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"No-one told us it was going to be like this" : compassion fatigue and foster carers

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Abstract

No-one told us it was going to be like this': Compassion fatigue and foster carers.
TRAUMA
COMPASSION
CARERS CHILD
FAMILY GROUPS FRIENDS
PAIN WORK
SOCIAL
BURN OUT
RESPITE
STRESS RELENTLESS
FATIGUE
FEAR
FOSTERING SUPPORT
CARE
Funded by
Fostering Attachments Ltd
Dr Heather Ottaway and Professor Julie Selwyn
School for Policy Studies, Hadley Centre for Adoption and Foster Care Studies
‘No-one told us it was
going to be like this:
Compassion fatigue and foster carers.
This study was commissioned
and funded by Fostering
Attachments Ltd. We are
particularly grateful to their
managing director, Sarah
Naish, whose commitment to
supporting therapeutic parenting
for traumatised children led to
this study being commissioned.
We are also grateful to the company’s staff
who arranged the venues and catering for
the focus groups.
We are particularly grateful to the foster carers
who gave their time and energy to answer the
survey and take part in the focus groups. Their
honesty and forthrightness about very difficult
and hidden issues in fostering has provided a
powerful narrative about the realities of fostering
traumatised children.
Our thanks also go to Dr Tabetha Newman of
Timmus Limited who designed the survey and
Mim Cartwright, our research assistant who
attended the focus groups.
Acknowledgements
Foreword by Sarah Naish
Compassion fatigue is a
lonely, desperate place to
be. It destroys confidence,
relationships and even whole
families. How do I know?
Well, I have been there.
I have also worked as a trainer with hundreds
of parents and carers who have all shared
similar experiences with me. I realised that
my own experiences of compassion fatigue,
(sometimes referred to as ‘blocked care’ within
the sector), was not an unusual one. I decided
to incorporate some data and research into
our training, and I set about finding out how
widespread the problem was. To my surprise, I
found a great deal of research into compassion
fatigue was available relating to other caring
services, i.e. nurses, doctors, social workers,
but could find nothing useful relating to fostering
or adoption.
The parenting model most widely recognised
in relation to caring for traumatised children,
is one of ‘Therapeutic Parenting’ which is:
a deeply nurturing parenting style, with a
foundation of self-awareness and a central core
of mentalization, developed from consistent,
empathic, insightful responses to a child’s
distress and behaviours; allowing the child to
begin to self-regulate, develop an understanding
of their own behaviours and ultimately form
secure attachments.
Our training in this field naturally brought us into
contact with foster carers, adopters, kinship
carers, and supporting professionals.
At almost every training event we hosted, we
encountered a substantial minority of carers
who were clearly suffering from the effects
of compassion fatigue. They reported feeling
unsupported, misunderstood, blamed and
judged. Naturally this had negative implications
not only for the carers, but for the traumatised
children they were looking after AND the
agency they were working for.
Through my experiences of running a
successful IFA, I already had some ideas
about the best ways to identify and manage
compassion fatigue, but noticed that supporting
professionals seemed unable to pause and
recognise the scale of the problem. I felt that the
impact of compassion fatigue was so great, that
it was essential that evidence based research
was conducted. I was therefore delighted when
the experienced research team from The Hadley
Centre, University of Bristol, agreed to undertake
this project with us, and would like to sincerely
thank Professor Julie Selwyn and Dr Heather
Ottaway for their professionalism and support.
Sarah Naish
Managing Director, Fostering Attachments Ltd
provides training nationwide to foster carers,
adopters and social work teams throughout
the UK regarding therapeutic parenting, child
trauma and compassion fatigue, through
Inspire Training Group
www.inspiretraininggroup.com
Sarah Naish
Formerly owned and ran an
Ofsted ‘Outstanding’ therapeutic
Independent Fostering Agency.
Is an adopter of five siblings, former
foster carer & Children and Families
social worker
Is an Author of therapeutic
parenting books
Runs the international Facebook
group ‘Therapeutic Parents
4 | Compassion fatigue and foster carers summary repor t
Background Aims and objectives
Children in care often have
early adverse life experiences
associated with abuse and
neglect (Department for
Education, 2016).
These experiences, alongside being removed
from their birth families and having multiple
caregivers can lead to difficulties associated
with trauma and loss (Howe, 2009). As a
result, looked-after children require a different,
therapeutic form of parenting which promotes
their developmental recovery from the complex
trauma they have experienced (Schofield &
Beek, 2009; Hughes & Baylin, 2012; Milot et
al., 2015).
Little attention has been given to understanding
the impact on foster carers of caring for
traumatised children, and none on whether
foster carers experience compassion fatigue.
This is surprising given the growing literature on
the presence and impact of compassion fatigue
on other helping professions such as social
workers, nurses, fire fighters and humanitarian
workers (Stamm, 2016).
This summary reports on a
study that aimed to explore:
a) the presence and experience of compassion
fatigue in foster carers in England
b) the support strategies that carers had
found helpful to mitigate the effects of
compassion fatigue.
The full report can be found here:
http://tinyurl.com/gn34fjb
6 | Compassion fatigue and foster carers summary repor t
What is
compassion fatigue?
Compassion fatigue is widely
understood to have three
separate but related dimensions:
burnout, secondary
traumatic stress and
compassion satisfaction
(Stamm, 2010).
Burnout
Burnout can be described as feelings of physical
and emotional exhaustion. Symptoms include
anger, frustration, hopelessness, depression and
feeling inefficient in your job.
Secondary traumatic stress
Secondary traumatic stress develops when
an individual hears about the trauma of others
and is directly affected. Symptoms are similar
to post traumatic stress disorder experiencing
intrusive images, sleep difficulties, problems with
concentration, irritability and anger.
Compassion satisfaction
Compassion satisfaction is the pleasure carers
get from their work in terms of feeling satisfied
with the job and also satisfaction from the helping
itself. Compassion satisfaction is believed to
moderate the effects of burnout and secondary
traumatic stress.
Compassion fatigue can be
experienced by those working
in the helping professions, as a
response to being exposed to
the trauma of people who they
are supporting (Figley, 1995).
It describes the numbness, suppression, and
defensiveness that people in stressful helping
professions report. It is sometimes referred to as
‘blocked care’ in the context of fostering and
adoption (e.g. Alper & Howe, 2015). Blocked
care is used to describe parent’s emotional,
physical and biological responses to children’s
insecure attachment behaviours resulting
in parents no longer able to make a healthy
connection to the child. The term compassion
fatigue encompasses not just the direct effect of
helping or caring in a stressful situation but
also the interaction with job satisfaction and the
quality of support a person receives. Therefore,
in this study we have used the concept of
compassion fatigue rather than blocked care.
Compassion fatigue has long been recognised
as affecting the performance of the police
force, fire officers, hospital staff, mental health
professionals and social workers, but it has
received little attention in respect of foster
carers. An on-line resource (http://www.
proqol.org/Bibliography.html) contains over
2,000 articles on compassion fatigue of which
only two small studies include foster carers.
It is surprising that so little attention has been
paid to the presence of compassion fatigue
amongst foster carers. The fostering task
requires carers who can become ‘therapeutic
parents’ to looked-after children in a way that
promotes the child’s developmental recovery
often after abuse, neglect and trauma. Unlike
other professions, a foster carer’s home is
also their place of work with respite from the
demanding task of caring for looked after
children difficult to achieve. Carers live with,
experience, and listen to children’s accounts of
maltreatment. It is demanding work.
8 | Compassion fatigue and foster carers summary repor t
Method
This study used a mixed methods
approach to investigate the
prevalence and experience of
compassion fatigue in approved
foster carers in England.
There were two elements: an
online survey of foster carers
followed by focus groups.
Focus groups (n=23)
Four focus groups were held in four English
counties in urban and rural areas. Five or six
foster carers attended each group. Carers
were selected from those who had completed
the survey and had given their consent to be
contacted. The groups were asked to consider
a) the day-to-day experience of caring for
traumatised children b) how compassion fatigue
affected their ability to be therapeutic parents
c) carer’s support needs and the support they
received from professionals and peers. Three
male and 20 female foster carers attended: 11
were local authority (LA) carers, 10 were from
independent fostering agencies (IFA) and 2
were from voluntary agencies. Most carers were
very experienced, with over 5 years’ fostering
experience, although a small number had been
fostering for less time. Their placement profile
ranged from emergency/ short term, respite,
parent and child, to long-term placements.
Most carers currently had children in placement.
95% white ethnicity
5% minority ethnicity
13% had adopted children
living in the household
64.5% work for an
independent fostering
agency (IFA)
35.5% work for a local
authority (LA)
39% had birth children
61% Did not have
birt h children
72% worked solely in
the home
90% were over 40
10% under 4 0
51% were caring for 1 child
33% had 2 foster children
12% had 3 foster children
3% had 4 or 5 fos ter child ren
90%
51% 39%
64.5%
72%
13%
78% had a partner
22% were single
78%
89% Female
11% M al e
89% 95%
The online-survey (n=546)
The survey included two measures; the
widely used Professional Quality of Life
(ProQOL) and the Warwick-Edinburgh Mental
Well-Being Scale (WEMWBS). The ProQOL
measures levels of compassion satisfaction,
burnout and secondary traumatic stress.
The WEMWBS is a validated measure of
mental well-being. Together, these measures
provided information about the presence
of compassion fatigue and compassion
satisfaction in foster carers and their general
mental well-being. The survey was widely
publicised by fostering agencies and through
social media (Facebook and Twitter).
10 | Compassion fatigue and foster carers summary report
Analysis of the survey found that in comparison
with people working in other stressful helping
professions, foster carers had slightly higher
levels of burn out, lower levels of compassion
satisfaction and similar levels of secondary
traumatic stress.
Figure 1 illustrates the scores on each of the
three scales. In other stressful helping professions
25% would have scores indicating no cause for
concern, 50% would have moderate symptoms
and 25% would have scores in the highest range
indicating major concerns.
There were no statistical differences on any
of the three scales by gender, by ethnicity or
whether the carer was single or had a partner or
if the carer had birth children living at home.
There were no statistical differences in the
compassion satisfaction or STS scales by the
age of the foster carers. However, the older
carers (60 years plus) were less likely to be
showing symptoms of burnout in comparison
with younger carers. This may be because
older carers who were still fostering were more
resilient and those most affected by burnout had
stopped fostering.
Length of time working as a foster carer was
correlated with the secondary traumatic stress
scale (STS). Carers who had been a foster
carer for 8 or more years were more likely to
have high scores.
From the three scales, Stamm (2010) identified
five combinations of scores (profiles) that are
typically seen in the helping professions. The
scores of foster carers did not fit easily into
the profiles.
The survey also asked about carer’s
well-being using the Warwick-Edinburgh
Mental Well-being Scale (WEMWBS). The
general population mean score is about
51 (Health Survey of England 2011). In this
sample of foster carers the mean score
was lower at 47.8.
More than one in four foster carers had low
well-being, suggesting that if they visited their
GP they would receive further assessment
and treatment for depression or anxiety
(Figure 2).
There was a statistical association between
the ProQOL measure and having low well-
being scores. The carers with concerning
scores on:
the burn out scale were 17 times more likely
to have low well-being.
the compassion satisfaction scale were 15
times more likely to have low well-being.
the STS scale were 5 times more likely to
have low well-being
Findings from the survey
Figure 1
Foster carer’s scores on the three scales of the ProQol (n=546)
Figure 2
A comparison of foster carer’s well-being with adults (age 35-54yrs) in the general population
Low Medium High
STS Burn Out Compassion Satisfaction
24%
50%
26%
13% 15% 12%
59%
75%
26% 26%
45% 45%
27% 28%
29%
100%
0%
100%
0%
Major Concerns
Moderate Symptoms
No Concerns
Foster Carers
General Population
Low Medium High
STS Burn Out Compassion Satisfaction
24%
50%
26%
13% 15% 12%
59%
75%
26% 26%
45% 45%
27% 28%
29%
100%
0%
100%
0%
Major Concerns
Moderate Symptoms
No Concerns
Foster Carers
General Population
The type of agency was associated with
scores on all three scales. A comparison
of means found that the scores of IFA
carers on the compassion satisfaction
scale were significantly higher and scores
on the burnout and secondary trauma
scale were significantly lower compared to
carers working for a LA. The effect size was
very large for the compassion satisfaction
scale (r=.996) but a small effect size for
burnout and STS (r=.210). This suggests
that the agency had a key role in
enabling carers to remain committed to
fostering and enjoying their work.
Compassion fatigue and foster carers summary repor t | 13
Focus group findings
Carers who attended the focus
groups commented on the
effects of compassion fatigue.
Effects were described as sometimes severe,
having a negative impact on: the quality of care
provided to children, the stability and continuity
of placements, foster carers’ mental and physical
well-being and carer retention.
The experience of being in compassion fatigue
meant that carers felt that at times they had shut
down their own emotions so that they could
simply get through each day. As a result, they
thought they had responded less sensitively to
the children in their care, and many described
themselves as only able to meet the child’s
basic needs. Carers said:
I’ve been there with children when you’re
just meeting the basic needs, and you’re
doing what you think they need, but you’ve
took on their trauma, and actually you can’t
cope with that as well as looking after this
person, so we’ve put a lid on it. We can’t
take any more in that glass, so you literally
are protecting yourself.
I was literally yawning all the way up here. I
had a good night’s sleep last night, but I’m
just exhausted, emotionally exhausted, and
that’s quite a biggie. I feel like a punch bag
and there’s no stuffing left.
It’s very hard when you’re talking to
a social worker about the reasons a
placement is going to break.
You give these reasons, and they look at
you and say ‘Oh that’s not a big thing, and
that’s not a big thing’, and you just think
but you don’t understand! This is relentless
… it’s 300 small things.
The carers’ experience of secondary traumatic
stress paints a concerning picture for those who
experienced it. Symptoms reported included
anxiety, fear, panic attacks, heightened emotions
such as frequent crying and anger, and a re-
experiencing of previous trauma in the carers
own lives:
Have you ever woken in the morning and
thought ‘I can’t do this again’? … I even
had one morning where I got out of bed,
got into the shower, and it must have been
about half five in the morning, because I
wanted to bawl my eyes out in the shower
with no-one banging on the door, because I
was still sad about the child’s history.
Compassion satisfaction appeared to moderate
some of the effects of compassion fatigue.
Satisfaction with being a foster carer was gained
from having a commitment to and love for the
child, and seeing a child’s progress, however
small. Carers said:
You’ve got to look for the little things. One
little child was probably with us six months
before they smiled, and it was just like the
sun came out. Because sometimes it’s
hard, very hard, and you’ve got to look for
the little things that make you think it’s
worth carrying on.
The one person I keep going for is her
… I love her and that’s what makes it
worthwhile. Looking after her its 95% hard
word and 5% reward, but that 5% reward
makes every day that’s hard worthwhile.
High quality support from knowledgeable
professionals was also said to contribute to
compassion satisfaction. However, it was rare
for the foster carers in this study to feel that they
were well supported by their supervising social
workers or the childrens social workers. Instead,
support came from other professionals and
fellow foster carers.
Within the focus groups, many of the foster
carers spoke of the direct primary trauma they
experienced as a result of fostering. Primary
trauma occurred from physical assaults on
themselves and family members (including
their own children), assaults on family pets,
and emotional/ psychological abuse.
The literature on compassion fatigue in
stressful helping professions notes that primary
trauma should be addressed first in order for
interventions that target compassion fatigue to
be effective (Figley, 2002).
However, for foster carers and their families,
who are unable to remove themselves from
the source of the primary trauma, this is not a
realistic possibility as their home is also their
workplace. It is inevitable that there will be
occasions when primary trauma is present for
foster carers, alongside secondary trauma and/
or burnout, given the complex needs of the
children they care for and the challenges they
can present. The support provided to foster
carers should therefore acknowledge this reality
and take account of it.
It’s very hard when
you’re talking to a
social worker about
the reasons a placement
is going to break.
You give these reasons,
and they look at you
and say ‘Oh that’s not
a big thing, and that’s
not a big thing’, and
you just think but you
don’t understand!
This is relentless …
it’s 300 small things.
Compassion fatigue and foster carers summary repor t | 1514 | Compassion fatigue and foster carers summary report
Impact of fostering
on day-to-day life
Carers reported that fostering
had an impact on carers’ lives
in a range of different ways.
Foster carers spoke of the relentlessness of the
daily caring task as a result of working hard to
meet children’s complex needs, leading to a lack
of physical and emotional space in their lives.
Carers spoke of feeling exhausted, ground down
and burnt out:
Some of them they’re like limpets, you can’t
prise them off. I have literally said I’m going
to the toilet, and they have been stood
outside the bathroom window talking to
me, and I was like ‘For God’s sake, I can’t
even go to the loo in peace!’
It was almost Groundhog Day every day.
Many foster carers commented on the
detrimental effect fostering had on friendships
and social activities. Carers stated that there
had been a reduction in friendship networks
and in the amount of time they spent socialising
because of exhaustion and/or concerns from
others about the fostered children’s behaviour,
particularly in public. Carers spoke of feeling
lonely and isolated:
It does make it very difficult. We’ve lost
friends over looking after this child.
People were pulling away, and it’s really
hard because you do feel very isolated, and
we don’t have any other carers within our
local area.
In particular, carers said that changes in support
networks should be anticipated and explained
by the social worker during the preparation and
home study process.
Family life was also tested to the limits on
occasions, with considerable stress being
placed on couple relationships and the well-
being of other children in the household being
affected. Where foster carers had
good support networks they were highly valued
and nurtured, and some friends provided much-
needed opportunities for the carer to have a
break away from the demands of caring.
However, the chance to rest and recharge
– something recognised as vital to address
compassion fatigue in other stressful helping
professions (Stamm, 2010), was rarely available
when carers needed it most. Carers often had
to book and take a break to suit administrative
purposes rather than when it was needed.
Financial pressures were a source of worry for
a number of the foster carers, particularly where
agencies required one person to be at home
full-time. The foster carers were at great pains
to emphasise that they were fostering because
they were committed to the children they cared
for. However, the lack of a guaranteed income
led to foster carers sometimes accepting
placements, because of needing to make
mortgage payments etc., when they knew it may
not be the right thing for themselves or other
children in placement.
Accepting inappropriate placements was
especially the case for those single foster carers
who were required to be at home full-time. The
foster carers also reflected on the view that
some carers ‘do it for the money’. As one foster
carer stated:
There are people out there who think we
shouldn’t be paid at all. I’d love them to
come and live my life for a week! We don’t
do it for the money … We’d be absolute
fools to do it for the money! I don’t get
weekends off, don’t get annual leave …
I love my foster children, and that’s what
makes it worthwhile.
It was almost
Groundhog
Day every day.
Compassion fatigue and foster carers summary repor t | 1716 | Compassion fatigue and foster carers summary report
The support received from
social workers and their
agencies strongly influenced
how carers felt about fostering.
While a few carers talked about
the excellent support they were
receiving, the majority spoke
about a lack of support.
Some foster carers blamed ‘the system’, describing
the care system as broken and dysfunctional with
social workers not having enough time to listen or
support because of high caseloads, financial cuts
and lack of experience. Several commented on the
high turnover of social work staff:
The system currently does not allow
enough time for social workers to support
either carers or looked after children
properly … Most of the social workers I
have met are good people committed to
the children they work with but the system
is overstressed, inefficient and clearly
underfunded.
Foster carers also attributed lack of support to
individual social workers’ lack of respect and
empathy, which resulted in the carers not being
trusted, their expertise being ignored and a lack
of partnership working. Many foster carers also
talked about social workers wanting to ‘solve’
problems rather than simply listening and being
empathic, and this is not what they needed:
I would just like the social worker to
say, ‘It must be really hard to look after
these children’.
Some foster carers felt judged and blamed by
social workers for the difficulties they experienced
in caring for traumatised children. Feeling judged
led to a reluctance to ask for help and concerns
from carers that if they were honest about the way
they were feeling they might get de-registered.
Lack of support is likely to have contributed to the
moderate to high levels of burnout and secondary
traumatic stress, and moderate to low levels of
compassion satisfaction which many foster
carers reported.
Most foster carers felt that the social work
professionals supporting them did not
generally have the appropriate knowledge
and understanding of issues of attachment
and trauma, its effects on children and the
challenges of caring. As a result, the support
provided did not meet their needs. Carers said:
The total lack of understanding of the most
basic rudiments of attachment theory
displayed by my supervising social worker
… has completely put me off attempting to
access [support].
The social workers and their lack of
understanding/ training cause me far more
problems than the children I care for.
Difficulties were also reported in physically
accessing support groups, and confidentiality
rules used in a way that prevented foster carers
sharing their experiences and gaining support:
The support groups aren’t what they
used to be. We’re now having to sign
confidentiality sheets saying we can’t
discuss our children within this setting …
Even if we don’t use names, we should be
able to talk freely about the problems
we’re having.
Support for foster carers
There was a diversity of views about the
purpose and role of support groups, which
suggests that independently run groups with a
more flexible approach would be preferable.
One of the most important forms of support,
perceived by carers as under-recognised,
viewed with suspicion by social workers
and insufficiently utilised by agencies, was
that received from fellow foster carers.
Carers repeatedly commented that the
mutual understanding of the fostering task
led to feelings of greater support without
feeling judged:
It’s like having a sounding board … and we
sit and cry sometimes because we’ve had
really bad weeks. We all understand each
other and we’ve all been there … I could
not pick up the phone to my supervising
social worker because I would feel judged,
or I would feel like a failure.
More opportunities for informal peer support
were particularly recommended by the foster
carers. Peers could mentor and were also
an excellent way to offload and gain support
from one another without any expectation of a
‘quick fix’. Foster carers reported that buddying
schemes were under-utilised, usually because of
a lack of facilitation by the agencies.
Foster carers were clear that the challenges of
caring for traumatised children meant that they
needed to be supported to have breaks in order
to rest and recharge their batteries. Having
respite gave carers the opportunity to stand
back and regain perspective. However, they
wanted respite to be relationship-based and
child centred using carers who the child knew.
Instead carers thought that respite did not take
into account the needs of traumatised children
and children were placed with strangers.
Respite also lacked flexibility with blanket
policies of minimum and maximum periods of
respite, which was not responsive to individual
needs. Many carers also said they would simply
appreciate a regular few hours off each week.
Foster carers were more positive about respite
care when they could work with the same
respite carer over time. Informal arrangements
could be put in place to allow visits until the
child felt comfortable and safe. Only at that
point were suggestions made to the child about
staying with the respite carer.
There were also many instances of respite being
seen as the carers not coping (often from LA
carers), and they felt judged and blamed for
this. Behind this, the carers felt that there was
a fundamental lack of understanding about the
realities of fostering traumatised children, which
meant that either the need for respite was not
supported, or a flexible understanding of respite
was not prioritised.
Almost without exception, the foster carers in
the focus groups felt that they had not been
adequately prepared during the three-day
preparation programme and their home study.
As one carer said,
‘fostering is about normalising the most
extreme behaviours and pretending it’s a
normal life, and it just isn’t a normal life at
all really’.
Another said,
‘No-one told us it was going to be like this’.
Compassion fatigue and foster carers summary repor t | 1918 | Compassion fatigue and foster carers summary report
Recommendations
Recognition and acceptance by fostering
agencies that compassion fatigue will be
present amongst foster carers
Agencies should provide carers with information
on the symptoms and consequences of
compassion fatigue and useful self-help
strategies. Carers also need to know how to
access support for compassion fatigue.
Agencies should ensure that their staff have
a good knowledge of compassion fatigue
and are able to identify and support (without
judgement) foster carers who are suffering.
The content of the 3-day preparation course
for foster carers needs to be re-examined
to place greater emphasis on the impact of
fostering traumatised children and the need
for a therapeutic approach to parenting.
Training needs to be developed for social
workers and carers on compassion fatigue.
We recommend joint training as both
social workers and foster carers may have
experienced symptoms and they have much
to learn from each other.
Further research is needed on ‘what works’ to
increase compassion satisfaction and reduce
compassion fatigue in foster carers.
The commissioning of inter-agency locally
based and independently run support groups
that promote a safe space for carers.
Peer support for foster carers should be
actively promoted and supported within and
across fostering agencies in order to provide
local informal support that addresses issues
of isolation.
Consideration should be given to reviewing
the remuneration of foster carers and their
conditions of service.
Greater investment in respite provision
which is creative, relationship-focused and
responsive to need, in order to reduce the
effects of compassion fatigue. Family and
friends who are potential respite carers should
be better informed and included in training.
In light of the findings from this study, we
recommend that the following amendments
are made to the Fostering Services: National
Minimum Standards (2011):
1. Standard 13: Recruiting and assessing
foster carers who can meet the needs of
looked after children. Standard 13.3 should
be amended in order to explicitly state that
the issues carers will encounter occur as a
result of their role. We are suggesting that the
amendment could read as follows:
Prospective foster carers are prepared
to become foster carers in a way which
recognises, addresses, and gives practical
techniques to manage the issues they are
likely to encounter through the demands
of the foster carer role and the needs of
the children they care for. The preparation
should also identify the competencies and
strengths they have or need to develop.
2. Standard 21: Supervision and support of
foster carers. This standard would benefit
from the addition of a clause which explicitly
requires that support is provided in order
to promote and protect foster carers’ well-
being. As it currently stands, the emphasis
is on support being given to foster carers in
order to meet children’s needs. The additional
clause will encourage agencies to include
a specific focus on emotional well-being as
part of regular support meetings. A great
emphasis is also placed on supervision within
this standard, rather than recognising and
addressing support needs.
This study has provided
significant insights into what
day-to-day life is like for those
fostering traumatised children.
It has identified that compassion fatigue is
present for a substantial minority of foster
carers, and some of the ways in which it has an
impact on them. Research with stressful helping
professions has underlined the importance
of providing support, which recognises the
presence of compassion fatigue, and acts to
moderate its effects (Cocker and Joss, 2016). It
is therefore vital to begin to re-conceptualise the
support foster carers require in the light of this.
Creating a safe space for carers to process the
child’s and their own trauma, and to offload
about difficult issues without the threat of
judgement or sanction, is also vital. This safe
space is needed within the context of support
groups, active promotion of informal peer
support and in the supervision and support
received from professionals. Without this, carers
will risk continuing to be and feel judged and
blamed for their own difficulties, and those of
the children they care for, and their needs will
continue to go unrecognised.
A lack of separation between the home and
work environment in fostering means that
creating some physical and emotional space
is challenging, particularly when considered
alongside the reduction in support networks
which many carers experienced as a result of
fostering. A reconceptualisation of respite is
therefore required, where carers can be afforded
some ‘time out’ on a flexible basis, and in a
child-centred way, in order to reduce symptoms
of compassion fatigue.
Conclusions
In order for foster carers
to be able to receive
appropriate support, those
supporting them need to
have an understanding of:
1. the effects of trauma and
attachment difficulties on children
and young people
2. the challenges these issues can
bring for those caring for these
children
3. the impact of the fostering task on
foster carers.
4. symptoms of compassion fatigue
5. how to reduce compassion
fatigue and increase compassion
satisfaction
20 | Compassion fatigue and foster carers summary report
References
Alper J. and Howe D. (2015) Assessing adoptive
and foster parents. London, Jessica Kingsley
Publishers
Department for Education (2011) Fostering
Services: National Minimum Standards,
London: HMSO
Department for Education (2016) Children
looked after in England including adoptions.
Retrieved from:
https://www.gov.uk/government/statistics/
children-looked-after-in-england-
including-adoption-2015-to-2016
Figley, C.R. (1995) Compassion fatigue: Coping
with secondary traumatic stress disorder in
those who treat the traumatised, New York:
Brunner-Routledge.
Figley, C.R. (2002) Treating Compassion Fatigue,
New York: Brunner-Routledge.
Howe, D. (2009) ‘The impact of histories of
abuse and neglect on children in placement’.
In: Schofield, G. and Simmonds, J. The Child
Placement Handbook: Research, theory and
practice. London: BAAF, pp. 47-62.
Hughes, D. and, Baylin, J. (2012) Brain-based
parenting: The neuroscience of caregiving for
healthy attachment, New York: W.W. Norton
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Milot, T., St‐Laurent, D. and Éthier, L.S. (2015)
‘Intervening with Severely and Chronically
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Contribution of Trauma‐Informed Approaches’,
Child Abuse Review 25 (2) pp 89-101.
Schofield, G. and Beek, M. (2009) ‘Growing up
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(3) pp 255-266.
Stamm, B.H. (2010) The Concise ProQOL
Manual (2nd Edition), Pocatello, ID:
www.ProQOL.org.
Stamm, B.H. (2016). ‘The Secondary Effects of
Helping Others: A Comprehensive Bibliography
of 2,017 Scholarly Publications Using the Terms
Compassion Fatigue, Compassion Satisfaction,
Secondary Traumatic Stress, Vicarious
Traumatization, Vicarious Transformation and
ProQOL, http://ProQOL.org.
... However, research investigating STS and related constructs is scant among foster parent samples. Th e few studies that explored foster parents' STS found that between 20% and 74% of foster parents reported moderate to severe STS (Carew, 2016;Ottaway & Selwyn, 2016). Importantly, STS has been associated with placement instability and foster parent turnover (Hannah & Woolgar, 2018;Ottaway & Selwyn, 2016). ...
... Th e few studies that explored foster parents' STS found that between 20% and 74% of foster parents reported moderate to severe STS (Carew, 2016;Ottaway & Selwyn, 2016). Importantly, STS has been associated with placement instability and foster parent turnover (Hannah & Woolgar, 2018;Ottaway & Selwyn, 2016). Further, foster parents who report lower support report higher secondary traumatic stress symptoms (Whitt-Woosley et al., 2020). ...
... Th ere is confl icting literature on whether age is associated with secondary traumatic stress. For example, some studies have found no association between age and burnout or STS (Bridger et al., 2020;Ottaway & Selwyn, 2016), while other studies have identifi ed that older foster parents have reported lower STS symptoms (Steen & Bernhardt, 2023). Although there is little research specifi c to foster parents, the rationale may be gleaned by examining research from other helping professionals. ...
Article
While scholarship exploring well-being outcomes among child welfare workers is burgeoning, few studies have examined predictors of well-being among foster parents. Utilizing the Professional Quality of Life (ProQOL) Scale, this study examined factors associated with foster parent burnout, secondary traumatic stress, and compassion satisfaction. Results demonstrated that several demographic factors predicted the ProQOL of foster parents. Strengthening foster parent well-being is important to achieving positive outcomes with children and families engaging with child welfare systems.
... The risk of developing secondary trauma has been studied mostly with professionals working with traumatized or crisis-affected individuals, including emergency personnel, police officers, firefighters, paramedics, clergy, and, more recently, foster parents (Perry, 2014). For the last, the fact that the child lives with them 24/7 makes their reality different from that of other professionals, for whom there is a separation between working and living environment (Ottaway & Selwyn, 2016). In addition, for foster parents, the likelihood of developing secondary trauma appears to increase with years of experience (Ottaway & Selwyn, 2016). ...
... For the last, the fact that the child lives with them 24/7 makes their reality different from that of other professionals, for whom there is a separation between working and living environment (Ottaway & Selwyn, 2016). In addition, for foster parents, the likelihood of developing secondary trauma appears to increase with years of experience (Ottaway & Selwyn, 2016). ...
... Recent studies of large representative samples of British foster parents (Bridger et al., 2020;Hannah & Woolgar, 2018;Ottaway & Selwyn, 2016) showed that this population demonstrated high levels of secondary trauma, as measured on the Professional Quality of Life (ProQOL) scale, comparable to those reported by professionals working with traumatized individuals. Furthermore, in focus groups conducted by Ottaway and Selwyn (2016) with 23 foster parents (20 of whom were women), some participants described severe effects of secondary trauma, which in turn had a significant impact on the quality of care that they provided to the children, the stability and continuity of the placement, their mental and physical well-being, and their desire to continue to foster. ...
Article
Full-text available
Children adopted from out-of-home care may present symptoms of developmental trauma that affect their functioning. This puts their adoptive parents at risk of experiencing secondary trauma. The purpose of this research was to understand the experience of adoptive parents who self-report symptoms of secondary trauma in relation to their child’s symptoms of developmental trauma. Individual semi-structured interviews were conducted, transcribed, and analyzed using Braun and Clarke’s (Qualitative Research in Psychology, 3(2), 77–101, 2006) thematic analysis method. Ten adoptive parents were recruited from four community organizations providing support for adoptive parents or parents of children with attachment disorder. All participants reported feeling strong emotions related to secondary trauma, as well as physical and mental health issues that appeared after the child’s arrival in the family. Participants reported experiencing aggression from their child, which greatly disturbed the parent–child relationship and led to the child being placed in residential care for half of the families involved in the study. Secondary trauma was insufficient to fully capture the experience of these parents as it failed to account for the suffering and distress linked to their efforts to establish a parent–child relationship. Instead, filial trauma was used to describe this experience. The authors conclude that a better understanding of filial trauma can contribute to improving post-adoption services for parents struggling to fulfill one of the most important roles of their lives: being the parent of their child.
... De esta forma, parece que se relaciona positivamente con la calidad del comporta- estas últimas investigaciones se han centrado en la evaluación de la autoeficacia, la cual, en niveles moderados, se relaciona con una mayor sensibilidad parental (Wilson et al., 2014) y con comportamientos más positivos por parte de los cuidadores y de los niños y niñas, incluyendo la expresión de afecto, más muestras de deleite y más entusiasmo durante el juego compartido (Mouton En cuanto a la investigación con familias acogedoras, en una línea similar a lo encontrado con otras poblaciones, el sentimiento de competencia parental se asocia a resultados positivos en la crianza y al deseo de continuar siendo familia acogedora (Cooley & Petren, 2011;Jiménez-Morago et al., 2018;Whenan et al., 2009). Sentir que el papel de acogedores y acogedoras está siendo desarrollado de forma eficaz y, además, experimentar satisfacción a través de ello, está relacionado con una mejor sensación de manejo de las dificultades de los niños y niñas acogidos (Cooley et al., 2015), lo que, a su vez, hace que esté relacionado con el desarrollo de menores sentimientos de estrés parental (Morgan & Baron, 2011;Ottaway & Selwyn, 2016;Whenan et al., 2009). Tal y como afirman Mares y Torres (2014), la capacidad de percibir los aspectos positivos de los niños y niñas acogidos y sentir que su crianza aporta una recompensa, se relaciona con un incremento del sentimiento de competencia parental de los acogedores y acogedoras. ...
... ;Jiménez-Morago et al., 2018). Además, en el Estudio 4, hemos evaluado un modelo de mediación entre las dificultades de ajuste psicológico y las dos variables parentales mencionadas, que también estaban relacionadas entre sí de forma inversa y significativa, es decir, los acogedores que experimentaban un nivel más elevado de sentimiento de competencia parental tendían a sentir menores niveles de estrés parental(Morgan & Baron, 2011;Ottaway & Selwyn, 2016; Whenan et al., 2019).De esta forma, el modelo de mediación evaluado planteaba que las dificultades de ajuste psicológico de los niños y niñas predicen el estrés parental a través del sentimiento de competencia parental, que actúa como variable mediadora. Tal y como muestran los resultados de este estudio, obtuvimos un modelo de mediación parcial que resultó significativo, coincidiendo con lo examinado por otros autores previamente(Morgan & Baron, 2011).2. ...
... Foster parents are responsible for children who often come with complex emotional trauma, losses and disappointments. Foster parents bring their values, trauma, and life experiences to the foster family [3, 4,5]. All of these are preconditions for secondary psycho-emotional stress when providing foster care [6]. ...
Article
One of the challenges in providing foster care services is the psycho-emotional stress that foster parents experience. The aim of the present study is to explore the risk factors increasing the levels of psycho-emotional stress and burnout in foster carers in the region of Gabrovo. Materials and methods: The study included 63 professional foster carers from the region of Gabrovo. We used a questionnaire designed by the research team, the Parental Burnout Assessment (PBA) and a structured interview. Descriptive statistical methods and nonparametric analysis were conducted with IBM SPSS Statistics Base - v. 25. Results: The main factors that contributed to the difficulties faced by foster parents in providing care were: the child's length of stay in the foster family; the child's age at the time of placement; the support provided by the state agencies, and ongoing training. Additional factors were the foster parents' income and place of residence, the child's current health and age; foster care being provided by couples.br /> Conclusion: Foster care needs to be provided in close collaboration between local authorities, state agencies, and foster carers, with continuous psychological support for both foster parents and foster children.
... It is also painful to parents (both biological and foster) and the professionals who must physically carry out the separations. In fact, we think it is so counter to professionals' motivations for working in child protection that it might contribute to burnout, high rates of turnover in staff and foster carers, [6] and even to moral injury [7]. ...
Chapter
Full-text available
It is unequivocally clear that separating children from parents through foster care is harmful. We offer several safe alternatives to foster care, including new assessment tools focusing on family strengths and parents’ readiness to learn and six interventions tailored to local needs. These alternatives keep children with their parents while under child protection supervision. All cost substantially less than foster care. The alternatives had several characteristics in common. Child needs, especially safety, were met. Parents worked with professionals in structuring new services, resulting in co-created bespoke services with a wide buy-in in each community. Using the new tools, the alternatives were assessed for strengths and parental readiness before intervening so that success was promoted. The best services combined individual learning and group activities, especially activities that involved exercise, outdoor green-time, and social engagement. They also offered 24/7 availability and affiliated with a university to provide better program design and evidence of outcomes. We discuss the impediments to accepting alternatives to foster care, and call for policy makers, judges, supervisors, and managers, as well as case workers, to reduce the use of foster care by using safe alternatives that strengthen families.
... Several studies have also found that the emotional wellbeing of foster carers is rarely considered by social workers (Lynes and Sitoe, 2019;Ottaway and Selwyn, 2016). Disagreements with social services can have a significant impact on carer retention (Wilson, Sinclair and Gibbs, 2000) which will have a knock-on effect on the stability of placements (Pithouse and Rees, 2014). ...
Article
This article reports on an evaluation of the Fostering Wellbeing programme, a set of five themed masterclasses delivered in two local authorities to a group of multi-disciplinary professionals in the team around the foster child. The programme also included the development of the role of the foster carer Pioneer. The evaluation found benefits of the multi-disciplinary training, but attendance and commitment from some professionals were limited. The programme demonstrated some traction in bringing the foster carer into the team around the child and strengthening their ability to advocate for the child. The Pioneer role showed promise but was yet to be fully embedded.
... Furthermore, it may be helpful for professionals to support caregivers to identify triggers for mentalizing or nonmentalizing moments, particularly understanding the impact of young people's emotional dysregulation on their own affect. Mapping caregivers mentalizing profile may be an important exercise for supporting them to maintain a mentalizing stance in difficult moments and to reduce their own risk of burn out, especially in the fostering context where burnout is common (Ottaway & Selwyn, 2016). ...
Article
Full-text available
Mentalization theory suggest bidirectional links between a caregiver’s capacity to mentalize their child and emotional regulation in their children. However, there has been little empirical investigation to verify this theory. The bidirectional relationship between caregiver mentalizing and child emotional regulation may be especially important to understand in caregiving contexts where there is greater risk of relationship breakdown or child emotional dysregulation, such as in fostering relationships. This study used a novel time-sequence analysis approach to explore the putative bidirectional relationship between caregiver mentalizing and child emotional regulation in the context of long-term foster care. Existing theories about caregiver mentalizing and child emotional regulation were evaluated and developed by looking at moment-by-moment interactions between a foster carer and a child in her care. The findings of this study gave mixed support for bidirectional relationships between foster carer mentalizing, and child emotional regulation predicted by existing theoretical models. These findings have implications for refining and applying mentalization theory broadly and more specifically in the context of foster care. Furthermore, this study provides a useful example of how time-sequence analysis may be useful for exploring the links between phenomena, such as caregiver mentalizing and child emotional dysregulation, occurring over time in observational data.
... As presented above, there is limited research on the concepts of BO and STS in the foster parent population, although these phenomena are common among professionals working with traumatized people (Meyers & Cornille, 2002;Ottaway & Selwyn, 2016). ...
Article
Full-text available
Purpose: It is very likely that many children who enter the foster care system have experienced at least one traumatic event, and can develop symptoms of PTSS. Consequently, foster parents’ level of sensitivity towards child symptoms of PTSS plays a significant role in child development, but the link between sensitivity and several professional characteristics is not well understood. The current study aims to explain the effect foster parents’ sensitivity towards child trauma exert on their job satisfaction, via foster parents’ compassion fatigue and the quality of their relationship with the children in care. This study is one of the few to investigate foster parents’ sensitivity towards child trauma, and the direct and indirect effects on other variables. Methods: Structural equation modeling was used to test a mediating model on this sample (N = 165) after using an online survey to collect the cross-sectional data. Results: The model produced good fit (RMSEA = 0.087; CFI = 0.899). The direct effects between variables are significant. The relationship between foster parents’ sensitivity towards trauma and their job satisfaction can be better understood with the contribution of compassion fatigue. Conclusion: Findings confirm the mediation effect of compassion fatigue and reveal more aspects of the sensitivity towards trauma concept. These results could be implemented by considering more accurate measurements for the caregiver’s sensitivity towards child trauma. The importance of considering interventions for increasing foster parents’ trauma knowledge and skills is highlighted.
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Full-text available
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Many clinicians and researchers have proposed considering child abuse and neglect from a traumatic stress perspective to better understand how they so profoundly impact child development. According to this perspective, child maltreatment (both child abuse and neglect) is viewed as a chronic interpersonal trauma which may severely interfere with normal developmental processes, often resulting in long‐lasting behavioural, emotional and psychophysiological dysregulations. In this paper, we summarise theoretical and empirical literature addressing the traumatic nature of child neglect, with a specific focus on short‐term consequences of neglect in childhood. We then give an overview of some key intervention elements stemming from trauma‐informed approaches with traumatised children and their families.Copyright © 2015 John Wiley & Sons, Ltd. ‘We summarise theoretical and empirical literature addressing the traumatic nature of child neglect’ Key Practitioner Messages Child neglect is viewed as a chronic interpersonal trauma which may severely interfere with normal developmental processes, often resulting in long‐lasting behavioural, emotional and psychophysiological dysregulations. Key intervention guidelines stemming from trauma‐informed approaches include: A detailed assessment of the child's trauma history and characteristics Providing a safe environment for the child Helping the child build feelings of emotional security Improving parental sensitivity Developing child emotional self‐regulation Offering emotional therapeutic support to the parent.
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The Concise ProQOL Manual
  • B H Stamm
Stamm, B.H. (2010) The Concise ProQOL Manual (2nd Edition), Pocatello, ID: www.ProQOL.org.
The Secondary Effects of Helping Others: A Comprehensive Bibliography of 2,017 Scholarly Publications Using the Terms Compassion Fatigue, Compassion Satisfaction, Secondary Traumatic Stress, Vicarious Traumatization, Vicarious Transformation and ProQOL
  • B H Stamm
Stamm, B.H. (2016). 'The Secondary Effects of Helping Others: A Comprehensive Bibliography of 2,017 Scholarly Publications Using the Terms Compassion Fatigue, Compassion Satisfaction, Secondary Traumatic Stress, Vicarious Traumatization, Vicarious Transformation and ProQOL', http://ProQOL.org.
Assessing adoptive and foster parents Fostering Services: National Minimum Standards, London: HMSO Department for Education (2016) Children looked after in England including adoptions. Retrieved from: https://www.gov.uk/government/statistics/ children-looked-after-in-england- including-adoption
  • J Alper
  • D Howe
Alper J. and Howe D. (2015) Assessing adoptive and foster parents. London, Jessica Kingsley Publishers Department for Education (2011) Fostering Services: National Minimum Standards, London: HMSO Department for Education (2016) Children looked after in England including adoptions. Retrieved from: https://www.gov.uk/government/statistics/ children-looked-after-in-england- including-adoption-2015-to-2016
The Child Placement Handbook: Research, theory and practice
  • G Schofield
  • J Simmonds
In: Schofield, G. and Simmonds, J. The Child Placement Handbook: Research, theory and practice. London: BAAF, pp. 47-62.