Child-Parent Psychotherapy as a Component of Safe Babies Court Team Interventions

Amy DickinsonJoy OsofskyAmy Dickson, PsyD, Department of Psychiatry, Louisiana State University Health Sciences Center
Director, Orleans Parish Permanency Infant and Preschool Placement Program (left)

Joy D. Osofsky, PhD, Clinical and Developmental Psychologist and Barbara Lemann Professor, Departments of Pediatrics and Psychiatry, Louisiana State University Health Sciences Center (right)

Summary: The authors describe “child-parent psychotherapy,” an evidence-based treatment proven to be effective when working with young children and their families involved in child welfare cases. This treatment has been successfully used as a component of the ZERO TO THREE Safe Babies Court Team cases. _____________________________________________________________________________________________________

Child-parent psychotherapy (CPP), an evidence-based treatment, is a highly effective therapeutic tool when working with young children and families involved in the child protection system. This relationship-based therapeutic intervention is particularly effective because of the focus on the disrupted child-parent relationship as a result of maltreatment. The parent works together with an infant mental health clinician who uses strategies that include following developmental guidance, learning to read and respond appropriately to the child’s cues, modeling positive interaction with the child, and helping the caregiver build and maintain a positive bond to their child. The parent learns ways to keep her child safe and provide nurturance in order to support social and emotional development, in addition to physical and cognitive growth.

When child-parent psychotherapy is implemented with a well-trained professional in collaboration with the other required components of dependency court, the treatment can have a significant effect on whether a child is reunified with her family or not. Parents often resist engaging in treatment as they understand the referral as an indication that they are viewed as bad parents. Many parents initially present to sessions feeling judged, and are defensive and hostile towards the clinician, who they assume will tell them how to parent their child. One of the most rewarding aspects of the treatment is the transition from the initial defensive, guarded, withdrawn or openly hostile parent to one who becomes an active collaborator in their treatment, as they feel empowered to adequately care for their child and meet his needs.

While outcomes in child-parent psychotherapy with court ordered cases vary, an illustrative example may be helpful to understanding how the process works. When Linda was referred to the New Orleans Court Team, she had three children by three different fathers. Her middle child, a two-year-old boy, received third degree burns on his foot and ankle while he was in the care of her current boyfriend, the father of her infant daughter. Linda was at work when her two-year-old received the burns, and when she returned, she immediately sought medical care for him. She was distraught about his injuries. Her older son was removed from her care despite his lack of injuries and given to his father, who then allowed Linda to have visits. Her injured son was placed with his aunt. Her baby was allowed to remain with her because she was also uninjured, though Linda was reportedly told that the baby could not be left alone with her father. However, when Linda appeared in court, it was learned that her infant was alone with her father, the perpetrator, so she too was removed and placed with the aunt who had her brother. 

When Linda first presented to the court team, she seemed agitated, with rapid speech and high emotional lability. What the clinician knew about her at the beginning of their work together was that Linda’s mother had a history of drug use, and the three fathers of her children all had criminal records. As the primary mental health clinician came to know Linda better, she learned that Linda had raised her younger siblings and kept them together, safe and in school, hiding her mother’s drug addiction and inadequate care so they would not be placed in foster care. She did this while becoming an honors student with positive peer friendships. Her own children were all developmentally on track, articulate and well-mannered, reflecting that they had been well cared for by their mother, to whom they were securely attached. Her emotional lability was reflective of her distress at being separated from her children, not of an emotional disorder. 

In treatment, Linda processed her grief at losing her children despite her many struggles to raise them in a safe environment and meet their individual needs. She did not need therapy to help her learn to read their cues or teach her to bond with them, as she had accomplished that on her own. Child-parent psychotherapy addressed her inadequate parenting in childhood and how it influenced her choice of partners who had strengths, but also serious weaknesses. Linda was able to use therapy effectively to reflect on her life, resume her original educational goals, utilize positive relative support, and handle the serious threats by her middle son’s father when he was released from jail. Through treatment Linda was able to recognize the benefits of working her case plan even though she was already a “good enough” parent, and she was able to reunify with her children in under a year. She also was able to keep her children away from the perpetrator and, during their time apart, maintain a bond with her children who continued to thrive and were very happy to return home to her care.    

This case illustrates the importance of intensive relationship-based therapeutic work as part of the overall case plan for maltreated young children. CPP allows the children and parents to grow and heal with the understanding support of the infant mental health clinician. Skilled clinicians are able to contain parents’ anxieties, empathize with their plight, and help them see their way to a more positive future for themselves and their children.

Author biographies:

Amy Dickson, PsyD, is a clinical psychologist with a specialization in infant mental health and the treatment of trauma victims. She is a primary clinician with the Violence Intervention Program (VIP) which includes staffing the 24-hour hotline, training the police to respond to incidents involving violence and children, and providing individual treatment to children and adults. She also consults to other professionals about the effects of violence on children. In addition, Dickson is on the teaching faculty for the Harris Infant Mental Health Fellowship and is the director of the Orleans Parish Infant Team which evaluates and treats children (ages 5 and under) and their families after the children have been removed from their biological parents due to abuse and neglect. This team helps the courts decide what is in the best interest of the young child(ren). Dickson additionally conducts family therapy with infants, children and their caregivers and consults to two local child protection offices. She provides supervision to residents involved in both of these programs.

Joy D. Osofsky, PhD, is a clinical and developmental psychologist and Barbara Lemann Professor in the Departments of Pediatrics and Psychiatry at Louisiana State University Health Sciences Center in New Orleans. She is head of the Division of Pediatric Mental Health. Osofsky is co-director of the Louisiana Rural Trauma Services Center, a center in the National Child Traumatic Stress Network, and director of the Harris Program for Infant Mental Health. She is editor of Children in a Violent Society (Guilford, 1997), Young Children and Trauma: Intervention and Treatment (Guilford, 2004), Clinical Work with Traumatized Young Children (Guilford, 2011), and co-editor of the four volume WAIMH Handbook of Infant Mental Health. For over two decades, Osofsky has consulted nationally and internationally related to trauma and disaster responses, especially for infants, children and families. She has consulted and collaborated with juvenile courts around the country and serves as consultant for the ZERO TO THREE Court Teams for Maltreated Infants and Toddlers.

Resources:

National Child Traumatic Stress Network                                                

The National Child Traumatic Stress Network provides resources that combine knowledge of child development, expertise in child traumatic stress, and attention to cultural perspectives.  The NCTSN is supported by a grant from the Substance and Mental Health Services Administration, US Department of Health and Human Services and is a unique, collaborative network that brings together leading experts in child trauma, frontline providers, and families to advance the quality of care and move scientific gains quickly into practice.

ZERO TO THREE                                                 

Early experiences matter. The care that adults provide for infants and toddlers has an enduring effect on their health and development. Investments in high quality care and services yield significant social and economic benefits today and in the future. ZERO TO THREE is a national, nonprofit organization that informs, trains and supports professionals, policy makers and parents in their efforts to improve the lives of infants and toddlers.

Safe Babies Court Teams                                                    

This section of the ZERO TO THREE website offers resources to policy makers and community stakeholders interested in improving outcomes for very young children in foster care.

 

 

 

 

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