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The Warmest Handoff: Using Child–Parent Psychotherapy to Ease Placement Transitions

Barbara Jessing, Fontenelle House, Omaha, Nebraska; and Jennie Cole-Mossman, JBS International Consulting, North Bethesda, Maryland

Abstract Young children in the child welfare system are inherently vulnerable to disruptions in early attachment, and abrupt changes of placement can function as trauma triggers. In this article, the authors present a case from a Child–Parent Psychotherapy (CPP) Learning Collaborative which exemplifies the potential trauma of placement changes, and how CPP is uniquely suited to support children and caregivers before, during, and after a placement change. They examine the elements needed at each stage of CPP—foundation, core intervention, and termination—to promote a healthy transition. Concurrent attention to the facilitating attuned interaction (FAN) model of reflective practice is a tool to help CPP practitioners navigate the difficult emotional experiences involved in these transitions.

In the pressured environment of child welfare, it is too common for the adults involved to dismiss the emotional experience of a young child. A judge orders a change in foster placement, which the child’s therapist and other team members learn about after the fact. A child goes home after 18 months with a foster family to a parent he has visited on only a few occasions, with no opportunity to prepare for this change with the help of his therapist. A caseworker decides not to refer a child for therapy when he or she enters foster care. In the aftermath of such actions, it is often unclear whether therapy will continue, with whom, and why. Therapists can experience secondary trauma when these abrupt changes occur. These are moments of emotional challenge as they see their small clients in distress.

The science of early adversity shows that dependable, supportive caregivers are the most important buffer of a young child’s stress, with the capability to transform toxic into tolerable stress (Harvard Center on the Developing Child, n.d.). Child–parent psychotherapy (CPP), an evidence-based practice for children birth to 5 years old, offers a flexible therapeutic framework to support caregivers and young children before, during, and after transitions in placement. The therapist can bring the unique lens of CPP to focus on case planning and decision making, with the goal of a healthy and supported transition (California Evidence Based Clearinghouse for Child Welfare, n.d.). Essential to the fidelity of CPP is reflective practice. The FAN (facilitating attuned interaction; Gilkerson & Imberger, 2016) model is both a conceptual tool and a set of skills that assist with reflective consultation. Its roots in early childhood mental health make it uniquely suited to CPP practice.

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