When Andrew and Allye Crosby started taking foster children into their home in New Orleans, they felt completely unprepared. Allye, a nurse, remembers watching “super-old videos from the ’80s” as part of the class they took through the local Department of Children and Family Services. And Andrew remembers thinking, “Okay, I know CPR—that was a big focus of the training—but that wasn’t day-to-day what we really needed.” (Thankfully.)

The three- and four-year-old brothers, among the first kids the Crosbys welcomed into their home several years ago, had been removed from their own family because of “severe neglect.” They had lived in a house with no running water or electricity. As Andrew recalls, the boys “were kind of just raising themselves. . . . They didn’t really eat and weren’t cared for there.” The children were “wild” and had sensory processing issues. Loud noises threw the older one off. The younger one frequently ate dirt.

When it came to caring for them during the 11 months they were with the Crosbys, Andrew says that there was a lot of “trial and error.” “More error,” adds Allye. The couple never resorted to corporal punishment but instead gave the kids “time-outs” for misbehavior, sending them to their rooms. In retrospect, Allye says, “That was the exact opposite of what they needed. They needed connection and for us to be with them through whatever they were going through.”

The Crosbys are not alone. Across the country, tens of thousands of foster parents have found themselves underprepared for caring for abused and severely neglected children. National estimates suggest that between 30 percent and 50 percent of these men and women quit within a year of volunteering to help. A recent Boston Globe investigation found that 2,000 foster families in Massachusetts had quit in the past five years—almost as many as the number of families remaining in the system. Even the most experienced parents can find their children’s difficult behaviors overwhelming.

It wasn’t until a few years later, when the Crosbys attended training in Trust-Based Relational Intervention (TBRI), that they began to understand how the brains of these children had developed differently, due to receiving so little attention from (let alone attachment to) the adults who were supposed to be protecting them. Since attending TBRI training—offered through Crossroads NOLA, a faith-based organization that helps to recruit, train, and support foster parents—Andrew and Allye say that their outlook and their parenting have changed completely.

“We have done a lot to try to give them the skills to manage their emotions and help them regulate their behaviors,” says Andrew. “We are managing our own expectations, realizing that they don’t hate us but that they don’t know how to express their emotions.”

The story of TBRI began about 20 years ago, when David Cross, a psychology professor at Texas Christian University, developed a plan with his late colleague Karyn Purvis to help families struggling with kids whom they had adopted internationally. The children adopted out of orphanages in Eastern Europe, China, and South America had varied stories, but many shared an almost complete lack of early attachment, as well as developmental issues associated with significant sensory deprivation. Adoptive parents who have visited these institutions almost always tell of their shock at the silence that greets them in a room full of infants and toddlers. The children learned not to cry because no adult had ever responded.

When such children arrived at their new homes, they were often out of control and sometimes violent. Cross recalls how the adoptive parents were “worn out” and just looking for some kind of break. In the late 1990s, there were a number of high-profile cases in which adoptive parents tried to send adoptees back to their native countries or simply abandoned them to authorities here. To offer relief, Purvis and Cross started a summer day camp for foster or adopted children that sought to address their emotional and social needs. He says that it wasn’t intended to be “therapy,” but it did turn out to be “therapeutic.”

Following the summer camp, children showed remarkable improvements in their behavior and social competency, but those gains proved short-lived. This led Purvis and Cross to develop a formalized program that could equip adoptive parents and professional caregivers with the ideas and practices necessary to form healthy relationships with children who have suffered “relational traumas”—that is, children exposed to prolonged abuse or neglect.

Their program, detailed in the book The Connected Child, was based on three “pillars” that new parents need to provide: a safe and structured environment, trust, and careful corrective training. Each pillar draws upon evidence-based elements used in therapeutic treatments for sensory processing disorder and post-traumatic stress disorder, as well as cognitive behavioral therapy.

In 2006, Purvis and Cross published a formal study of outcomes associated with a later session of their summer camp that employed more refined trauma-informed protocols and activities. They found that children experienced “reduced levels of salivary cortisol, reductions in child depression, and healthier attachment representations as assessed through family drawings.” In a 2016 study on parents utilizing TBRI training, the program was shown to reduce physical aggression in children and to yield “significant decreases on the Child Depression Inventory total score, negative mood score, and interpersonal relationships score for adopted children from pre-intervention to post-intervention.” TBRI is one of only a few programs designed to help this population that has been rated as “highly” relevant by California’s Evidence-Based Clearinghouse for Child Welfare registry.

Texas Christian University now offers weeklong training courses for TBRI trainers and others who will bring the techniques home to the professionals and foster parents in their local community. I attended one such training, dubbed “TBRI Fridays,” at the Woodland Park Baptist Church in Hammond, Louisiana, about an hour north of New Orleans. For six hours, including a one-hour lunch break, foster parents, school counselors, psychologists, and volunteers for CASA (court-appointed special advocates) learned what happens to children’s brains when they experience severe trauma and what they can do to help. Research has found that youth who have spent time in foster care have higher rates of post-traumatic stress disorder than combat veterans.

Kristen Carver, who led part of the training, is the adoptive mother of three girls previously in foster care. She described to the 40 or so attendees how she and her husband felt “isolated” because the girls were so “unpredictable” and violent. One of her daughters had spent time in a foster home as an infant in which she was placed in a back room, propped up against some pillows, and left alone in front of a television for 12 to 14 hours a day.

Within weeks of beginning the TBRI program in her own home, Carver noticed significant reductions in the children’s behavioral “meltdowns,” including their tendencies to harm themselves and others. They went from several tantrums a day for each child to one a day or none. Carver says that, like so many of the families she meets now, she and her husband had become desperate. Of TBRI, she says, “It saved our family.”

Much of the program is devoted to helping the child form a bond with the adult. For instance, adults are often asked to imitate the movements of the child—a kind of “Simon Says” but with no words. Sometimes putting on a shirt of the same color or wearing matching bracelets or ribbons allows children to feel not only that the adult is paying attention to them but also that they are forming a connection.

The TBRI trainers also remind adults to consider the basics first. Is a child hungry or thirsty? Kids who have been through severe trauma are often not capable of expressing their needs in the same way as others in their age cohort. Indeed, their own bodies might be so “dysregulated”—a term used often in TBRI training—that they might not even know that they are hungry or thirsty. Something as simple as having them drink a cup of ice water may help them calm down.

Alex Brian describes learning about the “fight-flight-freeze” response through his TBRI training and how that helps him understand the behavior of his now-four-year-old adoptive son when something upsets him. “Knowing why he is acting that way lets me know how to respond.” Alex says that his instinct would often be to say, “We’ve had this conversation 800 times. You need to respond to me respectfully.” After TBRI, he thinks instead, “It’s been an hour and a half since you’ve had a snack. It’s getting to be the end of your day. You’re being disrespectful. I’m going to model [the proper behavior] for you. I’ll ask you to do it again.”

Parents say that TBRI training helps them respond more effectively to the often-challenging behavior of their adoptive children. (STORMI GREENER/STAR TRIBUNE/GETTY IMAGES)
Parents say that TBRI training helps them respond more effectively to the often-challenging behavior of their adoptive children. (STORMI GREENER/STAR TRIBUNE/GETTY IMAGES)

TBRI has been adopted broadly by Christian communities around the country that participate in international adoption and, more recently, that have added foster care and adoption out of foster care to their missions. In these instances, people who may already be parents to children of their own have had to learn new parenting approaches.

Aaron Vogel, a local restaurant owner, already had four biological children when he and his wife took in their first foster child. But he says that he had to reconsider a lot, even his physical posture when he stands. With his own kids, he tried to project the image of a strong father, but these days, he and his wife are taking in children who have never had a father or have encountered men who hurt them. When a foster child comes into their home, Vogel now hangs back, asks questions, and offers help, never saying, “This is how we do things around here.”

Self-awareness is central to the training. Justin Baird, an admissions associate at Tulane University, has been fostering with his wife, Shelby, for a few years. I met them at a seafood restaurant in New Orleans with an 18-month-old girl they are fostering (who looks about half that age). “I would love to say I’m a go-with-the-flow person . . . but that’s not the case. I feel like the hardest part is that lack of control I feel that I have.” Justin says. He’s learned how to keep himself “regulated, especially in the midst of a tantrum or screaming.” He reminds himself, “They’re not mad at me. A need is not being met within them. They don’t know how to express their big emotions, especially at three or four years old.”

Or when they are much older: as Purvis and Cross found, in traumatized children, the mental age often doesn’t match the physical one. Development has simply halted at a certain point, and parents may need to speak to an eight-year-old the way they would normally speak to a five-year-old. Of course, the idea is to move them forward developmentally, but you have to start where they are.

Learning about the effects of trauma should guide both the small, day-to-day routines of children and the larger changes in their lives. Unfortunately, making sure that youth experience as few disruptions as possible in their routines, in the adults caring for them, and in the number of schools they attend has not been a strong point in our child welfare system. Children get moved not only from foster home to foster home but also back and forth with their biological families, often with little transition time.

One foster mother in New Orleans told me that she received a call on a Friday afternoon from a caseworker asking if she could take in a child. She called her husband to make sure that he was okay with it, and by the time she called the caseworker back a few minutes later, the worker had already placed the child somewhere else for the weekend and said that she would bring him over to her on Monday morning. Why bother with that extra placement?

Anna Palmer, the founder of Crossroads NOLA, says that “when you understand attachment and its role in child development, you understand how important transitions are.” It’s important not only to have fewer transitions but also to prevent them from happening suddenly, unless absolutely necessary. Some families with Crossroads NOLA have described how workers would come to pick up kids after school and bring them back to their biological families without giving them a chance to say good-bye to siblings they had lived with for months or even years.

To understand the trauma experienced by these kids is to recognize the importance of giving them security and permanency as soon as possible. Anna took in a four-year-old foster child who had already been in six other placements. It was clear by that time that parental rights would be terminated and that Anna and her husband would be adopting him, but the court was dragging its feet. The child’s attorney told Anna and her husband, “It’s no big deal. He’s with you. He’s fine. He’s safe.” But Anna knew how important it would be to be able to tell the boy that “he’s going to be here forever.”

It is these interactions that have led Palmer and her team at Crossroads to believe that offering TBRI to a broader audience than just foster parents is an important step. It is now incorporated into training for new Department of Children and Family Services workers (two full days are required). Those already on staff can get continuing education credits for attending more in-depth sessions on trauma-informed care. Palmer estimates that they have trained at least 2,000 professionals at the workshops with the support of grants from private foundations.

Brandy Young, who has worked for the Department of Children and Family Services in the Covington region of Louisiana for 13 years, says that TBRI was like a “missing puzzle piece,” helping her and others understand what was going on in the brains of the children they were trying to care for, as well as in the brains of the parents, who had often been in foster care themselves. Though she holds a master’s degree in social work, she was never given the tools to handle someone with a background of severe neglect or abuse.

Sonja Smith, who runs a local juvenile drug court, tells me that after she attended TBRI training, she put together a group for kids over the summer that used many of the connecting techniques recommended by Cross and Purvis. The 37 teens in the program, she says, saw a 90 percent reduction in positive drug tests.

It would be easy to say that a lot of the TBRI training would be useful in parenting any kids. All children need to form strong connections with adults and routines. All small children have trouble expressing emotions. All kids (and plenty of adults) get cranky if they haven’t eaten in a long time.

So why shouldn’t we just use TBRI on everyone? After all, it’s hard to find anyone without some kind of “trauma” in his or her background. We use the same word to talk about the experience of children in foster care, men in battle, and people called names at work or in school.

In a blog post, the American Enterprise Institute’s Frederick Hess wrote about how he had recently received numerous solicitations for professional-development sessions on “trauma-informed teaching.” He notes: “Sometimes it was trauma-sensitive, or trauma-aware, or some such. In nearly every case, the same data point was cited: that half of all students in the United States have experienced serious childhood trauma. And every time, the same question was raised: ‘How can we best support these students and their families?’ ” Hess wonders: “Are we at risk of pathologizing childhood by viewing even normal childhood bumps and bruises as trauma?”

We are. And universalizing TBRI practices would result in watering down the kind of work done by its practitioners, to the point that the kids who genuinely need this kind of intensive behavioral intervention would not get the highest-quality version of it.

If TBRI is taught correctly, more foster and adoptive parents will likely find that the methods enable them to care effectively for the children in their homes over the long term. And when more professionals in child welfare, schools, and courts also understand how to help these children, TBRI has the potential, says Palmer, “to expand the healing capacity of our community.”

Top Photo: Andrew and Allye Crosby and their children in New Orleans (PHOTO BY GREER GATTUSO, COURTESY OF THE CROSBY FAMILY)


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