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Cultivating Resilience in Families Who Foster: Understanding How Families Cope and Adapt Over Time

CYNTHIA A. LIETZ* FRANCIE J. JULIEN-CHINN*

JENNIFER M. GEIGER†

MEGAN HAYES PIEL‡

Families who foster offer essential care for children and youth when their own parents are unable to provide for their safety and well-being. Foster caregivers face many chal- lenges including increased workload, emotional distress, and the difficulties associated with health and mental health problems that are more common in children in foster care. Despite these stressors, many families are able to sustain fostering while maintaining or enhancing functioning of their unit. This qualitative study applied an adaptational pro- cess model of family resilience that emerged in previous studies to examine narratives of persistent, long-term, and multiple fostering experiences. Data corroborated previous research in two ways. Family resilience was again described as a transactional process of coping and adaptation that evolves over time. This process was cultivated through the acti- vation of 10 family strengths that are important in different ways, during varied phases.

Keywords: Family Resilience; Foster Families; Coping and Adaptation

Fam Proc 55:660–672, 2016

Licensed foster caregivers are an essential part of the child welfare system. According to the U.S. Department of Health and Human Services (2015), the number of children

in out-of-home care has surpassed 400,000. Licensed foster homes, both kinship and non- relative placements, offer a familial environment for these children and youth at a time when their parents are unable to provide for their safety and well-being. Families may have foster children for short periods of time or these stays may be extended, particularly if it is determined that a child cannot return home. During this time, families who foster provide care until children are returned home or other permanent homes can be found. In some cases, foster parents adopt children in their care. The contribution of families who foster is substantial in ensuring the safety, permanency, and well-being of children and youth in out-of-home care.

*School of Social Work, Center for Child Well-Being, Arizona State University, Phoenix, AZ. †Jane Addams College of Social Work, University of Illinois at Chicago, Chicago, IL. ‡School of Social Work, Wayne State University, Detroit, MI. Correspondence concerning this article should be addressed to Cynthia Lietz, College of Public Service

& Community Solutions, Arizona State University, 411 N. Central Avenue, Phoenix, AZ 85004. E-mail: [email protected]. The authors acknowledge the Arizona Department of Child Safety and the Arizona Friends of Foster

Children Foundation for their support to this project. Thank you also to the many committed families who

provide a loving home for children in foster care.

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Family Process, Vol. 55, No. 4, 2016 © 2016 Family Process Institute

doi: 10.1111/famp.12239

Fostering is a meaningful and impactful experience. Many families who foster report that they have experienced great benefits as a result of providing for the needs of children in out-of-home care. For example, some contend that their families grow closer as they develop a shared mission of caring for vulnerable children (Buehler, Cox, & Cuddeback, 2003). Many appraise fostering as rewarding due to their ability to care for a child in need (Geiger, Hayes, & Lietz, 2013; Whenan, Oxlad, & Lushington, 2009). Foster parents report great satisfaction when they can observe positive changes in the children for whom they care (Brown & Campbell, 2007; Preston, Yates, & Moss, 2012; Wells, Farmer, Richards, & Burns, 2004).

Despite these positive experiences, families also face substantial stressors that are asso- ciated with parenting children in out-of-home care (Wells et al., 2004). Foster parents must navigate public child welfare systems that are complex and confusing (Cooley & Pet- ren, 2011). They face substantial time pressures as they manage busy and complicated schedules. Increasingly, foster parents have to provide medical care for children diagnosed with chronic illnesses (Kools & Kennedy, 2003; Marcellus, 2010; Rubin, Halfon, Ragha- van, & Rosenbaum, 2005). Children in care also face emotional distress as a result of the removal and are at higher risk for mental health problems (Stahmer et al., 2005). In these cases, managing difficult behavior is quite stressful (Buehler et al., 2003; Preston et al., 2012; Whenan et al., 2009).

Beyond the challenges associated with managing schedules and the increased work- load, families who foster also experience increased emotional distress. Children and youth are commonly placed with little time to prepare and limited information about the needs of the child. Foster caregivers experience confusing emotions as they may be frustrated by acting out behaviors yet simultaneously develop meaningful attachments to the children in their care, something that is essential for each child (Hallas, 2002; Schofield & Beek, 2005). As children leave their homes, families often experience a great sense of loss (Min- uchin, Colapinto, & Minuchin, 2007). Fostering involves emotional ups and downs that can put any family at risk for discord and even break-up. For this reason, most families leave fostering within just 1 year (Gibbs, 2004), citing frustration with the system and concerns about negative effects on their family as one of the primary reasons for discontin- uing (Geiger et al., 2013). Despite these challenges, many families continue fostering for extended periods of time and multiple placements, and have come to cope with the stress of fostering in a way that promotes child and family adaptation.

FAMILY RESILIENCE

Family resilience is the process through which family units overcome the negative effects of risk, sustaining and often enhancing family functioning despite experiencing highly stressful challenges that in some cases lead to break-up or discord (Black & Lobo, 2008; DeFrain & Asay, 2007; Hawley, 2000; Patterson, 2002; Walsh, 2003, 2006). Grounded in previous research with families who maintained healthy functioning despite facing a variety of serious risk factors such as the death of a child (Lietz, 2006, 2007) and families who achieved reunification after the removal of a child by child protective services (Lietz & Strength, 2011), a model emerged that offers a description of family resilience as a process that develops over time. The process includes five phases (survival, adjustment, acceptance, growing stronger, and helping others) and 10 family strengths that support healthy coping and adaptation. The objective of this study is to understand if the model offers explanation regarding how families overcome the stressors associated with fostering.

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METHOD

A sequential explanatory design was used to identify a purposive sample of 20 families who remained licensed for over 5 years, fostering several children for varied periods of time, and who rated within the healthy range on the Family Assessment Device (FAD; Epstein, Bishop, & Levin, 1978), a standardized measure of family functioning. The ability to link child-level outcomes with each foster family was not possible due to the need to pro- tect privacy of these children and because of the extensive records for the hundreds of chil- dren who have been fostered by this sample. However, each family continued to foster for 5 years or more, whereas most leave fostering within a year of being licensed. This longev- ity suggests a level of adaptation not sustained by most other families. In addition, these families were all licensed, meaning they were evaluated regularly by their licensing agen- cies and were determined to meet or exceed the standards of quality required for licensure renewal; this oversight was used as a proxy for effectiveness.

The study involved two phases. First, in collaboration with the public child welfare sys- tem, a link to an online survey including the FAD and some demographic questions was sent to all licensed foster parents with current e-mail addresses on file in one southwest- ern state to determine study eligibility. Of the 1,864 licensed foster parents, 681 responded to the survey, representing a 36.5% response rate. Seventy-one families met study criteria. Twenty families were chosen from these 71 to ensure diversity in the sam- ple based on family structure, racial/ethnic identity, and location across the state. The length of time fostering ranged from 5 to 26 years (M = 9.4 years) for 3–25 or more chil- dren (M = 14.9). All families had provided nonrelative foster care, four also provided kin- ship care, and one was licensed as a therapeutic foster family.

The sample, all working and middle class families, included 7 single-parent households and 13 two-parent households; 12 families identified as multiracial, 6 Caucasian, and 2 nonidentified. Many families included biological children, children who were adopted, and those who were currently in foster care. Over the years, the 20 families fostered over 350 children, whose racial/ethnic background was more diverse, demonstrating the increasing difficulty in matching, or finding homes for children with a similar racial/ethnic back- ground. Fourteen families adopted foster children (two families adopted eight each). Of 37 adopted children, 14 were identified as Latino, 5 African American, 1 Native American, 1 Asian, 3 multiracial, and 13 Caucasian.

In-depth narrative interviews were conducted with each family in the sample to under- stand how adaptation was activated, creating pathways for units to effectively cope with the stress associated with fostering. All adult members of each family system were invited to participate in the interviews. This involved one or two parents depending on family structure. All adult children who grew up in each family were also invited to participate. Four of the families included adult biological children in the interviews. (Regrettably, chil- dren were not included because participation of children in foster care would require approval by the court, making their inclusion not feasible. To include biological or adopted children and not those being fostered could imply that foster children are not part of the family unit, a message not consistent with our perspective. Therefore, we chose to only include adult members of each family in the interviews.)

Narrative interviewing involves using a limited number of open-ended questions that allow the research participants freedom in guiding the content and depth. Although the questions do provide focus, this style of interviewing creates time for families to move away from a question/answer format into one of storytelling. Discussion involved current functioning as well as retrospection about how adaptation occurred over time. The first interviews ranged from 45 to 136 minutes (M = 89 minutes), plus additional time to gain informed consent, orient the family to the process, and for debriefing after the interview.

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Families were invited for a second interview, 18 of the 20 families participated in this follow-up.

All interviews were recorded, transcribed verbatim, and loaded into NVivo10 (QSR International, 2015) to prepare for analysis. Four researchers conducted the interviews and engaged in thematic analysis of the transcripts using the template method. Several strategies were used to increase trustworthiness of the findings. First, an audit trail was kept throughout to maintain a record of coding decisions and report issues of bias or research reactivity that arose. Reflexivity, which involves making one’s sociopolitical posi- tion known, occurred in written form in the audit trail and was discussed at all of the meetings. Peer debriefing involves bringing someone onto the research team with an insi- der perspective to ensure the participant’s stories can be understood in an authentic way. We included a foster parent who also works professionally as a foster parent advocate as an advisor on the project. To manage bias, triangulation by observer was used such that all transcripts were analyzed by at least two researchers and any discrepancies in coding were discussed until consensus was achieved. Finally, once preliminary findings were available, we used an online discussion board to conduct a member check by inviting par- ticipants to anonymously provide feedback about our findings.

FINDINGS AND DISCUSSION

The construct of resilience concerns the interaction between risk and protective factors in predicting varying levels of functioning. Families discussed the challenges of fostering prior to discussing the process of healthy coping and adaptation. Seven themes emerged from these narratives, highlighting several ways fostering is challenging. These chal- lenges include: (a) navigating the complex child welfare system, (b) experiencing difficult emotions stemming from transitions of a child entering and leaving home, (c) obtaining medical and behavioral health services for foster children, (d) managing difficult behaviors of children in care, (e) feeling devalued or misunderstood, (g) lacking information needed to provide adequate care, and (h) adapting to a schedule that is full and at times over- whelming.

Family Resilience as a Process Over Time

Once the challenges associated with fostering were discussed, the families offered sto- ries that were rich with illustrations of coping and adaptation. Similar to our previous studies of families who made the adaptations needed to achieve reunification and families who overcame adversity associated with a multitude of stressors (Lietz, 2006, 2007; Lietz & Strength, 2011), foster families in this study experienced resilience as a process that develops through five phases and the emergence of 10 family strengths over time (see Fig- ure 1). Families who foster must adapt during transitions such as the entrance or exit of foster children, adoption of foster children, or launching of biological or adopted children into adulthood. Adaptation for these families did not involve reaction to one particular loss or crisis; instead, families were continually facing new challenges with each transition involving a new set of stressors requiring coping and another process of adaptation. Very few family systems require the level of ongoing adaptation to the structure, roles, bound- aries, and daily activities as that of families who provide foster care.

An examination of long-term stories of fostering suggests family resilience is not an out- come, but a culture of coping and adaptation that remains responsive to the changing cir- cumstances that accompany each transition. The conceptualization of adaptation as a process was also discussed by foster parents in Brown and Campbell’s (2007) study and a model developed by Marcellus (2010). Similar to Rolland’s (2012) discussion of how

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families cope with serious illness or disability, movement across phases is not necessarily linear, meaning families can move in and out of various phases depending on circum- stances. Each phase corroborated through this study will be discussed with content from

Phases of Coping & Adaptation Family Strengths

Phase One: Survival

Phase Two: Adjustment

Phase Three: Acceptance

Phase Four: Growing Stronger

Phase Five: Helping Others

Connectedness

Social Support (Receiving)

Initiative

Commitment

Shared Meaning Making (Appraisal)

Social Support (Giving)

Shared Meaning Making (Insight)

Communication

Humor

Boundary Setting

Creativity/Flexibility

Morality/Spirituality

FIGURE 1. The Process of Family Resilience.

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the narratives that illustrate the adaptational process of resilience for families who provide foster care.

Survival

The survival phase represents a time when families are facing the most disruptive changes to the family system. The focus at this point is more about coping than adaptation as families are just trying to get through the day. For families who foster, this was identi- fied as relevant during two particular time periods: (a) just after first being licensed and providing the first placement and (b) during difficult transitions such as the entrance of a new foster child who had a particularly difficult transition into the home or during place- ment disruption (when a placement was discontinued unexpectedly or prematurely).

All families discussed the challenges they faced when they were first licensed. The onset of fostering was particularly challenging for the four families who began as kinship providers. For them, starting in foster care was not just a transition, but also involved a crisis in their family network that necessitated kinship care. In families that fostered chil- dren in multiple placements over many years, they reported that their initial experience was their hardest time. During the survival phase, families identified connectedness and mutuality, social support, and the family’s sense of morality/spirituality as essential to their capacity to cope effectively with difficult transitions.

Mutual support and connectedness

Walsh (2006) describes connectedness as the “emotional and structural bonding among family members” (p. 94). The process of family resilience is advanced when units develop shared meaning and offer mutual support to one another. Consistent with this idea, fami- lies discussed how a strong sense of cohesion allowed families to get through the initial time frame just after a crisis or disruptive transition. For example, one mother explained, “We have to be a team . . . there are times when I’ve had a stressful day and I just can’t deal with a certain thing, and my husband will step in and take care of it. We do that a lot, share the workload.” Similarly, one adult daughter explained, “How in our family it worked really well was because everybody was on this team . . . so even if something else comes along, like, we already got this and everybody’s pitching in.” Helping families to build a strong sense of family connectedness and mutual support within the family unit is important during the survival phase.

Social support

Corroborating other studies (Buehler et al., 2003; Cooley & Petren, 2011; Lietz, Lacasse, & Cacciatore, 2011; Oke, Rostill-Brookes, & Larkin, 2013), social support was identified by all families as essential to their capacity to cope with the challenges of foster- ing, an external strength that also first emerges during the survival phase. Social support involves the tangible and emotional assistance families who foster receive from people out- side of the family. This includes natural occurring support systems such as friends and neighbors and the formal support provided by professionals. For example, one mother sta- ted, “Probably the biggest piece, we have wonderful neighbors just down the street, they have been a huge support system.” In addition, connecting with other foster parents was cited as helpful by many. For example, one couple explained, “Earlier on, we had a mentor [an experienced foster parent], and honestly, that helped a lot. Just having, you know, someone with common experiences that you can connect with and get advice with.”

When speaking of social support, many stories highlighted the value in positive work- ing relationships with child welfare professionals such as caseworkers, licensing workers, and counselors. For instance, one parent stated, “Anytime we’re having a struggle, I was

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calling her [licensing worker] a lot just because I didn’t know how things worked really.. . . I don’t think we would be doing it this long without that.. . . I’m very blessed with our licensing agency.” Considering how complicated the child welfare system is, parents need practical support (e.g., respite care, information about the child or system, help with reim- bursements, training) and emotional support (e.g., empathic listening, validation) from professionals to ensure they have what they need to provide foster care (Cooley & Petren, 2011; Oke et al., 2013).

Morality/spirituality

During the survival phase, families cited a value system that guides moral actions and decision making. Walsh (2006) discusses these shared beliefs as a “moral compass” that guides how families respond to situations that can spark fear and frustration. For some, this was grounded in a family’s strong sense of spirituality, also noted in a study of suc- cessful fostering by Buehler et al. (2003). As one parent stated, “I couldn’t do this without God. I read my Bible every day and when we’re in the hardest parts, I’m finding verses to hold on to that remind me that God is faithful and He will not fail us,” a strategy she shares with her husband and children. Similarly, another mother responded, “Our faith; if we didn’t have that, I don’t even know how people without faith can [foster], you have so many challenges,” suggesting it is their shared beliefs that allow them to cope. As families faced their most disruptive challenges, they were able to move from the survival phase by relying on connectedness within the family, social support from outside the unit, and a moral compass that grows out of the family’s moral and/or spiritual traditions.

Adjustment

As families progress beyond survival, the process of resilience involves creating changes to the structure, schedule, and daily functioning of the family unit. During the adjustment phase, families continue to rely on the connectedness of the family unit, social support, and shared beliefs. As they begin to make real changes to their daily functioning, addi- tional family strengths are discussed as important to the unit’s ability to make needed adjustments and they begin to adapt. These included initiative, boundary setting, and cre- ativity/flexibility.

Initiative

Initiative refers to a family’s ability to take action. Families who foster discussed the importance of planning, organization, and action. Put simply, they have a lot to accom- plish each and every day and as Walsh (2006) suggests, maintaining a belief that they have the capacity to influence the outcome helps families take action. Illustrating this point, one single mother who has been fostering children for over 20 years discussed how initiative allowed her to gain the information she needed. She explained, “I’m so surprised that a lot of foster parents don’t know that there’s extra funds available. Like for school- aged kids, you can get an educational allowance. And they’re like, ‘What? Nobody ever told me.’ Nobody even told me [either], but I just continued to ask a lot of questions.” This mother worked in collaboration with her extended family and her son to take action needed to provide for children placed in their care. As families move from survival to the adjustment phase, they have to be willing to take the action needed to move the family for- ward and believe that action can make a difference.

Boundary setting

From a structural perspective, units organize themselves through boundaries, or the rules that govern the level of differentiation (Minuchin, 1974). In families who foster, the

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family boundary, defining who is in the family unit or household, is flexible and perme- able, expanding with the entry of a foster child, contracting as a child leaves, and shifting again to welcome others into the home. The sense of belonging, feeling connected, as a member of the foster family, even when a placement is not permanent, is crucial for chil- dren vulnerable to issues of attachment and loss and was something that was evident in these stories of long-term fostering.

Emotional boundaries, or the ability to diffuse emotional reactivity, are also essential to healthy family functioning (Bowen, 1985). In this study, boundary setting was discussed not just in terms of family structure, but also when identifying the importance of setting limits, both emotionally and practically. For example, several families talked about the importance of knowing when to say “no” and when to take breaks, such as one mother who explained, “And I think the biggest thing for us, we know when it’s too much for us to handle and sev- eral times we have taken breaks.” Using respite, taking a break between placements, and being realistic about the number and age of children for which each family can care repre- sent important ways that families sustain fostering through practical boundary setting.

There were also stories about emotional boundary setting similar to what Preston et al. (2012) describes as “emotional resilience” (p. 157). When discussing setting these boundaries, the families were clear in the importance of loving the children while separating from the stress of the situation. For example, one father stated, “You have to develop a relationship with the children. They’re in your home. They’re part of your lives. If they’re not a part of your life, you shouldn’t be doing foster care.” Instead, he explained that foster families need to set emotional boundaries around “the drama in the case” but not boundaries regarding their love for the children. Another foster father stated, “Sometimes it gets very hard. You disagree with the CPS case plan. Well, it’s not going to help the children in your home by being upset about it . . . you have to work on not letting it interfere with your relationship with the child in your home.” Similar to a study by Marcellus (2010), when families are able to set boundaries by knowing when to take breaks and when to emotionally disengage from unhelpful case content, they more effectively deal with the stress of fostering.

Creativity and flexibility

Creativity refers to the ability to identify multiple solutions to a problem, whereas flexi- bility is the willingness to try new things. Walsh (2006) suggests adaptive change or “bouncing forward” is an important part of family resilience (p. 84). Considering the amount of adaptation needed to foster, families offered many stories that illustrated the importance of these strengths. For example, one parent stated that families have to be “. . . very flexible and adaptive.” Another family described a story where an adult on an air- plane did not believe the foster parents were the parents of a child whose race was differ- ent than theirs and confronted them during the flight. Rather than become angry, this family explained, “We’ve learned we have to carry a family picture everywhere we go. We always take one with our family that says I’m a foster parent and identified us with the picture,” an illustration of creativity and flexibility. As families adapt to disruptions to the unit, helping families develop new strategies and maintain a level of flexibility is seen as important.

Acceptance

As families moved beyond surviving a dramatic disruption and learned to make the needed adjustments to their schedule, roles, or family structure, they discussed a time per- iod during which they recognized their acceptance of their new reality. As families dis- cussed the acceptance phase, they identified shared meaning making, commitment, communication, and humor as important.

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Shared meaning making

Shared meaning making refers to a family’s ability to develop an understanding about an experience. According to Walsh (2006), when families work together to attach positive meaning to the difficulties they face, the challenges are easier to accept. Illustrating this strength, one parent explained, “The only thing you have control over is loving these kids. You have to do that. Just knowing that you can’t change a lot and you don’t have control over a lot . . . there are some battles that are not worth fighting.” Developing realistic expectations about what foster families can influence demonstrates how the development of shared insight helps them to accept the things they cannot change and yet take action in those areas in which they have influence.

Commitment

In previous research (Lietz & Strength, 2011), family commitment was described as an intense desire to keep the family together. In families who foster, this commitment was expressed both as a desire for cohesion of the original unit of the fostering family and as a commitment to continuing as foster parents. Consistent with previous research (Hendrix & Ford, 2003; Oke et al., 2013; Preston et al., 2012), families expressed a strong desire to provide a home for vulnerable children. For example, one parent explained, “I continue to foster because I know the need is out there.. . . I think a lot of foster parents go into foster- ing because they want to adopt. That was not my goal. My goal was to strictly foster. I want to see children reunified with their parents.” This vision became shared among mem- bers through strong leadership in the family st

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