Exploring Options for Better Visiting
National and local programs develop their own best practices for visiting
By Meghan Williams with Marty Beyer
This is the second of two articles about changes to parent-child visits.
In response to an emerging consensus about the importance of allowing children in care to visit with their birth parents, there are several programs that aim past the limited policy and create better practice. Visit coaching and therapeutic visiting are two systemic approaches; Reunity House in New Jersey and Families Together in Rhode Island are well-known local innovations.
A mother and son take a break from building with wooden blocks at the Providence Children's Museum.
Working with major system reforms in Oregon and Alabama prompted child welfare consultant and author Marty Beyer to think about improving visits. "We interviewed a bunch of families whose children had been in care longer than six months," Beyer explains. "Among the interview questions was 'Why did the child come into care?' It was really impressive that none of the parents could answer that question."
She knew it was important not just for visiting, but also for the post-reunification parent-child relationship, that parents could identify the unique needs of their children. Beyer felt parenting classes were too broad in approach and supervised visits didn't contribute to progress; she settled on the idea of a visit coach to support parents as they took back responsibility for their children.
Which does a visit coach more closely resemble--the first-base coach for a baseball team who stands on the field and offers real-time guidance, or the head coach who watches from the dugout, saving critique for after the game? It depends, Beyer says. She likes to think a visit coach is more like a soccer coach, giving individualized instruction.
"When people first hear about visit coaching, they will say, 'oh, I already do that,' and what they mean is, 'I tell parents what to do during the visit,'" Beyer says. "That's not what visit coaching is."
Beyer used her experience with families to give an example of how a case might unfold: A young mother, upset by her newborn's removal, confronts her caseworker at supervised visits. The mother wants more visits and a different placement for the baby, who cries frequently. A visit coach would help the mother put aside her own frustrations and focus on the baby's needs, suggesting visits in the morning when the baby is less cranky. The mother may also propose a quiet, private room and soothing music to calm the baby, which the coach could arrange.
Visit coaching is based on a belief that parents can overcome anger, sadness, and other obstacles to make visits happy for their children. The program aims for interactions similar to those the family enjoyed when they were living together.
Supporting Parents to Support Children
Coaching comes from "a child-needs-focused approach rather than a parenting approach to visits," Beyer says. This shift in perspective means visit coaching is fundamentally different from supervised visits and parenting classes; Beyer believes in many cases it can replace both.
Instead of viewing the agency as owning the visit--setting the time, place, frequency, and conditions--families are coached to make visits as homelike as possible. Parents are encouraged to make visits a celebration of the family by including favorite activities: taking pictures, making a scrapbook, telling stories, singing songs, and so on. A 15- to 30-minute meeting with the coach before and after each visit provides time to plan ahead and reflect. By planning their own visits with a coach's guidance, parents practice the lifelong habit of identifying a child's needs and adjusting parenting to meet them.
A father and daughter learn about bones and x-rays at the Providence Children's Museum.
Stella Husbands, a family visiting specialist at Richmond Hill Family Center in New York, has been visit coaching the past two years but has 11 more years of experience with visiting in general. She believes the planning meetings help parents think about their goals with their children and how to achieve them. "By having a post-visit and a pre-visit, it makes a big difference," she says. "In the pre-visits we normally try to find out if [the parents] have any plans or anything they would like to do."
Siblings may compete with each other for their parents' attention, but coaches help parents spend a little special time with each child during every visit. Special visit planning also occurs in visit coaching with infants and teenagers. Visit coaches support parents in attuning to their infants by emphasizing that reciprocal communication with newborns develops attachment, and they facilitate improved communication between teens and their family members and other adults to build connections that endure after they leave foster care.
Coaching helps the parent and foster parent encourage the child to live happily in two different families, which relieves painful "loyalty" pressures. It is important not only for the foster parent and parent to communicate but for the child to see them interact in a friendly way. When caseworkers and visit coaches include parents and foster parents together in regular discussions, everyone has a shared understanding of a child's difficult behaviors and can use the same approaches in managing them.
One of the challenges of visit coaching is helping parents not get discouraged--change takes time, time when they feel they are losing their children. Many parents are themselves debilitated by trauma, learning disabilities, and poverty, and they are fragile as they "start over" in alcohol and drug treatment and domestic violence programs. Husbands said she works with case planners to find out what other issues the parent is working to overcome, and she helps parents see the importance of solving their problems. "What I do as a visit coach is encourage them," she says.
When they have a visit, parents may be overwhelmed by their mixed feelings of pleasure, sadness, awkwardness, and defensiveness, as well as competitiveness with the foster parent. Even though they enjoy their children, visits make many parents feel inadequate and powerless, and separating from their child in visit after visit is very painful. Coaches help parents work through these obstacles and emotions so they are able to return consistently over the long months that their children are in care. Parents benefit from the visit coach's validation of their complicated feelings about visits, but the coach's primary goal is to help the parent understand what the children are feeling and what they need.
Implementing Visit Coaching
Implementing visit coaching with families when their children enter care, or in preparation for home visits prior to discharge, requires leadership for an approach entirely different from supervised office visits. Visit coaches need to be trained to resist directing visits or telling parents how to parent, since it's unlikely to be productive.
"Imagine that you've been doing something all your life without anyone telling you how to do it," Husbands says. "Of course we have a little resistance." Her agency does visit coaching for a family over a period of 90 days, with one visit a week in a private room. This is an improvement over their previous practice of biweekly visits, when a private room was not guaranteed; parents have appreciated the change. "Some parents say yes, they do feel much better, they do like coming here," Husbands says. "They are much more receptive to visit coaching."
Children and families alike enjoy the hands-on exhibits at the museum, including Water Ways.
Training for visit coaching can include a diverse group, with more potential coaches than visit supervisors--MSW interns, foster parents, parent advocates, parenting class teachers, and others. Caseworkers may want to be trained as coaches for some of their families, and welcome separate coaches working with other families.
Coaches should meet with parents 15-30 minutes before and after each visit to help the parents control their feelings and review their children's needs. Revised documentation means an individualized format for coaches to write notes about each visit that document the child's needs and what the parent did to meet each one, as well as a parent self-assessment.
Coached visits occur outside of the agency much sooner than unsupervised visits, because the coach stays with the family. Parents can get involved in their child's school and attend extracurricular activities and medical appointments with a coach. Visit coaching playgroups of young children are also a way for parents to learn from each other.
Above all, visit coaches learn to be comfortable in a supporting role, guiding parents to recognize and fill the needs of their children during and after their time in foster care.
In its application, visit coaching resembles therapeutic visitation; "they're definitely very closely linked," says Marian Silverman, director of therapeutic visiting at the Albert Einstein College of Medicine in New York. She's worked with Beyer in the past, and currently works closely with the Administration for Children's Services and BridgeBuilders, a community organization. Like coaches, therapists are "part of a team with the parent," and they help keep the focus on the children's needs, but can also counsel parents when they want to talk about issues outside of visiting.
Therapists are also able to work with special populations of parents. "Therapeutic visitation can provide a service to families that are a little bit more difficult to work with, either because there's some sort of personality issue or mental health issue," Silverman says. It can also be a tailored approach for parents who may have two of three children back but need help to fully reunify their families.
Silverman emphasizes that therapy can come into play at any point in the process. "It doesn't always have to mean that the parents are so far off [from reunification] that we got them," she says. "Sometimes people definitely use us as a last resort…but that doesn't always work out anyway." She added that some judges require therapeutic visiting sessions as part of a visiting plan.
Nearly 10 years after finishing her master's degree, Heidi Brinig started working at the Providence Children's Museum--as an intern. "That was the way to get my foot in the door," she explains. She had been a children's outpatient therapist in foster care, and saw the museum as a great potential resource for a therapy program. But to design something she had to know how the museum worked, so the director and the board agreed to an internship that let her work in every department.
Brinig also consulted the Rhode Island Department of Children, Youth and Families (DCYF) to get a better grasp on the system. "I gained a thorough understanding of what was needed not only for the families, but also for the workers," she says. She came up with a program--a therapeutic visiting session for families to play and learn together at the Children's Museum during its regular hours--and piloted it in February 1992.
The families DCYF currently refers to the program are on the road to reunification; most have been in the system at least four months and have a permanency plan. But Brinig is making a push to offer Families Together sooner, to parents whose children were removed fewer than 60 days before. She feels an earlier start may help put families on the right track.
Several years ago the Families Together program added a component; in addition to the clinicians who work with the families at the museum, there are consultants who work with DCYF social workers to bolster their visit training. Consultants help social workers meet with families, develop a visit plan, and document visits. Brinig is happy to have discovered a way to aid social workers. "They have incredibly complicated and difficult jobs, and if we can support them and that improves their practice, I'm all for it," she says.
Brinig is not shy about sharing the lessons learned from the program. "We have certainly contributed to change how visitation is viewed," she says. Families Together staff has worked with DCYF to design a visiting room in Federal Hill House, a Providence community center. They also collaborate with the Rhode Island College of Social Work on training for new social workers.
After receiving national attention and awards, Families Together wants to spread the program. "We developed a toolkit for children's museums that may want to replicate Families Together," Brinig says. She mentioned a handful of children's museums in New England that are working to partner with their social services systems on similar programs: The Long Island Children's Museum, the Children's Museum of the Arts in New York City, The Children's Museum of Southeastern Connecticut in Niantic, and the Please Touch Museum in Philadelphia.
After starting as a one-woman operation, Families Together has expanded to include five full-time staff, three part-time staff, and three interns. Over almost 17 years, about 1,300 families have gone through the program. "I've learned something from every family that's come through this door," Brinig says. "We try to bring out the best in every one of them, and hopefully we succeed."
She specifically recalled a father and young son meeting in the museum after years of very scarce contact. The little boy had been removed from his mother's care, and she was unable to meet the goals of her case plan. The father, who had not been involved in the process before, arrived at the museum early so staff could explain what was expected during the visit. When the boy came in, Brinig took his hand and walked him to see his father. "The little boy looked at me and said, 'Is this my dad?' The dad started to cry, and the child started to cry," she says. "This child and father embraced in a way--it was one of the most touching moments I have ever experienced… It gave me such an affirmation of what we were there to do."
In April 2002, New Jersey's Family Connections opened the doors to Reunity House in South Orange. Director Jennifer Kerr explains that the agency worked with participants in a parenting skills group to identify three of the biggest problems with visits: "Visits were happening in a very sterile environment. They were happening too infrequently and they were being cancelled, and the people assisting weren't very helpful."
The setup of Reunity House aims to overcome all three issues. Inside the house are four spaces for visiting: two living rooms, and upstairs two functioning apartments, complete with kitchens and bedrooms. The staff provides transportation to visits and is quick to reschedule if inclement weather or a holiday interrupts the schedule. "To promote reunification you need to promote a positive bond between children and their families; to do that you have to visit frequently," Kerr says. "Our goal is to provide visits at all costs." The Reunity House staff includes six: Kerr, two other master's-level clinicians, and three counselors. They provide a therapeutic, supervised program within a plan developed with the families.
"We really want to address the underlying issues that led to the removals in these families," Kerr says. To that end, Reunity House hosts parenting classes, and has an in-house intensive outpatient program to treat drug addiction; it's part of an effort to have as many services as possible at one site, Kerr explained, making it easier for parents.
Ideally, Kerr would like to see families immediately after they become involved with the Division of Youth and Family Services (DYFS); "the sooner the better," she asserts. Commonly, families have already been in foster care four to six months before they are referred to the Reunity House program.
Kerr explains that the therapist's role changes as each case progresses. "The therapist is in the room [at Reunity House] with the family when they start," she says, explaining that therapists actively model positive behavior and intervene if necessary. Parents meet with the therapist after a visit to discuss what happened and to set goals for the next week. Kerr said it is imperative that parents help plan visits so they are better prepared to plan life after reunification. She said New Jersey policy was recently revised to include more family involvement in the process.
A second phase of visiting includes longer visits out in the community. "The parents then start practicing," Kerr says; they may experience the child misbehaving at a restaurant or having a tantrum when it is time to leave a park. Overnight visits at Reunity House come later: "The family is getting ready for reunification, it's going to happen in the next month or two months," Kerr explains. She believes overnight visits--something of a litmus test for reunification readiness--are too often overlooked, and without them, parents can be overwhelmed when their children come home.
Parents are responsible for planning everything that happens from Friday evening to Saturday afternoon--making mealtime, bathtime, and bedtime go smoothly. "[It's] a snapshot of what it's going to be like when their children come home," Kerr says. Each family in the program gets one over-night visit to Reunity House, but often judges will ask for an additional one or two.
Reunity House videotapes the overnight visits and usually one of the earlier daytime visits, so the therapist and parents can review the tape and identify problem areas. "It's pretty powerful," Kerr says, recalling one mother who was surprised to see how harsh she seemed. "She actually was shocked: 'Is that what I sound like?'" Therapists hope to see parents applying the skills they have learned throughout the program and responding to their child's needs. But the overnight visit is not a final exam. "There's still time to work on things," Kerr says. "They're still having their weekly supervised visits."
After families are back together, Reunity House's work still is not done--and that's why more than 90% of families who go through the program remain stable, according to Kerr. She calls it the after-care phase, when staff members make in-home visits in the few months after reunification, "the most fragile time for the families." Parents get help with concrete issues, like arranging for daycare, and more intangible things, like helping children transition back into their birth families while they still have an emotional attachment to their foster families. Staff also provide referrals to community services the family may need.
Last year, two more Reunity Houses opened, in East Orange and Patterson, New Jersey. The South Orange program serves about 70 families a year, East Orange serves 80, and Patterson serves 35. "We've always believed in the program and wanted to expand it," Kerr says.
Meghan Williams is a contributing editor for Children's Voice.
Marty Beyer is a child welfare and juvenile justice consultant with a PhD in clinical/community psychology from Yale University. Her child welfare publications include Visitation as a Powerful Child Welfare Service and Visit Coaching: Building on Family Strengths to Meet Children's Needs. She invented visit coaching, and was invited by the New York City child welfare agency to train their staff and private foster care agencies in the practice. She can be reached at email@example.com.
To comment on this story, e-mail firstname.lastname@example.org.
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