understood that just keeping calm and focusing on those serve-and-return moments was the best thing I could do for him.

In my case, what helped me build back the attachment I had with my son was remembering our unbreakable bond before the system. That kept me consistent with going to visits. No matter how mad, confused, or crazy I may have been, I loved my son more than life itself and I never missed a visit. That helped my son see that I wasn’t going anywhere and would always keep fighting for him. I brought toys he liked and kept reminding him that, no matter where he slept, I loved him. Slowly he began to draw my way.

It wasn’t easy for me to get myself back together, to reorganize my thoughts and get my feelings under control. Ultimately, what helped me get my son home from foster care was having people who believed in me. My husband was my biggest support.

My fifth caseworker also helped. She was honest, clear and real. After I blew up at her, she pulled me aside. “I am not here to argue with you,” she said. “I just want you to understand that your actions are setting you back.”

She said if I didn’t stop my craziness I would lose my parental rights to my son, and that made me open my mind. As we talked, it did sink in that that the workers saw me as someone who would try to fix any situation with yelling and hitting, and my actions were hurting my case.

My son’s second foster mother, Gladys, made a big difference. She thought that my son and I belonged together. She used to tell my son, “You are going home with Mommy soon and you will always be welcome here. You will have two homes when you go back to live with Mom for good.”

Though the agency didn’t give my son and me more visits together, Gladys made it happen! After school I would often walk home with Gladys and my son, help him with homework, eat dinner with their family, and even put him to bed. At Christmas, she invited me to come over.

Getting to share small moments with my son helped me ease my anger.

It wasn’t easy to get my feelings under control, but I did it. I didn’t want to be the cause of my son staying in care any longer.

I do think if I’d been able to put words to what was happening to me, I could have addressed my behaviors and my actions with more control. I think my son could have come home faster.

Empower Your Staff

 These recommendations I’m giving you and that you’ve heard here today may seem hard to implement. I understand how difficult change can be.

You may be feeling a little overwhelmed right now. Maybe you are feeling like a parent who’s forced to do one more thing. As soon as you think your service plan is done, the worker just added more services.

You may be thinking, “I need anger management after taking all this in.”

But if you’re feeling stressed right now, remember: it is not toxic stress. Trust me.

I hope you’re feeling what you want parents to feel: willingness to try, and to keep trying, to be able to provide something better for themselves and their children.

I ask you to empower your staff with the understanding of toxic stress and how it seriously affects parents in planning for their children. And I ask you to prepare parents for the feelings they and their children may experience during the foster care process.

I can assure you that looking at your agency from a toxic stress perspective and a parent’s perspective might be hard, but changing how you welcome, inform, orient and encourage parents can make your work easier and it can make a powerful difference for your staff, for the kids you serve and for parents like me.

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