Monday, May 9, 2016

Great things about the Texas Hill Country

Texas makes my heart happy. 
As a surgical technologist, I have had the opportunity to take on jobs across the country as a traveler, typically for three months at a time. My very first travel assignment that I took from October 2013 to January 2014 was to the hill country of Texas. The hospital was then located in Llano, Texas. I liked the experience of working in Llano, and enjoyed the people I worked with very much. After several travel assignments to new locations and the pleasure of meeting so many new people, I was ready for something familiar and comfortable and opted to go back to Texas. This time, the hospital moved to a brand new building, 30 minutes away. Here I will discuss some of my favorite things about my time in the Texas Hill Country. 
Flowers
On my first assignment to Llano, when I told my new friend Laura that I would be leaving in January she said, "Oh, you'll miss the bluebonnets- they are so awesome!" I wasn't too concerned as I had seen spring flowers before. This time around, I saw the bluebonnets and oh my wow, they were truly a sight to behold. We're not talking about a few flowers here and there that you have to search far and wide for. They are EVERYWHERE in great abundance in the hill country. The stuck around for a good 6-8 weeks and as they were fading, new wildflowers from every color of the rainbow sprung up in their place. It was the kind of beauty that either you have to see in person or experience through the lenses of great photographers. 
H-E-B   
H-E-B is an acronym short for the founder, Herbert E. Butts (I kid you not), and is the grocery store monopoly exisiting in Texas. It's great, and there are plenty of them. 
Barton Springs Pool
In Austin there is a pool kind of like Glenwood Hot Springs pool except it is twice as long at 900 feet and much, much colder. It has an average chilling temp of 68-70 degrees. The clarity is awesome, and the bottom of this pool is all natural. On one exceptionally warm day in February I thought it would be pretty awesome to go for a swim. I felt confident as I watched others jump in and swim laps back and forth. I dove in and was shocked to the bone at it's cold unwelcoming hug and got out as fast as I humanly could. I also forgot a towel, so drying off after a shower was tricky. I bet its more fun when its ungodly hot outside in the summer months. 
Hamilton Pool, near Bee Cave
My biggest regret is that when I visited Hamilton Pool, I did not bring my swim suit. I was a bit scared off by the freezing cold waters of Barton Creek Pool to trust that I wouldn't be immediately disappointed in the water temperature. I'm a little fuzzy on the details but I believe the cost is $15 per car to get in, and then a short hike of a quarter mile or so to get down to the pool. I visited while my family was in town and we had a lot of fun just marveling at the beauty of this place, as well as walking around behind the waterfalls and in the cave area. It was awesome and highly recommended to anyone who finds themselves in the area.
Enchanted Rock
I heard it said over and over again that the hike to do in the hill country was Enchanted Rock. I am trying to be cautious in not sounding like an arrogant Coloradan when I say, yeah, its cool, but as far as hikes go it did not offer much. Enchanted Rock is a huge rock that climbs 425 feet from the base in 0.6 miles. It's like climbing stairs to see a great view of the hill country. I noticed, and may have laughed a little on the inside when I saw people climbing it with thick hiking socks, hiking boots, trekking poles and backpacks. Additionally, although racing to the top may not be the point, I quickly discovered that climbing straight up was tiresome and noticed many people taking long breaks after 10-20 steps. I decided to go up by way of switchbacks, which may have looked ridiculous to some as it requires more steps, but I didn't need to take breaks and I got to the top much faster.
Whole Foods
When I was 15, my best friend's recently divorced mom paid for and invited me out to Austin to visit. (It sounds a little weird in hindsight that my best friend did not join me, but I digress). The first place we went to after she picked me up from the airport was a health food store. All that produce and "health food store smell" that hit my 15 year old nose was odd to me. It stuck out to me so well because I'm not sure I had been to one before. At one point, many years later, I saw a picture of the original Whole Foods that started in Austin, Texas and realized that it was the same store I went to ! Since then, they have expanded and rebuilt their flagship store on Lamar Blvd. Its very nice, and kind of fun to visit. They have a hot food and cold food bar for everything from Italian to subs, juice and pizza. Everything is put very nicely in its own place.
Copyright wholefoods.com 
Fiesta Texas, San Antonio
I love amusement parks, specifically, rollercoasters. I grew up in Colorado, where Elitch Gardens was the best I ever knew. And for a long time, Elitches was good enough, but Texas has ruined me on this. I decided to get a season pass to Fiesta Texas and it blew my mind. The rollercoasters were bigger, longer and more terrifying than anything I had ever experienced before. I got to visit about 4 or 5 times and was well worth it to go first thing on a Saturday morning, ride a few rides and then leave as the lines got too long.
Park Road 4, Between Marble Falls and Kingsland
If you like rollercoasters, you'll like this road. The speed limit on this two lane road is 55 miles an hour with some of the steepest dips and hills I've seen on a country road with a speed limit that high. It will freak you out the first time you do it. I was disappointed by how out of the way and inconvenient it was as a route home from work. I wish I could have driven it every day.
The Alamo, San Antonio
The Alamo, I'm sad to admit, was not as exciting as I had hoped. I went there hoping to learn more about it and came away more confused than educated. Maybe I'm not into shrines, or museums enough to appreciate the huge piece of history that was before me. The same thing happened when we visited Gettysburg last year. 'Tis unfortunate, for me. If any of you go, or have gone, I truly hope your experience is/was more exciting. One of the most abruptly interesting things one notices upon arrival is that it is right in the middle of downtown. Like, right there.
Fredericksburg
I enjoyed this town. It seems to have a lot of German influence which I was too lazy to research why. I particularly enjoyed all of the eclectic and gift shop-y stores. The town just has a nice feel to it, with cool victorian type houses and neat architecture. The Pacific Wars Museum looked neat but I did not visit it beyond the gift shop. I got a little teary eyed when I thought of my Grandpas and the men of their generation that fought in those wars to the point of wanting to leave. Interesting. 


 Texas State Capital, Austin
The Capital building in Austin is fascinating. I loved visiting there, and have been three times. It is the biggest state capital, which does not (obviously) include the nation's capital in Washington, D.C.. It is a beautiful building with so much detail and splendor of Texas. I highly recommend checking it out to anyone who is visiting. You can do guided tours for free or self- guide.
Llano, Texas
I just think Llano is so neat. To me, it is the heart of the Texas Hill Country. It's a town of a mere 3000 people that has so much character, great food, and beautiful scenery. 

Riverwalk, San Antonio
Its awesome, and a must do. Lots of good restaurants, and very pretty scenery. There are is a lot of walking to be done, so make sure you wear comfortable shoes.
 
BBQ
Nearly everywhere in San Antonio, Austin or the Hill Country you will find great and amazing BBQ.
Mom, Dad, sister Heidi and brother Zach visiting from Colorado, enjoying Black's BBQ in Austin. 
I'm not huge on BBQ, but oh my goodness, Coopers BBQ in Llano Texas is incredible.
Saint Anthony's Cathedral, San Antonio
Here lies Davy Crockett and other significant people in Alamo history. Its neat. 

Wading/swimming in Llano River
Bat watching at Congress Bridge, Austin
Yes, bats live in the bridge, and go out from it around dusk. Its a sight to behold, once. Best viewing is on the bridge, not below it. 
Alamo Drafthouse
I think others have started doing what makes the Alamo Drafthouse so dang cool for so long. You can watch a movie and eat a meal, drink beer and have your popcorn and beverage refilled without ever leaving your seat. I really like watching movies, so it was great for me. Side perk: the popcorn comes with real butter, and its bottomless. Awesome.

Shark Bait

David and me (with red goggles). Thunder Buddies for life. Photo by Joe Troiano


WATCH THE DIVES ON YOUTUBE HERE!!!

When David and I decided it was time to go on a scuba diving trip, the idea of tried and true Cozumel, Mexico sounded easy to plan until a cheaper, potentially better trip idea came up.
David spent a huge amount of time researching the best dive locations, hotels, dive charters and restaurants in Florida. He read forums and reviews while planning it all out. In the end, we spent a week full of wonderful diving near Boynton Beach and Jupiter, Florida. We saw a lot of awesome fish and large creatures, as well as beautiful reefs, amazing clarity, and plenty of life moving along as usual under the sea. I was very impressed and surprised by how great the diving was in Florida. 

Jupiter, Florida waters.
David put into the mix three dives with a company that baits and attracts sharks and allows divers to get up close and personal with those sharks- without a cage. I had weeks to think about this, and naturally had a little bit of anxiety. I also assumed that it must be safe, since a lot of people dive with sharks without injury or harm. 

Before our trip I watched an old episode from Shark Week titled, "Shark Trek" that focused on tagging and trekking the migratory patterns in great white sharks that have been found in Cape Cod. The episode started out really interesting until the sharks were trekked all the way down to the exact places we would be diving in: Jupiter, Florida (holy crap!).  I also learned about the huge influx of black tipped sharks that end up in Jupiter, as well as the hammerheads, tiger sharks and bull sharks that basically live there. And of course, everything mentioned about all sharks was extremely dramatic. 
I freaked out a little bit. In the past I had been diving with nurse sharks without any problem, and most people would say that they are harmless "puppy dogs of the ocean." But hammerheads, bull sharks and great freakin' whites? Ugh. Sometimes my husband has some crazy ideas of what "fun" is. 
We went with a reputable dive company that has allowed so many (experienced) divers to witness these majestic man eaters without a single fatality. And yeah, Shark Week, and movies like Jaws tend to make people a little anxious with their overly-sensational dramatizations of a shark's behavior. Sharks have a bad rap, but it is also important to respect their ability to rip you to shreds by being cautious and educated on how to protect yourself. Sharks are known for seriously harming or killing people.
I went onto the shark bait diving boat a bit naive. I figured that we will probably get an amazing run down before the dives of what to do if a shark approaches you with the intent of eating you, and how to stay safe. I did not do my research, and I did not know really know what to expect. I have only logged 60 dives, and although I am technically a dive master (DM) at this point, I am more book smart about diving than I am in practice. Therefore, I am still figuring out buoyancy and how to not look like a flailing idiot who can't look calm underwater (at times). For the first dive, we got a run down of staying North to South (or something?) of the DM in order to stay safe and staying close but not too close or whatever. I think I was pretty nervous so I missed most of what he said. I just knew that I did not want the blood of the barracuda to drift near me in the current while the dive master was chumming.
Flailing Emmy. 
On the first dive I made a stupid mistake of following the DM's depth as we descended and found myself at a depth of 136 feet. This was dangerously deep on Nitrox, a gas blend I was breathing. So, even though you can't really hear yelling underwater, I sure felt it as I was corrected by the DM to check my depth. Eventually everything calmed down and we were in the midst of bull sharks. I started fidgeting with gear, working on being horizontal and ended up flailing about. Several times a shark came right up to me, mouth open and then turned away at the last possible second. I think I wet my wetsuit, if you catch my drift. When I asked the DM what that was all about, and if I could have done anything to save myself in the event of an attack, he just said, "You looked like a dying, struggling seal or something and the shark wanted to check you out. When he found out you weren't, he lost interest." Thanks.
That's me, ever so close to a thing that could eat me. 
The next two dives were pretty cool, as we descended down to the ocean floor and watched lemon and tiger sharks come up to a box of bait. Some of the sharks got so close that we were brushed by a fin or tail as they passed by. Although slightly unsettling, it almost became a little bit monotonous and boring. There were a lot of smaller white fish and ramoras in the mix that joined in. Every once in a while a nurse shark came a long (remember, puppy dogs?) that the DM pushed away so as to say, "You're not welcome here." When I asked him about this later he said that the only times he has been bit or attacked by a shark, its been by a nurse shark and he "$@#*ing hates them." Interesting. 
It is a really cool thing to look back on but I remember how much I dreaded and disliked the anxiety at the time. I made more than a few rookie mistakes that made me feel like an idiot. I think this is why the dives are advertised for experienced or advanced divers only. We were not really given much of a safety orientation, which surprised me, however the dive company did an awesome job at giving us a once in a lifetime experience. I survived, yet at times it seems just barely. I am so glad I did it, but even more glad that it is over.
Bonus picture: While walking along the beach in Jupiter, Florida, we looked North and realized what we were watching was a rocket launch from Cape Canaveral. 

Thursday, December 17, 2015

A Completely Different Post: Food Hoarding Behavior in Foster Children

Below is a research paper I wrote for a class in English II, about food hoarding and foster children. I received a good grade and my instructor said he found it, "compelling and interesting" as well as "I think this is of publishable quality." Well, I'm pretty sure I have no idea where else I would publish it other than here.

When I was 11 months old, I was extremely malnourished and weighed only 11 pounds. I was taken away from my birth mother by social services and placed in a foster home with amazing people who adopted me soon after. As a child, I hoarded food and I never really understood why. I was fed meals regularly and we always had snacks around the house. Despite that, I found a way to keep a stash of candy bars and Little Debbie snacks in a drawer in my bedroom. I was told I was an extremely picky eater. I remember waking up early, sneaking downstairs and raiding the freezer or fridge with calorie dense foods, and getting caught on only a few occasions. There was another time where I ate pizza at a friends house, came home and discovered we were having pizza, too; I ate two dinners. I hated being hungry, no matter how temporary the feeling was. For the most part, I think my parents were oblivious to my habits. Before I was three, I had my stomach pumped several times for climbing up on counters and getting into med cabinets and drinking Dimetapp. I thought it tasted like grape juice.

As I got older, I remember talking to a woman with several kids of her own who then ended up adopting a girl from another country. She was talking to me about how her daughter sneaks around, lies, hides food in her bedroom and is a very picky eater. I heard more stories about how kids who have spent time in foster care tend to hoard food- that this is a common thing! I started connecting the dots and realized this had me written all over it. The missing piece for me was that I could not have remembered the time in my life where I was malnourished. I didn't spend any marked amount of time in foster care or spent time needing to provide for myself. My best guess is that it doesn't matter. Somehow, my body, my psyche, whatever remembered that time in my life, and I developed, even as young as I was, ways of getting what I needed: calorie dense foods.
Now as an adult, I look back on my food habits and see a common theme. I can eat healthy, and I do love some very healthy foods, however, I find that I will eat in excess if there is something I love. I tend to gravitate towards buttery, sugary, horrible-for-you foods. Sometimes I eat as if I'm not sure I will ever eat again.

Thoughts? Cares? Concerns? Learn something new? Let me know.




Food Hoarding Behavior in Foster Children
Emmylou Strathman
English 1020
Larimer County Community College



Abstract
Food hoarding among foster children is a common problem many foster and adoptive parents are aware of, but accurately diagnosing and effectively treating the behavior remains difficult. In existence are few studies and articles to explore solutions to giving case workers and foster families the necessary tools for success with the children in foster care who come with multiple physical and mental health problems. The research conducted was an attempt to identify the scope of food hoarding by describing who it affects and how they are affected, by gaining a better understanding of the experiences and history of children entering foster care. As I conducted research, the scope of attention was expanded to include why children enter foster care, how they handle the transition, and health care availability. Other topics I explored included hoarding and food behaviors lacking a connection to the foster system. Sources obtained and cited were collected with the highest scrutiny for their validity, reputation, and amount of useful information.

Food Hoarding Behavior in Foster Children
Most individuals in child welfare are aware that many foster and adopted children have a tendency or history of hoarding food. It is important to know how to properly diagnose food hoarding and seek out treatment for the child to avoid a lifetime of poor diet and eating behaviors. Children hoard food for a variety of reasons and barriers to treatment can be numerous. Foster and adoptive parents can implement many useful tactics and practices to help calm anxieties related to food hoarding. In regards to child welfare and government intervention, there are gaps in the system that affect children’s access to services they need to thrive. Food-hoarding research is shedding new light on diagnosis, etiology, treatment and long-term consequences. Many foster children have experienced traumatic events and have been found to hoard food; thus, additional research and distribution of information about food hoarding is essential to its diagnosis and treatment.  
Discussion
There is currently little literature available about hoarding disorders in children and adolescents. Burton, Arnold and Soreni explain how “there is very little published research into hoarding in youth” (2015, p. 128), and Storch et al. (2011) offer that there is “relatively scant attention devoted to compulsive hoarding among youth” (p. 507). Casey, Cook-Cottone and Beck-Joslyn (2012) state that the elevated risk for foster children having issues with physical and mental health is “well established” (p. 307), yet the research for prevention and intervention is “limited” (p. 320). Stiegler (2005) believes that the benefits of further research would be helpful to clinicians and people interacting with individuals with developmental disabilities in regards to pica behavior (p. 27). Burton et al (2015) wrote an article titled Three Reasons why Studying Hoarding in Children and Adolescents is Important. In it, they explained that if hoarding symptoms are present in childhood, there is a high likelihood of it continuing into adulthood when left untreated. Hoarding individuals have reported that the onset of their behavior usually began in childhood. Researchers believe that although this is usually the case, it can be difficult to see the behavior in children due to lack of access to money, mixed with parental intervention to prevent excess accumulation of clutter (p. 129). The path of hoarding can produce unhealthy outcomes, which have the potential to affect family members and endanger people close to the individual hoarder (p. 130).
Common Problems with Foster Kids
Evidence shows that the majority of children come into foster care with a range of problems in physical, mental and emotional health. Of these, food disorders and bad food behavior are commonly discovered after placement has been made with a new family who may be more observant. Some children may have experienced periods without adequate food provision or nutrition while others come with memories of extreme abuse or neglect. Still others might arrive in foster care tired, sick, and dirty with experience in stressful situations at a young age. These listed scenarios imply that children involved with child protective services are at a greater risk for mental and physical health problems. Food may have been used as a control mechanism and withheld as a form of punishment. With poverty stricken families, a child may have experienced hunger. Beam (2012) placed the connection that in her interactions with foster children, she observed that “the poorer you are, the more likely you are to get entangled with child welfare”  (p. 262).
Regardless of the circumstances surrounding removal from a biological family, the experience itself is usually a traumatic event for the child. In many cases, children are removed from their homes at a moment’s notice, sometimes arriving in a stranger’s home with only the clothes they are wearing. They may have been faced with many stressful events including malnutrition, recent abuse and neglect. Simms, Dubowitz, and Szilagyi (2000) commented that the Adoption and Safe Families Act of 1997 was focused so much on the reunification of children with their biological families and less concerned with the actual safety and protection of those children. The idea of being reunited with birth families may give some children hope while others may experience anxiety about returning to an unsafe environment (Simms et al, 2000). On occasion, some foster children may be placed in up to 20 different homes while waiting for their parents to gain back custody, moving around more often if they exhibit behavior foster families dislike (Beam, 2013, p. 11). Landau et al (2010) discovered that the prevalence of traumatic life events typically precede a diagnosis of hoarding disorders (p. 201).
Why Children Enter Foster Care
It may not be clear to a child why they are being removed from their home and placed into foster care. DeGarmo (2013) discussed in his book The Foster Parenting Manual, that the move from home can be traumatizing and the effects may last a lifetime. It may be easy for those children to internalize and blame themselves with the thinking that they did something to cause the separation from their family. Often times, the trauma of being ripped from their familial homes and placed in an unfamiliar setting with new people, new rules, and new expectations can be so overwhelming that foster children struggle to deal with the adjustment. This can result in an array of disorders, symptoms and struggles such as anxiety, depression, obsessive-compulsive disorder, panic attacks, hoarding and social disorders (pp. 49-51).
Regarding the placement of newborns in foster care, in her book To the End of June, Beam (2013) briefly explained that if birth parents seem capable to remedy their situation, the newborn may be placed in the care of experienced foster parents who are taught and do well with not becoming attached, whereas a newborn who is removed from parents who may fail at or have no interest in retaining custody may be placed with foster parents who want to adopt and might form attachments deliberately. Essentially, Beam (2013) exclaims, “…its all guesswork and hope” (p. 15).
Hoarding, Food Hoarding, and OCD With Hoarding
There are several types of hoarding, which include hoarding, Obsessive-Compulsive Disorder (OCD) with hoarding, and food hoarding. Often the lines between those three forms of hoarding are easily blurred as each can include elements of the other. Research and studies have been conducted to draw more definable borders for each disorder for the sake of diagnosis and treatment.
Hoarding is simply defined as a difficulty in discarding items, which may or may not have any actual monetary or sentimental value. If left alone, the accumulation of these items may become a significant risk and endanger the individual and those living with them. OCD is a set of behaviors that can be broken down into groupings of symptoms, one of which contains “hoarding” (Storch et al, 2011, p. 507). Other symptoms associated with OCD-like behavior include obsession with cleaning, caloric restriction (anorexia), counting, repetition, symmetry, checking (i.e., making sure doors are locked multiple times), and collecting. In regards to possessions, hoarders typically place a large amount of emotional attachment to objects for sentimental purposes (pp. 507-509). Food hoarding may be a large component of hoarding with and without OCD. However, food hoarding as a stand-alone diagnosis is the acquisition and storage of excess food, mostly out of fear of going hungry.
Hoarding is compulsive behavior that may have stemmed as a survival tactic to ensure resources are present in times of need. Hoarders tend to have extreme difficulty and anxiety related to letting go and discarding possessions (Storch et al, 2011). The assumption is often made that those who hoard must also have OCD, but there is evidence to suggest that this is not always the case (Landau et al, 2010, p. 193). Both hoarding and OCD with hoarding may come from a time period of lack, trauma, or unreasonable fears. For food hoarding in children, especially those who have been in foster care, a period of deprivation, hunger or stress related to food is typically the cause.  
Food hoarding occurs when a child demonstrates behavior that indicates an uncertainty about when and if they will eat again, even if they are currently in a safe home where they are well provisioned. The effects of food hoarding on these children can last throughout a lifetime if the symptoms are not properly acknowledged, diagnosed and treated early on.
Food Hoarding: Causes and Behavior
Because of the traumatic history trailing behind some children in foster care, there may be an elevated sense of anxiety surrounding food. With food hoarding, what appears to be bad behavior to caregivers might be a subconscious habit of instinct and survival to the child. It is my belief that most foster children do not hoard food intentionally, and in some cases, may not even be aware that they are doing anything wrong. Child food hoarders have learned to acquire what they need to ward off hunger. A case study presented by Storch et al (2011) focused on a ten-year -old girl named “Abby.” When Abby hoarded food, she would often forget to account for a nearly constant supply of food in her home and would become anxious with fears of hunger. In her bedroom, Abby’s parents would find up to 20 food items hidden, stashed and sometimes rotting in her bedroom (p. 511). Forgotten hiding places have the potential to become hosts to rotten, infested and moldy food items, which can have dangerous consequences if consumed when found.
If a child has had to instinctively hoard food as a means of survival but is no longer in that situation, it can be difficult to convey that stealing, hoarding and hiding food is considered bad behavior. It is suggested by Purvis and Cross (2007) that caregivers give discipline in a gentle manner while also encouraging foster parents to set compassionate limits for children (cited in Casey et al, 2012, p. 318).
Although food hoarding can be a very useful tool for survival, that skill becomes problematic when obtaining and consuming calorie or fat dense food is no longer necessary. After a time of unreliable food supply, a child’s relationship to food can develop into one of distrust and anxiety. These habits and fears can be hard to let go of. In the child’s mind, it might be difficult to comprehend and understand that there will be enough food available once they are placed in a stable home (Rowell, 2013). Children may develop irrational thoughts that once food is out of sight, it will be gone forever. Overeating habits may develop when uncertainty exists, whether real or imagined, about when and if they will eat again (Rowell, 2013). 
In pursuit of food, children might become engaged in behavior that can put them in danger by stealing, lying, and sneaking around. Food hoarding children may hide or save food in their bedrooms in locations such as under pillows, under beds, in drawers and in closets. Other risk factors associated with food hoarding may include obesity, comorbid diseases, personality disorders, anxiety, depression, as well as susceptibility to other food disorders (Casey et al, 2012, p. 310). Sometimes a child will become emotional when food is controlled, portioned or taken away, or be picky with what will be eaten as well as consuming a large amount of food beyond the point of being full (Rowell, 2013). DeGarmo (2013) adds that the tendency to over-eat may be due to an insecurity many foster children experience, in which gorging on food may be of comfort (p. 78). The foods sought after tend to be of high caloric and fat value, or something familiar and comforting. Jessica Good recalls how her adopted 3 year-old twin boys became “dangerously adept at getting over safety gates, past doorknob covers and child-locked cupboards, and into just about anything without even waking us” (Good, 2014).
Diagnosis      
Steele and Buchi (2008) discovered that 35% of children over 3 years of age in foster care had “A Body Mass Index (BMI) at or above the 85th percentile” (cited in Casey et al, 2012, p. 309). A high BMI is not a good indicator of food hoarding, as many children who have food-related concerns and disorders are not overweight (Casey et al, 2012, p. 313). Although food hoarding is a common and well-known set of behaviors that foster parents have become acquainted with, awareness does not necessarily mean foster parents are fully prepared to properly treat food hoarding. Many researchers have expressed concern that caregivers and social workers are ill prepared when it comes to recognizing, diagnosing and treating food-hoarding behavior. Many children who hoard food are not overweight and have become skilled at acquisition and storage of food without raising suspicion. It is recommended that with any changes in weight or appetite, especially with foster children, a pediatrician and a mental health professional be contacted for further evaluation (p. 319).
Problems Acquiring Health Care and Assistance
According to the US Department of Health and Human Services Administration for Children and Families (ACF), it was estimated that in 2014 over 264,000 children entered foster care with a total of 415,000 in foster homes (2015, p. 1). With numbers that high, it might be wise to know as much as possible in order to understand common problems foster children are faced with. As a first line of defense, caseworkers are in a position to help find and acquire resources for foster parents to get foster children proper treatment. Simms, Dubowitz and Szilagyi (2000) stated that despite having multiple interactions by a range of qualified adults in the lives of foster children, many go without health services, such as basic immunizations and yearly checkups. With the state governments removing children for the sake of their protection and health, it would seem appropriate that the same governing body then have an obligation to provide even better care. This is not always the case, as sometimes children fare even worse than they began with declining health and sometimes death while wards of the state (p. 2). Simms et al (2000) said that this “points to the need to clarify roles these individuals should play to ensure that children receive needed services” (p. 8).
The use of Medicaid is one of the contributing factors to the problems of acquiring healthcare for foster children, according to Simms et al (2000). Medicaid has been supplied as a free government issued health insurance for poor children, which many foster families accept and use. Reimbursement to practitioners has not increased at a rate that accounts for inflation since the inception of Medicaid. Because of this, some healthcare providers refuse to take Medicaid, making it difficult for children to acquire medical attention. Since foster children may frequently move from house to house, many receive poor continuity of healthcare (p. 7). One of the barriers to the provision of physical and mental healthcare for foster kids is their biological parents; When consent from birth parents is required for treatment (as in some jurisdictions), it may be hard to obtain if they are upset, unwilling or unavailable (p. 9).
Dangers of Food Hoarding
            The dangers of food hoarding mostly involve those of personal health. As a child, the effects of obesity and unhealthy eating habits may be hard to observe. Consequences such as incarceration due to stealing may be obvious, but one of the biggest dangers caused by food hoarding is when it creates a situation where the child’s safety is at risk, especially in the pursuit of finding and gathering food (Casey et al, 2012, p. 308).
Childhood Hoarding Outside of Foster Care
            There are several reasons worth discussion, other than trauma or being in foster care, that can result in food obsessive behavior. Hoarding, pica behavior, bingeing, or abstaining from food can be caused by chemical and hormonal imbalances. Poor food habits and hoarding may be triggered due to anxiety, depression, traumatic life events and insatiable appetites.
            Prader-Willis causes physical developmental delays and mental retardation and is characterized in part by a short stature, underdeveloped extremities and lowered hormone production (Casey et al, 2012, p.509). These individuals are sometimes found to have insatiable appetites and an inability to feel full, which can cause them to consume three to six time more calories than necessary and can lead to dangerous weight gain (Stiegler, 2005, p. 28; Storch et al, 2011, p. 509). Pica behavior is commonly found with sufferers of Prader-Willis Syndrome, autism and other forms of developmental disability although it has been seen among a wide spectrum of developmental ability, including children in foster care. Pica behavior is the habitual and recurring consumption of non-nutritive substances that persists beyond 18 months of age. For some, the desire to eat non-nutritive substances stems from a desire to satisfy sensory sensitivities (as with an oral fixation), but can also be used to acquire attention (Casey et al, 2012, p. 310). The danger of pica behavior occurs when non-food substances such as plastic, metal, or sharp objects are consumed which can lead to malnutrition, toxicity, infection, bowel perforation, and death if untreated (pp. 29-31). Some cultures believe in a pic-like practice of eating dirt and clay for fertility enhancing benefits (Stiegler, 2005, p. 27).
Treatment and Ideas for Recovery
The role of a foster parent or caregiver can go a long way in the treatment of food hoarding. In his book The Foster Parenting Manual, DeGarmo (2013) discusses how the life of a foster child completely changes once they are placed with a family either temporarily or permanently. The need for rules and expectations must be provided, as some children may have never been introduced to them. Patience and kindness will be required of the foster parents when expressing expectations of the child, while also letting the child know what can be expected of the parents (p. 59-60). Foster parents “Shannon” and “Jim” explain that with their food-hoarding foster children they “constantly reinforced with words that we will not harm them in any way; we will provide them with meals every day and also snacks if they are hungry,” and continues that, “having food is a huge concern for them” (p. 60). Sometimes enforcing rules in regards to nutrition and portion control can have an effect of driving the child deeper into food hoarding. Attempting to restrict or control food intake may only heighten the anxiety a child feels about their supply of food. Despite obvious signs such as being an appropriate or excessive weight, a child may still believe that they may starve or not have enough to eat (Rowell, 2013).
Allowing children to hold on to or carry food (snacks) with them all day is a method that tends to work, and the child can be weaned from it as they develop a stronger sense of trust that food will continue to be available to them (Rowell, 2013). To encourage diversity in food consumption with picky eaters, allowing children the option to politely spit out food they don't like the taste of may be useful for trying new options (Rowell, 2013). Caregivers can help by offering reassurance of a constant food supply mixed with proof by providing snacks and options as well as a consistent schedule for meals. Encouraging the child to exercise while placing limitations on the amount of time spent watching television and electronic devices may also be beneficial in shaping healthy lifestyles. Caregivers should place an emphasis on providing healthy nutrition and not merely empty calories (Casey et al, 2012, p. 315-317). When dealing with pica behavior, one suggested strategy is to create an association of the non-nutritive item with something unpleasant. A taste of lemon juice or the smell of ammonia is a useful at the time when ingestion is desired (Casey et al, 2012, p. 318).
            Pacifici (1996) put together and tested a training program intended for use by foster parents that was “designed to give parents a neutral, practical, and effective way of understanding and responding to noncompliant behavior” (p. 2). The videos teach appropriate ways to discipline and interact with children in order to change undesirable behavior. Most participants found the videos and training to be useful, helpful and informative; However, when it came to an actual change in behavior from children, the results were less inspiring. Most participants in the study determined no difference in behavior as a result of watching and implementing discipline tactics being taught (p. 10). It may be necessary that foster parents seek out professional help from psychologists, nutritionists, and pediatricians. Cognitive Behavioral Therapy has been a useful form of treatment in conjunction with parental and child participation at home. Casey et al (2012) offer that “information on evidenced-based interventions” for a child dealing with food-related behaviors is “sparse” (p.317).  
In most cases, the best advice for caregivers is to be consistent in regularly providing food to children who hoard (Rowell, 2013). Snacks or meals do not need to be high in sugar or caloric value but should be offered with repeated assurance that there is more food available and the child will not go hungry. This is believed to help calm the child and relieve any pressure they may have about providing food for themselves. Several studies have been conducted to illustrate and test the importance of families coming together for mealtime. When good examples are presented, it has been found that problematic eating behaviors such as anorexia and bulimia may be reduced. There has been a push by organizations such as WIC to promote families of all socioeconomic backgrounds to come together for meals (Casey et al, 2012, p.316). Eating food together usually results in a positive bonding experience (Rowell, 2013).
It is difficult to pinpoint one solution or method for treating food hoarding because it deals with individuals who may have unique circumstances, past experiences, and levels of dedication in treating it. The treatment needs to be appropriately fitted to the cause of the food anxiety and hoarding (Rowell, 2013). It may be necessary to tailor treatment of food hoarding to the specific needs and situations of the child and caregivers (Casey et al, 2012, p. 318).
Problems
Programs such as Women, Infants, and Children (WIC) and Thrifty Food Plan (TFP) exist to help low income households provide quality nutrition and education about nutrition (United States Department of Agriculture). WIC focuses on children and expecting mother while TFP is helpful for families who are already receiving the maximum food stamp allowance. Despite help from agencies and governmental programs, some children still go hungry (Casey et al, 2012, p. 315).
Awareness among social workers and caretakers is on the rise but it is difficult to quantify. As a first line of defense, Casey et al (2012) recommended that child welfare workers obtain a better understanding of eating disorders so they can quickly recognize these behaviors and seek help for the child in collaboration with foster and biological parents (p. 308).
Consistency and Stability
At the epilogue of To the End of June, Beam suggests the idea of having one parental figure to remain through a child’s formative years may be the answer to a shift in a healthier foster care system. In reality the goal of child welfare agencies is to reunification of children with their parents (p. 259).  Some psychologists offer that in order for a child to thrive, they need to bond with at least one “parental figure or caregiver” (DeGarmo, 2013, p. 49). “Children who experience long-term, stable placement show significant improvements in health status, physical growth, and educational achievement” (Simms et al 2000, p. 6).
Conclusion
            The more that is known about the causes, symptoms, diagnosis and treatment of food hoarding in children, the better the outcomes are as those foster children enter adulthood. The behavior associated with food hoarding can carry negative consequences such as obesity and other dangers to physical health. Treatment can be as simple as redirection and assurance from a caregiver who consistently attends to the dietary needs of a child, or it can be extensive and intensive therapy sessions with a psychologist or psychiatrist. Foster children come with and develop enough problems naturally through circumstances outside of their control. The concern of having enough food in a home where there is plenty should be addressed with constant reassurance and proof in an effort to spare children the stress of providing for themselves at any cost.

References
Beam, C. (2013). To the end of June: The intimate life of American foster care. New York, NY. Houghton Mifflin Harcourt.
Burton, C. L. PhD, Arnold, P. D. MD, Soreni, N. MD. (2015). Three reasons why studying hoarding in children and adolescents is important. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 24(2), 128–130.
Casey, C.M., Cook-Cottone, C., & Beck-Joslyn, M. (2012, May 26). An overview of problematic eating and food-related behavior among foster children: Definitions, etiology and intervention. Department of Counseling, School, and Educational Psychology. University at Buffalo, The State University of New York. DOI: 10.1007/s10560-012-0262-4
DeGarmo, J. (2013). The foster parenting manual: A practical guide to creating a loving, safe and stable home. London and Philadelphia, PA: Jessica Kingsley.
Good, J. (2014). When foster or adopted children hoard food: Overcoming food insecurity and feeding problems with our foster children. Retrieved from http://adoption.com/foster-adopted-children-hoard-food
Landau, D., Iervolino, A.C., Pertusa, A., Santo, S., Singh, S., & Mataix-Cols, D.  (2010, September 2). Stressful life events and material deprivation in hoarding disorder. Journal of Anxiety Disorders. 20(2011)192-202. DOI:10.1015/j.janxdis.2010.09.002
Pacifici, Caesar. (1996). Foster parent training: Managing child behavior problems (Phase I). Retrieved from Northwest Media, Inc. website: http://northwestmedia.com/research/fpbeh-i-pdf
Rowell, K. (2013). Healing from food insecurity: Beyond the stash. North American Counsil on Adoptable Children. Retrieved from https://nacac.org/adoptalk/beyondthestash.html
Simms, M. D., Dubowitz, H., & Szilagyi, M. A. (2000, October). Health Care Needs of Children in the Foster Care System. Pediatrics,106(4), 909. Retrieved from http://go.galegroup.com/ps/i.do?id=GALE%7CA66665158&v=2.1&u=wylrc_laramiecc&it=r&p=AONE&asid=b230e12494b012a92faeee2dd44268ca
Stiegler, L.N. (2005). Understanding pica behavior: A review for clinical and educational professsionals. Focus on Autism and Other Developmental Disabilities, 20(1), 27-38. Retrieved from http://search.proquest.com/docview/205003823?accountid=29648
Storch, E. A., Rahman, O., Park, J. M., Reid, J., Murphy, T. K., & Lewin, A. B. (2011). Compulsive hoarding in children. Journal of Clinical Psychology, 67(5), 507-516. doi:10.1002/jclp.20794
United States Department of Health and Human Services. Administration for Children and Families. Children’s Bureau. 2015, July. Preliminary estimates for FY 2014 as of July 2015. Retrieved December 8, 2015, from http://www.acf.hhs.gov/sites/default/files/cb/afcarsreport22.pdf
United States Department of Agriculture. Food and Nutrition Services. Women, Infants and Children (WIC). WIC at a glance. Retrieved December 8, 2015, from http://www.fns.usda.gov/wic/women-infants-and-children-wic