“Nothing but a pair of shorts and a lifetime of trauma”: Trauma-related concerns of US foster caregivers

Abstract

BACKGROUND:

Caring for a child who has experienced trauma is a common expectation for foster caregivers; it is well-recognized that youth entering care will have experienced at least some level of trauma, often needing trauma-sensitive caregiving and mental health supports while in care. Foster caregivers receive varying degrees of trauma-related trainings, and have a range of experience providing care for this population.

OBJECTIVE:

This study sought to understand the themes relating to trauma that foster caregivers raise when discussing their experiences with fostering, and how this relates to their reported trainings received.

METHOD:

A convergent mixed-methods study was conducted with non-kinship foster caregivers (n=45); we intentionally merged findings from a phenomenological inductive analysis of semi-structured interviews about their lived experiences with a description of quantitative results from a survey about trauma training experience.

RESULTS:

Five primary themes were identified, each with several sub-themes: recognition of child trauma, child behaviors linked to trauma, service issues, foster caregiver experiences, and trauma from the foster care process. The majority of participants reported receiving trauma training, yet felt unprepared to manage the trauma experiences and needs of children in their care.

CONCLUSIONS:

Foster caregivers have a baseline training in trauma that facilitates their ability to identify the effects of trauma on child development and functioning. However, they still feel overwhelmed providing this care and see significant gaps in training and services that warrant attention and intervention.

In the United States, each year, there are over two million reports of child abuse or neglect that result a child welfare investigation for varied reasons (e.g., suspected neglect, abuse, parental drug abuse; Children’s Bureau, 2025; Administration for Children and Families, 2022). In 2023, over 540,000 youth were involved in investigations that were substantiated, confirming them to be victims of abuse or neglect, and approximately 20% of these youth were removed from their home and placed in foster care (Children’s Bureau, 2025). It is estimated that 62% of removals are due to neglect, 33% are due to caregiver drug abuse and 13% are due to physical abuse (Children’s Bureau, 2023).

Youth in foster care have a lifetime history of traumatic event exposure twice that of the general population of children in the US; estimates suggest that 82% of foster youth have experienced at least one traumatic event, with the majority of them experiencing multiple (Salazar et al., 2013). Additionally, prevalence of posttraumatic stress disorder (PTSD) ranges from 14 to 30% among youth in care, compared to approximately 7% among the general population (Salazar et al., 2013). Youth in child welfare who have experienced trauma, including that from placement instability while in care, often have higher emotional vulnerabilities such as difficulty identifying and regulating their emotions, or increased rates of avoidance in attempts to mitigate feeling triggered (Delaville & Pennequin, 2020). Supporting and nurturing youth who have experienced trauma is therefore a primary part of being a foster caregiver. Having the knowledge and capability to interpret child behaviors and emotions in a trauma-sensitive way, and provide trauma-informed care, has been linked to numerous outcomes across various stakeholders in the child welfare system, including case workers, caregivers, educators, and service providers. Research has documented that trauma-informed care can improve the mental and emotional wellbeing of youth in care, while also reducing caregiver stress and increasing placement stability (Bunting et al., 2019). However, the effectiveness of trauma-informed care on improving child outcomes while in state custody likely vary based on the intervention strategies used, among other contextual factors (Zhang et al., 2020).

Trauma Training for Foster Caregivers

Foster caregivers, be they kinship or non-relative, undergo training, certification, and monitoring by state child welfare agencies (Hebert & Kulkin, 2018). These measures are taken in an attempt to reduce the risk of ongoing harm to youth, and to hopefully facilitate an environment in which they can heal from the trauma or adversity they have experienced. However, findings from both foster care youth (Riebschleger et al., 2015) and foster caregivers (Carew, 2016) underscore the need to receive more training to increase awareness of the trauma histories of youth in care. Bonfield et al. (2010) found that foster caregivers with less mental-health-related knowledge were less likely to seek mental health services for the foster child in their care, compared to those with more mental health-related knowledge. Thus, it is essential that trauma-informed care systems are utilized by child welfare systems and effectively implemented into accessible training for foster caregivers.

In Virginia, where the present study was conducted, foster caregivers are required to complete pre-service training and attend annual in-service training (Virginia Department of Social Services, 2022). State training requirements include core competencies related to trauma (Virginia Department of Social Services, 2022). For local departments of social services across the state, Virginia Department of Social Services (VDSS) utilizes the Parent Resource for Information, Development and Education (PRIDE) curriculum (Virginia Department of Social Services, 2022). While PRIDE has been rated favorably among foster caregivers and shown to be effective in increasing their post-training knowledge on PRIDE topics covered, including “ameliorating the effects of trauma” (Child Welfare League of America, 2025; Nash & Flynn, 2016), there is limited research evaluating the long-term effects of pre-service training on caregiver behaviors or child outcomes (Dorsey et al., 2008; Cooley et al., 2019). Further, there is no universal system for implementing and tracking the fulfillment of these requirements, and private agencies within the state may opt to offer trainings other than PRIDE (Haynes, 2024). Several studies evaluated the effects of trauma-focused training programs for foster caregivers, developed by the National Child Traumatic Stress Network, finding that programs on trauma-informed parenting were effective in increasing caregiver knowledge and recognition of child trauma symptoms, reducing symptoms over time, and alleviating parenting stress (Gigengack et al., 2019; Konijn et al., 2020). Although prior research has established that implementing trauma-informed care systems carry benefits for foster children in care, child welfare agencies, and foster caregivers (Bartlett & Rushovich, 2018), the lack of standardized requirements poses the question of whether foster caregivers are receiving the trauma trainings necessary to meet their needs when it comes to caring for a child who has experienced trauma.

Present study

The present study used a convergent mixed-method design. For the qualitative portion of the study, we took a hermeneutic phenomenological approach to understand which aspects of caring for a foster child with a history of trauma were salient enough that foster caregivers would raise the topic when discussing their experiences, more broadly. Caregivers were interviewed as part of a larger mixed-method study exploring their experiences fostering and their relationship with the child in their care. The interview did not include questions directly asking about trauma, but asked about a range of experiences and scenarios relating to their work as foster caregivers. However, participants frequently raised the topic of trauma. These observations led the study team to inquire which trauma-related themes could be identified within the interviews, and how they related to survey responses simultaneously assessed which asked about which training topics caregivers had experienced during certification, their feelings of preparedness from the training, and continuing education they desired through their agency. Documenting the topics relating to trauma that are top of mind for foster caregivers, and additional services they desire, will help identify areas in which the child welfare system can improve to support them in this work, thereby improving child mental health and wellbeing.

Method

Participants

This study included 45 foster caregivers who were recruited for a larger convergent mixed-method design study. Caregivers had to speak English, be currently licensed to foster in the state of Virginia, and be caring for a child between the ages of 3–17 years who had been with them for at least the previous 30 days and who was anticipated to remain in their care for at least another 30 days. Caregivers were excluded if they were a kinship placement. The decision to exclude kinship caregivers from the larger study was in an attempt to control for some variation in experiences within our sample; kinship caregivers have inherently different experiences and relationships with the youth in their care, because of their prior relationship with them, whereas non-kinship caregivers are starting their relationship with the child from scratch at the start of placement.

Procedure

Ethical approval for the study was obtained from the [blinded for review] Institutional Review Board. Caregivers were recruited through study flyers distributed by their local department of social services, private licensed placement agency, foster care school liaison, or other community resources, such as libraries or mental health clinics. Interested individuals were invited to complete a pre-screener to determine qualification. Participants were consented through an online Zoom meeting and then completed an online survey. A subset of the survey respondents was invited to complete the interview which took place via Zoom and was recorded for transcription. Participants were invited to the interview based on purposive recruitment attempting to capture a range of perspectives from caregivers of varying backgrounds and experiences. Demographic data including participant age, gender, relationship status, income, employment, educational attainment, and duration of time fostering were collected.

Semi-structured interviews were conducted by trained interviewers (AWW & DF). Caregivers were asked about their motivations to begin fostering, their relationship with the foster child in their care, their views on the child’s current functioning and wellbeing, their relationship with the child’s family of origin, the caregiver’s practices when discussing race and culture with the child, and caregivers’ thoughts on services and trainings they wished they could access (for themselves in their caregiving role, or for the youth in care). The interview concluded by asking advice they would give to individuals considering fostering, as well as those working within child welfare. Participants were compensated $50 via e-gift card for their time. Interviews lasted an average of 53 minutes (range 20–120 minutes). Transcripts were automatically drafted using the Trint software and then verified by two independent research assistants for accuracy.

Measures

Demographic, placement duration, and certification duration data were all collected via the quantitative survey from the larger study. The survey also included several items regarding pre-service training topics that foster parents may have covered, whether this prepared them, and what else they desired in terms of trainings. To begin, they were asked, “What counseling and/or training did you receive from the placing agency while you were becoming a certified foster parent?” Response options were yes or no to a series of 17 different topic items. Two of the items, trauma-informed parenting practices and the impact of trauma on child behaviors/how to understand your foster child’s actions and emotions, were used for the mixed-method analysis in the present study. Following this question, participants were asked whether they felt this fully prepared them to become a foster parent (response options: yes or no). Lastly, participants were given a free response field to indicate “what else [they would] have wanted, to feel more prepared?”

Data Analysis

For the qualitative analysis, a hermeneutic phenomenological approach was decided on due to the goal of understanding the phenomenon of being a foster caregiver, particularly in regards to how that relates to themes of trauma, while taking into account the context and impact of the researchers’ perspectives and subjective experiences (Lopez & Willis, 2004). Data was coded and managed in the Dedoose version 10.0.59 software (Dedoose, 2025). The coding team read each transcript in full, coding for any instances in which the participant mentioned trauma directly, be it their own, or that of a family member, including the foster child.

The coding team included: the primary investigator (AWW), who is a clinical psychologist working with adoptive and foster families and was raised in her biological family; a research assistant with a MSW (DF) who currently works at a private licensed placement agency within Virginia and is an international adoptee; and a research assistant with a bachelor’s degree in psychology (GC) whose research has focused on family dynamics and trauma and was raised for in her biological family. Each coding team member had varying degrees of clinical or professional training relating to trauma. To begin, the team met to engage in reflexivity and discuss experiences that could shape or bias their viewpoints during the coding process. The team identified personal and professional experiences they each had which led them to empathize with foster youth and sometimes hold a guarded view of foster caregivers, particularly if they expressed parenting practices that were not aligned with what the research suggests is most conducive with positive youth development, or if they expressed stigmatizing views of the child in their care.

The team used an interactive, inductive coding approach, following the methods outlined by Cohen et al. (2000). A number of strategies were incorporated to ensure trustworthiness of the findings (Lincoln & Guba, 1986). To increase consistency of findings, the team began by independently coding five transcripts before coming together for group coding. Codes were merged and nested into themes as they were identified, with the structure of the coding system evolving through an iterative process. The coding team met weekly during coding to discuss emerging themes as well as personal biases or experiences they were noticing within themselves during the coding process. An audit trail of all decisions about coding was maintained to enhance dependability of findings. Each transcript was double-coded, and discrepancies between coders were resolved by the third team member. Additionally, to increase credibility, a fourth team member external to the coders (HAM) with a doctorate in social work who researches adoption and has lived experience as an international adoptee engaged in peer debriefing in which she reviewed the coding structure and sample excerpts in order to provide feedback and additional interpretation to inform the final themes and codes presented.

A descriptive quantitative analysis was conducted on the survey responses regarding experience with different trainings, feelings of preparedness, and desires for additional trainings, or services. Quantitative findings were then intentionally merged with the qualitative themes for the summarized convergent mixed-method results (DeCuir-Gunby & Schutz, 2018). Individual transcripts were not returned to participants; however, following the summarizing of the findings, all participants were invited to a series of webinars in which findings were shared back, and feedback was welcomed. Twelve of the participants engaged in the webinars, and comments indicated that they agreed with the interpretation of quotes and found the overall findings to accurately represent their experiences.

Results

Sample Characteristics

Forty-five foster caregivers who participated in the larger study completed the qualitative interview. Four interviews did not mention trauma, 10 mentioned it one or two times, 23 mentioned trauma between 3–10 times, six mentioned it 10–25 times, and the two participants with the highest frequency of trauma discussion had 49 and 60 codes within their interviews. Despite four not mentioning trauma, they were retained in the sample given we felt their lack of discussion of trauma was still a valuable and noteworthy contribution to the mixed-method analysis. Participants had a mean age of 44.8 years (range 27–63) and had fostered for an average of 7.3 years (range >1–35 years). They identified as female (71%), male (27%), and non-binary (2%); white (67%), Black or African American (27%), Asian (4%), Hispanic or Latino (9%), and Other (2%), with several selecting more than one racial or ethnic identity. The majority were married or cohabiting with a long-term partner (78%). Most identified as being Christian (71%), while a large proportion reported no religious affiliation (18%). Educational attainment spanned from less than a high school diploma (4%) to one or more years of graduate school (49%). Approximately half of the sample was making under $100,000 as a household, excluding their foster care stipends. These characteristics are fairly consistent with demographics of the state of Virginia, with the exception of the sample including a much higher proportion of single-parent households than is typical across the state.

Based on survey responses, thirty-seven (82%) foster caregivers reported having received training from their agency regarding the impact of trauma on child behaviors, as well as how to understand the child’s behaviors and emotions within the lens of trauma. Thirty-six (80%) reported having received training on trauma-informed parenting practices, such as discipline. Thirty-four (76%) endorsed having received training that covered both topics, while six (13%) reported not receiving training in either area. Of those who received neither type of trauma training, two still reported feeling fully prepared to become a foster caregiver. Nineteen (42%) of those who received training covering one or both topics felt prepared, while twenty (44%) still felt unprepared, despite having these and other parenting- and mental health-related trainings.

When asked in the survey to identify additional trainings they felt would have made them feel more prepared, five out of the 17 who provided responses endorsed still wanting more trauma-related trainings. Three identified that having the chance to shadow families providing trauma-sensitive care or discuss case examples would have helped them feel more prepared. Five participants noted that they didn’t think any amount of training could have fully prepared them, and another five noted that continued case-specific trainings, such as those tailored to a child’s diagnoses, after a child is placed with them would have helped them to feel more prepared and supported in their caregiving role.

Themes

Five key themes were identified throughout the interviews, each including several subthemes (see Table 1). Description of each, including supporting quotes, are detailed further.

Table 1.

Trauma Themes and Sub-Themes

Theme	Sub-Theme
Recognition of Child Trauma	High Trauma Load
	Trauma Age
	Trauma Triggers
	Impact on Child Mood
Child Behaviors Linked to Trauma	Difficulty Forming or Maintaining Relationships
	Hygiene Issues
	Need for Control
	Challenging Authority
	Opportunity for Healthy Functioning
Service Issues	Lack of Necessary Services
	Additional Trauma Training Needs
	Importance of Trauma-Informed Care
Caregiver Experiences	Need for Flexibility
	Constant Challenge
	Overwhelm
	Preference for Youth Without High Levels of Trauma
	Lack of Transparency Regarding Child Behavior Before Placement
Trauma from the Foster Care Process	Entry Into Care is Traumatic
	Grief Relating to Child Leaving Placement

Recognition of Child Trauma

By far, the most prevalent theme was foster caregivers’ recognition of trauma within the youth that they care for. Many participants shared experiences that highlighted their ability to recognize a history of trauma and the impact that has on current child functioning.

High Trauma Load.

Foster caregivers noted the high trauma load they understood the children in their care to have experienced. One participant emphasized the importance in recognizing that “the trauma that these kids have endured is nothing like you could ever imagine.” She noted that children coming into care will have experienced a wide range of traumas. Others noted that their recognition of the high trauma load was a motivating factor to become foster caregivers, so that they could facilitate healing from the trauma:

Just being taken out of your home is traumatic, and you add the layers of all the reasons why kids are removed from home, and you get kids who don’t know how to behave or can’t behave because of all the things that have happened, and that made a big impression on me… just watching my parents provide that safe place for kids to heal.

Trauma Age.

Many foster caregivers observed that the child in their care appeared to be developmentally delayed in certain regards, or stuck developmentally at the age in which a significant trauma happened. Caregivers referred to this as the child’s “trauma age” and found it surprising that the child did not know how to do certain things they would expect of a child that age. One participant with decades of experience as a foster caregiver noted that, “the one thing I can see with every foster child I’ve had is, the time they are taken from their home, it’s like a time in… they’re frozen. It’s like there’s a spot they can’t get over.”

Participants frequently described observations of age-inappropriate emotional outbursts in response to not getting their way, such as an eight-year-old who “hissed and growled at other children” or a fourteen-year-old who lay on the floor throwing a tantrum “equivalent of, like, a five-year-old hissy fit.” Further, they identified gaps in what the child had learned by that age: “by that age it was expected for her to be able to say a few words, but she was not able to… because of what she had gone through.” These observed gaps or delays in development led some to have concerns when it came to the amount of developmental catch-up that was needed. A caregiver of a teen in foster care shared that, “she runs up to people that she does not know like she’s five years old… I’m worried about this one because she’s going to be eighteen and there’s a lot for her to learn in a short period of time.”

Trauma Triggers.

Foster caregivers frequently referred to trauma triggers, identified as objects, people, or places that were associated with the trauma the child had experienced and ignited a strong emotional outburst, trauma response, or traumatic memory when the child experienced the trigger. The discussion of triggers came up in two contexts. One was the recognition of things caregivers knew triggered the child in their care. Often, they identified specific people who were triggering for the child to be in the presence of. One caregiver noted that “grandparents were a trigger because he wanted to know why they didn’t come and save him earlier, you know.” A foster caregiver of an elementary school-aged child shared:

The resource officers are triggers to a lot of kids because they look like the person that came and took them out of the home…They’re triggered every day seeing them… then there might be a trigger with just teachers in general, because they’re the ones that told on Mommy and Daddy. They’re the ones that got me removed from home.

The second context in which trauma triggers were discussed was in regards to frustration over the caregiver not being able to identify which things were triggering for a child, and therefore unable to protect the child from feeling triggered. “We just don’t know… sometimes it’s very clear, the triggers that are going to happen and other times it’s- it’s hard to anticipate.” Multiple foster caregivers described attempts to ask social workers, biological family, or former foster caregivers if they knew specific triggers for the child, so that caregivers could help avoid accidental triggers. However, they often found that they were left in the dark due to unknown histories or poor communication across care contexts. One participant described this uncertainty as one of the most challenging aspects of his relationship with the child in his care; “Working through triggers and figuring out how to support him when other people trigger him inadvertently… That has been extremely difficult and continues to be difficult.”

Impact on Child Mood.

Foster caregivers acknowledged that trauma had an impact on child mood. They observed two ends of the spectrum in terms of impact, including a heightened negative emotion and reactivity, which led to daily struggles in remaining regulated; “she came from a lot of trauma, so she has a lot of emotional stuff. Every day is hard…” or a blunted/numbing response in which the child would close up or “kind of go emotionless when you bring up tough topics.” Caregivers found both experiences to be difficult to maintain patience for within their caregiving role. They also observed how the impact of trauma on child mood to affected the child’s ability to socialize. As one caregiver explained, “once she’s in the right headspace, she can hang out with our kids and have a great time, but there’s a lot of time where she’s not in the right headspace.”

Child Behaviors Linked to Trauma

The next most frequently observed theme was linking behaviors witnessed from the child to the trauma caregivers understood the child to have experienced. These themes came up most frequently in response to interview questions relating to the caregiver’s observations of the child’s strengths and difficulties, and their relationship with the child.

Difficulty Forming or Maintaining Relationships.

Foster caregivers repeatedly described the ways in which they observed the child’s trauma to interfere with their ability to form and/or maintain relationships. This could be with caregivers, peers, or others. The caregiver for an eight-year-old boy observed that “he doesn’t seem to have really stable relationships with kids his own age,” while another caregiver of a five-year-old girl noted, “she definitely knows how to do first impressions very well. It’s the lasting impressions that’s not so great.”

Sometimes participants discussed this in relation to attachment with themselves as a caregiver. One felt unable to connect with the child, and that their relationship had developed “more into a landlord-tenant situation than a family situation.” Another felt targeted due to the child’s specific trauma history being linked to the child’s mother as the perpetrator: “[She] has a lot of trauma… Unfortunately, attachment is very, very hard with this child. Most of the aggression and the unhappy moods are placed on me being the motherly figure.”

Others referenced atypical social behaviors that hindered their ability to form or maintain genuine relationships. Indiscriminate friendliness was observed in youth as old as 17; “If she knows your name, she thinks you’re her friend. She runs up to everybody now.” Additionally, “people-pleasing” by way of adopting the interests of whomever the child was in the presence of, and making “desperate” attempts for attention were reported. Some went so far as to describe their foster child’s social behaviors as self-sabotaging:

Everything always falls back on that stopping point that they’re feeling too happy and wants to make sure that there is no happiness to be had after a while. So that looks like self-sabotaging birthday parties, self-sabotaging playdates, self-sabotaging a lot of things and as much as the child loves to do these things and really wants to continue to do these things, they can’t help but to self-sabotage.

Similarly, foster caregivers observed youth holding back from attempts at social engagement in an effort to avoid rejection;

Rather than going to things to try to make friends, she’s now more reserved. Even though that’s her desire, she’s less likely to go do those things because she’s afraid of rejection… I think her desires and her struggles both really stem from that inability to feel loved.

Hygiene Issues.

One of the behavior problems that foster caregivers tied most directly to a child’s trauma history were hygiene issues. They observed avoidance with bathing or showering, and using appropriate hygiene products, such as deodorant. Caregivers were not always sure of whether this was related to a specific trauma, or broader neglect the child had experienced which resulted in a lack of knowledge about appropriate self-care:

Teens dealing with hygiene issues, and like, what does that mean? Like, what’s the cause of that? Is that trauma-related? Is that self-sabotage? Is it just depression-related? Or is it just like lack of training like they’ve never been taught?

However, toileting issues were also noted, and caregivers interpreted this as tied both to a history of trauma as well as a desperate attempt to gain control of something the child felt they had power over. A caregiver with several decades of experience shared overarching observations of children she had cared for, noting “you know, if it was sexual abuse, they’re going to pee the bed, they’re going to poop their pants, that sort of thing, because it’s the only thing they can control.” Another caregiver who was newer to fostering and only on his second placement expressed some surprise at the extent to which the child in their care would avoid the bathroom: “There was a trauma-related bathroom thing, from his far past that made him not want to use the bathroom. Like, he would actually soil himself instead of going to the bathroom.”

Need for Control.

In addition to toileting concerns in some children, foster caregivers observed a broader drive within the children they cared for to find ways to gain control of their environment; “She had a meltdown over that because she wasn’t in charge.” Some of them recognized that this was related to the child’s need for safety, but that this could create a power struggle between caregiver and child; “[The child] has learned that in order to have any kind of calming mechanisms, they must feel totally in control and that’s not practical at this age.”

However, despite recognizing the links to trauma, some still felt that these behaviors were willful or manipulative, which further hindered the relationship between caregiver and child; “some people would balk at me using this word manipulative, some people would say that, you know, traumatized kids with ADHD aren’t manipulative, but we feel like he manipulates us or tries to manipulate us fairly often.”

Challenging Authority.

In a similar vein to a child’s need for control, foster caregivers reported feeling that the children they cared for were constantly challenging authority figures or breaking rules. They saw this as happening for several reasons, including in an effort to understand their environment and feel safe:

When the child was being told, ‘no you can’t do that’ or ‘not right now.’ Those were replaced with um ‘well, why not?’ A lot of questioning behaviors, which is fine. Initially you’re like okay, new environment, you want to make sure the child understands everything.

Several saw challenging authority as a demonstration of the child’s lack of trust in adults, due to their experience with adults as sources of abuse or harm, which led to their not understanding the need to follow rules set by adults. One caregiver shared frustration with their foster child’s “decision to break the rules on the regular” noting that it “is just hard to know how to navigate, and yeah, help her see why authority is important.”

Opportunity for Healthy Functioning.

On the more positive side, when caregivers were asked about their greatest satisfactions in their relationships with the child, many shared feelings of pride in having the chance to witness the child grow toward healthy, or typical functioning, once they were in an environment that was safe, stable, and predictable. Participants observed growth in the child’s confidence, improvements in mood, academic achievements, and more:

When she came into our home, she had very, very low self-esteem, very low self-confidence… I just think she didn’t have a good environment where she could grow into herself and feel comfortable with her likes and dislikes. So, in our home she’s been able to explore her interests.

When sharing their observation of a child developing more healthy emotion-coping skills, one caregiver noted “Now he’s so much better. I mean, it’s just almost night and day. It’s amazing. He still struggles with it, but it’s like instead of it being an all-day affair, it’s like ten minutes.” Another caregiver reflected on how having the chance to envision a different life for herself seemed to inspire a lot of positive changes for the teen in her care:

Over the past year she has come to start seeing herself as someone who has a future… And that has manifested in lots of ways from like, I mean, she just did like a total 180 academically. She has been remarkably resilient in the face of some really difficult, difficult experiences… She’s grown so much, you know, like to see her go from someone who I think was really living in the moment of like, surviving, because that’s what she had to do, to someone who’s really making, I think, big plans for themselves and kind of like making decisions that are not just about this moment. So that’s been pretty cool.

Service issues

It will likely come as no surprise to individuals who work within mental health or child welfare contexts, that foster caregivers expressed concerns regarding the services and trainings they needed while caring for a child who had a history of trauma. This broad theme came up in two primary areas of the interview, but were seen throughout; one area was when asked directly about services they wished they had access to, and the other came when asked for advice they would give to those working within child welfare.

Lack of Necessary Services.

Foster caregivers expressed frustration when it came to accessing mental health services to support the child in their care in healing from the trauma they experienced, and fostering healthy development following; “I cannot believe that children are waiting months and months for appointments when they have experienced all types of trauma and absolute loss because they are separated from their home.” The frustration could be over a lack of services broadly, such as long wait times leading to intervention happening after critical periods of development; “it also looks like finally getting attachment therapies, but it’s too far gone. So even though I’m finally getting attachment therapy, I’ve already seen the fact that this is not going to work, so, it happened too late,” or a lack of providers who were trained in the intersection of trauma, child welfare experience, and other diagnoses or identities (e.g. autism, gender identity, religious affiliation). One caregiver illuminated the frustration well:

I mean, what are you supposed to do when you have a child that has a diagnosis, but there’s no one to go to in your area? You have to commute at least an hour and a half to the nearest place and that place has a backup for over a year because they’re the only place. So, what are you supposed to do? Then when you finally get in, you realize this place was a joke, and then you’re mad and you’re like, wait, I waited a year for this.

Additional Trauma Training Needs.

Foster caregivers had many ideas when it came to additional trainings relating to trauma that they felt they, or others, could benefit from in order to better-support the development of the child in their care. While many felt that they had received decent baseline training, several noted that they still wished for more extensive training in understanding specific child behaviors within a trauma lens, as well as in-home supports in managing trauma symptoms after a placement was made:

I feel there needs to be more of a focus on trauma parenting techniques and not just books… And maybe some kind of like after training, like something as stupid as a hotline to call… I feel like a hotline would be honestly the most convenient thing… nonjudgmental, anonymous even would probably make people feel more comfortable calling like, you know, ‘I might have really screwed this up, but like, what do I do?’

They also wanted more training for themselves in terms of differentiating trauma symptoms from other diagnoses, so that they knew how to respond sensitively to the child:

I wish that I had legitimate trauma training that looks hands-on for children on the spectrum because they don’t work together. Yeah, it’s either you have trauma or you have something else and I’m like, you do realize kids have a plethora of things? Everything that I bring up with behaviors is blamed on the spectrum… or the things that are on the spectrum are being confused with traumas.

Many felt that youth in care needed training to understand what to expect, particularly during transitions in and out of a placement; “I think foster kids need more training when they get separated from their siblings. How to cope with a lot of stuff, you know, because, I mean, it’s a lot.” Additionally, they felt that other children in their homes, such as their biological children, would benefit from direct trainings targeting their experience as other youth in the home engaging with a child who had experienced trauma:

It’s really hard for these kids, especially when they see kids come and go. A lot of these kids become best friends with these kids that come into their home, some of these kids hate these kids… it’s a lot of tears, it’s a lot of yelling, it’s a lot of crying, it’s a lot of happiness, it’s a lot of joy. It’s a lot. And people keep on forgetting that there are adopted and bio and other foster kids in the home that are not getting the training.

Foster caregivers also felt that medical and mental health care providers need more trauma training in order to be fully qualified to treat youth in foster care. They felt that the focus on trauma training was decent within the child welfare circle, but that once they stepped out into the broader community, the supports fell short; “Even in our medical fields, trauma-informed care is lacking, and so you can have all of these great training resources through your different agencies and still hit roadblocks everywhere else you go.”

Importance of Trauma-Informed Care.

A final sub-theme within the services issues was a broad emphasis on the importance of trauma-informed care, be it mental health care or caregiving. This centered around the deficits and downfalls that were observed when a child did not receive the trauma-informed care they needed;

All of our issues have been regarding trauma-informed care. One of our kiddos was discharged from mental health services because he was ‘fine’ and just needed to grow out of it and he’s been the one that’s been gone for 9 months at a behavioral facility… he wasn’t fine and you just released my drowning child back into the world to fail.

However, participants also highlighted how helpful the trauma-informed parenting trainings they received had been, and how important it was for future foster caregivers to seek as much trauma training as they could access. One participant reflected on how she applied her trauma trainings to her parenting to help herself remain regulated during a stressful interaction with the child in her care:

He is constantly challenging me and for me to have to keep my cool, you know, and try to like… always be trauma informed and assess things through that lens and react to things when it’s things that happen to also really push my buttons, I think are the hardest parts.

Caregiver Experiences

Another primary theme was the ways in which caring for a child who had experienced trauma impacted caregivers’ own experiences and emotions. Aside from the pride and satisfaction expressed in the previously described sub-theme of “opportunity for healthy functioning,” the experiences described by caregivers tended to be negative with undertones of frustration, burnout, and difficulty. Sentiments often related to their feeling under-supported or pushed to personal limits.

Constant Challenge.

When navigating difficult behaviors and emotional outbursts from children in their care, which they knew were associated with the youth’s experience of trauma, caregivers reported feeling like their “boundaries [were] being pushed constantly.” Despite their trainings in advance of bringing a child into their home, they still felt unprepared for the level of challenge they would be taking on a daily basis; “I didn’t expect it to be this hard. It is a true test of my patience, and I have a lot of patience.”

Need for Flexibility.

This constant challenge related to caregivers’ observations that there is a strong need for flexibility in their parenting approaches, in order to be successful and reduce unnecessary instances of relational difficulties or emotional turmoil within the household. When giving advice to future foster caregivers, one advised, “be prepared for a lot of unknowns and you’re not in control.” Caregivers felt that individuals considering fostering needed to be open-minded to their vision of parenting shifting over the course of fostering, because they would not be successful if they stick to one parenting approach. One participant explained, “some [children] may have been through minor trauma, others through severe trauma… So, you have to be sensitive to that and be sensitive to changing your own parenting style and your own ideas of what parenthood looks like.” Another caregiver noted that he didn’t think anything could truly prepare him in advance, and the ability to be comfortable with navigating this unpredictability was important:

Fostering is really expecting the unexpected… We can receive training 20 hours a day for the rest of our lives, but we’re never going to be truly prepared for somebody who walks into our door with, you know, nothing but a pair of shorts and a lifetime of trauma.

Preference for Youth Without High Levels of Trauma.

The awareness of the impact of trauma on a child and those around them made caregivers cautious as to who they indicated they could care for within their home. Some identified behavioral difficulties they felt would be hard to manage; “the only thing I remember saying is that I didn’t want kids that ran away,” or could be related to the caregiver’s own trauma history:

I think one area that would need more attention than I would – than I could give was someone that was, you know, deeply abused sexually or something like that… Not that I would turn it down, but… probably wouldn’t be my preference, because I know that pain.

Caregivers seemed attuned to the level of support children with different trauma experiences may need, and expressed cognizance of their limitations within the caregiving role, or due to limitations with the mental health services they knew to be available in their region. Setting these boundaries often appeared to be an attempt to channel the child to a placement most well-equipped to support their mental health needs.

Lack of Transparency Regarding Child Behavior Before Placement.

Unfortunately, despite best intentions in recognizing their limitations, several caregivers felt they had been “duped” by their case worker who had withheld information about a child’s history or behaviors in order to make a quick placement. Caregivers did not see this as a lack of knowledge by the case worker, but rather a deliberate attempt to withhold information that would have otherwise led the caregiver to decline a placement. One caregiver shared her experience in talking with a child’s case worker following a placement leaving her home and noted that, “their social worker was like, ‘woo, you last longer than I thought you would because I know homegirl was a handful’ and I’m looking at them like, ‘but you told me they were good,’ you know?”

Overwhelm.

The combination of all of these experiences revealed a strong sense of overwhelm among participants. This overwhelm led to periods of closing their home to new placements, or even questioning if they would continue fostering altogether. “We don’t feel supported anymore, and I think that that’s the reason why a lot of foster parents are quitting, to be completely honest with you.” Those who didn’t close their home relayed an emotional weight that it took to persist in their attempts to be good caregivers while feeling burnt out; “Some of that energy is not there as much; right now, we’re tired… So, trying to still love her and encourage her while also just feeling like after a year and a half, it’s just been a lot of hard.”

Trauma from the Foster Care Process

The final theme identified was the idea that individuals experienced additional traumas due to the way the US foster care system is currently run. Foster caregivers felt that there were two primary ways in which the processes that take place perpetrate further harm, and that these could be avoided or lessened through some changes in practices.

Entry into Care is Traumatic.

The first was the idea that, for “a lot of these kids, just coming into foster care itself is traumatic.” Caregivers observed that the way in which children are removed from a home and entered into state custody or foster care, is in and of itself traumatic to the child. They felt it could often be avoided through different practices, and that the weight of the trauma caused by entry into the system was often not weighed in contrast to the trauma the children had experienced in their prior home, when making decisions to remove them and place them under state custody:

We’ve had thoughts about both of our foster children that maybe they shouldn’t have ever even been removed. Like, yeah, they were being neglected and going through trauma… we feel like the system has at least doubled the trauma, maybe even more. Maybe it would have been better off if they had never even been removed, and that really sucks for them.

Caregivers recognized that there are certain instances of imminent danger which require a child to be removed suddenly and without warning, but they felt this was not always the case and that resources could often be provided to avoid traumatic removals altogether:

I absolutely understand for the safety of that child, you have to get them out. But in the circumstances we are in, put the resources in upfront to keep these guys from having to be ripped from the only mother they know. I don’t believe they were in imminent danger. Mom did not have the resources to properly care for them. Let’s give her the resources to properly care for them, and save the trauma of these kids being taken from their mother.

Others noted that, when removal was necessary, the system should adapt practices to allow for a less traumatic transition, when possible;

There’s no notice. There’s no warning… We come with the police, we pick these children up, we take them and we got you your suitcase. And guess what? I got a place to take you. Boom! And it’s that quick… It’s just such a cold process. It’s not comforting…

Grief Relating to Child Leaving Placement.

The other way in which foster caregivers described the system as causing further trauma, was when it came to a child leaving a foster placement, either for another placement or to return to previous caregivers. They described the rupture in attachment between the foster caregivers and the child as being traumatic for the child;

Our previous foster child, the trauma of her leaving us, we think, was probably worse than what was happening before she was removed. So, it gets to the point where you feel like ‘am I really helping or am I just part of a system that’s traumatizing children?’

They described this as being an overwhelming emotional experience for themselves as well as other youth in the home, such as the caregiver’s biological children. One participant described how the intensity of her grief, in tandem with her experience of postpartum depression, resulted in her needing inpatient mental health care; “I spent five days at adult psych for suicidal ideations… We had just had a case be reunified with their parents. And so like, the grief and all of that, dealing with that, just… it broke me.” Another noted that the heartbreak her biological son felt after a foster child left their home resulted in him disengaging with subsequent foster youth in their home; “my son took a big step back and he stopped being so involved. And he was one of our biggest supporters in all of this. But now it’s like him protecting his heart.”

This grief was something many caregivers felt unprepared for. They knew going into their role that they were providing temporary care for a child. However, they didn’t fully understand the emotional weight they would face, and wished that they had post-placement support services to help them cope with the grief. One participant detailed his experience;

I had kind of like a traumatic experience before; got attached to two young [foster] girls and… They got along with all our family… my mom-in-law was a foster parent too, so she was like, ‘get ready because you’re attached and I worry about you.’ I thought I would be good… I won’t okay… And I wish we got more help there, like, just for the grieving process. Like the transition, ‘cause that can be very traumatic, not only for the kids but for the parents, too.

Mixed Methods Analysis

Those who reported on the survey that they had not received any trauma training, yet felt fully prepared to become a foster caregiver, mentioned trauma the least during their interview. When examining the themes that did occur in their interviews, two participants mentioned the high trauma load of children in care, while one focused solely on hygiene issues. The only other theme endorsed by these participants was frustration with the lack of transparency regarding child behaviors prior to placement. Those who felt fully prepared, regardless of having received either training, were more likely to discuss hygiene issues (71%), trauma age (73%), and entry into care being traumatic (83%). Alternatively, those who felt unprepared were the ones who talked more frequently about service issues (69–78% across sub-themes), trauma triggers (85%), feelings of overwhelm (92%), and the preference for youth without high trauma (71%).

Caregiver overwhelm, and the subsequent risk for loss of trained caregivers was a concern that arose from the qualitative interviews. Of those who endorsed themes of overwhelm in their interview, 92% had reported on the survey that they did not feel their training fully prepared them to go into the fostering role. Another theme that related to feelings of preparedness was the grief relating to a child leaving their care, which many felt unprepared for. When comparing this qualitative theme to the survey response relating to preparedness, 69% of those who discussed grief over the child leaving reported feeling unprepared, broadly.

Discussion

The present study sought to document the sentiments of trauma that were salient enough for foster caregivers to raise when discussing their experiences of fostering, and to tie those to their reported perceptions of trauma-related pre-service training and feelings of preparedness for their foster caregiving role. The goal was to identify concerns and perspectives in order to improve the child welfare system and support foster caregivers, thereby improving outcomes for children in care. Interviews were conducted with foster caregivers who spanned a range of ages, backgrounds, and experiences with foster caregiving. The majority (82%) reported on the survey that they received trauma training on the impact of trauma on child behavior and (80%) trauma-informed parenting practices, with 75% reporting they received both trainings. This is consistent with efforts in the state of Virginia to require pre-service training related to trauma. Trauma informed training likely primed many foster caregivers to view child behaviors through a trauma-sensitive lens, which influenced their likelihood to discuss it during their interview. However, there is no state-wide system for implementing and tracking the fulfillment of these requirements (Haynes, 2024), which helps explain our findings that 20% of the sample reported not receiving trauma training. Within the interviews, five meaningful themes were identified, each with several subthemes, which highlight areas of concern raised by foster caregivers. In analyzing the themes, several key takeaways emerged.

The most prevalent theme reflected caregivers’ ability to recognize the impact of trauma on child functioning. Foster caregivers are aware of the high trauma load for youth coming into their care, and they know that this creates a strong need for stability, predictability, and control within the child. They demonstrated ways in which they work hard to be flexible and patient, even when this can feel tiresome or frustrating. Further, they recognize the impact that trauma has on the child’s mood, as well as their ability to relate socially, across all stages of child development. This heightened ability to detect the impacts of trauma is supported by prior research that links trauma training to an increase in foster caregivers’ trauma sensitivity and recognition of trauma symptoms (Gigengack et al., 2019; Konijn, 2020). However, despite some decent baseline training, foster caregivers still struggle with many aspects of caring for a child who has experienced trauma, and the majority don’t feel the training they receive is enough for them to feel competent in their role. This aligns with systematic reviews of the research on pre-service trainings, which have noted that there is not yet strong enough evaluation of training outcomes or changes in caregiver behaviors following trainings (Dorsey et al., 2008; Cooley et al., 2019). It seems that the lack of evidence-based trainings for foster caregivers is having a meaningful impact on their feelings of preparedness or competence in providing trauma-informed care for foster youth. As a result, many participants noted needing to seek outside training or resources to supplement those provided by their agency, while others leaned on their own professional experiences and trainings outside of their caregiving role, such as working in education, mental health, or even child welfare.

A second takeaway was that foster caregivers feel overwhelmed and under-supported in caring for a child who has experienced trauma. Caregivers feel there is a huge gap between the need for mental health services for youth in care and the availability of trauma-informed providers within their area. For some, basic barriers such as distance and wait time were a concern, but for many there was a more concerning observation that the providers they came in contact with were not proficient in understanding child trauma and the impact this had on symptoms and functioning, or the intersection of trauma with other physical and mental health concerns. This left caregivers feeling discouraged regarding the likelihood that they could fully support the child’s healing. This notion aligns with previous studies that link the demands of caring for a foster child who has experienced trauma with increased levels of parenting stress, secondary traumatic stress, and compassion fatigue (Carew, 2016; Hannah & Woolgar, 2018; Reisz et al., 2023). Additionally, increased levels of stress among foster caregivers are associated with more post-traumatic stress symptoms in foster youth (Vasileva & Petermann, 2017), showing that this type of caregiving stress has implications beyond just the caregiver themselves.

The weight of caring for a child with such high behavioral and emotional needs within the home coupled with the concern that support services were sorely lacking has led many of our participants to question their willingness to continue fostering, and they observed this trend in other foster caregivers they know outside of our study. This relates to research showing that increased trauma-informed care on a system-level can reduce caregiver stress and increase retention, thereby improving placement stability (Bunting et al., 2019). These concerns risk caregivers feeling burnt out and closing their homes to future placements, which means that the efforts made for training, screening and monitoring these skilled caregivers during their certification will be lost, and the process will have to be re-started with new caregivers. In an age where recruitment of caregivers has been a persistent problem (Hanlon et al., 2021), agencies and communities would do well to reflect on the cost-benefit ratio of losing trained caregivers and needing to train new ones, rather than supporting the qualified individuals already providing care within the system.

The mixed-method analyses revealed some interesting co-occurrences which warrant discussion. One was that the participants who reported not receiving any trauma training, yet still felt prepared to become a foster caregiver, were also those who endorsed frustration with the lack of transparency regarding child behaviors prior to placement. This frustration has been echoed in prior research (Mack, 2023). However, this co-occurrence begs the question of whether these caregivers really did not receive the information about the child behaviors, or if they were perhaps under-informed when it came to trauma, and therefore did not have accurate baseline expectations about what caring for children with trauma histories would look like. Another interesting finding was the co-occurrence of themes based on feeling fully prepared vs. not; those who felt unprepared were also those who discussed service issues and feelings of overwhelm at a higher frequency. This raises the question of whether better training and more support or services would lead caregivers to feel prepared and therefore less overwhelmed.

A final reflection was that foster caregivers have important ongoing concerns regarding the way the system functions currently, and can identify ways in which the system could be improved to support the mental health of youth in care, or at least reduce the risk of further perpetuating harm. Many felt passionately that there are ways in which the system currently functions which increases trauma for the child; they felt that abrupt removals without informing the child of the process were often unnecessary and could be handled differently. Further, several questioned why the state was able to provide stipends to foster caregivers to care for a child while the same financial resources could not have been provided to the biological parent of the child in order to prevent the need for a traumatic removal. Lastly, they identify the experience of separating from a child they have fostered as being traumatic for themselves as caregivers, for the youth in their care, and potentially for other children in the home. They did not feel prepared for how difficult this would be and felt that additional support to navigate talking to the child about this impending separation would be helpful. This aligns with past research examining trauma among foster caregivers, which recommended services to address ambiguous loss and trauma post-fostering, as well as mental health supports for the caregivers and youth following the separation, in order to reduce the harm caused by this experience (Nesmith & Hartley, 2023).

Implications and Areas for Action

Findings from this study have several important implications, and suggest areas for action on a national, state and local level. First, it is clear that the training caregivers are receiving have a positive impact on their ability to understand child behaviors within a trauma-sensitive lens; the continuation of these trainings is essential to equip caregivers with the skills needed to provide safe and restorative homes for children. However, there are additional trainings that need to be developed to further prepare foster caregivers and members of their home for the transition of youth with trauma into, as well as out of, the home. Further, caregivers highlighted the lack of training and education for youth in care, which they feel would be beneficial to facilitate their understanding of what to expect while in foster care, as well as how to advocate for their needs within the system. Additionally, the variations in reports of training received and levels of preparedness support the development of national standards in training, so that all caregivers are receiving the same level of preparation before entering into their foster caregiving role.

Within the mental health and education fields, we need to do a better job of training providers, teachers, coaches, and others on the impact of trauma, and how to provide trauma informed care. A more trauma-sensitive community will reduce the feelings of overwhelm for caregivers, who often feel isolated in their understanding of the needs of children in their care. Communities can aid this population by offering support groups and gathering spaces for those who are navigating the child welfare system. Lastly, participants emphasized how valuable it would be to have a hotline providing real-time support focused on caring for a child with trauma.

Limitations and Future Directions

While the present study had many strengths, including a diverse sample and rigorous qualitative design, there are several limitations that warrant discussion. First, this qualitative interview did not ask directly about trauma. Rather, the interview focused on topics spanning the caregiving experience in which participants volunteered commentary that included themes relating to trauma. A future study could build upon this by asking specifically about caregivers’ observations of the ways in which trauma manifests, their feelings about the training they receive, and the impact this has on their own wellbeing. Additionally, we did not assess the child’s perspective; while caregivers spoke as if they were providing trauma-sensitive care, it is unknown whether youth in their care felt that their triggers and trauma histories were being navigated sensitively. Further, we relied on self-report of trauma training and did not assess knowledge or verify training attendance. Lastly, we did not ask whether participants were certified to provide treatment foster care, which includes more intensive training in order to provide a more therapeutic environment for youth with higher needs. Future studies exploring foster caregiver trauma training would benefit from building upon these limitations.

Conclusion

This study highlighted numerous themes relating to trauma that appeared to be salient to foster caregivers while discussing their broad experience fostering. Current trainings have provided baseline knowledge on the impact of trauma; however, many caregivers still feel unprepared and overwhelmed when it comes to providing trauma-informed care. Agencies and communities must work to improve and increase supports available to these families, to reduce the loss of certified caregivers who close their homes to placements after feeling burnt out.