MICHIGAN DEPARTMENT OF HUMAN SERVICES
AND
MICHIGAN ASSOCIATION FOR INFANT MENTAL HEALTH
JOINT POLICY STATEMENT ON ATTACHMENT IN INFANCY
AND BEST PRACTICE RECOMMENDATIONS FOR DECISIONMAKING FOR INFANTS/TODDLERS IN FOSTER CARE
INTRODUCTION
This policy statement is jointly developed by administrators of the Michigan Department of Human
Services responsible for the Michigan foster care system and representatives of the Michigan
Association for Infant Mental Health, an organization that promotes and supports nurturing
relationships for all infants/toddlers (0-47 months). Because the quality of attachment in caregiving is
so central to infant development, DHS and MI-AIMH agree that foster care and permanency
arrangements for infants/toddlers must be considered with great care. This joint policy statement and
recommendations support best practice and serve to promote, protect and support the attachments of
infants/toddlers who come to the attention of the child welfare system.
BACKGROUND
As an organization concerned with the social-emotional development of very young children, the
Michigan Association for Infant Mental Health has long had an interest in the child welfare system as it
impacts infants/toddlers. DHS workers are often required to make very difficult decisions in the
interest of child protection and securing an appropriate and safe permanent placement for
infants/toddlers. Policies and best practices that mitigate the effects of separation are necessary to
enhance the safety, well-being and permanency of infants/toddlers in child welfare.
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DEFINITION OF ATTACHMENT
Attachment is a relationship between a parent/caregiver and infant/toddler that promotes the
infant/toddler’s sense of security and impacts development. In the fields of social and emotional
development, attachment theory is the most visible and empirically grounded conceptual framework1.
Research indicates that securely attached children are more flexible, curious, socially competent and
self-reliant in preschool as well as more sympathetic to their peers and more assertive in their needs.
Children with insecure attachments in infancy are more likely to have lower reading and math scores,
poor peer relationships, behavioral problems in childhood, and high-risk behaviors in adolescence.2
Attachments are formed with specific people. They can be transferred to new caregivers, but the loss of
a familiar caregiver will be stressful even for very young infants. Loss affects infants most profoundly
after 6-9 months, when the infant’s attachment to caregiver—whether parent or foster parent—has been
consolidated. To facilitate the development of healthy attachments for infants/toddlers in child welfare,
we must view infants/toddlers through a developmental lens, recognizing the special vulnerability of
these infants/toddlers to developmental harm, and intervene early to prevent or minimize negative
effects. (Addendum 2 elaborates these concepts.)
DISCUSSION
Strengthening Families
Negative foster care experiences may extend and compound developmental impairments3 that, research
indicates, can affect each domain of developmental functioning.4Separation from parents, sometimes
sudden and usually traumatic, coupled with the difficult experiences that may have precipitated out-ofhome placement, can leave infants/toddlers dramatically impaired in their emotional, social, physical,
and cognitive development.5A range of family support services intended to keep infants/toddlers safe
with their families is the priority.
Infants/toddlers and their parents may be referred to an infant mental health specialist at community
mental health home-based services. Infant mental health specialists within the community mental
health system provide services to young children 0-47 months and their caregivers. Infant mental health
specialists may also be asked by the court or the county office to do an assessment of the infant/toddler
and parent(s). To assist in these endeavors, MI-AIMH has published a series of guides.
Infants/Toddlers Placed in Foster Care
When removal from a parent’s home is being considered for an infant/toddler, decisions must be made
to ensure developmentally appropriate parent-child contact, family continuity, stability in placement
and timely permanency. Family Team Meetings (FTM) should be utilized to gather information and
1
J. Cassidy & P. Shaver, (2008) Preface in Handbook of attachment: Theory, research and clinical applications, 2nd edition
(pp. xi-xvi), New York: Guilford Press.
2
L. A. Sroufe, et al., (2005), The development of the person, New York: Guilford Press; R. A Thompson, (2008)
Early attachment and later development: Old questions, new answers; K.A. Kerns (2008), Attachment in middle
childhood, In Cassidy & Shaver, op.cit.
3
Douglas Goldsmith, David Oppenheim, & Janine Wanlass, “Separation and reunification: Using attachment
theory and research to inform decisions affecting the placement of children in foster care. Juvenile and Family Court
Journal 55, no.2 (2004): 1-13.
4
B. J. Harden, (2007),Infants in the child welfare system: A developmental framework for policy and practice. Washington
DC: Zero to Three.
5
A. Lieberman & P. Van Horn, (2007), Assessment and treatment of young children exposed to traumatic events”
In J. Osofsky, ed., Young Children and Trauma: Intervention and Treatment, New York: Guilford Press, 2007, 118-138.
2
discuss an infant/toddler’s development, family connections and transition planning. At the time of the
FTM, all placement options should be discussed. A thorough exploration of available relatives for
placement and support must be made. When placement is necessary, an infant/toddler’s distress will be
lessened if the new environment can be made very consistent with the old one, and if the biological
parent(s) can visit regularly, ideally daily, and provide direct care to the infant in the placement
setting.6It is important to recruit and retain foster parents as mentors for birth families and encourage
foster parents to continue as resources to birth families or guardians or adoptive families once
permanency is achieved.7Infant mental health specialists should also work with foster parents and
relatives when a child enters foster care.
Relatives can be a great source of comfort for infants/toddlers placed in foster care, even if they are
unable to provide a placement. Workers must encourage relatives to stay involved during an
infant/toddler’s placement in foster care by visiting on a regular basis. The continuation of a
relationship with a suitable relative will permit possible consideration of placement within an
infant/toddler’s family network should a child become available for adoption. Sibling relationships
must also be considered when placing infants/toddlers in foster care. These relationships are
emotionally powerful and critically important not only in childhood but over the course of a lifetime.
As children, siblings form a child’s first peer group, and they typically spend more time with each other
than with anyone else. Sibling relationships can provide a significant source of continuity throughout a
child’s lifetime and are likely to be the longest relationships that most people experience.8
BEST PRACTICE RECOMMENDATIONS
1. Whenever possible, when reunification is not anticipated, infants/toddlers should be
placed in foster homes that are interested in adoption.
DHS policy and case practice require that case managers develop a concurrent
permanency plan for a child as early as possible. This process of concurrent
permanency planning requires foster care workers to provide reasonable efforts for
reunification while at the same time developing an alternate permanency plan for the
child if reunification cannot occur. With the philosophy of “first placement is the last
placement”, the need to reach out to and involve relatives early is urgent. The BCAL3130, Initial Foster Home/Adoption Evaluation, is used to license foster homes and
provide preliminary approval of foster and recruited parents for adoption. If a
prospective adoptive parent is licensed for foster care and approved for adoption on the
BCAL-3130, this documentation would meet the requirement for a dual assessment for
preliminary approval of the applicant to adopt.
2. Because the break from familiar caregivers will in most instances be traumatic, the
transition to a foster home should be facilitated by providing a child with familiar
objects from the biological home such as a blanket, sheets and teddy bear. These
objects will provide a young child with a sense of continuity that will increase the
sense of security in the midst of this difficult transition.
6
J. Caye, (1993), Capturing best practice in foster care and adoption for North Carolina: Trainer’s notes, Chapel Hill, NC:
UNC School of Social Work.
7
American Humane Association, Center for the Study of Social Policy, Child Welfare League of America,
Children’s Defense Fund and ZERO TO THREE, (2001), A Call to Action on Behalf of Maltreated Infants and
Toddlers.
8
Child Information Gateway, (2013), Sibling issues in foster care and adoption, Washington, DC: U.S. Department of
Health and Human Services, Children’s Bureau.
3
DHS foster care policy has been amended to include a section on the placement and
replacement of infants/toddlers. The policy will incorporate this recommendation.
The Family Team Meeting (FTM)-CPS Court Intervention protocol addresses the need
to prepare the infant/toddler for the transition from home to foster care. This is
discussed with the family at the FTM. The protocol will be updated to include best
practices when transitioning infants/toddlers. Addendum 1 is a guide that can be used
by workers when moving infants/toddlers.
3. Stability in foster home placement is a primary objective. When disruption of a foster
care placement is threatened because of an infant/toddler’s behavior, an infant mental
health specialist should be requested to assist the foster parent.
DHS will amend policy by September 2014 in the Health Services section of the Foster
Care Manual to describe infant mental health specialist services and provide guidance
to workers on the access and use of these services.
4. When an infant/toddler who has developed an attachment to foster parents is moved to
an adoptive home, arrangements should be made whenever possible for preplacement
visitation and continuing contact between foster parents, adoptive parents and the
infant/toddler.
DHS will include this recommendation when updating policy that addresses placement
and replacement of infants/toddlers.
5. Infant mental health specialists can be used to provide a therapeutic intervention
designed to remediate and strengthen the attachment relationship between parent (or
consistent caregiver) and the infant/toddler.
The intervention provided includes developmental guidance, emotional support,
support in developing life coping skills and parent/infant/toddler psychotherapy. The
infant mental health specialist works directly with the parent, and with the parent and
infant/toddler together. She also uses her knowledge and insight to enable the foster
parent, relative or adoptive parent to cope with challenging behaviors. The infant
mental health specialist may provide information to DHS and the court regarding
assessment, treatment and treatment progress with the written consent of the infant’s
parent(s), recognizing that the primary relationship of the infant mental health
specialist and the infant and family is a treatment (not forensic) relationship.
If an infant mental health specialist was working with the family prior to the placement
of the infant/toddler in foster care, services continue to be provided after placement. In
three counties in Michigan9, a specialty court involves infant mental health service and
a designated DHS worker as well as more frequent appearances before the judge.10
Visits with biological parents for infants/toddlers in foster care should occur at a minimum
frequency of 3 times per week. Parenting time provides an opportunity to support and help
parents to address issues that impede their ability to be consistent and nurturing. DHS has
9
Wayne County, Genesee and Midland. These programs were initiated by Director Corrigan when she was Chief
Justice.
10
MDCH has developed a listing of Common Elements for these specialty courts.
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supportive visitation services available in 45 counties. A visitation coach uses the Bavolek
nurturing parent education model to individualize intervention for each child and family.
In the most difficult situations, referral to an infant mental health specialist for a therapeutic
intervention should be considered.
In areas without supportive visitation services, the appropriateness for referring the parent
and infant/toddler to Community Mental Health for infant mental health therapeutic services
should be explored. Please note: IMH services cannot be used to support parents during
parenting time. The use of supportive visitation and/or an infant mental health specialist will
be addressed in the Health Services section of the Foster Care manual.
6. When removal or placement decisions are being made for an infant/toddler, DHS
workers are advised to invite involved professionals to Family Team Meetings. A
Family Team Meeting is held before placement and at every replacement. Involved
professionals should include the infant mental health specialist if one is working with
the family.
Current policy requires the inclusion of community based service providers at Family
Team Meetings.
CONCLUSION
In developing this joint policy statement, the Michigan Association for Infant Mental
Health and the Michigan Department of Human Services remain committed to serving the
needs of the vulnerable infants/toddlers involved in the child welfare system. We will
continue to work together to promote practices that protect the development of
infants/toddlers as well as their safety.
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Addendum 1
Infants and Toddlers Need a Hand When They Move A. Transportation for Supervised Visitation or Move from One
Home to Another
Suggested Items to Have in the Car •
•
Soothing music, blankets, infant wipes, finger foods
Familiar toys/books
B. Move from One Home to Another
These guidelines are relevant for the following situations:
• When the infant or toddler transfers from
o Biological home to foster home
o Foster home to foster home
o Foster home to parent’s home
o Foster home to adoptive home
• When the infant or toddler goes on a daylong or overnight
visit with the biological parent or prospective adoptive parent.
(1) Infants
• Health
•
Is the infant on any medications or special formulas? If so, have
caregiver provide remaining supplies to worker.
• Feeding
•
What does the infant drink? Infant should be fed whatever he has been
getting.
• Identify any food or formula allergies or insensitivities. What type
and brand of formula is used?
• Is the mother breastfeeding the infant? Is there a way for her to
continue breastfeeding by expressing milk and visiting often? If
not, how will the transition be made to formula?
•
What is a typical feeding schedule?
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•
•
•
When was the infant last fed?
How does the infant cue when she is hungry?
o e.g, cry, root, fidget.
How does the infant like to be held when being fed?
•
What type of bottle/nipple does the infant use/prefer?
• Infant should have same bottle/nipple for feeding at new home.
•
If the infant is eating solid food – what is the solid food eating schedule?
• What are the infant’s favorite foods?
• Are there allergies/sensitivities to solid food?
• Sleep
•
•
•
•
What is the infant’s typical sleep schedule?
• Describe the length, frequency, and time of naps taken during
the day.
• Describe nighttime sleep patterns.
• When did the infant last nap?
How does the infant usually get to sleep?
• Does the caregiver assist the infant to sleep or is the infant left
alone? How long does he sleep at night before needing to be
fed?
• Describe the routine used, does it include: pacifier, music, bottle,
rocking, swaying, swing, other?
Where does the infant usually sleep?
Crib, bassinet, Pak-n-Play, with caregiver (educate new caregiver about
Safe Sleep). If infant has slept with caregiver, consider that she/he may
have difficulty adjusting to sleeping alone and will need extra soothing.
• Eliminating
•
Ask about typical voiding patterns for the infant to determine if any
changes occur after shift in domicile.
• Calming Needs
•
•
•
•
What are the infant’s nicknames?
When and why does the infant usually cry?
Does the infant have any specific fears?
Identify specific soothing techniques.
• Rocking, swaddling, pacifier, swinging, music
o Some infants are adverse to certain types of stimuli like
swinging, music, lights, etc. so be sure to identify the
infant’s likes/dislikes.
• Ensure that the favorite pacifier, toy, stuffed animal, blanket or
rattle goes with the infant to the new home.
• Ask the caregiver to lend a shirt or pillow case to accompany the
infant, so that the caregiver’s smell is present for infant in the
new home.
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•
Ask about detergents and soaps used in order to try to keep
some familiar smells, if possible.
(2) Toddlers
• Health
•
•
Is the toddler on any medications? If so, ensure that the medication is
taken to the new setting and follow up with the physician.
Ask if the toddler is on any special formula or medications related to
food intake.
• Acid reflux medication
• Prescription formula for failure to thrive toddlers
• Lactose free milk
• Feeding/Eating
•
•
•
•
•
What does the toddler drink?
• Ask if the toddler is on high-calorie formula to help with weight
gain. Whole milk – any lactose intolerance or milk allergy?
• Whenever possible, resist switching the type of milk the toddler
was drinking (i.e., breast milk, formula, vitamin D milk) to reduce
stomach upset.
Describe the feeding schedule for the toddler.
• When and what did the toddler last eat?
• How does the toddler cue when she is hungry? Can she tell
you?
What type of cup does the toddler use/prefer?
Some toddlers still drink from bottle; continue this until attachment with
new caregiver is established.
Solid food
• Identify the toddler’s favorite foods.
• Ask about allergies/sensitivities to solid food.
• Sleep
•
•
•
What is the toddler’s sleep schedule?
• Does the toddler take naps and if so for how long?
• When did the toddler last sleep?
Where does the toddler sleep?
• Crib, toddler bed, with caregiver?
How does the toddler usually get to sleep for nap and at night?
• Music, bottle, rocking, swaying, pacifier?
• Door open/closed, night light, no light?
• Eliminating
•
Ask about the toddler’s typical bowel patterns so that any changes in
typical patterns in the new placement can be identified.
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•
Is the toddler toilet trained and if so, how is he usually helped to use the
toilet? (i.e., fully self-sufficient, needs help with clothes, uses a portable
potty, afraid of toilets?)
• Calming Needs
•
•
•
•
What nicknames is the toddler called?
When does the toddler typically cry and for what reasons?
Does the toddler have any specific fears?
Identify specific techniques used to soothe the toddler.
• Rocking, swinging, music?
• Some toddlers may still use pacifier –continue pacifier use until
placement is well established, to help with self-regulation and
comfort needs.
• What words does the toddler use for hunger, mommy/daddy,
hurt, tired, etc. and how are they pronounced?
• Ensure that a favorite pacifier/ toy/stuffed animal/ blanket comes
to the new home.
• Whenever possible, try to have a picture of the caregiver for the
toddler to bring to the new home.
Developed by B. Davidson and J. Ribaudo, 2008
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Addendum 2
Relevant PublicationsMichigan Association for Infant Mental Health
.
Michigan Association for Infant Mental Health (2006). Guidelines for comprehensive
assessment of infants and their parents in the child welfare system. Southgate, MI: Author.
Michigan Association for Infant Mental Health (2000/2007).Guidelines for infant mental health
programs (Revised).Southgate, MI: Author.
Michigan Association for Infant Mental Health (2002/2011).MI-AIMH endorsement
competencies.(Revised). Southgate, MI: Author.
Rains, M. & Tableman, B. (2010). Supporting relationships for infants and toddlers with two
homes. Southgate, MI: Michigan Association for Infant Mental Health.
Weatherston, D. and Tableman, B. (2002). Infant mental health services: Supporting
competencies/Reducing risks. Southgate, MI: Michigan Association for Infant Mental Health.
Tableman, B. & Paradis, N. (2008). Courts, child welfare and infant mental health: Improving
outcomes for abused/neglected infants and toddlers. Southgate, MI: Michigan Association for
Infant Mental Health.
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