Post Adoption Services

Caseworkers often perceive the placement of a child in an adoptive family as the end of their work. Although placement may signal the end of the child’s sojourn within the child welfare system, in reality, it is the beginning of a lifelong journey. Post-adoption services cannot be understated. Hopefully, it is a journey that will lead to overcoming the effects of whatever traumas led to the child entering the system in the first place, as well as the negative impact of experiences he or she may have experienced while in care.

Children who join adoptive families after experiencing abuse– either physical or sexual, neglect, parental separation, and loss– bring with them a legacy of failed family relationships. Their new family provides new hope and possibility for them to more successfully experience the intricacies and benefits of family life.

Although previous life experiences may have led to emotional insults that can benefit from formalized therapeutic interventions, primary healing (if it is to occur at all) will occur within the contexts of day-in and day-out family life. It is the result of the interface between the characteristics of the child and family that leads either to healing for the child or to disruption of the placement. According to Barth and Berry, the characteristics of the child– behaviors, temperament, habits, and academic skills– are important only about family characteristics and patterns.

Children and parents alike come to adoption with some added risk factors when compared with children joining their permanent family at the time of birth.

Child risk factors include:

• Survival behaviors that originated when they lived in dysfunctional families and a dysfunctional system,
• Individual vulnerabilities,
• Previous traumatic events, and
• Unresolved separations or losses.

Parent risk factors may include

• A lack of empowerment and entitlement,
• “Echoes” from their past,
• Unrecognized or unresolved losses, and
• Unrealistic expectations for child or self.

Elbow identifies three facts in older child adoption that contribute to difficulty in mastering family developmental tasks:

1. Distortion of the family life cycle. Adoptive families begin with distance and are expected to move toward closeness, while birth families start with symbiosis and are expected to move toward individuation.
2. Stress on family boundaries caused by agency intrusiveness, lack of family empowerment by society and agency, and the child’s conflicted loyalties.
3. Individual issues of the child and echoes from the past for the parents.

Because of the nature of special needs adoption, involvement with post-placement services and mental health resources should be considered a normal part of this adoptive family’s experience. Adopted children and their families are best served when there is a collaboration between the family, social service agencies, and mental health resources. Each recognizes not only what they, but also what the others, have to offer.

The family provides the foundation on which the child’s continued development is dependent and the environment for change, as well as continuity and commitment.

The fact that the family needs help in meeting the child’s needs does not mean that they do not care or that they are incapable of participating in decision making. If the family is made to feel impotent, it is harmful to the overall treatment. If the family is recognized as doing the best they can in difficult circumstances and as having an important role in any change process, they can be stronger partners.

Unfortunately, families may not seek help until they feel overwhelmed and desperate, and, then they will present themselves at their worst. Many times it is difficult to have a solid assessment at that time of the parents’ long-range capacities.

Social workers know how the system works and are more likely than others to know how to access information about the child’s specific history, information that may be critical to providing adequate treatment.

They can help families locate and access the specific services that they need (i.e. support services, respite care, therapist’s knowledge about adoption), and they can provide information to therapists about common behaviors seen in “systems” children. Social workers also predict times that will be difficult for the child and family (based on developmental information and knowledge about anniversary reactions, etc.)

Mental health professionals may provide assessments of families and children, both before and after placements, and may also be able to intervene early enough that they can help prevent problems from becoming entrenched. They can help families connect with support groups and do direct work with children and families when there are ongoing problems.

These professionals can also provide information as to when families might anticipate future problems and be involved in crisis intervention. They are also qualified to help determine if out-of-home care is necessary and the level of care that would be most useful.

Post-adoptive services need to be provided by individuals who understand adoption-related issues and the social service and legal systems and their impact on the child before placement. They also must be supportive of the adoptive family’s role and importance in the child’s life. They include the parents in the assessment, planning, and treatment. These individuals will work with parents to develop strategies for behavioral interventions and collaborate with others who are involved with this child and family (schools, etc.).

Post-adoptive services may take a variety of forms:

• Supportive services (groups for parents, children, respite care, training, and educational services) that can meet the needs of many adoptive families.
• Services aimed at helping the child and family come together soon after placement.
• Intermittent preventative therapy, which is instituted as children reach certain developmental levels that are likely to lead to re-triggering old issues (i.e. sexual abuse, loss, identity, etc.).
• Intermittent short-term problem-focused therapy aimed at interrupting problem behaviors.
• Crisis intervention with threatened families.

Support Services

Families who were prepared for adoption using a group process frequently use other group members as an informal support system. Agencies may provide parent support groups or help individual families connect with others who have had similar problems, and they may also provide parent education presentations.

The PARTNERS project in Iowa arranged respite care for special needs children one weekend per month at a local camp. This was combined with a week-long summer camp as well. Respite care can be a very useful service, but unfortunately, families are frequently left to their own devices in terms of providing it regularly.

Even those families who need more intensive services still tend to view support services as helpful. Initial post-placement services are aimed at helping the child and family come together as a unit. The emphasis is on resolving current separation and loss issues, addressing current behavioral problems, and facilitating the attachment process. The focus is primarily on the present.

According to Linda Katz, the client is neither the child nor the parents, but rather the relationship. During this period the provider should prepare families and children to identify times that preventative work might be undertaken and times that old problems are likely to reemerge.

Preventative work

New cognitive skills, combined with current life experiences, will lead to repeated opportunities for reintegrating the effects of earlier life experiences. Understanding the developmental tasks presented at various ages helps professionals and family members alike to understand the impact of pre-adoption events and to make use of opportunities provided to overcome these effects. When adoption issues are not addressed at these developmental times, it can be difficult for the adoptive family and young person to master the developmental tasks at hand.

Intermittent short-term problem-focused therapy

When families are faced with living with children with disturbing behaviors, they are looking for therapy with goals and timelines that they and the therapist agree to. Parents tend to abandon therapy when they are not included and when the therapy does not address the behavioral concerns that initiated the parental request for intervention.

Crisis intervention with threatened families

Kay Donley and Maris Blechner identified threatened families as usually being those with

• A long-term adoptive relationship in place;
• Evidence of repeated self-destructive or violent behavior by the child;
• Episodes of problem behaviors intensifying;
• The parents have made a variety of unsuccessful efforts at obtaining help; or
• The parents feeling that the situation is out of control.

According to Pam Grabe, this is not the time to question a family’s commitment, the size of their family, or their motivation to adopt. It is a time to offer some initial relief that will help the family hang together until substantive improvements in the relationships can be achieved. This necessitates a more complete assessment and being flexible in providing services that can help this family unit.

Donley and Blechner point out that it is very important that the intervenors not mistake these people for chronically troubled families who have never experienced a period of relative calm adjustment. Many times these are very competent parents who may have difficulty convincing others of the seriousness of the problem. They may be more skilled than the people they are turning to for help, who, in turn, may be intimidated by the parents.

In general, these parents either didn’t expect the adolescent to have as severe behavior problems as are evident or misperceive the long-range prognosis. The family may be under a variety of current stresses. The young person’s individual pathology may be becoming more evident.

These kinds of situations call for intensive adoption preservation services. These include all aspects of support services, including short-term, out-of-home placement. The overall goal at this time is to engage the families in treatment and to help them see the problems in a realistic context. During the provision of these intensive services, it may become apparent that the young person needs out-of-home care. This must be provided in a timely enough manner that the family continues to be available as a long-term resource for the youngster.

TRADITIONAL THERAPY APPROACHES ALONE HAVE NOT BEEN PARTICULARLY
SUCCESSFUL WITH THIS POPULATION

Individual non-directive therapy with the child

• Frequently never addresses the issues of abuse or neglect if the child does not introduce these topics,
• Rarely focuses on the behavioral issues that ultimately will determine whether the child remains in the placement,
• Tends to disempower the family and distance them,
• Does not focus on family relationships, and
• May never identify the child’s misperceptions.

Traditional family therapy

• Views the child’s behavioral problems as a manifestation of the overall family dysfunction,
• Does not take into account the concept of imported pathology (child bringing pathology into the family), and
• May view the parent as more a part of the problem than part of the solution.

Adoptive families who represent the source of real change and remediation must be actively involved in the healing strategies.

BELIEFS IN FAMILY SYSTEMS APPROACH TO TREATMENT IN SPECIAL NEEDS ADOPTION

• Although the adoptive family is not the source of the child’s problems, it is within the context of family relationships that primary healing occurs.
• It is the result of the interface between the characteristics of the child and family that leads either to healing for the child or disruption of the placement.
• Many children are internally driven to reenact their earlier life experiences in the new family setting.
• The reenactment may lead to the adoptive parents looking quite dysfunctional by the time they seek help.
• It is more important to interrupt the non-helpful patterns of family interactions and learn new interactional behaviors than see either parent or child as the “cause” of the problem.
• Therapists need to empower the adoptive parents by including them in the therapeutic interventions.
• When under stress and feeling vulnerable, individuals (parents and children alike) become more defensive, resistant, and frequently more rigid.
• Although neither the adoptive parent nor the therapist can undo the early damage from inadequate nurturing or abuse, they can minimize the scarring and help the adopted individual compensate by learning new skills.
• Any intervention that threatens the parent-child relationship undermines the goal of preserving the family as a resource for the child.
• Although we might prefer the “best interests of the child” standard, in reality, we must frequently invoke “the least detrimental alternative available” standard.
• Decisions must be made considering not only the identified child’s needs, but also the interests of the family as a whole, as they will impact parents, siblings, and extended family members as well.

WHEN OUT-OF-HOME PLACEMENT IS NECESSARY:

Out-of-home placement may be indicated in a wide variety of circumstances, ranging from brief respite to lengthy residential treatment, from assessment to treatment. Special needs adopted children have many reasons for possibly needing the most intensive therapeutic interventions.

Out-of-home placement should not be considered an adoption failure. Indeed, it may be a strong indicator of an adoption success when the family recognizes that their young person needs more help than they alone can provide, and they are willing and able to advocate that their child receive this help.

Children who are not experiencing success in any of the major areas of their life– family, school, and peer relationships– are frequently candidates for out-of-home placement. Family and professionals should also be assessing the child’s functioning within the community and his or her more personal functioning. Looking at these areas in detail frequently helps determine the most beneficial type of placement.

Grotevant and McRoy, in their research on adopted children in residential treatment, found that, although adopted and non-adopted youth in the residential treatment had similar behaviors and diagnoses, there were significant differences, as well. When compared with the control population, the parents of adopted youth had fewer mental health issues and more stable marriages. Of the 50 adopted individuals studied in 33 cases, the adoption played a major role in their emotional disturbance. In nine cases it played a minor role, and in eight cases it seemed to be playing no role.

The intensity of family life at the period when the young person is reintegrating earlier life experiences and redoing the tasks associated with individuation and identity formation may interfere with the achievement of the tasks at hand. Some youth can make much better use of their family when they are not living with them. The family may be able to be more emotionally supportive because they are less drained in this situation as well.

The goal of all post-placement services is to aid in maintaining the long-term commitment and accessibility of the family as a positive influence in the adopted individual’s life.

Bibliography

Barth, R., Berry, M., Goodfield, R. and Carson, M.L. OLDER CHILD ADOPTION AND DISRUPTION. Washington D.C.: The Children’s Bureau, April 1987.

Bourguignon, J.P., and Watson, K.W.: AFTER ADOPTION: A MANUAL FOR PROFESSIONALS WORKING WITH ADOPTIVE FAMILIES. Springfield, Ill. Illinois Department of Children and Family Services, 1987.

Brodzinsky, Schechter, and Henig. BEING ADOPTED: THE LIFELONG SEARCH FOR SELF. New York, Doubleday, 1992.

Busch, L. editor: THE MENTAL HEALTH CHALLENGE OF SPECIAL NEEDS ADOPTION: A Resource Book for Professionals Working with Adoptive Families.

Grabe, P.V. editor: ADOPTION RESOURCES FOR MENTAL HEALTH PROFESSIONALS. New Brunswick: Transaction Publishers, 1990.

Grose, V.; Young, J; and Corcoran-Rumppe, K. PARTNERS: POST-ADOPTION RESOURCES FOR TRAINING, NETWORKING AND EVALUATION SERVICES. WORKING WITH SPECIAL NEEDS ADOPTIVE FAMILIES.

Prew, C; Suter, S; and Carrington, J. POST-ADOPTION FAMILY THERAPY.

This paper developed for her training workshops for child welfare professionals is related to material from Dr. Fahlberg’s book A Child’s Journey through Placement.