Attachment experiences of grandparent kinship caregivers and nonkinship foster parents with preschool-aged children in their care

This study explored the attachment relationships of grandparent kinship caregivers and nonkinship foster parents with preschool-aged children in their care. Research suggests that attachment is crucial in early childhood relationships and can impact relationships throughout the lifespan. Children in kinship care or nonkinship foster care are removed for abuse, neglect, dependency, and other traumatic life experiences, which can affect their ability to form positive attachment relationships. The goal was to understand attachment relationships in the grandparent kinship caregiver and nonkinship foster care milieu. Qualitative research methods were utilized. There were 8 grandparent kinship caregiver participants and 8 nonkinship foster parent participants. The themes that emerged were: 1) importance of family; 2) attachment, trauma, and traumatic grief and loss; 3) challenges; 4) roles; and 5) family relationship styles. Each theme contained subthemes. All participants reported challenges and the majority reported positive attachment relationships. This was the first qualitative study to explore attachment experiences of grandparent kinship caregivers and nonkinship foster parents with preschool-aged children in their care. The findings from this study can be used to inform mental health professionals, the child welfare system, grandparent kinship caregivers, nonkinship foster families, and serve as a guide to future research.

ATTACHMENT EXPERIENCES OF GRANDPARENT KINSHIP CAREGIVERS AND NONKINSHIP FOSTER PARENTS WITH PRESCHOOL-AGED CHILDREN IN THEIR CARE by Nancy Coyne Baird A dissertation submitted to the faculty of The University of Utah in partial fulfillment of the requirements for the degree of Doctor of Philosophy College of Social Work The University of Utah December 2013Copyright © Nancy Coyne Baird 2013 All Rights ReservedThe University of Utah Graduate School STATEMENT OF DISSERTATION APPROVAL The dissertation of Nancy Coyne Baird has been approved by the following supervisory committee members: Christina E. Gringeri , Chair 5/1/2013 Date Approved Joanna B. Schaefer , Member 5/1/2013 Date Approved Norma J. Harris , Member 5/1/2013 Date Approved Joanne Yaffe , Member 5/1/2013 Date Approved Susan L. Morrow , Member 5/1/2013 Date Approved and by Jannah Mather , Dean of the College of Social Work and by David B. Kieda, Dean of The Graduate School.ABSTRACT This study explored the attachment relationships of grandparent kinship caregivers and nonkinship foster parents with preschool-aged children in their care. Research suggests that attachment is crucial in early childhood relationships and can impact relationships throughout the lifespan. Children in kinship care or nonkinship foster care are removed for abuse, neglect, dependency, and other traumatic life experiences, which can affect their ability to form positive attachment relationships. The goal was to understand attachment relationships in the grandparent kinship caregiver and nonkinship foster care milieu. Qualitative research methods were utilized. There were 8 grandparent kinship caregiver participants and 8 nonkinship foster parent participants. The themes that emerged were: 1) importance of family; 2) attachment, trauma, and traumatic grief and loss; 3) challenges; 4) roles; and 5) family relationship styles. Each theme contained subthemes. All participants reported challenges and the majority reported positive attachment relationships. This was the first qualitative study to explore attachment experiences of grandparent kinship caregivers and nonkinship foster parents with preschool-aged children in their care. The findings from this study can be used to inform mental health professionals, the child welfare system, grandparent kinship caregivers, nonkinship foster families, and serve as a guide to future research.TABLE OF CONTENTS ABSTRACT .................................................................................................................... iii ACKNOWLEDGEMENTS............................................................................................. viii CHAPTER I INTRODUCTION ...................................................................................................1 Problem Statement ...................................................................................................5 Purpose of the Study and Research Question ..........................................................6 Research Approach ..................................................................................................7 Research Perspective ...............................................................................................8 Research Significance..............................................................................................9 Understand Attachment Relationships.......................................................10 Guide Mental Health Professionals ...........................................................10 Inform the Child Welfare System..............................................................11 Contribute to Literature Base.....................................................................11 Summary................................................................................................................11 Overview of the Chapters ......................................................................................12 II REVIEW OF THE LITERATURE .......................................................................14 Overview................................................................................................................14 Children in Foster Care..........................................................................................14 Kinship Caregivers and Nonkinship Foster Parents ..............................................19 Attachment Theory and Preschool-Aged Children................................................23 Internal Working Models.......................................................................................26 Attachment Reactions, Reactive Attachment Disorder, and Attachment Disorders......................................................................................28 Building Attachment Relationships with Children in Foster Care ........................31 Attachment Perceptions of the Caregivers.............................................................33 Summary of the Literature .....................................................................................34 III METHODOLOGY ................................................................................................36 Overview................................................................................................................36 Rationale for Qualitative Research ........................................................................36Paradigm ................................................................................................................37 Research Design.....................................................................................................38 Research Participants .............................................................................................39 Sampling Procedures .............................................................................................41 Inclusion Criteria ...................................................................................................41 Recruitment............................................................................................................42 Informed Consent...................................................................................................42 Data Collection ......................................................................................................43 Phase I: Individual Interviews ...................................................................43 Phase II: Transcription...............................................................................44 Phase III: Member Checking/Follow-Up Interviews.................................44 Phase IV: Focus Groups.............................................................................45 Field Notes .................................................................................................46 Data Analysis and Interpretation ...........................................................................47 Organization of the Data............................................................................47 Immersion ..................................................................................................47 Generating Categories, Themes, and Patterns ...........................................48 Coding the Data .........................................................................................49 Search for Disconfirming Evidence...........................................................49 Writing the Report .....................................................................................49 Researcher as Instrument .......................................................................................50 Pilot Study..............................................................................................................51 Trustworthiness......................................................................................................52 Study Limitations...................................................................................................54 Dissemination of Findings .....................................................................................54 Summary................................................................................................................55 IV FINDINGS.............................................................................................................56 Overview ...............................................................................................................56 Theme 1: Importance of Family ............................................................................57 Nonkinship Foster Parents .........................................................................57 Unable to have biological children ................................................58 Desire to increase family size ........................................................59 Altruism ........................................................................................60 Grandparent Kinship Caregivers................................................................61 DCFS involvement.........................................................................62 Stepped in before DCFS involvement ...........................................63 Grandchild already in our care.......................................................64 Summary of Theme 1.................................................................................66 Theme 2: Attachment, Trauma, and Traumatic Grief and Loss ............................67 Nonkinship Foster Parents .........................................................................67 Age.................................................................................................67 Temperament .................................................................................68 vAttachment, trauma, and traumatic grief and loss .........................69 Failed placements...........................................................................72 Coping strategies............................................................................74 Grandparent Kinship Caregivers................................................................74 Family ties......................................................................................75 Family history ................................................................................76 Attachment, trauma, and traumatic grief and loss .........................77 Coping strategies............................................................................79 Summary of Theme 2.................................................................................81 Theme 3: Challenges..............................................................................................82 Nonkinship Foster Parents .........................................................................82 Visitation........................................................................................82 Caseworkers...................................................................................84 Limited options ..............................................................................85 Grandparent Kinship Caregivers................................................................86 Diminished social networks...........................................................86 Health.............................................................................................88 Boundaries .....................................................................................89 Summary of Theme 3.................................................................................91 Theme 4: Roles ......................................................................................................92 Nonkinship Foster Parents .........................................................................92 Mom...............................................................................................92 Two moms and two dads ...............................................................93 Temporary mother role ..................................................................93 Nonmother role ..............................................................................94 Foster mother role ..........................................................................94 Grandparent Kinship Caregivers................................................................94 Grandparents identified as grandparents........................................95 Grandparents identified as parents.................................................96 Role conflict...................................................................................96 Summary of Theme 4.................................................................................98 Theme 5: Family Relationship Styles ....................................................................99 Nonkinship Foster Parents .......................................................................100 Healthy and strong family relationships ......................................100 Trauma history in family relationships ........................................102 Grandparent Kinship Caregivers..............................................................104 Healthy and strong family relationships ......................................104 Trauma history in family relationships ........................................106 Summary of Theme 5...............................................................................108 Findings of Focus Groups....................................................................................109 Nonkinship Foster Parents .......................................................................109 Grandparent Kinship Caregivers..............................................................111 Summary of the Five Major Themes ...................................................................112 viV DISCUSSION......................................................................................................115 Overview..............................................................................................................115 Theme 1: Importance of Family ..........................................................................117 Theme 2: Attachment, Trauma, and Traumatic Grief and Loss ..........................119 Theme 3: Challenges............................................................................................121 Theme 4: Roles ....................................................................................................122 Theme 5: Family Relationship Styles ..................................................................123 Theme Discussion................................................................................................125 Limitations of the Research .................................................................................127 Implications of the Study.....................................................................................128 Implications for Caregivers......................................................................128 Implications for Practice ..........................................................................128 Implications for Policy.............................................................................130 Implications for Research ........................................................................132 Conclusion ...........................................................................................................133 APPENDICES A. CONSENT DOCUMENT FOR HUMANITIES OR SOCIAL BEHAVIORAL SCIENCE RESEARCH.......................................135 B. INTERVIEW PROTOCOL AND INTRODUCTION ..................................137 C. PSEUDONYMS OF PARTICIPANTS AND CHILDREN IN THE STUDY.......................................................................138 REFERENCES ................................................................................................................139 viiACKNOWLEDGEMENTS I dedicate this dissertation to my parents, Esther Jane Coyne, née Koehler, and Douglas Mulnix Coyne, who taught me the meaning of a secure attachment. Their love, compassion, and support were immeasurable throughout my life. I am forever grateful for their kind, gentle understanding of who I am, what I wanted to achieve, and for their belief in me. I also dedicate this dissertation to my husband Bruce who made it possible for me to achieve this goal. His constant love, support, and wisdom as well as his patience inspired me throughout this process. I really could not have done it without him. Bruce, I love you for loving me through it all. And, special thanks to Collier and Brice who understood my many hours of writing and not cooking. My sincere thanks to my sister Barbara, my brother (-in-law) Rick, my niece Katie, and my nephew Matthew-they have cheered me on through every educational milestone. Thanks to my friends who supported me and understood that someday they would have their friend back. In closing, I would like to thank my professors and mentors throughout this process. Thanks to my committee members Christina Gringeri, Norma Harris, Sue Morrow, Joanna Bettmann Schaefer, Joanne Yaffe, and Douglas Goldsmith for their knowledge, advice, and patience.CHAPTER I INTRODUCTION The number of children entering foster care in the United States has dramatically increased over the past 10 years. The Adoption and Foster Care Analysis and Reporting System (AFCARS) reported approximately 289,415 children in the United States residing in foster care at the end of Fiscal Year (FY) 2003 (Children's Bureau, 2012a). By the end of the FY 2011, that number rose to 400,500 (Children's Bureau, 2012a). The number of children entering foster care is disturbing as it indicates an increase in the number of children being removed from their homes. There are various reasons child welfare workers remove children from their homes, including abuse, neglect, dependency, abandonment, and family problems such as parental incarceration, substance abuse, or death (American Academy of Child & Adolescent Psychiatry [AACAP], 2005; Division of Child and Family Services [DCFS], 2013. The Child Maltreatment Report 2011, based on data from the National Child Abuse and Neglect Data System (NCANDS) reports that 3.4 million referrals were made to Child Protective Services (CPS) for alleged child maltreatment for approximately 6.2 million children (1.82 children per referral), and 681,000 of these referrals were substantiated for child maltreatment (Children's Bureau, 2012b). Children entering foster care are maltreated, vulnerable, and at risk and deserve to have their needs addressed by mental health professionals, the child welfare system, and researchers.2 Over the last decade, Utah has seen an increase in children entering the foster care system. At the end of FY 2003, there were 1,928 children in foster care as compared to 2,701 at the end of FY 2012 (Children's Bureau, 2012a). This increase is attributed to the number of children who are identified as abused, neglected, or dependent (J. Armstrong & B. Madsen, personal communication, January 8, 2013). Trainers Armstrong and Madsen from the DCFS Salt Lake Valley Region report that in 2010, CPS received 13,372 hotline calls for suspected child abuse of which 8,502 became opened cases and resulted in 3,241 abuse cases being verified (personal communication, January 8, 2013). In some cases, these children can remain in their homes and in other cases children need to be removed for their protection. DCFS seeks kinship placements or nonkinship foster care placements to provide temporary or permanent homes for children who are removed. With the growing numbers of children being removed, the foster care system is challenged with finding foster families. The Utah Foster Care Foundation (UFCF, 2012) states there are upwards of 2,600 children in foster care at any given time and fewer than 1,400 licensed foster/adoption families. Approximately half of the foster care cases in Utah have substance abuse as a contributing factor (UFCF, 2012). Due to abuse and/or neglect, children in foster care are not only vulnerable, but often have special needs because of their adverse life events (UFCF, 2012). There is an urgent need for out-of-home placements to serve these displaced children. Policy guidelines have changed over the past 30 years to address the needs of children in foster care. The federal foster care policy was created by virtue of The Adoption Assistance and Child Welfare Act of 1980 (AACWA). According to Geen 3 (2004), the child welfare system primarily utilized nonkinship placements over formal kinship placements to fulfill the permanency goal. The Adoption and Safe Families Act of 1997 (ASFA) reversed AACWA policy and endorsed that kinship placements should be considered before nonkinship placements (Christenson & McMurtry, 2007). The most recent policy known as the Foster Connection to Success and Increasing Adoptions Act of 2008 is considered to be "the most significant reform for the foster care system in over a decade" (Pew Commission on Children in Foster Care, 2008, p. 1). The act increased the child welfare system's accountability and mandated that relatives be notified within 30 days of a child's removal and amended part B and E of Title IV of the Social Security Act, making foster care and adoption accessible for relative caregivers and tribal nations. While any relative may be considered for a kinship placement, the most common placement is with grandparents. The most notable increase over the past decade is the number of children living in grandparent-headed households (Goyer, 2010). The most frequent kinship placements are women, with 30% of these placements with aunts and more than 50% being with grandmothers (Scannapieco, 1999). The American Association for Retired Persons (AARP) reports that the number of children under the age of 18 living in grandparent-headed households in the United States 10 years ago was 4.5 million; in 2010, that number rose to 4.9 million children (Goyer, 2010). According to the Census Bureau, 42% of these children are between the ages of 12 and 17, 34% are between the ages of 6 to 11, and 24% are under the age of 6 (as cited in Generations United, 2009). Many of these grandparents face financial, health, housing, and work challenges that indicate a need for support, resources, and services (Goyer, 2010).4 Consistent with national statistics, Utah has experienced an increase in relative placements for children in need. According to the 2010 Census, there were 70,520 children under the age of 18 living in grandparent or other relative-headed households in comparison to 42,000 in 2000 (as cited in GrandFacts Utah, 2011). Jacci Graham, Director of the Grandfamilies Program of The Children's Society in Utah, reports that in one county alone, there are 7,800 children living with grandparents or in other relative placements (Bennion, 2013). According to Graham, the most common out-of-home placement for children in Utah is with grandparents (personal communication, October 18, 2010). The Grandfamilies Program addresses the needs of grandparents who are raising their grandchildren in informal or formal placements. Informal implies that the arrangement has occurred without the involvement of a child welfare agency while formal indicates that the kin acted as state-approved foster parents for children in the state's custody (Geen, 2004). When responsibility for grandchildren is assumed, a grandparent may choose to become a guardian, foster parent, or adoptive parent. As outlined by the Convention on the Rights of the Child in 1989, a child's basic rights include freedom from abuse, neglect, and violence (United Nations Human Rights, 1990). The mission of DCFS is to "protect children at risk of abuse, neglect, or dependency," which is achieved by "working with families to provide safety, nurturing, and permanence" through a partnership with the community (J. Armstrong & B. Madsen, personal communication, January 8, 2013). This community partnership includes relationships with kinship caregivers and nonkinship foster care families as resources for safe homes. Pardeck (2006) defined foster care as "any living arrangement in which 5 children live with people who act as substitute parents" (p. 7). Whether these substitute parents are grandparent kinship caregivers or nonkinship foster parents, there is an enormous need to assist these families in their efforts as they raise our nation's children. Problem Statement The goal for children who have been removed from their homes is to achieve permanency through reunification with their biological parent(s) or with their substitute caregivers (Adoption Assistance and Child Welfare Act, 1980). Armstrong states, "permanency equals relationships," which may apply to a foster child's relationship with the biological parent(s) or an alternative caregiver (personal communication, January 8, 2013). Children exposed to maltreatment or inconsistent and inadequate parenting often struggle with forming relationships, which in turn can affect the stability of permanency of the placement (Jones Harden, 2004). However, we know very little about the relationships grandparent kinship caregivers and nonkinship foster parents have with preschool-aged children in their care. When considering relationships with young children and their caregivers, the work of John Bowlby is influential. Bowlby developed attachment theory and described attachment as an "affectional tie with some other differentiated individual who is perceived as stronger and wiser" (Bowlby, 1977, p. 201). He argued that developing an important relationship with a primary caregiver is a child's major drive (Bowlby, 1982). While attachment relationships begin to develop in the infancy stage, they are considered equally important as a life-span task (Cicchetti, Cummings, Greenberg, & Marvin, 1990). This study focuses on attachment relationships in the preschool-aged stage. 6 There is a paucity of research that explores attachment relationships of grandparent kinship caregivers and nonkinship foster parents with preschool-aged children in their care. This is an especially vulnerable population because children entering preschool face new stressors that provoke attachment behaviors in different ways (Cicchetti et al., 1990). Preschool-aged foster children not only face the challenge of entering a preschool setting, but they bring with them a history of disrupted attachments and traumatic life events. Maladaptive attachment patterns are the primary cause for emotional and behavioral problems in early childhood settings (Goldsmith, 2007). It is imperative that we increase our understanding of the attachment relationships of grandparent kinship caregivers and nonkinship foster parents with preschool-aged children in their care so that we may better serve this population. This study explores and compares the similarities and the differences of grandparent kinship caregivers and nonkinship foster parents who are raising preschool-aged children in their care. Purpose of the Study and Research Question The purpose of this study was to explore attachment experiences of grandparent kinship caregivers and nonkinship foster parents with preschool-aged children in their care. Qualitative research should describe, understand, and clarify the human experience (Polkinghorne, 2005). The research question was: What are the attachment experiences of grandparent kinship caregivers and nonkinship foster parents with preschool-aged children in their care?7 Research Approach I selected qualitative research methods, as they were best suited for my goal of developing a deeper understanding of attachment experiences in this population. The purpose of this study was not to quantify attachment behaviors, but to go beyond the measurable and mine for the essence of the relationship. Attachment is based on the quality of the relationship in terms of level of insight to a child's needs, the responsiveness to a child's cues, and the experiential reciprocity in the child/caregiver bond. I conducted 16 in-depth face-to-face interviews with 14 individuals and 2 couples; 14 face-to-face follow-up interviews with 12 individuals and 2 couples; and 2 focus groups with 5 individuals participating in one group and 2 individuals and 2 couples participating in another group. A couple was counted as 1 participant. The initial interviews and focus groups were audiotaped. The follow-up interviews were utilized as a member-checking strategy to increase validity of the findings and were not audiotaped. During the follow up interviews, I took handwritten notes to collaboratively correct the transcripts with the participants' direct input and process the content. I used interpretive, phenomenological methods to analyze the data. This research approach gave me the opportunity to conduct the first qualitative study that explored attachment experiences of grandparent kinship caregiver and nonkinship foster parents with preschool-aged children in their care. Qualitative methods allowed me to understand the complexities of attachment relationships and how they developed or failed to develop over time. I was able to analyze valuable information 8 regarding the similarities and differences within and between groups through a series of emerging themes and subthemes. Research Perspective The topic of this study evolved from my work at The Children's Center, a private nonprofit agency with two locations providing mental health services to young children and their families. The agency provides the only therapeutic preschool program in Utah and the largest of its kind in the United States. For over 50 years, The Children's Center has served families guided by their expertise in attachment theory and emphasis on relationships. Over the last 4 years, the agency has partnered with trauma experts and the National Childhood Traumatic Stress Network (NCTSN) to become a nationally recognized trauma-informed center. Over the years as a practicum student, clinician, clinical director, and director at one of the locations of The Children's Center, I had the opportunity to work with many preschool-aged children who were living with grandparent kinship caregivers and nonkinship foster families. I observed many common problems in children who have been removed from their families such as attachment difficulties, separation anxiety, traumatic symptoms, and traumatic grief and loss. While the caregivers cited behaviors as the reason for seeking treatment, most often the family needed support in building secure attachment relationships. During my internship at the center, there was an informal group for grandparents who were raising their preschool-aged grandchildren. Through this process, I learned more about grandparents and their challenges, hardships, and joys of raising their children's children. Three other interns from the University of Utah College of Social 9 Work and I proposed a grant to fund an 8-week psychoeducational group entitled "Here We Go Again." My interest grew as I thought about the relationships grandparent kinship caregivers and nonkinship foster parents have with their preschool-aged children and grandchildren. To fulfill a research assignment during my doctoral curriculum, I conducted a pilot study in 2006 with these families in mind. The study was called Two Hearts: A Qualitative Study of Kinship and Non-kinship Foster Care Parents. In this study, I posed a research question regarding the attachment experiences of grandparent kinship caregivers and nonkinship foster parents. Results of the pilot study are discussed in Chapter III Methodology. With the increasing number of children living in grandparent kinship and nonkinship foster families who were seeking treatment at the center, I realized there was an increasing need to study this population. For my dissertation research, I selected to study grandparent kinship caregivers and nonkinship foster parents who are raising preschool-aged children. I brought to this research my clinical expertise of attachment, trauma, and traumatic grief and loss, my experience of working with the child welfare and foster care systems, and my desire to help the young children who have been removed from their biological parents and the families who are raising them. Research Significance I hope that the findings will 1) provide increased understanding of attachment relationships in the grandparent kinship and nonkinship foster parent milieu; 2) guide mental health professionals in providing most appropriate services for children and their 10 families; 3) inform the child welfare system in decision making for placements, services, and support; and 4) contribute to the literature base and promote further research. Understand Attachment Relationships I believe the findings will increase our knowledge of attachment relationships of both grandparent kinship caregivers and nonkinship foster parents who have preschool-aged children in their care and facilitate better understanding of the nuances of their relationships. With increased knowledge, these families might gain a better understanding of their attachment relationships and view problems in a different manner, realize they are not alone, and know that their challenges are common in this population. As a result of this knowledge, I hope these families feel empowered to seek the type of services needed to improve their relationships, which in turn may decrease failed or disrupted placements. Guide Mental Health Professionals I believe the findings will provide mental health professionals with increased awareness of the importance of attachment, trauma, and traumatic grief and loss as they are often the etiology of maladaptive behaviors in preschool-aged children. With this knowledge, professionals could provide the most efficacious treatment to build secure attachment relationships. Children in kinship care and nonkinship foster care are referred to mental health professionals with complex issues, and treatment needs to be tailored to best facilitate positive outcomes.11 Inform the Child Welfare System I believe the findings will provide the child welfare system with the tools and the context to better understand attachment relationships, trauma, and traumatic grief and loss so that this knowledge might inform their decisions for placements, services, and support. While professionals are beginning to understand these important issues for children in foster care, this research will hopefully shed more light on how they deeply affect preschool-aged children and their caregivers. Contribute to Literature Base I believe the findings will contribute to what currently is a nonexistent literature base on this topic. The attachment relationships of grandparent kinship caregivers and nonkinship foster parents with preschool-aged children in their care have not been studied. It is my hope that the findings may provide the groundwork and promote interest from other researchers to explore this important area. Summary This is the first known qualitative study to explore attachment experiences for grandparent kinship caregivers and nonkinship foster parents with preschool-aged children in their care. One qualitative study conducted by Backhouse and Graham in 2012 focused on the experiences of raising grandchildren, but did not investigate the meaning of their attachment relationships. With the increasing number of children entering grandparent kinship homes and nonkinship foster homes, I think this topic is vital to the placement outcomes of so many preschool-aged children. My hope is that by increasing our understanding of attachment experiences, we will be able to better help 12 this vulnerable population in making more positive attachments, reducing trauma, and attenuating the risk of lifelong emotional, behavioral, and physical problems. Overview of Chapters The following chapters include a review of the literature, an outline of the methodology, presentation of the findings, and discussion. Chapter II is the literature review. I provide an overview of the chapter. The chapter begins with literature about children in foster care. I present research regarding the number of children in foster care, both nationally and in the state of Utah, reasons these children are removed from their biological parents, their traumatic life events and need for mental health service, their educational needs, and why this population is vulnerable and at risk. I continue with research that focuses on kinship caregivers and nonkinship caregivers which includes comparative research of the two groups. This is followed with research about attachment theory and its importance for preschool-aged children and internal working models. I then present research regarding reactions, reactive attachment disorder, and attachment disorders and how these affect building relationships with children in foster care. I conclude Chapter II with thoughts about kinship caregivers and nonkinship foster parents followed by a summary of the chapter. Chapter III is the methodology. I provide an overview of the chapter. This chapter begins with an outline of the rationale for qualitative research, paradigm, research design, research participants, sampling procedures, inclusion criteria, recruitment, informed consent, and data collection procedures. This chapter continues with an explanation of the data analysis and interpretation, organization of the data, immersion, how categories, themes and patterns were generated, how data were coded, the search for 13 disconfirming evidence, and how the results were written. The last sections of this chapter include researcher as an instrument, trustworthiness, researcher bias, study limitations, and dissemination of results. I conclude the chapter with a summary. Chapter IV is the findings. I provide an overview of the chapter. This chapter begins with a presentation of the five themes, which are 1) importance of family; 2) attachment, trauma, and traumatic grief and loss; 3) challenges; 4) roles; and 5) family relationship styles. Each of the five themes includes subthemes. I first present the nonkinship foster parent responses followed by the grandparent kinship responses. Summaries are provided at the end of each theme. I then present the findings from the focus groups. I conclude the chapter with a summary of the findings. Chapter V is the discussion. I provide an overview of the chapter. This chapter provides a narrative of the five themes and how they relate to attachment relationships. I present the findings and how they are situated in the context of current literature followed by a summary. I present the limitations of the research and the implications for caregivers, practice, policy, and research. I share my thoughts and gratitude to the participants as my conclusion.CHAPTER II REVIEW OF THE LITERATURE Overview The purpose of this qualitative study was to explore the attachment experiences of grandparent kinship caregivers and nonkinship foster parents with preschool-age children in their care. As a foundation to the research, several comprehensive literature reviews were conducted. Literature from 1990 through 2013 was the focus to provide a knowledge base of attachment, foster care, and kinship care. Seminal works of attachment theorists and researchers were included as they are integral to current knowledge and research. The sections reviewed in the literature were 1) children in foster care; 2) kinship caregivers and nonkinship foster parents; 3) attachment theory and preschool-aged children; 4) internal working models; 5) reactions, reactive attachment disorder, and attachment disorders; 6) building attachment relationships with children in foster care; and 7) attachment perceptions of the caregivers. Children in Foster Care It was important to review literature that pertains to children in foster care to gain a better understanding of the target population in this study. I reviewed literature regarding the number of children in kinship and foster care, the reasons for their removal, 15 stability of placements, traumatic life events, mental health concerns, educational experiences, and stigmatization of children in foster care. It is estimated that currently, there are half a million children residing in foster care (Pew Commission on Children in Foster Care, 2008) and approximately 4.9 million children residing in kinship placements in our nation (Goyer, 2010). In Utah, there are approximately 2,700 children in foster care and another 70,500 in kinship care (GrandFacts Utah, 2011). These children are in need of out-of-home placements for a variety of reasons, including abuse, neglect, dependency, exposure to violence in the home, parental substance abuse, and mental illness. The Child Maltreatment 2011 report states that the most common types of maltreatment for children are neglect, physical abuse, and sexual abuse based on substantiated cases (Children's Bureau, 2012b). More than 75% of children suffered from neglect; more than 15% suffered from physical abuse; and less than 10% of children suffered from sexual abuse (Children's Bureau, 2012b, p. 9). The Child Abuse and Treatment Act (CAPTA), as amended by the CAPTA Reauthorization Act of 2010 defines child abuse and neglect as: Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act or failure to act, which presents an imminent risk of serious harm. (as cited in Children's Bureau, 2011b, p. 15) The Child Maltreatment 2011 report notes that there has been an increase in referrals for child maltreatment since 2007, which translates into more children in need of services in the home or children in need of out of home placements (Children's Bureau, 2012b). The report also states that one of our nation's most serious concerns is child abuse and 16 neglect; the safety, permanency, and well-being of these children need to be addressed (Children's Bureau, 2012b). The goal for safety, well-being, and permanency is mandated by ASFA (1997). This goal includes the responsibility to seek stable, consistent, and permanent homes environments for children who have been identified as maltreated and removed from their homes. There are risks associated with maltreatment and these risks are exacerbated by the instability of the foster care milieu (Jones Harden, 2004). Instability refers to the frequent disruptions or the number of times a child changes foster homes. Based on national statistics, 24.3% children experience two placements; 13.1% experience three placements; and 25.3% experience four or more placements (Fostering Connections, 2010). In Utah, the prevalence of multiple placements is higher, with 25.6% of children experiencing two placements, 14.2% of children experiencing three placements, and 29.9% of children experiencing four or more placements (Fostering Connections, 2010). Foster children who experience more placements are more likely to display clingy behaviors, oppositional behaviors, and crying (Gean, Gillmore, & Dowler, 1985). The emotional and behavioral issues commonly exhibited by foster children are closely tied to disruptions in foster care placements (Oosterman, Schuengel, Slot, Bullens,& Doreleijers, 2007). Some findings in literature suggests that children who have been exposed to traumatic life events are at greater risk for numerous negative outcomes for health, mental health, education, and social-emotional functioning. The most comprehensive study that focuses on the effects of childhood traumatic events on adult physical health, emotional health, and mortality in the United States is The Adverse Childhood 17 Experiences (ACE) Study (Center for Disease Control and Preventions [CDC], 2013). The study was conducted by Felitti and Anda between the years 1995-1997, and over 17,000 people participated at the Department of Preventive Medicine at Kaiser Permanent (CDC, 2013). An adverse childhood experience includes childhood abuse, neglect, traumatic stressors, and family dysfunction (CDC, 2013). Felitti explored the association between childhood maltreatment and health in later life and found there is a "conversion of traumatic emotional experiences in childhood into organic disease later in life" (Felitti, 2002, p. 2). Results indicate that the more ACEs an individual experiences, the higher their risk is for health problems, mental health issues, and social concerns. Felitti's research dramatically highlights that abuse, neglect, violence in the home, parental substance abuse, mental illness, and/or incarceration that children experience in their lives may place them at risk for negative outcomes throughout their lifetime (CDC, 2013). Children in foster care need more mental health services than children in the general population (Grayson, 2012). In a study funded by The National Institute of Mental Health (NIMH), results indicate that 47.9% of children in foster care were diagnosed with significant emotional and behavioral problems (Burns et al., 2004) and children entering foster care exhibit behavioral and social competence problems that result in nearly one-half to two-thirds needing mental health services (Landsverk, Burns, Stambaugh, & Rolls Reutz, 2006). Traumatic life events are common for children in foster care and may include the reason for their removal, separation trauma from their families, and numerous placements (Racusin, Maerlender, Sengupta, Isquith, & Straus, 2005). Hieger (2012) states that over 21% of foster alumni suffer from Posttraumatic 18 Stress Disorder (PTSD), which is a higher rate than United States veterans of war (Pecora et al., 2005). Landsverk et al. (2006) observed that developmental problems are evident in children under the age of 7 who are entering the foster care system. The educational experiences for children in foster care have significant challenges that can create negative outcomes. Bruskas (2008) asserts that "poor educational outcomes of children in foster care increase their vulnerability and impact their future" (p. 71), and Zetlin and Weinberg (2004) agree that this already vulnerable population is at risk to become more educationally vulnerable. In a review of literature, The Vera Institute of Justice (VIJ, 2012) found that children in foster care have poorer attendance rates, are less likely to perform at grade level and attend college, are more likely to have behavior and discipline problems, and are more likely to be assigned to special education classes. There are many factors contributing to these outcomes such as low expectations by teachers, foster parents, and caseworkers; lack of educational advocates for the children; the stigma of being in foster care, which decreases socialization in school; lack of emphasis on education; and the priorities of the child welfare system, which may focus on the safety of the children, finding appropriate homes, and transferring children when placements are not working (VIJ, 2012). Academically, children perform better, are more successful on achievement tasks, and are less likely to repeat a grade or drop out of school when they have stability in their relationships with consistent caregivers (Hickson & Clayton, 1995). Foster children are often stigmatized by their life events. This situation can be exacerbated by their residing in foster care families. Bruskas (2008) described foster 19 children as a population that suffers from oppression, domination, and cultural imperialism based on criteria in Young's (1999) Five Faces of Oppression. The dominant population makes these children feel invisible when they are removed from the biological parents, become children without families, and do not have the opportunity to socialize with other children in foster care (Bruskas, 2008). Many foster children believe that they are abnormal or inferior, experience feelings of shame, and often do not share with others their status as foster children (Courtney, Piliavin, Grogan & Nesmith, 2001; Kools, 1997). Shame is often a reason children do not seek relationships in the school setting and may isolate themselves to avoid embarrassment, bullying, or teasing (VIJ, 2012). Without social interactions, foster children are at greater risk for low self-esteem, poor peer skills, and feelings of incompetence (Bruskas, 2008). Kinship Caregivers and Nonkinship Foster Parents It was important to review the literature that pertains to kinship caregivers and nonkinship foster parents as they were the participants in the study. For many years, nonkinship foster parents were the first choice for out of home placements for removed children, but this has changed in the last two decades (Geen, 2004). With kinship caregivers pursued before nonkinship placements, it was integral to know the differences and similarities found in literature. I reviewed demographics, benefits and risks for each placement, challenges, and outcomes for the children. Kinship caregivers tend to be older, single, in poorer health, have lower incomes, and are less educated than nonkinship foster parents (Geen, 2004). Kinship caregivers are more likely to be female, with 50% being grandmothers and 30% being aunts (Scannapieco, 1999). It is estimated that 48% of kinship caregivers work outside the 20 home and 50% own their own home. The percentage of nonkinship homeowners is higher (Scannapieco, 1999). Recent statistics indicate that the majority of grandparent kinship caregivers are White and Non-Hispanic; 46% of grandparent kinship caregivers are married and have a spouse present; 32% of grandparent kinship caregivers live below the poverty level; 14% of the children in care have a disability; 45% of grandparent kinship caregivers own their own homes; and 30% have less than a high school education (Generations United, 2009). Kinship caregivers receive less supervision, services, and support as compared to nonkinship foster parents. There has been research that specifically focused on kinship placements. Hegar (1999) cited that the advantages of kinship placements are: (a) continuity of family identity; (b) access to relatives besides the kinship caregiver; (c) continuity of the child's ethnic, religious, and racial community; and (d) a pre-established relationship with the caregiver that provides familiarity of the child. The Center for Law and Social Policy (CLASP) reviewed literature and compiled a current list of the benefits of kinship care (Conway & Hutson, 2007). The authors found that (a) children in kinship care experience greater stability; (b) children in kinship care report more positive perceptions of their placements and have fewer behavioral problems; (c) kinship care respects cultural traditions and may reduce racial disparities in a variety of outcomes; (d) kinship caregivers provide stability to children and youth with incarcerated parents; (e) myths still remain in spite of numerous benefits associated with kinship care; and (f) old fears about the risk of placing children with kin are not true. Grandparent kinship caregivers have their own set of challenges. In a review of empirical kinship studies, kinship caregivers are more likely to be older, have lower 21 education, live in poverty, and are at risk of poorer health than nonkinship foster caregiver (Hong, Algood, Chiu, & Lee (2011). Kinship caregivers often receive minimal or no support before taking children into their homes, have limited resources, and do not understand the child welfare system (Geen, 2004). Kinship caregivers frequently experience financial stress, ambiguous roles, new daily lifestyles, and new challenges as primary caregivers (Hayslip & Kaminski, 2008). Grandparents who assume care of their grandchildren have to manage and coordinate the legal, medical, educational, and social service needs of their grandchildren (Kelley, Yorker, Whitley, & Sipe, 2001). In the aforementioned qualitative study, researchers in Australia asked the questions "can you tell me how the grandchildren came into your care" and "can you tell me about your experiences raising your grandchildren" (Backhouse & Graham, 2012). The grandparents in this study discussed grandchildren between the ages of 1 and 17 years old (Backhouse & Graham, 2012). The grandparents reported that they experienced disappointment and frustration, felt used by the government, believed they were less appreciated than foster parents, but overall were committed to care for their grandchildren (Backhouse & Graham, 2012). Some authors are concerned that grandchildren could be at risk in a grandparent kinship placement due to intergenerational abuse, neglect, and substance abuse (Gennaro, York & Dunphy, 1998) and poor parenting across generations (Hunt, 2003). This fear ties into the myth that "the apple doesn't fall far from the tree" or that their inappropriate parenting was learned from their own parents (Geen, 2004). One study found that nonkinship foster parents were twice as likely to have a confirmed report of maltreatment compared to licensed kinship foster parents (Zuravin, Benedict, & Somerfield, 1993), and 22 another study found that children in kinship foster care were at a lower risk for maltreatment when compared to nonkinship foster care or specialized care (A Child Welfare Research Agenda for the State of Illinois, 1998). Another concern is that grandparent kinship caregivers may not follow the guidelines regarding visitations as closely as nonkinship foster parents (Geen, 2004). This problem was identified by child welfare workers who said they could not prevent kin from allowing unsupervised contact with the biological parents (Geen, 2004). It was suggested that increased education regarding the risks of unsupervised visits, increased supervision by child welfare, and more support to kinship placements may decrease the problem (Geen, 2004). While there may be hardships and challenges that kinship caregivers endure, they seem to be consistently willing to take care of their grandchildren in need. Following her literature review, Connolly (2003) stated that kinship caregivers were found to be strongly in favor of kinship care, citing their deep affection for the child and support for the parent, the belief that the best place for the child is with the family, and a strong interest in preventing the child from entering stranger care. In a Campbell Systematic Review, Winokur, Holtan, and Valentine (2009) reviewed 62 quasi-experimental studies and concluded that children in kinship foster care have better outcomes for behavioral development, mental health functioning, and placement stability as compared to children in nonkinship placements. This study found no difference on reunification rates between the two groups; however more kinship foster caregivers were more likely to have guardianship while more nonkinship foster caregivers adopted the children in their care (Winokur et al., 2009). The authors also 23 noted that nonkinship caregivers were more likely to access mental health services. Winokur et al. (2009) suggested that a natural outgrowth of their review would be qualitative research "that explores the underlying dynamics of kinship care along with factors associated with positive outcomes" (p. 38). Cuddeback (2004) published a systematic review of quantitative research on kinship care based on over 100 empirical studies. The author found that qualitative research "contributed in many ways to our depth of understanding of kinship foster care and has been useful in guiding and informing quantitative research" (Cuddeback, 2004, p. 624). At the time, this review included much of what was known about kinship care in terms of demographics, families of origin, familial psychosocial characteristics, child functioning, placement stability, reunification, training, services, and support. The lack of research on informal kinship placement was cited as a gap in our knowledge base (Cuddeback, 2004). It was concluded that "kinship care is a complicated issue and presents many challenges to social work practitioners, policy-makers, and researchers" (Cuddeback, 2004, p. 634). Attachment Theory and Preschool-Aged Children It was important to review the literature that pertains to attachment theory and preschool-aged children to elucidate the theoretical framework of this study and its relevance in this specific age group. Young children's social and emotional functioning is affected by the relationships with their primary caregivers (Troutman, 2011). This is a concern because children under the age of 5 years are twice more likely to be placed in foster care homes and spend a longer amount of time in foster care than older children (Goerge & Wulczyn, 1998). I reviewed attachment theory, the four phases of attachment, 24 the significance of preschool years and attachment, and why the preschool years are significant in a child's education. Bowlby's developmental theory suggested that an important relationship with a primary caregiver is a child's major drive (Bowlby, 1982), and the quality of this relationship provides the child with emotional security. The attachment process has social, emotional, cognitive, and behavioral components (Goldberg, 2000). As a property of social relationships, attachment is an "affectional tie with some other differentiated individual who is perceived as stronger and wiser" (Bowlby, 1977, p. 201). Bowlby (1969) defined attachment as a "lasting psychological connectedness between human beings" (p. 194). While we know that the ontogeny of attachment behavior is in the first 12-15 months of a child's life, attachment is also critical in the preschool years as children expand their social and physical world (Marvin & Britner, 1999). There are three accepted developmental phases for infants (Goldberg, 2000). The initial phase is during the first few weeks of life in which an infant does not discriminate or signal specific caregivers. The second phase is during the 6- to 7-month period during which the infant's preferences develop. This is followed by the third phase during which there is a "clear emergence and consolidation of a special relationship" (Goldberg, 2000, p. 16). Ainsworth (1973) described these phases as preattachment, attachment in the making, and clear-cut attachment. The fourth phase of attachment development is goal-corrected partnership that develops in the preschool years (Goldberg, 2000). Goal-corrected partnership refers to the child's ability to change attachment behaviors from a primary caregiver-driven function to a more reciprocal interaction (Bowlby, 1969/1982).25 The preschool years are significant in a child's life because there is an increase of linguistic, cognitive, and motor skills, which results in more control and increased autonomy (Goldberg, 2000). The preschooler practices new skills, developmental tasks, and physical-social environments (Cicchetti et al., 1990). As previously mentioned, there are new stressors in the lives of preschoolers that elicit attachment behavior in different ways (Cicchetti et al., 1990). During this time, children realize that their attachment figures have their own goals and needs and therefore, children must negotiate this new context to get their needs met (Goldberg, 2000). Children also learn that they are able to verbally express themselves, understand explanations about separations from their parents, and learn social rules (Goldberg, 2000). Children have increased ability to rely on "representational thought in organizing the attachment system" (Goldberg, 2000, p. 35). Success in preschool is important for children for many reasons. From the National Institute for Early Education Research, Barnett and Hustedt (2003) proposed that preschool may be the most important grade in that it can produce substantial gains in children's learning, development, and future success. Preschool also strengthens socialization skills, teaches children how to compromise, be respectful of others, problem solve, gain sense of self, explore, play with peers, and build confidence (Kanter, 2007). Children in foster care may be challenged in the preschool setting due to maltreatment, which has adverse effects on brain development, cognitive and language skills, physical health, and social and emotional functioning (Cicchetti & Toth, 1997).26 Internal Working Models It was important to review literature that pertains to internal working models as it is a component of attachment theory and may explain the difficulties foster children have in building relationships. I reviewed literature on the basic concept of internal working models, the four types of attachment patterns, categorizations of internal working models, and the relevance of internal working models with preschool-aged children. Bowlby (1973) postulated that internal working models are mental representations of an individual's self and attachment figure relationships that are developed through interpersonal interaction experiences. Internal working models include "expectations of the accessibility and responsiveness of attachment figures" (Bowlby, 1973, p. 238). Internal working models are mostly shaped in a child by the age of 5 years, but can change thereafter depending on the caregiving experience (Bowlby, 1988). There are four types of attachment patterns known as secure, insecure/ambivalent, insecure/avoidant, and disorganized/disoriented (Ainsworth, Blehar, Waters, & Wall, 1978; Main & Solomon, 1990). The secure children's internal working model of self is the belief that they are able to get needs met, have an available caregiver, and are worthy of affection and love (Bowlby, 1998). Whelan (2003) indicated that the three insecure attachment patterns have the following associated internal working models. The insecure/ambivalent children's internal working model of self is the belief that they are unable to communicate to get their needs met consistently by the attachment figure (Whelan, 2003). The insecure/avoidant children's internal working model of self is the belief that they are isolated and discounted by the attachment figure (Whelan, 2003). The disorganized/disoriented children's internal working model is the belief that they have no 27 control over the response thy will receive from the attachment figure (Whelan, 2003). These internal working models are then generalized by children to all other relationships in their environment, creating adaptive or maladaptive pathologies (Bowlby, 1998). Internal working models were categorized by Crittenden (1990) as open or closed and as working or nonworking. Open internal working models allow for new interpretations of events based on relationship interactions while the closed internal working model applies the same model to all data with expectations for the same outcomes (Crittenden, 1990). A working internal model allows for "cognitive manipulation of possible responses of the self in relation to others," while the nonworking internal working model does not allow for "the person to consider him or herself as having several responses to others in the context of a relationship" (Crittenden, 1990, p. 27). A child with a closed nonworking internal working model pattern will continue to repeat negative interactions (Whelan, 2003). Crittenden's concept of internal working models explains why some children are able to change their schemas in a new home environment and others are unable to do so (Whelan, 2003). Internal working models of foster children are developed by the quality of care received from earlier primary caregivers, so they often become "warily self-reliant" due to maltreatment and disruptions (Schofield & Beek, 2005, p. 5). For these children, it is difficult to cognitively process or adapt to even the most positive environments. Attachment relations beyond infancy are facilitated by internal (mental) working models based on the experiences the young individuals had with their primary attachment figures (Bretherton & Munholland, 1999). This is important for children entering the preschool years because if they have experienced responsive and sensitive caregivers, 28 they will have positive working models and will be able to feel secure when physically separated from their attachment figures (Bretherton & Munholland, 1999). If children have not experienced reliable and available caregivers, they are more likely to have negative working models and will fear the environment, be unable to explore, display negativity and exhibit aggression toward others (Bretherton, 2005). Attachment Reactions, Reactive Attachment Disorder, and Attachment Disorders It was important to review literature that pertains to attachment reactions, reactive attachment disorder, and attachment disorders because they may have significant impact on the ability of foster children to build attachment relationships. I reviewed the four stages that children commonly experience with their removal, the vulnerability of preschool-aged children being diagnosed with reactive attachment disorder, classification of attachment disorders, importance of a secure attachment, and therapeutic treatment. With the overwhelming rise in both kinship and nonkinship foster placements, child welfare professionals must address the physical safety and mental health issues of the children. Foster children experience numerous problems associated with their removal and need sensitive support to attenuate negative effects. There are four common stages experienced by children who have been removed from their homes and described as shock, protest, despair, and adjustment (Pardeck & Pardeck, 1998). Shock is the initial response children experience when they are separated from their parents. The protest stage is characterized by anger as children often act out hoping to be sent home. The despair stage is characterized by sadness, depression, and/or regression. Children in the despair stage often seek comfort from their foster parents, but then reject them. The 29 adjustment stage is a time during which children may accept their reality but may emotionally never overcome the separation from the biological parents. It was found that 24% of foster children are between the ages of 1 and 5 years old (Stukes Chipungu & Bent-Goodley, 2004) and that an increasing number of infants and children under the age of 5 are entering foster care based on the AFCARS Report in 2001. Preschool-aged children are at risk for Reactive Attachment Disorder (RAD), a psychiatric disorder defined in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-IV-TR, 2000). The essential feature of RAD is "markedly disturbed and developmentally inappropriate social relatedness in most contexts that begins before age 5 years and is associated with pathological care" (DSM-IV, 2000, p. 127). The two subtypes associated with this disorder are Inhibited Type and Disinhibited Type. The Inhibited Type is characterized by the child's "persistent failure to initiate and to respond to most social interactions in a developmentally appropriate way" (DSM-IV, 2000, p. 128). The Disinhibited Type is characterized by the child's "indiscriminate sociability or lack of selectivity in the choice of attachment figures" (DSM-IV, 2000. p. 128). The etiology of the disturbed social relatedness is presumed to be pathological care, which may include a disregard of the "child's emotional needs for comfort, stimulation, and affection, persistent disregard of the child's basic physical needs, or repeated changes in primary caregiver that prevents formation of stable attachments (e.g., frequent changes in foster care)" (DSM-IV, 2000, p. 128). Some children who have been abused and neglected do not meet the criteria for RAD, but still exhibit attachment problems (Cicchetti, 1989). Zeanah and Boris (2000) developed an alternative classification of attachment disorders, which include Disorders 30 of Nonattachment, Secure Base Distortions, and Disrupted Attachment Disorder. The criteria for Disorder of Nonattachment are met when the child has no preferred adult caregiver and exhibits either inhibited or disinhibited patterns of attachment (Zeanah & Boris, 2000). The criteria for Secure Base Distortions are based on the child who has preferred familiar caregivers, but cannot use the adult for safety while exploring the environment (Zeanah & Boris, 2000). Disrupted Attachment Disorder is the result of an abrupt separation or loss of familiar caregiver with whom the child has an attachment (Zeanah & Boris, 2000). A child's psychological and developmental health is based on a secure attachment to a sensitive, responsive, and reliable caregiver (Cassidy & Shaver, 1999). Through her research in 1963, Ainsworth demonstrated that there are various differences in attachment behaviors, which correlate to infant-parent interactions during the first year of life. Bowlby (1979) stated "Whilst especially evident during early childhood, attachment behavior is held to characterize human beings from the cradle to the grave" (p. 129). Attachment plays a key role in future relationships and psychopathology because the initial parent-child bond creates the working model for every subsequent meaningful relationship (Cicchetti, Toth, & Lynch, 1995). There is evidence that suggests a child's early experiences can be overcome with therapeutic interventions, emotional stability, and security (Clarke & Clarke, 1999; Messer, 1999). Children who are removed from their biological homes commonly experience anger, anxiety, depression, low self-esteem, behavioral problems, post-traumatic stress disorder, and developmental delays (Gauthier, Fortin & Jeliu, 2004; Pearce & Pezzot-Pearce, 2001). It is important to consider interventions for foster 31 children that will facilitate a healthy, stable, and securely attached relationship with either kinship or nonkinship foster parents in the hope of decreasing disruptions. Two evidence-based treatments, Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) and Child-Parent Psychotherapy (CPP) were indicated to be equally effective with children in foster care (Hieger, 2012). Building Attachment Relationships with Children in Foster Care It was important to review literature that pertains to building relationships with foster children as it is often challenging for child and caregiver. I reviewed literature regarding the challenges of building relationships, children at risk for placement disruptions, and why secure attachments are crucial to children's development. Children in foster care have difficulty building attachment relationships. It was suggested that the distrust in foster children may be so deep that even discrepant information is not enough to trigger the mind to adapt to the new reality (Crittenden, 1995). Foster children's representation of reality is often reversed, making good seem bad and true seem false (Crittenden, 1995). With good care being perceived as a threat or deception, these children reject and alienate their foster caregivers (Crittenden, 1995). Maltreated children lack trust, have a need to control people around them, and are compelled to control their environment, which are major challenges for foster parents (Schofield & Beek, 2005). Paradoxically, as children begin to feel more comfortable with the stability of care, they inadvertently resist these new experiences and fight creating a new schema. Children from homes in which they were maltreated generalize 32 their history to the foster home. This can make it difficult to process a different reality, and good care can evoke even more fear and resentment (Schofield & Beek, 2005). The development of a secure attachment is greatly impeded by child abuse and chronic neglect, referred to as trauma of absence and multiple placements, which can create a compromised ability in foster children to form attachments even with families who are committed and loving (Crittenden & Ainsworth, 1989; Hughes 1999). Secure attachment is central in early psychological development as it assists the child to regulate emotions, control behavior, and establish a sense of self (Schore, 1994). Children who have not experienced secure attachments are likely to develop symptoms such as "little empathy for others, limited awareness of the consequences of his behavior, little guilt and remorse, difficulty expressing thoughts and feelings, and poor discrimination among relationships" (Hughes, 1999, p. 549). In addition, other symptoms include poor regulation of bodily functions, emotions, and behavior, as well as profound shame (Hughes, 1999). Foster parents report that building relationships with their foster children can be so difficult that the children are at risk for placement disruptions. The children's mistrust originates from external circumstances, which are then internalized as a belief that they are undeserving of love (Bowlby, 1998). While it may be challenging, foster/adoptive parents who create a secure attachment for the first time in a child's life facilitate a psychological birth (Hughes, 1999). Conceptually, this is similar to a corrective experience that facilitates a new and more positive experience (Hughes, 1999). Internalized beliefs can be challenged and set a new course to healthier attachments and development of a more positive sense of self (Bowlby, 1998).33 Attachment is fundamental to a child's growth because it promotes the development of either adaptive or maladaptive psychological development. Securely attached children can proceed to the developmental tasks that are part of the growth process (Greenspan & Lieberman, 1988). In a review of longitudinal studies, securely attached children have more positive developmental outcomes (Cassidy & Shaver, 1999). Early attachment relationships have a significant role because original parent/child relationships provide the working model for all future meaningful relationships and psychopathology (Cicchetti et al., 1995). Attachment Perceptions of the Caregivers It was important to review the literature that pertains to the perceptions of grandparent kinship caregivers and nonkinship foster parents because the research asked for their experiences with the children in their care. I reviewed literature regarding the reciprocal nature of attachment relationships, difficult behaviors that may impede caregiver responses, and a model that highlights the dyadic nature of attachment relationships. Attachment is a dyadic relationship and a reciprocal process (Poehlmann, 2003). How a caregiver perceives the child's behaviors and emotions has an effect on attachment relationships and this can be more challenging with foster children. Dozier, Albus, Fisher, and Sepulveda (2002) cited that children in foster care are often unable to elicit nurturance from new caregivers and incapable of regulating their behaviors, emotions, and neuroendocrine system, and caregivers find themselves confused about how to provide nurturance to distressed children. All children in out of home placements experience stress, even though their behavioral and emotional symptoms vary 34 (Lieberman, 2003). Foster children may exhibit emotional distance, inability to be comforted, lack of appreciation or preference for the caregiver, mood shifts, indiscriminate sociability, defiance, noncompliance, and aggression (Lieberman, 2003). In turn, the caregivers may not experience an emotional satisfying reciprocity and experience feelings of hopelessness (Lieberman, 2003). The Circle of Security: Secure Base and Haven of Safety is an attachment-based intervention that highlights the dyadic nature of attachment (Marvin, Cooper, Hoffman, and Powell, 2002). In this model, the caregivers increase their sensitivity and appropriate responsiveness to the child's signals; increase their ability to reflect on their own and the child's behaviors, feelings, and thoughts; and reflect on their own experiences and history that affect their current caregiving techniques. This well-known model was created to improve attachment relationships and has been especially successful with preschool-aged children and their caregivers. Summary of the Literature Currently, there is no qualitative research that focuses on the attachment experiences of grandparent kinship caregivers and nonkinship foster parents with preschool-aged children in their care. Grandparent kinship caregiver qualitative research is limited and primarily focuses on demographics, perceptions, and challenges. One qualitative study in Australia focused on the experiences of being a kinship caregiver, but not the attachment relationships (Backhouse & Graham, 2012). There are no studies that focus on attachment experiences from the nonkinship foster caregivers. It was my aim to increase our knowledge of attachment experiences and fill the void in current literature. To accomplish this, I posed the question:35 What are the attachment experiences of grandparent kinship caregivers and nonkinship foster parents with preschool-aged children in their care?CHAPTER III METHODOLOGY Overview The purpose of this study was to explore the attachment experiences of grandparent kinship caregivers and nonkinship foster parents with preschool-aged children in their care. My goal was to gain insight into the world of grandparent kinship caregivers and nonkinship foster parents who are raising preschool-aged children and learn more about their attachment relationships. I wanted to understand the similarities and differences within and between the groups. To do this, I posed the research question: What are the attachment experiences of grandparent kinship caregivers and nonkinship foster parents with preschool-aged children in their care? In this chapter, I describe the methodology of the research which includes (a) rationale for qualitative research, (b) paradigm, (c) research design, (d) research participants, (e) sampling procedures, (f) inclusion criteria, (g) recruitment, (h) informed consent, (i) data collection, (j) data analysis and interpretation, (k) researcher as instrument, (l) pilot study, (m) trustworthiness, (n) study limitations, and (o) dissemination of findings. I provide a summary as the conclusion to this chapter. Rationale for Qualitative Research No other study has explored attachment experiences of grandparent kinship caregivers and nonkinship foster parents with preschool-aged children in their care. 37 Because this topic has not been studied before, my goal was to interview the participants and develop a context from which to understand the attachment experiences in this population. Qualitative research has unique strengths for exploratory and descriptive research and is best suited when studying individual lived experiences (Marshall & Rossman, 1999). Qualitative researchers study things in their natural settings and attempt to interpret a phenomenon through the meanings that people bring to them (Denzin & Lincoln, 2005). The phenomena examined in this study were the attachment experiences and their meanings that emerged through participants' narratives. This study was conducted in the environments in which the grandparent kinship caregivers and nonkinship foster parents lived and the raised preschool-aged children in their care. Quantitative research methods were not appropriate for this study as quantitative researchers rarely "capture their subjects' perspectives because they rely on remote, inferential empirical methods and materials" (Denzin & Lincoln, 2005, p. 12). The definitive choice to explore attachment experiences of grandparent kinship caregivers and nonkinship foster parents with preschool-aged children in their care was a qualitative research approach. Paradigm There are certain assumptions that researchers make regarding how and what they will learn during their inquiry (Creswell, 2003). My approach for understanding attachment experiences in this study was interpretivist and phenomenological. With an interpretive approach, meanings emerge from the research process, which is generally through interviewing and observations. Denzin and Lincoln (2005) describes the 38 researcher in this approach as a "bricoleur," or one who assembles the pieces to create the whole "bricolage," which is an emergent construction of the researcher's understanding of experiences and their meanings. In this manner, the approach contextualizes and textualizes the data from the participants' experiences and interprets the data through the researcher's open lens of experience. Phenomenology is the study of lived experiences through which we develop a worldview by understanding these experiences (Marshall & Rossman, 1999). Phenomenology was developed by the German philosopher Edmund Husserl (1859-1938) over a century ago (Embree, 1997). Husserl believed that to know the world and ourselves, we must first examine human consciousness. He approached the phenomena of consciousness by suspending presuppositions and allowing the phenomena to be "captured in the giveness" (Viney & King, 1998, p. 408). The goal of phenomenology is to discover the essential, invariant structure or underlying meaning of the participants' experiences. This "essence" is what Husserl called "evidenz," which is "awareness of a matter itself as disclosed in the most clear, distinct, and adequate way for something of its kind" (Embree, 1997, p. 1). The researcher sets aside scientific and "naïve" prejudgments or suppositions. The researcher also recognizes "the role of descriptions in universal, a priori, or ‘eidetic' terms as prior to explanation of causes, purposes, or grounds" (Embree, 1997, p. 2). The "lived experience" of the participants is a unique experience of the world and the phenomena. Research Design This study had four research phases. During the first phase, I conducted 16 in-depth face-to-face interviews with 14 individuals and 2 couples. A couple was counted 39 as 1 participant. During the second phase, all audiotaped initial interviews were transcribed by professional transcribers. The transcripts were then mailed or emailed to the participants for their review and feedback. During the third phase, I conducted 14 face-to-face follow-up interviews with 12 individuals and 2 couples. The follow-up interviews were not audiotaped. The follow-up interviews were utilized as a member-checking strategy, and my goal was to review the transcripts in a collaborative manner with each participant. I chose not to audiotape the interviews so that I could create a less formal session. During the fourth phase, I conducted two focus groups with 5 individuals participating in one group and 2 individuals and 2 couples participating in another group. One focus group was held for the grandparent kinship caregivers and one focus was held for the nonkinship foster parent. The focus groups were audiotaped. Research Participants For qualitative research, the number of participants is generally small (Polkinghorne, 2005). It was my goal to interview 16 participants, 8 of whom were grandparent kinship caregivers and 8 of whom were nonkinship foster parents who had preschool-aged children in their care. The study included 8 participants in each group; however, in the grandparent kinship caregiver group, there were 2 couples who participated during the interview. Since the couples were not interviewed separately, I considered couples as 1 participant. Of the 8 participants in the grandparent kinship caregiver group, 6 identified as married and 2 identified as divorced. In the nonkinship foster parent group, 8 nonkinship foster mothers participated in the interviews and all identified as married. The participants were Utah residents and lived along the Wasatch 40 Front in Utah. Their age range, mean age, age of child in their care, length of time in care, and follow-up status of the child in their care are found in Table 1. In the grandparent kinship caregiver group, 7 children remained in these placements at the time of the follow-up interviews. One set of siblings was returned to their biological parents and the grandparent still had contact. In the nonkinship foster parent group, 3 children remained in these placements at the time of the follow-up interviews and were adopted by the families. One of the 3 adopted children was later removed due to attachment issues. Of the children who were no longer in these placements, 2 children were reunited with their biological parents, 1 child was reunified with the biological parent and removed again, and 2 children were disrupted from their placements and adopted by other families. Table 1 Demographics of the Participants Nonkinship Foster Parents Grandparent Kinship Caregivers Female Caregiver Age M=39.0 years Range 28 - 46 years n=8 M =54.5 years Range 38 - 66 years n =8 Male Caregiver Age M =39.0 years Range 26 - 48 years n =8 M =58.8 years Range 43 - 70 years n =6 Age of Child in Care M =3.75 years Range 2 - 5 years M =3.75 years Range 2 - 5 years Length of time in care M =12 months Range 5 - 38 months M =20 months Range 3 - 60 months DCFS involvement 100% n =8 62.5% n =5 Number of children remaining in participant's care at follow-up n =3 n =741 Sampling Procedures The sampling procedures I used in this study were purposive and criterion-based. The idea of qualitative research is to purposefully select the sites and participants that will enhance the researcher's understanding of the problem and question (Creswell, 2003). I carefully defined what criteria the participants were required to meet as outlined in the following section. Additionally, the snowball sampling procedure was utilized as participants shared the names of other people who might be interested. Inclusion Criteria The inclusion criteria were that any grandparent kinship caregiver or nonkinship foster parent was eligible to participate in this study if they were raising a preschool-aged child between the ages of 2½ and 5 years old and who was not yet in kindergarten. The child had to be in their care for a minimum of 4 months. The grandparent kinship caregivers were required to be licensed foster parents in the state of Utah or have custodial or guardianship rights. The nonkinship foster parents were required to be licensed foster parents in the state of Utah. The participants had to agree to be available for the first 90-minute face-to-face interview in their home or other designated location and for a second 60-minute face-to-face follow-up interview in their home or other designated location. The participants had to agree to review their transcripts and make any changes they thought necessary. The participants were also asked to participate in a focus group. Monetary compensation was given at the end of each face-to-face meeting ($20.00 for the initial interview; $10.00 for the follow-up interview, and $20.00 for focus group participation).42 Recruitment Participants were recruited through the following five methods. The first invitation to participate in this study was sent out in The Foster Care Foundation of Utah's Foster Roster. This newsletter was electronically mailed (e-mail) to all licensed foster and or adoptive parents as well as kinship foster parents. The second invitation to participate in this study was mailed by the Department of Human Services (DHS) from a list generated by the DCFS of all foster parents, both kinship and nonkinship. The third invitation to participate in this study was by presentations I made at the Grandfamilies classes. I left flyers with Grandfamilies staff members to display during future classes. The fourth invitation to participate in this study was by flyers displayed at The Children's Center at the downtown location. The fifth invitation was through a snowballing sampling procedure in which participants referred interested parties to contact me. As potential participants contacted me by telephone or email, I called them and introduced myself, reviewed the criteria, briefly explained the study, discussed the requirements for their participation and the informed consent form, and outlined the monetary compensation. I informed them that at any time they had the option to withdraw from the study. I thanked them for their interest and offered them the opportunity to think about their participation. All interested people who met the criteria accepted to participate during the initial telephone contact. Informed Consent This study was approved by the University of Utah Institutional Review Board (IRB) on June 10, 2009. I coordinated all research documents with the University of Utah Institutional Review Board and the Utah State Department of Human Services 43 (DHS). Foster parents are considered independent contractors who provide services to children in custody of the State of Utah. The participants would be discussing these children in the study and therefore, I was required to submit a research proposal, a signed research agreement, and included an introduction to the informed consent regarding the confidentiality of foster children in the participants care. The Consent Document for Humanities or Social/Behavioral Science Research (Appendix A) was approved by both agencies and presented to each participant. Data Collection Qualitative studies often combine several data collection methods in the research process and these choices should be linked to the conceptual framework, research questions, overall strategy, and primary decisions about roles (Marshall & Rossman, 1999). This process is referred to as multiple data sources or triangulation, which Creswell (2003) defined as "different data sources of information by examining evidence from the sources using it to build a coherent justification for themes" (p. 196). Triangulation increases the validity of the findings by checking the accuracy through multiple sources (Creswell, 2003). This study used in-depth face-to-face interviews, member-checking, face-to-face follow-up interviews, focus groups, and field notes as the primary sources for data. Phase I: Individual Interviews After the initial call confirming their eligibility and interest, I arranged to meet the participants. Fifteen participants requested that we meet in their homes and 1 participant requested that we meet in my office. It is considered important in ethnographic interviewing to gain trust and establish a rapport with participants (Spradley, 1979).44 Before each interview, I made the participants feel comfortable by engaging them in brief conversations. I thanked the participants for agreeing to be in the study, reiterated the purpose of the study, asked them to read and sign the consent form (see Appendix A), and answered any questions. During many of the interviews, I was assisted by a research associate who audiotaped the interviews on my personal laptop computer. This enabled me to give my full attention to the participants without technical distractions. The research associate was trained in research procedures, ethics, and confidentiality. I began the interview process and used the specific questions (see Appendix B), and I followed up with additional probe questions as needed. The in-depth face-to-face interviews ranged in length from 90 minutes to 2½ hours. I conducted a total of 16 in-depth face-to-face interviews, and each was audiotaped. I took notes during all of the interviews. Phase II: Transcription During the second phase, all audiotaped initial interviews were transcribed. The transcriptions were completed by transcribers familiar with research ethics and confidentiality. I reviewed the transcripts and listened to the audiotapes of the initial interviews to check for accuracy. Next, I contacted the participants and mailed or emailed their transcripts with a brief explanation. The decision regarding how the participants received their transcripts was based on their request. I requested that each participant read and make notes before the face-to-face follow-up interview. Phase III: Member Checking/Follow-Up Interviews I contacted each participant to begin the member checking process. I mailed or e-mailed the participants their transcribed interviews and requested that they correct any 45 errors, make sure they communicated what they wanted to say, and make additional statements or clarifications. I scheduled 1-hour face-to-face follow-up interviews with the participants. The goal of member checking was to insure that the participants said what they meant to say and were given the opportunity to make any changes. The follow-up interviews were scheduled approximately 6 to 9 months after the initial face-to-face interviews. For the follow-up interviews, 15 participants requested that we meet in their homes, and 1 participant requested that we meet in my office. During these interviews, I responded to any changes they asked me to make as well as clarification to my questions. In the audiotaping and transcription process, some responses were inaudible and therefore left gaps in the transcripts. The participants and I filled in the gaps. There were no significant changes in the content; however, some participants asked me to remove repetitive "you knows," "ums," and "likes." Phase IV: Focus Groups Focus group research can take interpretive memory and expression beyond the individual memory, can induce social interactions, and can generate multiple meanings and perspectives (Denzin & Lincoln, 2005). The focus groups were important because the participants had a forum to process their individual interviews and relate to other participants in their group. In addition, varying accounts were reconciled by cross-referencing and adding to the multiple meaning of the participants' experiences. The focus groups were held in the conference room at The Children's Center. There was a morning group for nonkinship foster parents and an afternoon group for grandparent kinship caregivers. In the nonkinship foster parent focus group, there were 5 participants (all individuals) and in the grandparent kinship caregiver focus group, there 46 were 6 participants (two individuals and two couples). Participants gave their consent to be videotaped, but there was a technical malfunction, and the groups were audiotaped instead. I explored the common themes and opened up discussion for dissimilar responses. Following the focus groups, I listened to the audiotapes and made notes on the content of the groups. Each group was approximately 2 hours in length. The focus groups were structured to be a collaborative interaction that was guided by the participants. However, I did have several questions that I posed to the groups. For the nonkinship foster parents, I asked 1) if they do foster care for the money; 2) if the goal is adoption, does this affect their attitude toward visitation; 3) do they hold back building attachments when they know the children will eventually leave their care; and 4) should children be placed with kin. For the grandparent kinship caregivers, I asked if they could share feelings about 1) their own children, 2) their challenges with the system, 3) their role changes, and 4) to please share their thoughts about "the apple doesn't fall far from the tree" myth. Field Notes Field notes are descriptions of what was observed and should be detailed and nonjudgmental (Marshall and Rossman, 1999). Lofland (1971) suggested researchers a) take notes regularly and promptly, b) write down everything no matter how unimportant it might seem at the time, c) try to be as inconspicuous as possible in note taking, and d) analyze notes frequently. I made field notes, or analytic memos, which were analyzed by ongoing interpretation conducted throughout the length of the study. These field notes were helpful in tracking how my initial reaction, perceptions, and thoughts evolved. The expansion of my preliminary analysis was documented during the entire research process.47 Data Analysis and Interpretation The description of the analysis process is to bring "order, structure, and interpretation to the mass of collected data" (Marshall & Rossman, 1999, p. 150). I originally planned to analyze the data using the phenomenological approach as set forth by Moustakas (1994). However, as I began to immerse myself in the data I discovered that it was better served by the analytic procedures outlined by Marshall and Rossman (1999). The procedures are organizing the data, generating categories, themes, and patterns, coding the data, testing the emergent understandings, searching for alternative explanations, and writing the report (Marshall & Rossman, 1999). Organization of the Data I had three typed sets of data at the conclusion of the research phases. The first set of data was the audiotaped recordings of the initial face-to-face interviews and the focus groups. The second set of data was the typed transcriptions of the initial face-to-face interviews. The third set of data was the handwritten field notes. Throughout the process, I stored all of the above in a locked file cabinet in my home office. Immersion Immersion was not included as a procedure in Marshall and Rossman's 1999 Designing Qualitative Research, but it was added in their 4th Edition in 2006. Immersion is integral for qualitative analysis and I include it as one of my procedures. Sufficient immersion in the data was based on the length of time I spent with the participants and their responses. I spent many hours with the participants throughout the project. I came to know them intimately as they shared their very personal thoughts, feelings, and stories. When the interviews and focus group were completed, I spent hours analyzing the data. 48 The quality of the results was based on the experiences that these participants shared and their willingness to have their voices heard. The sense of immersion was evident when I felt the data were thoroughly shared, recorded, processed, and written up to reveal the rich accounts of the participants. Generating Categories, Themes, and Patterns I listened to the interviews before the actual transcription process and read my notes from each interview. When the transcripts were completed, I read through them many times. The transcripts included the 20 questions followed by the participant responses. By this time, I developed a sense of what themes were emerging. Participant responses were lengthy, in depth, and filled with emotional content. I highlighted responses that were related to attachment relationships, trauma and traumatic grief and loss, and other pertinent or interesting responses. I highlighted similar responses, and I highlighted different responses. I made a list of all 20 questions and placed all the responses under the specific questions grouped by grandparent kinship caregiver or nonkinship foster parent. The responses for both groups were kept separate and this provided me the opportunity to compare within each group as well as between groups. I then made a list of all participants and created individual participant profiles, which turned into biographical sketches for each participant that described the lives with the preschool-aged children in their care and of their own lives. It was through this process that numerous themes and subthemes emerged. Given the vastness of the data, it seemed overwhelming to reduce the themes to a manageable number. I was advised to refocus on the original research question instead of 49 the specific interview questions (C. Gringeri, personal communication, August 18, 2012). The final step was to name the themes and subthemes that revolved around the key concept of attachment relationships. Coding the Data I reviewed the transcripts once again with the five themes in mind. I extracted specific statements from the interviews to support each of the themes and began organizing them under each theme. Each group was designated by a different color and each theme was designated by another color. Search for Disconfirming Evidence Cross case comparative analysis is a method to designate similar instances and disconfirm examples of cases (Yeh & Inman, 2007). In phenomenology, this is referred to as intersubject analyses, and the purpose is to conduct a thematic analysis across the cases (Yeh & Inman, 2007). I utilized this method as I coded a single case and then compared it to other cases or transcripts. This process was helpful when looking at the similarities and differences among and between the two groups. Writing the Report The writing model is a way to present the collected data gathered through in-depth interviews and participant observations through the participants' point of view and lived experiences (Marshall & Rossman, 1999). As I approached the writing, I was confident that I had the foundation to describe the participants lived experiences. I wrote numerous drafts until I was certain that I was genuinely communicating the participants' 50 attachment experiences. The results of this study were written as thematic narrative and provided rich examples of the themes and subthemes through transcript passages. Researcher as Instrument In the fundamentals of qualitative research, the researcher is uniquely considered an instrument in the research process. The researcher is involved in an intensive and sustained interactive relationship with the participant and this association allows the researcher to interpret the findings (Creswell, 2003). The researcher uses self-awareness in acknowledging, expressing, and understanding how personal particular biases, values, interests, and personal characteristics may influence the research, and this is known as reflexivity. The personal self cannot be separated from the researcher self (Creswell, 2003). I am the researcher of this qualitative study and I am a Licensed Clinical Social Worker. I provide mental health services to young children, many of whom are living in grandparent kinship placements and nonkinship foster families. There is a considerable overlap in the interviewing skills that counselors and researchers are trained in, as well as different aims for these professions (Polkinghorne, 2005). It is important for counselors who are doing research to be clear and clarify to the participants the goal in the process (Polkinghorne, 2005). During the research, I made a conscious effort to maintain a professional researcher stance and only employ therapeutic skills as a method for engagement, not therapy. Researchers should clarify the bias they may bring to the study (Creswell, 2003). It is important in qualitative research for the researcher to acknowledge biases before as well as throughout the research process. My research interest is based on my clinical 51 experience and desire to help grandparent kinship caregivers and nonkinship foster parents with preschool-aged children in their care. I am cognizant of the abuse, neglect, and traumatic life events that many children suffer while in the care of their biological parents. I provide mental health treatment to attenuate the significant referral concerns for these children in out of home placements. My bias is that I strongly believe that the best interest of the child supersedes any other parties' interest. I am an advocate for the child to live in a safe, nurturing, and healthy environment be it in a grandparent kinship caregiver home or a nonkinship foster family. I believe the needs of the child are the priority in these cases. Pilot Study During my doctoral curriculum, in 2006 I designed a study, developed an interview protocol, interviewed participants, analyzed data, and presented the results. I based my research on attachment theory because it was an important perspective in my work with children and their families. The study was entitled Two Hearts: A Qualitative Study of Kinship and Non-Kinship Foster Care Parents. Two grandparent kinship caregivers and two nonkinship foster parents participated in the study. There were several interesting observations that emerged from the data, which helped guide my dissertation research. In both groups, participants reported that parental drug abuse was the reason that the children in their care were removed. By the grandparent kinship caregiver reports, the child/parent dyads were characterized as mostly positive until their children became involved in methamphetamine. This challenged the assumption that grandparent kinship 52 placements may be inappropriate due to intergenerational transmission of negative attachment patterns and/or other adverse childhood experiences. Grandparent kinship caregivers reported more positive perceptions of the grandchildren in their care. They also reported more secure attachment characteristics; a shared perception that their roles were to provide safety, nurturing, and healing; experienced role conflict; and had feelings of anger towards their adult children's choices. Nonkinship foster parents reported less positive perceptions of the children in their care. They also reported less secure attachment characteristics; a shared perception that their roles were to be a disciplinarian, teacher, and to correct behaviors; had mixed feelings toward the biological parents; and were embarrassed when their foster children misbehaved in public. Trustworthiness The four constructs in qualitative research to establish trustworthiness are credibility, transferability, dependability, and confirmability (Denzin & Lincoln, 1994). Credibility refers to the truth of the findings and the lived through experiences of the participants (Leininger, 1994). There are strategies in qualitative research that check the accuracy of the findings (Creswell, 2003). I used triangulation, member-checking, peer debriefing, and negative or discrepant information. I used triangulation, which is the process of incorporating various sources of information such as interviews, videotapes, and field notes. I used member-checking to verify the accuracy of the participants' meanings to facilitate appropriate additions or edits to the material. Negative or discrepant information was investigated during the cross analysis of themes because53 "contrary information of an account adds to the credibility for the reader" (Creswell, 2003, p. 196). Transferability refers to whether particular findings can be transferred to another similar context or situation (Leininger, 1994). This should not be confused with generalizability, which was not the purpose of this study. The intent of this study was to add to the body of knowledge regarding attachment theory, offer rich descriptions of grandparent kinship caregivers and nonkinship foster parents, and explore the greater meaning of the world of grandparent kinship caregivers and nonkinship foster parents. Thick descriptions enhanced the transferability of this research. This writing technique transports readers to the setting and brings a feeling of shared experiences with the participants (Creswell, 2003). The grandparent kinship caregivers and nonkinship foster care parents shared many stories about their attachment relationships. This was the first qualitative study to explore the attachment experiences of grandparent kinship caregivers and nonkinship foster parents. Additional research in this area may support the transferability of the findings. Dependability refers to stability of the findings over time and the cogent relationship between the data to the findings and interpretations (Denzin & Lincoln, 1994). Dependability is achieved by an audit trail, which documents the chronology of the research activities, processes, data collection, analysis, emerging themes, models, and analytic memos (Morrow, 2005). I created an audit trail by documenting all activities, procedures, notes, and analyses from the beginning of my research. Confirmability refers to repeated direct participatory and documented evidence from the participants to ensure the observer is gaining the correct information (Leininger, 54 1994). I probed and verified feedback as I conducted the initial interviews, the follow-up interviews, and focus groups. I asked the participants to verify the accuracy after the transcription phase and make any necessary changes. I suppressed any preconceived thoughts or judgments that might influence my interpretation of the data. Study Limitations The first limitation is that the sample is inherently dissimilar in many ways as grandparent kinship placements are different than nonkinship foster care families. Grandparents have existing relationships with their grandchildren giving them the advantage in attachment experiences. Nonkinship foster families are at a disadvantage because they may only have hours or days before children enter their home, and these children are often traumatized and confused by the whole situation. The second limitation is that the grandparent kinship caregivers in this study all participated in the Grandfamilies Program and/or participated in therapy at a mental health facility. This might suggest that these caregivers had some basic knowledge of attachment issues such as RAD, trauma, and traumatic grief and loss. However, nonkinship foster parents had more systematic resources such as trainings, financial support, and access to medical and mental health services provided by the state. Foster families generally have their own support system, respite care, and the opportunity to receive help in times of crisis. Dissemination of Findings This study has four areas of dissemination. I will first disseminate the final written dissertation to the University of Utah Marriott Library and other national dissertation databases. The second area is the opportunity to write papers based on the results and hopefully inspire other researchers to conduct additional research. The third 55 area involves potential educational presentations at conferences and seminars for DCFS, mental health providers, and grandparent kinship caregivers and nonkinship foster parents. The fourth area is to contribute my findings to the TF-CBT foster care collaborative conducted by Judith A. Cohen, M. D, Anthony Mannarino, PhD, and Esther Deblinger, PhD and to the NCTSN in their goal to address traumatic stress in young children. Summary In this chapter, I described the methodology that guided the research process. With this framework in place, I moved into the actual research phase. It is important to note a significant challenge I encountered while I attempted to enlist participants. I discovered that grandparent kinship caregivers do not identify themselves as foster parents and did not respond to the original flyers. I respected these participants and changed the wording of the flyers and adapted the title of the study to reflect their preferred identities. In Chapter IV, I present the findings from the interview, analysis, and write-up phases of the research. There were five themes that emerged and subthemes for each of these themes. The qualitative research approach facilitated the following in-depth responses and thick, rich descriptions of attachment experiences in the grandparent kinship and nonkinship foster care milieu.CHAPTER IV FINDINGS Overview The purpose of this study was to explore the attachment experiences of grandparent kinship caregivers and nonkinship foster parents with preschool-aged children in their care. Having worked as a therapist for preschool-aged foster children and their families, I believed that their unique experiences deserved further attention and understanding so the mental health field, the child welfare system, and involved families could better serve this population. The world of grandparent kinship care and nonkinship foster care is a phenomenon and their experiences are rich and varied. I conducted the analysis through an interpretive phenomenological approach to truly understand the depth and the breadth of their experiences. This chapter presents the key themes and findings from in-depth interviews, follow-up interviews, and focus groups. The five themes that emerged were: 1) importance of family; 2) attachment, trauma, and traumatic grief and loss; 3) challenges; 4) roles; and 5) family relationship styles. The following thematic narrative provides information to support and elucidate each theme and finding. The purpose of this section is to make connections between the data, interpretation, and conclusions. To better understand the lived experiences of the participants, I use direct quotations to illustrate, deepen the meaning, and give voice to the participants. I use the spoken words of the participants to honor their valuable 57 contributions and allow the readers to gain further insight to the underlying meaning of the participants' experiences. Throughout this section, I first present the responses of the nonkinship foster parents followed by the grandparent kinship caregiver responses. All nonkinship foster parents were married but only the wives participated in the interviews. Of the grandparent kinship caregivers, 2 married couples participated in the interviews and the others were divorced single women. The couples that participated in the interviews did not have separate interviews and are considered as 1 participant in the summary. Pseudonyms were used for all participants as well as for the children in their care. Theme 1: Importance of Family The family is considered a fundamental unit of society and the root of culture (Macionis, 2000). The importance of family was the driving force for the participants in the study. For the nonkinship participants it was about "building" a family, for the grandparent kinship caregivers it was about "maintaining" the family. This became evident as I explored the reason each participant decided to take on the role of nonkinship foster parent or grandparent kinship caregiver to a preschool-aged child. The participants' desire, motivation, and hoped for outcome with the child in their care provided insight to the attachment process within the context of family. Nonkinship Foster Parents In the nonkinship foster parent group, there were three reasons the participants decided to become foster parents to preschool-aged children. The majority of the participants identified their reason as being unable to have biological children. Several participants identified that they had biological children but wanted to increase their58 family size. Several participants identified that they were motivated by altruism. Whether it was to build a family or help children until they could reunite with their families, the value of family was highlighted in this group's narratives. Unable to have biological children. Four couples pursued foster care because they could not have children of their own. Their goal was to become parents and raise a family, and they viewed fostering as a conduit to adopting children. These participants were identified by DCFS as "legal risk placements," which means if the reunification process with the biological parent(s) is unsuccessful, the children would become available for adoption. A legal risk placement is also referred to as "foster to adopt." All 4 couples pursued adoption before fostering, but adoption proved to be unsuccessful. Jane explained: I decided to become a foster parent because…we don't have any biological children of our own. We got licensed to become adoptive parents…or approved to do adoption. We still are approved to be adoptive parents, but nothing panned out with that over 4 years. So, we decided it was the right time to look into foster parenting. We called up the lady, and she came to our house, and we made the decision to go ahead and do it. Cara stated, "We weren't able to have kids, so we looked into foster care or adoption and we attended both [classes]." The LDS faith-based adoption class provided information about parent profiles and the increasing rate of single mothers keeping their babies. Cara described the feelings she and her husband Brice experienced: Also the statistics they gave us were really discouraging. They said that. They said but if you pray and you know there are children coming to you, then this is where you need to be. That's great, but we didn't feel like that was right for us. The adoption agency told the couple that if they were not interested in adoption there was a foster class, which is also faith-based at the Utah Foster Care Foundation. They attended that class and as Cara admitted, "We felt more in tune there…it was great." It is 59 important to Cara that I included that it was great having classes based on her religion. She strongly felt it would be important for other religions to have faith-based foster classes. Two couples in this group noted the favorable financial aspects of fostering to adopt as compared to private or international adoption. The approximate cost for a foster care adoption ranges from $0 to $2,500, while a licensed private agency adoption ranges from $7,000 to $40,000; an independent adoption ranges from $8,000 to $40,000, and an international adoption ranges from $7,000 to $40,000 (Children's Bureau, 2011). Kelly remarked: My husband and I can't have kids, and doing foster to adopt is the cheapest, fastest way to get young children adopted into your home that we have found. There's obviously other ways to adopt, but it takes a long time and costs a lot of money. So, we decided to do foster to adopt. Leslie and her husband Paul were pursuing an international adoption for 2 children in Bulgaria before they decided to become foster parents in the hopes of adopting. Leslie commented: "When we looked into all the paperwork and things to go through we thought about all the little children here that needed families, so we decided to do foster care." Desire to increase family size. Two couples pursued foster care because they wanted to have larger families. These foster parents had biological children but valued large families and hoped to adopt through fostering children. Both of these wives who participated in the interviews grew up in large families. Patty was raised in a family of 13 brothers and sisters and this number included several internationally adopted children. Patty and her husband Kyle had 6 biological60 children, adopted children from other countries and the United States, and fostered several other children. Patty admitted: That's a really long story. We wanted to adopt one or two more kids, and we had been trying to adopt for about 5 years. And we kept having failed situations. So, we decided that we would try the foster care route. About…several months after we had signed up as foster parents we got notified about one child. So, we thought we were going to adopt her and didn't, but we still wanted one or two kids. We just decided we would do that, and luckily our second placement is turning into an adoption. Our purpose was to adopt. We didn't do it just for the good intentions for helping people. Although, if we continue to do it, that's what we will be doing. Lynne was raised in a large family of 7 and described it as a "strict religious household." Lynne said her mother stayed at home while her father worked full time. Lynne and her husband Edward have 3 biological children but wanted a larger family. Lynne recalled, "So, we decided to look into foster care as a way to expand our family either temporarily or permanently. We had the space in our home and in our hearts to welcome in more children." Altruism. Two couples pursued foster care to fulfill their desire to give back and help children and families in need. The goal for these families was to take foster children in on a temporary basis until they were able to reunify with their biological parents or until the state made other decisions. During the interviews, both participants shared altruistic motives. These 2 participants were different as 1 has been a foster parent for over 8 years and the other participant agreed to become a foster parent because she knew the children through community ties. Vivian and her husband Trent raised her biological children, were foster parents to many children in their homes, adopted 2 sibling foster children who were in their care, and just recently adopted 2 more sibling foster children. Vivian always wanted to be a 61 foster parent, but she wanted her own children to be old enough to share the experience. Vivian explained how it all came about. I had lost my job and said, you know what I would love to do is hang out in sweats all day; I would love to hang out with kids, and I know I can help. I know I can do something to make their lives better, and my husband said if that's what you want to do, then we will do it. So we started 8 years ago, and I love it. I miss working with grownups and being around people that form full sentences, but I love what I do, and I finally found what I was meant to do. Susan and her husband Jordan raised 3 biological children before they became foster parents to a sibling set of 2 preschool-aged children whom they knew in their community. Susan said the children had been in their home while her daughter babysat them, but she didn't "have any particular attachment to them." When the situation arose that the children needed an out of home placement, it was Jordan's encouragement that swayed Susan's decision. Susan stated: They [DCFS] were trying to rush…it's interesting how things from years ago kind of play into it. Like my friend had a foster child 3 or 4 years ago. My husband kind of thought we should do something like that. We have a good stable family, and we should give back somehow. Yet, we didn't want to just go through the system and take any foster child. So this came up, it just seemed right. But on the other hand, my husband had a couple of foster kids growing up in their family that really ruined relationships in their family. He had a lot of negative things thinking about foster kids. I would have never suggested it. He's the one who said, yes we'll take them, and I said, yes we'll do that. Susan admitted that not everyone in the family was supportive of their decision to become foster parents. Years before, Jordan's mother had been a foster parent to children in the system and warned Susan, "You're going to get your heart broken, don't do it. You're going to get your heart broken." Grandparent Kinship Caregivers In the grandparent kinship caregiver group, there were three reasons participants decided to become caregivers to their preschool-aged grandchildren. Several participants 62 were designated as kinship placements when DCFS became involved. The majority of participants took charge of their grandchildren before DCFS removed them. Several participants were already acting as primary caregivers to their grandchildren. In every case, the children were removed or taken in by their grandparents due to exposure to drugs, alcohol, neglect, and/or child endangerment. These grandparents wanted to provide their grandchildren with a safe environment and maintain family ties. The value of family was highlighted in this group's narratives. DCFS involvement. Two couples identified that their grandchildren were removed by DCFS, and they were designated as kinship placements by the court. Both participants had different experiences of becoming a grandparent kinship caregiver placement. Elizabeth and her husband, Dan, were at the hospital the day their grandchild was born. The situation quickly changed, as they became a kinship placement that same day. My daughter, Whitney, her mother was using meth, and at the time of her birth DCFS came in and told us that my daughter had used meth and they had taken custody of Carly. We as a family took custody of the 2 granddaughters, her older sister Judy and Carly. Time went by and Whitney went through classes through DCFS, and we had custody of the girls. She tried to get herself clean along with the children's father, and they couldn't get clean. They didn't want to get clean. So, then the judge didn't have a choice but to take the children away from her. At that time, my husband and I were given the opportunity to take the children. Of course we did. We told him that we would adopt them. So, we adopted both of them. Carol did not have much contact with her grandchild, but she knew there were problems. It was not until Vanessa was 3 years old that the child was removed by DCFS from her mother for child endangerment. It was at this time that grandparents, Carol and Nathan, became a kinship placement for their grandchildren. Carol gave her reason: "To keep the family together and we're the only family they know."63 Stepped in before DCFS involvement. Four participants stated that they did not want their grandchildren to go into foster care so they took action to avoid this from happening. Two of the 4 participants are divorced single grandmothers and the other 2 are married, but only 1 spouse participated in the interviews as a couple. All of the participants felt a responsibility to keep the family intact. Julie was already acting as primary caregiver for her grandsons when she decided to seek guardianship. Julie's daughter left her son Jerry for such long periods of time that he considered his home to be with his grandmother. Julie felt she needed to "get something in writing" so she could make decisions on behalf of her grandson. Julie explained: Like my decision to raise you guys was I had to step up. I didn't want the state to take them. It was my responsibility, and they have always been with me off and on. Even when I lived with my mom they have always been in my life. Nina's daughter and her husband lived down the street with their 2 children. Nina had a close relationship with her grandchildren and saw them every day. Nina was aware the couple had used illegal drugs before, but did not know they were still involved with them. One night, law enforcement raided the couple's home for producing and selling methamphetamine. Nina took her grandchildren before DCFS arrived. It was a quick decision to take them and a quick decision to keep them, as she commented: "Well, that was kind of made on the spur of the moment in the juvenile court. We walked into the court for a juvenile hearing, and the judge asked if I wanted permanency. It was decided in a heartbeat." Joyce beca