This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

All foster children experience the trauma of separation from their birth parents — and too many others have experienced other adverse experiences like neglect or abuse. In light of these challenges, Michigan's child and family service agencies are working to provide the mental health services foster kids desperately need.

According to the Centers for Disease Control and Prevention (CDC), "Adverse childhood experiences (ACEs) can have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity." ACEs include traumas like domestic violence, sexual abuse, substance abuse in the home, the daily experience of racism, or separation from a parent due to divorce, death, imprisonment, or loss of parental rights. 

"Almost 100% of the foster care children have experienced some form of trauma, different traumas at various levels," says Michael Williams, president and CEO of Orchards Children's Services, a child and family services agency with locations in Genesee, Macomb, Oakland, Washtenaw, and Wayne counties. "Leaving your family is traumatic for any child. Neglected children sometimes don't have as many traumatic episodes as the ones that were abused, but nonetheless, it affects all of them."

The Michigan ACE Initiative shares that children who experience ACEs can develop the resilience needed to live healthy, happy, and productive lives. And many Michigan organizations are helping them do just that through behavioral health services.

Eastern Michigan: EMDR and an emphasis on education

In addition to making traditional therapies available to the foster children it serves, Orchards Children's Services has found Eye Movement Desensitization and Reprocessing (EMDR) to be an effective way to help kids build resilience after experiencing trauma. This evidence-based form of psychotherapy uses eye movements or other bilateral stimulation while processing traumatic memories. EMDR helps the brain to alter the emotions, thoughts, and responses associated with the traumatic experience. 

Orchards has trained all its therapists and staff working in child welfare in EMDR. Williams says EMDR helps children immediately rather than waiting on time-consuming, continuing diagnoses.
Michael Williams.
"EMDR helps us to find solutions to help that child to better understand how to deal with the trauma or any of the emotional issues that he or she has experienced," he says. "Some children do better with talk therapy, based on their ability to have cognitive understanding of some of the issues that they face. I think in order to be effective in treating them, you need to have both options available."

Northwest Michigan: summer camps, horsing around, and traditional therapies

With offices in Gaylord, Harbor Springs, and Traverse City, Child and Family Services of Northwestern Michigan (CFS) supports the mental health needs of its communities, particularly foster children and foster parents. In addition to traditional therapies, CFS offers an Equine Assisted Therapy program, summer camps, group therapy, and support groups. In the near future, CFS will introduce trauma-informed parenting classes for foster parents and other child caregivers. Many of these services are available virtually.
Michelle Nichols.
"We're going to also resurrect our support group for adoptive parents, foster parents, and possibly other parents," says Michelle Nichols, site manager and family resource specialist with CFS. "It's more of a prevention effort to try to keep children in their placement as long as possible."

CFS contracts with mental health providers like Megan Morrissey, a therapist who often works with foster kids.

"Almost all children in foster care meet the criteria for post-traumatic stress disorder," Morrissey says. "Many of them also have attachment disorders, which is the preliminary to developing personality disorders in adulthood and puts them at significant risk for substance use disorders, as well as other things that are not necessarily mental health conditions but are connected, like being victims of domestic violence in adulthood."

Morrissey notes that many children in foster care also experience high levels of anxiety and depression. Because of these underlying mental health issues, children in foster care may experience difficulty sleeping, nightmares, wetting the bed, and food-related issues like hoarding food, stealing food, overeating, chronic indigestion, overeating, or undereating. They often express emotional dysregulation, which can manifest as not being present (dissociation), lack of motivation, withdrawal, or temper tantrums.

"Foster parents are going to be the ones who see the vast majority of symptoms," Morrissey says. "Often, children who are in foster care have a history of being bullied and a lack of social skills because those aren't being demonstrated for them at home. That can result in a lot of social anxiety, a lot of self-consciousness. Children who've experienced a lot of trauma can be either hyper-aware of their bodies or don't feel their bodies. They are numbing up."

Lansing-based agency builds trust, works on attachments

Based in Lansing, Child and Family Charities (CFC) has sent five of its practitioners for training in Trust-Based Relational Intervention (TBRI) at the Karyn Purvis Institute of Child Development. These five will, in turn, train CFC's other staff members in the modality, which is designed to meet the complex needs of children who have experienced adversity, early harm, toxic stress, or trauma. These kids often find it difficult to trust the loving adults in their lives, so they act out.
Dr. Andrea Calabrese.
"It's a trauma-based model of looking at behavior differently — less shaming and more supportive for not only the child, but teaching the parent how to be more supportive, listening to the child, and understanding where the behavior is coming from," says Dr. Andrea Calabrese, CFC's chief operations officer.

Calabrese notes that kids who have been abused or neglected often have difficulty with attachment issues. Removing children from their birth homes can exacerbate those attachment issues. Calabrese shares that foster children also experience ambiguous loss, a loss felt strongly when their loved ones are alive but not present.

"Some of our children act out violently. Some of our children withdraw. Some of our children self-harm, from ingesting substances and burning or cutting themselves to putting themselves in serious situations, such as human trafficking," Calabrese says. "A lot of these behaviors come from disrupted attachment."

TBRI seeks to heal the child's ability to make healthy attachments by building trust.
Mary Corrigan.
"Sometimes foster parents come in thinking, 'Well, I'll just love them. And as a result, this child's behavior will change.' Love is a good starting point. But it's a slow trajectory," says Mary Corrigan, CFC behavioral health therapist. "Foster parents hate when I say this, but I tell them to keep parenting but let go of the results. The ongoing support we provide them is crucial to them continuing to have a healthy perspective."

State of Michigan "very attuned" to foster childrens' mental health needs

At the state level, the Michigan Department of Health and Human Services (MDHHS) Bureau of Children's Coordinated Health Policy and Supports (BCCHPS) enhances access to and oversight of behavioral health services for children who receive Medicaid, including foster children. MDHHS also provides incentive payments to community mental health systems at the regional level for these children.
Dr. Jeanette Scheid.
"There also are trainings and conferences that foster parents can come to and hear from other foster parents and from local, regional, and national experts," says Dr. Jeanette Scheid, medical consultant at MDHHS' Children's Services Agency. "Our mental health systems are also very, very attuned to the importance of the systems of care principles that include family-driven, youth-guided principles for parents, broadly speaking, and parents who are in the foster parent role."  

MDHHS also requires foster parents going through the licensing process to take formal training that addresses foster children's mental health needs, the impact of trauma, and the emotions and behaviors that these children express. In addition, MDHHS provides Foster Parent Navigators who not only help potential foster parents with licensing but also offer them ongoing support.

"As a society, we all share the value of supporting the health and wellbeing of children," Scheid says. "We have three main goals in child welfare — permanency, safety, and wellbeing. We're trying to work on lifting all of those up. Part of doing that is identifying and addressing mental health needs as early as possible."

Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Michael Williams photos by Steve Koss. 

Andrea Calabrese photo courtesy of CFC. Michelle Nichols photo courtesy of Michelle Nichols. Mary Corrigan photo courtesy of Mary Corrigan. Jeanette Scheid photo courtesy of MDHHS.