As The Fostering Network in Scotland launch Health Matters, a new programme exploring health issues affecting foster carers, their families and the children they care for, Sara Lurie, director of The Fostering Network in Scotland writes:
Two years ago, I was invited to present at a conference on the subject of medical issues affecting foster carers, and in preparation for doing so contacted foster carers across Scotland to ascertain any health issues they may have. The feedback was both overwhelming and alarming. Through this simple exercise, we realised that we had uncovered a major problem affecting foster carers in Scotland , one that was previously unknown and yet is in urgent need of being addressed.
Our Reach Out project, which addressed issues relating to fostering a disabled child further emphasised the need for some work to be done looking at medical and health issues affecting fostering families. During our Reach Out focus groups, many foster carers confided in us their own health concerns and the effect this has on their role. During Reach Out we heard numerous stories of how health issues were impacting on foster families: a foster carer explained that she has twice delayed her own surgery because she was told the sibling group in her care would be separated while she was in hospital, and we have heard alarming stories from foster carers concerning confidentiality in relation to the storage of their medical files and reports.
One of the issues of most concern is that many foster carers have told us they are reluctant to approach their GP to discuss health issues, even physical symptoms, due to the fear their issues may be misconstrued as being stress-related and their medical records could subsequently be misinterpreted, leading to deregistration. Sadly, this is a very real fear, and many foster carers will ignore symptoms of stress for the same reason. Often such problems relate to isolated incidences linked to the traumatised children in their care and are short-lived, but during that time the foster carer is in urgent need of medical support which they ignore. Secondary traumatic stress is a condition which can result from hearing about the first-hand trauma experienced by another, and is frequently experienced by foster carers who offer care, love and support to some of our most traumatised children. The symptoms resemble those of post-traumatic stress. Yet it is also rarely addressed. We even uncovered incidences of foster carers self-medicating to avoid approaching their GP.
Feelings of grief and loss
Research shows that foster carers often harbour the same level of care, concern and hopes for the children in their care as for their own children, and as such the loss feelings experienced when a child leaves their home can be overwhelming. They not only have to deal with their own grief, but the grief and loss experienced by their own children as well. A 2013 literature review entitled ‘The Impact of Fostering on Foster Carers’ Children’ emphasised the emotional trauma which can be felt. One daughter of foster carers expressed feeling guilty when a placement ended, thinking it was her fault. She adopted a strategy of not getting too close to foster children: “you have to try not to get too close to them because then it’s harder when they go.” Buehler, Cox and Cuddeback (2003) identified a child's departing, and even fear of this happening, as a key factor affecting placement success. It can be difficult for a foster family to ‘bounce back’ following that loss, delaying future placements. The recruitment and retention of foster carers is a continuous challenge for fostering agencies, with many prospective carers being put off by the emotional risks of the role. When grief is unresolved, it can compromise the competence of the care being provided to the traumatised child, or even result in the foster carer ceasing to provide care. According to Hebert et al.'s 2013 report, and backed by our own experience and research, 'the support of a fellow foster parent, who understands the special grief a foster parent experiences, is also often immeasurable.'
In addition to the secondary trauma, loss and grief often experienced by foster carers, we have also uncovered major concerns from foster carers concerning confidentiality in relation to the storage of their medical files and reports. Social workers should only have access to recommendations from medical reports, yet we have discovered numerous incidences where they have access to full medical reports, which is likely to include information they are not in a position to fully understand and which can easily be misinterpreted. Foster carers are reviewed on an annual basis, and medical updates are passed to social work departments as a part of this. Some agencies are unsure of the regulations they should be following in relation to the storage of medical reports, and some GPs lack a basic understanding of fostering and are in need of training. There is an urgent need for clear guidelines to be put in place.
Health Matters will allow us to carry out a comprehensive consultation exercise regarding medical and health issues affecting fostering families, following which we will produce guidance both for foster carers and fostering services. The consultation will involve hosting a series of focus groups, bringing together foster carers from across Scotland and providing the opportunity for them to raise medical issues and concerns in an environment where they feel comfortable doing so.
The second stage will be to consult with social workers and fostering agencies to establish the procedures they have in place for storing medical files and information on foster carers. Where appropriate, we will additionally consult directly with medical practitioners to ensure we have considered their perspective and to establish any support, training or guidance which may be beneficial in the longer term.
Finally, we will gather together the results of our consultation in order to produce guidance both for fostering services and for foster carers.