Even if the children in your care are happy to be with you, they have been through a lot. Losing a parent is hard on a child, and so are too many changes. One or both parents may abuse drugs or alcohol, be violent or mentally unstable. Because of these problems, the children in your care may have been hurt physically or emotionally. They may have been left without enough food, or without the care they needed to stay safe and to grow. They may have been allowed to see sexual activity or even have been sexually abused. As a result, the children in your care may need special help to grow and thrive.

In addition to physical abuse or neglect, children who have suffered a loss seem to share several common mental health issues. However, each child's reaction or response to the loss depends on:

• The significance of the loss
• Whether the loss is temporary or permanent
• Inherent coping abilities of the child
• Availability of supports
• Age and cognitive abilities of the child (at the time of the loss and the present time

Consequently, while some children may react in very extreme ways, others may respond mildly or not at all. In addition, one child may be affected in one area while another child may be affected in another area. Below is a list of common mental health issues that may affect the children in your care.

Grief
When children have been separated from significant figures in their lives, their emotional response is one of grief and mourning. There are five identifiable stages of grief: shock/denial, anger/rage, bargaining, depression and resolution/understanding.

Control
Many children who have experienced a loss feel that they have no control over their lives. Consequently, they may try to regain control by being orderly, compulsive, routine-focused or planning ahead. Other youth may demonstrate their need for control via power struggles with authority figures, truancy, defiance, substance abuse or tantrums.

Loyalty
Having at least two sets of parents creates a conflict for the child. The child may feel that closeness and love for one set of parents may be an act of disloyalty toward the other set of parents.

Rejection/Fear of Abandonment
Regardless of the circumstances surrounding the child's loss, the child may feel that they were rejected and abandoned by the birth family. To avoid the risk of that happening again, some children may not allow themselves to get close to others, or they may react by continually seeking acceptance and approval from those around them.

Self-Esteem
The perception of being rejected is a direct blow to a child's self-esteem. They may feel unwanted and that something is wrong with them. School performance and self-confidence may suffer.

Trust
This is a particularly crucial issue for children who have had multiple moves during their young lives. Separations at an early age may make it difficult for them to trust and become attached to their new caregivers.

Identity
The lack of information and secrecy that often surround a child's history and birth family make it difficult for the child to establish his/her identity, a major task of adolescent development. The child may find this issue confusing, frustrating and scary.

Not all children will experience problems with these issues. Some may experience minor difficulties at different developmental stages. These minor difficulties may be handled successfully by the kinship caregiver or with the help of a professional. It is recommended that kinship caregivers experiencing these issues find supportive services that can address each child's specific needs.

Common Signs of Physical Abuse

• Inflicted bruises such as human hand marks, human bite marks or strap marks.
• Inflicted burns such as cigarette burns, match tip or incense burns, branding burns, or scalds.
• Inflicted retinal hemorrhages or subdural hematomas-a form of traumatic brain injury-caused by direct blows or violent shaking resulting in skull fractures.
• Inflicted head injuries such as subdural hematomas, scalp bruises or black eyes.
• Inflicted abdominal injuries such as ruptured liver or spleen, ruptured blood vessels, or injury to kidneys. Inflicted bone injuries such as chip fractures, fractures at different stages of healing, repeated fractures to the same site or unusual fractures such as those to the ribs.
• Underfeeding resulting in an underweight condition, failure to gain weight and ravenous appetite.

Ohio Department of Job and Family Services. (n.d.) Ohio Resource Guide for Relatives Caring for Children [Brochure].