A) A Case for Cross-Fertilization: Adoption and the Reproductive Technologies Jean Benward, L.C.S.W., San Ramon, CA and Adrienne Asch, Ph.D., Wellesley College, Wellesley, MA

B) Concurrent Planning: The Ethical Dilemmas Facilitator: Laura Williams, B.A., State of California Department of Social Services, Sacramento, CA

C) Ethics and Adoption: A Spiritual Perspective Moderator: Rev. Rich Buhler, LL.D., Branches Communications, Inc., Orange, CA

D) The Ethics of Staffing Adoption Services Facilitator: Elias Lefferman, Ph.D., Vista del Mar Child and Family Services, Los Angeles, CA

A) A Case for Cross-Fertilization: Adoption and the Reproductive Technologies
Jean Benward, L.C.S.W., San Ramon, CA and Adrienne Asch, Ph.D., Wellesley College, Wellesley, MA

I. Jean Benward

The use of donor gametes began a century ago with the donation of sperm, by a "good looking" medical student, that was used to inseminate the wife of a merchant. Neither the wife nor the husband were told of the nature of the procedure. The medical community, in fact, did not formally acknowledge the use of donor sperm until the 1950s and secrecy has continued to surround gamete donation. Each year there are an estimated 20,000 to 30,000 children created through sperm donation compared to 30,000 to 40,000 children adopted each year. Historically, the providers of gamete donation kept minimal records; gave little information to the recipient couples; assumed that the donor had no interest in the offspring; and provided no opportunity for the offspring to learn about the donor.

Anonymity in gamete donation was designed to protect the couple from stigma, protect the donor from legal liability [such as for child support] and protect the physician from social condemnation. Beyond secrecy and anonymity, donor insemination has always been characterized as a medical treatment and "cure" for infertility. The social and psychological features have been invisible. This medicalization of family building facilitated physician control over the complete process and even now, their control is not seriously challenged.

Until the 1980s, few countries enacted legislation addressing the status of donor assisted families. In the U.S., 35 states have statutes governing sperm donation and five states have statutes governing the status of children produced through egg donation. The number of programs that offer donor egg services has grown and now exceeds 200 programs in the U.S. Between 1989 and 1996, there were 7,110 reported births as a result of donor eggs. Through 1999, the projected number is about 15,000. Embryo donation is relatively uncommon, with only 53 reported births.

Who generally selects the donor? In sperm donation, patients select from profiles, which may provide pages of information. In egg donation, patients have less autonomy. The medical team makes the "match" based on physical characteristics - as has been the case in adoption - to "relieve" the patient of the "daunting task" of selection. Because of the need for donors, however, the use of known donors is more accepted and the past decade has seen the emergence of third party egg donor agencies.

The need for counseling in sperm donation is not established for either donors or recipients. Mental health professionals are rarely used, despite the fact, for example, that 25% of sperm donors are married. Two-thirds of embryo donors do not see a mental health professional. In egg donation, mental health counselors are more often a part of the team and work with patients from early on.

There have been a number of changes in donor insemination practice: Sperm banks -- rather than doctor-recruited medical students - are now the usual source of donors. More information is given to the recipients of sperm and egg donation [although questions remain as to what information is collected, how it is collected and how it is disclosed]. Profit-oriented intermediaries have entered the field [which has de-medicalized the use of donor gametes and moved the practice into a market economy]. The medical profession recognizes the need for information collection and preservation.

One solution to the quandaries about information collection and release is the creation of donor registries. Although there is no single model used in the establishment of a donor registry, there are two common types: 1) The legally mandated registry with mandated release of all non-identifying information and 2) The legally mandated registry with mandated release of all information about the donor, including identifying. Three countries have registries: 1) Sweden [where offspring are entitled to all information in the records but many doctors have sent patients to other countries to avoid information release]; 2) The United Kingdom [with a mandated release of non-identifying information and varying quality and amounts of information available]; and 3) Australia, where the state of Victoria legislated the most far-reaching registry in 1995. This law provides offspring with access to all information, including identifying; gives donors legal rights regarding non-identifying information on recipients and offspring; and allows sperm and egg donors to request identifying information on offspring/recipients [with the authorities required to locate the offspring/recipient regarding their consent to the release of this information].

Unlike adoption, there is no expectation in most countries that donor assisted families will disclose the use of a donor for family building. Many - both professionals and lay people - assume that information disclosure is neither necessary nor preferable. It is assumed that most families do not want to tell their children of their origins, but research reveals that families' feelings are complex in this regard. Barriers to disclosure include lack of information about the donor to give to the offspring, social isolation from other donor assisted families and supportive professionals, and uncertainty about how to do "the telling." A growing body of literature recommends disclosure but there has been little attention given to the implications of disclosure, including the issue of search and the extent to which disclosure puts the underpinnings of the entire system into question.

Biogenetic ties are central to our cultural model of parenthood. Donor kinship does not correspond to our model of family. There is no script to define roles and great fear that biology will trump family ties. Pressure continues to construct a family that is "as good as" the blood tie. We have not yet been able to construct a model in which kinship with the donor is recognized but does not define the family. What do we know about donors? Very little until recently. We know from research that between 25% and 60% are not opposed to the disclosure of identifying information and would donate if information were to be released to offspring at the age of majority. Few programs, however, support information release. What is the role of money in donor recruitment? In egg donation, there is extensive advertising and competition. Compensation averaged $1,000 in 1990 and now may be as high as $5,000. Personally-placed ads offer $10,000 to $25,000 for an egg donor. Efforts are made to distinguish between money for the gamete and money for time and inconvenience, but the distinction is not persuasive.

There is a tension between the concept of altruism - the donor as kind and helpful [a model which requires us to see the donor as a person] -- and the market approach in which the donor is paid but can, as a result, be removed from personal connection. Neither model fully explains the workings of gamete donation.

In comparing adoption and donor conception, the essential differences are that in donor conception: There are relatively few laws. Neither the offspring nor the donors are recognized as having rights. Counsel and support for donors or offspring are not powerful service considerations. There is no court or institutional review. Control lies with the medical profession.

II. Adrienne Asch

It would not be a good idea to cross-fertilize between adoption and the reproductive technologies. Both sides are taking the worst from one another. Both need reform.

Third party reproduction - which adults seek in order to have a genetically connected child and the pregnancy experience - parallels traditional biological procreation. Why do people choose reproductive technology - using their own or others' gametes? Some choose it because there are not enough babies of the "right sort" [age, race, health] and others do not like the home study event connected with adoption. Fertile biological parents are not studied to be approved as parents, and people may have a distaste for agency examination because of privacy issues or because of something in their backgrounds that may render them "unacceptable" to adopt.

There is a collision of values in the reproductive technologies and adoption: reproductive autonomy, family privacy, non-exploitation, and the "best interests" of all who are involved in adoption. There is also a high level of involvement of the market in reproductive technologies in which the people with the money and power "win." Doctor control replaces social work control. Clinics choose who they will serve, implicating issues of assessment of social worth. But prejudices exist in adoption as well regarding who is a "good" adoptive parent and which children are "adoptable." We may not want people to become parents who are truly "bizarre" or who have completely unreasonable expectations of parenting. But are people who seek to become parents through reproductive technologies or adoption much different than biological parents? If we take the reproductive technologies out of medical control and do not screen or select - and let anyone who can pay get the services, have we substituted commercialization for paternalism? Given the current high levels of payment of donors, are we there already?

Recipients have a right to get certain characteristics in seeking donors just as they would get certain characteristics in a partner with whom they biologically conceived a child. But what genetic characteristics are they getting? If we truly believe that social relationships are the basis of parenthood, what about the willingness to parent whichever child you get? We, however, test embryos and fetuses, and there are all kinds of matching in adoption.

In the ethics of reproductive technology, the question of payment has been addressed by the rule of not paying for gametes [just as we should not pay for children, although it happens]. If the rule was actually followed and no money was exchanged for gametes, would that reduce the number of donor inseminations? Would that be a bad thing?

One important aspect is the counseling received by surrogate mothers. Nominal mental health counseling is provided to ensure that the woman will release the child at birth. The expectation in the counseling is that the mother will say that she wants to "give the gift of life." However, rarely is she asked about her other kinds of "giving" activities. The reason is that no one really wants to know because it may give rise to questions about the motivation of altruism.

There is a strong market environment surrounding the reproductive technologies with a focus on recipient couples - ensuring that people who believe that they have a right to a child are happy. It fits within a commercial system in which "if you can buy it, you can have it." The same dynamic operates in adoption in that people use independent adoption to get what they want without having to do what they do not want to do.

We need to ground the discussion on what we spend little time on - the meaning of parenthood. Why do we have children? The reasons range from narcissistic to altruistic, from transmission of family lineage to seeing a child grow and develop.

There has been a misuse of adoption research in the reproductive technologies. For example, it is not appropriate to apply relinquishment data in the context of unplanned pregnancies to decision-making regarding surrogacy. Questions regarding the mother-child bond during pregnancy are different in surrogacy and adoption.

The issue in the use of gametes focuses on the fact that these people have not been social parents. Is consent really possible in such cases? Reproductive technology is affected by secrecy, anonymity, lying and marketing - if adoption is to be reformed, it cannot borrow from the reproductive technologies.

Discussion: Points Raised by Workshop Participants To get minority gamete donors, we offer more money. By contrast, the adoption of minority children costs less. We cannot justify this on the grounds that we pay less to promote these children's adoptions - we pay less because we believe that they are worth "less."

The objection to home studies by those who seek reproductive technology is not the real issue. They want to avoid the adoption process and the barriers to getting the healthy white baby they want. They engage in a fiction that the child will be "more" genetically connected to them even if they are using donated sperm and a donated egg.

We need to watch the tendency to demonize infertile people and remember their extreme powerlessness, the devaluation and stigma they have experienced, and the invasive procedures which they have undergone.

Many people want to experience the social, psychological and physical aspects of pregnancy. They may feel that pregnancy is the important beginning of a relationship and that they will have a greater sense of control after the baby is born.

Couples seeking donor insemination are often not given information on adoption as an option.

The comparison of donor egg/embryo and adoption is problematic, particularly in relation to access to medical/genetic information. Who makes the decision regarding donor matches? What about the use of relatives?

Why do we want genetic ties? It is less about medical history and more about a complicated set of not very well understood reasons. Identity is more complicated than genes and is tied to parents' values and communities.

Not everyone wants information about the woman from whose egg they came. Not everyone needs it. If infertile people try so hard to have a genetic child, then offspring/adoptees also feel genetic needs. We need to focus on the product of reproductive technology - the child who needs a genetic identity and a connection to social and ancestral history.

The cultural value is that "blood is thicker than water." Many people are driven by a fear of not being able to make a real connection with someone with whom they are not genetically connected. It is heightened by the medical and social work professions who are focused on a perfect, non-medicated birth to ensure bonding.

The United Nations Convention on the Rights of the Child states that a child's identity is a matter of right. We see this right recognized in New Zealand where the culture supports the release of identifying information and almost all donors voluntarily agree to information release [also, it is a very small program - only about 100 donor offspring a year]. Donor conception groups are also very active in Victoria, Australia.

One issue is that lesbian couples do not want to disclose. They focus on a "donor," not a "father." What will be the effect on a child of having two mothers and no father?

Word choices are important. Everyone is afraid of biology and people want to create social families. What is wrong with saying, "this man provided sperm, he is your biological father, he's your friend, he's our friend?" The social mother or father may fear that their legitimacy will go away if the biological reality comes to light.

The law presents some of the difficulty with the legal definitions of "family," "marriage," and "parent." A person is either a "parent" or "not a parent." We need to create other statuses, such as "limited father."

There are many problems in adoption but things are happening that can inform the reproductive technologies. Children want connections with their biological roots at varying levels and want to know who their birthmothers and birthfathers are. Adoption is accepting the positive nature of these connections.

Information and contact should not be withheld until age 18. Questions may arise well before an individual reaches that age and information should be available earlier.

We could borrow from adoption to establish a model of donor kinship. But there are other issues: sperm donors may contribute to the creation of 20 offspring and egg donors may have 5 or 6 offspring. Guidelines suggest that sperm donors contribute to 10 families but this is not enforced. Research suggests that men will sign on to multiple offspring even when they agree to be contacted by offspring at adulthood.

Disclosure of donor information is more complex than in adoption. Sorosky counsels not telling children of their origins. Others disagree. Children can learn of their backgrounds gradually and in a developmentally appropriate way. Parents can gradually add to the narrative, starting at age 3. We should not wait until adolescence. Some families find it harder to disclose the fact of donor conception than the fact of adoption.

There are legal issues. We may need to institute DNA testing to ensure that people do not marry a sibling.

B) Concurrent Planning: The Ethical Dilemmas
Facilitator: Laura Williams, B.A., State of California Department of Social Services, Sacramento, CA

Overview of Concurrent Planning The concept of concurrent planning is intuitively logical to us because we use it in our daily lives. For example, when the weather forecast is for rain, we carry umbrellas. The purchase of life insurance plans for life and death at the same time, and pre-nuptual agreements plan for both marriage and divorce. Carrying a spare tire in a car is the anticipation of a common and possible adverse situation that can be easily remedied.

Concurrent planning is a refinement of reunification services which expedites permanency for the child. According to Linda Katz: "It is simply to work towards reunification while at the same time developing an alternative permanency plan." This does not suggest a belief that the reunification plan will not be successful, but asks the question, What if this child doesn't reunify? and plans for this possibility early in order to minimize negative impact on the child. Concurrent planning addresses the balance of a parent's right to parent and a child's right to have a safe, legally permanent family.

In California, 31% of children who enter into kinship care and 21% in foster care are still in foster care four years after their first placement. After two years of being in kinship care, approximately 23% of children are placed three or more times. After four years, the percentage rises to 31% and after six years, it is close to 35%. Forty-three percent of children in foster care experience three or more placements within the first two years of foster care. The percentage rises to 59% by the sixth year. These high percentages have led to concurrent planning becoming part of the law in the state of California. The lives of children are improved by concurrent planning because children spend less time in foster care; experience fewer placements; and avoid long term foster care.

Although a few children may require long term foster care in preparation for emancipation, the programmatic goal for all children is legal permanency. The best kind of permanency is reunification. Adoption or relative guardianship is second choice and non-relative guardianship is third.

Implementation Requirements In order to do concurrent planning, there are system, process and practice requirements. System requirements are attributes of the service delivery system that provide the background for implementation of concurrent planning. Process requirements are necessary agency procedures that direct workers in how to complete specific work tasks important in concurrent planning. Practices are those activities that workers do with clients.

System requirements: A program to recruit, train and support permanency planning families Adoption for non-relatives and adoption or kin guardianship for relatives as the permanency alternatives if reunification fails Strong reunification services Frequent visitation A redefinition of worker success from reunification to creation of timely permanency Non-adversarial decision making such as family conferencing The involvement of service partners, especially substance abuse and domestic violence, to provide services within child welfare timelines Implementation of concurrent planning process listed below Training and support for practice changes, also listed below

Strong reunification services are particularly important because adding concurrent planning to a weak reunification program will not improve it. Frequent visitation is absolutely essential because parents who visit are the ones who will likely reunify.

Process requirements: Early relative disclosure Early paternity determination Assessment of reunification prognosis Assessment of relatives for legal permanency Discussion of concurrent planning in the court report Matching of children with a poor prognosis for reunification with permanency planning families Informing parents about availability of relinquishment

In California in 1997, 66% of the children that entered into care and stayed three or more days reunified with their families. A concurrent planning prognosis assessment differentiates these children who are likely to reunify from those who are likely to grow up in foster care unless a concurrent permanency plan is implemented. If there is little potential for reunification, the goal is to place that child in a permanency planning home - a home which supports reunification and, at the same time, offers a permanent home in the case that reunification efforts fail. A prognosis assessment is a social worker's judgement based on a structured assessment which reflects the balance between family strengths and poor prognosis indicators. There is no common definition for a poor prognosis because of variations in social worker practice and the culture of each court.

Change first needs to take place at the systems levels. Counties need to choose a prognosis tool, formulate policies and procedures, encourage judges to order paternity tests early in the case, and collect relative information. All of this has to be done early and resources need to be available from the beginning because decisions need to be made quickly. Only when these are in place should workers be trained in the needed practices.

Practice requirements: Placement of children with a poor prognosis for reunification with permanency planning families Full disclosure - discussion of the standards for reunification, the parent's progress toward these standards, and the consequence of not meeting these standards in the available time Recognition, exploration, and resolution of parental ambivalence Exploration of legal permanency with caretakers

Placing children with a poor prognosis for reunification in permanency planning families is a key aspect of concurrent planning. Concurrent planning helps social workers and birthparents stay focused on the importance of achieving timely permanency for children by maintaining clear timelines and expectations.

The parameters that underline concurrent planning case decisions include: Permanency is achieved in a timely manner. The number of placements is minimized. Fewer placements will help children develop and/or maintain attachment behaviors. Relatives are potentially the best kind of permanency planning families. A family is sought to provide the child's permanency alternative, not the other way around. A child's current and potential relationship, including those with the birth family, are maintained whenever possible, regardless of the form of permanency selected. If reunification fails, adoption or relative guardianship is viewed as the preferred alternative unless detriment to the child is established. A family decision making meeting is seen as a very effective way to select a permanency planning family.

Workers may face ethical dilemmas when implementing concurrent planning. Acknowledgment and discussion of these dilemmas, such as the ones encountered in the following case scenario, may assist workers in understanding concurrent planning theory and in resolving personal issues that may undermine its ethical implementation.

Case Summary Johnny (5 days old, African American and White) was reported by the hospital where he was born prematurely (weighing 4 pounds) as testing positive for cocaine and other drugs. He is in ICU, suffering from apnea, convulsions and a cleft palate. Child protection has placed a hold on his discharge. His mother Carmen (age 25, African American) left the hospital the day of his birth, but has been back to visit him briefly each day. When the worker visited the mother's home, the house was filthy, there was no food and Elizabeth (age 6, African American) was visibly underweight. Elizabeth and Akeem (age 7, African American) showed no physical signs of abuse and denied ever having been abused. Neither child had eaten since the day before and there was no adult present, although Akeem said that the neighbor helped when Akeem asked for his assistance.

The detention hearing for all three children was Friday 9/13. The jurisdictional/dispositional hearing is scheduled for 9/22. Akeem and Elizabeth were placed with their maternal grandparents, Mary and Frank Farmer (aged 40 & 45, both African American), on an emergency basis.

Carmen has been supporting herself with welfare and was supplementing these payments with prostitution until the latter part of her pregnancy. Carmen was married to Kareem Miller (aged 25, African American - the father of Elizabeth and Akeem) at age 18 and worked throughout her marriage and subsequent divorce (4 years ago) as a grocery cashier. She became involved in drugs during her relationship with Herman Jones (age 30, White - father of Johnny) which overlapped her divorce date by 16 months. She quit her job and took her children to live with him. He supported the family through dealing drugs and fencing stolen property and is currently serving his second year of a 15 year prison term for manslaughter. Carmen admits being dependant on drugs for the past 2 ‡ years and doesn't believe she can quit because she has enrolled in two drug treatment programs and has not been able to stay clean.

This is the third CPS referral for Carmen. Both previous referrals stemmed from arrests for prostitution. No dependency petition was filed since Carmen was able to reach her parents to care for the children. She refused voluntary child protection services each time.

Carmen visits her parents at least once a month and has no relationship with Herman Jones' family. She accepts responsibility for having her children removed and states that she never should have gotten involved with Herman Jones and left her husband. She repeatedly states that she has ruined not only her life, but also the lives of her children and feels that Johnny's cleft palate is a sign from God that she is evil.

The two older children are closely bonded. Akeem displays some parentified behavior, but there are no observable developmental delays or medical problems.

The following relatives express interest in providing ongoing foster care for the children:

1) Mary and Frank Farmer want to provide long term care for Elizabeth and Akeem but are afraid that they won't be able to meet Johnny's needs. They rent a 3 bedroom apartment in a transitional neighborhood where gang violence is becoming a problem. Frank has worked at Firestone Tire Factory for 4 years which has had frequent lay-offs in recent years. Mary is not currently employed, although she has periodically worked as a hotel maid. They are assessed as meeting all placement criteria except a willingness to provide legal permanency and take all sibling group members. They place a strong emphasis on school attendance and preventive medical care; they are relatives; and they have a strong and loving relationship with the children.

2) April & Gunther Jones (aged 52 and 57, both White - parents of Herman Jones) are eager to be a permanency planning family for Johnny and are willing to take Akeem and Elizabeth if it is necessary to keep the sibling group together. They own a 3 bedroom house in an ethnically diverse middle class neighborhood. Gunther has had a civil service job for 20 years and April has never worked outside the home. The assessment finds that the only impediment is April's 10 year-old conviction for driving under the influence. She says the incident was not due to a problem with alcohol but bad judgement. The Jones' believe that corporal punishment isn't appropriate; they have a strong marriage; they are a part of a close church community; they are committed to adoption if reunification does not occur; they are willing to take all siblings; and they value education and medical care.

Which home should the reunification worker choose for placement of the children?

Case Discussion There is no correct answer to the question posed above. Carmen's prognosis for reunification should be the main consideration in determining where the children should be placed. Because this is a probable poor reunification case based on Carmen's history of drug use and prior attempts at recovery, the social worker's first obligation is to place the children with a permanent planning family who will support reunification and offer them permanency. The issues of race and culture are troubling in this case because both families have significant drawbacks.

Does concurrent planning rob minority children of their family and community? An ethical dilemma sometimes stated regarding concurrent planning centers around the fact that there are more African American children in the foster care system than African American families available to adopt them. Concurrent planning advocates for permanency (adoption or kin guardianship) through placement with a permanency planning family when reunification is failing. Because of the shortage of African American families and the provisions of MEPA, concurrent planning will result in many African American children finding permanency outside their communities with adoptive families of a different race. On the other hand, California requires the relatives be given placement preference and funds relative guardianship at a level similar to foster care in order to remove financial barriers to legal permanency. Discussion about this hypothetical case included the following points made by workshop participants: The Farmers might not support Johnny ës biracial heritage. It is often assumed that Caucasian children don't have a distinct culture. Biracial children have a right to maintain connections with both their cultures and this must be considered in selecting a placement. On the other hand, whenever a child is part African American, no matter what the percentage, society tends to view that child as solely African American. A white child in a black family is not in danger of losing touch with white culture because it is the dominant culture. The Jones live in an ethnically diverse neighborhood which would probably help the children to maintain a sense of their African American culture. If the Jones' adopted the children and the Farmers maintained contact and played a very active role in the children's lives, the Jones' would offer them permanency and would keep the siblings together while the Farmers would help the children to maintain connections to their African American culture. Older children have a sense of their race and culture. The children would most likely lose their cultural connections if placed with the Jones.

Does concurrent services devalue long term foster care with a relative? Some would argue that it does because relatives are only acceptable if they offer legal permanency -- either adoption or relative guardianship. This ignores the kinship commitment that doesn't seek validation by a bureaucracy. On the other hand, concurrent planning identifies relatives early in the dependency process in order to evaluate them for placement. California statue mandates that certain relatives be given placement preference. Given the mission of creating safety, timely permanency, and well-being for children, we do want to place with relatives, but only relatives who will offer legal permanency. The following points were raised: For some children, foster care may not give them the feeling of permanency that adoption would. In Indian communities and Latino families, however, care provided by extended family is considered permanent. It is a traditional form of child rearing. Neither a blanket prohibition nor a blanket endorsement of long term relative care would serve children. It depends on what each child is accustomed to and what the family is able to do for that child. The social worker needs to inform the Farmers' of their options - both in terms of available financial and medical support and the types of care that they may need to provide. Knowing that they will receive financial and medical support may cause them to decide to care for Johnny or they may decide that such support would enable them to adopt the children. Perhaps adoption is not a consideration for them because of cultural differences and they might be willing to become legal guardians of the children. Workers need to inform families of all options and be careful not to allow their own perceptions of permanency to influence the views of families. Workers sometimes have only two hours to find a placement for a child and that quick decision can impact the future of the child in terms of permanency. From the children's perspective, permanency is not a legal issue. For them, permanency is the lifelong relationship that they have had with their grandparents.

Does concurrent planning allow sufficient time for substance abuse recovery? Substance abuse services are not often readily available nor do the treatment timelines conform with child welfare's time limits for reunification. But, children can't wait for long time periods while their parents rehabilitate. Also, the alternative of losing the child can be a powerful motivator for the parent to enter treatment. Participants raised the following points regarding this issue: What is our responsibility to advocate for timely, effective substance abuse services? What is our stake in a strong reunification program? Oftentimes, funding is separate so that adoption is able to close its eyes and say "that it is not an adoption issue, but a child welfare issue." Is that an ethical stance? Current timelines fail to take into account that a substance abuse problem will not be overcome in a short period of time. Given this reality, some believe that it is not the recovery but the demonstrated attempts by parents to deal with their problems that are important for social workers to look at in their evaluations. Can placement choice be used to encourage the mother's involvement in treatment and reunification? Placing the children with the Jones' would be a strong message to Carmen that she is going to lose contact with her children if she cannot be reunified with them. On the other hand, would her family be more supportive of her rehabilitation efforts? Which of these families has a better chance of facilitating reunification? While it is true that the well-being of the child must be considered before that of the mother, the well-being of the mother is undeniably linked to the well-being of the child. Substance abuse services need to be made more available. Do people really get the services they need to reunify? In general, society takes a band-aid approach. Services are either hit or miss or they are not designed for women with children. Our value system needs to be changed and the focus needs to be on the family system. Adoption advocates need to advocate for welfare or TANF benefits, substance abuse treatment, family preservation, and the whole range of services that precede adoption so that they can be certain that when a child is adopted, it is because it is the best option. The principle of full disclosure can help to empower and motivate parents. Social workers have a responsibility to inform parents of the behavior that is expected of them, how close they are to that standard, and what the consequences of not reunifying are. A parent's response to this information will ultimately determine whether reunification is achieved.

Other points raised regarding the case scenario include: Siblings groups must stay together. Whether they know each other or not at the time of placement is not the issue because they will grow up to know each other. Both families should take part in family group conferencing where they would be assisted in formulating a plan that everyone could live with. Both families should work together. An open placement should be established with Jones' adopting the children and the Farmers maintaining contact and playing a very active role in the children's lives.

C) Ethics and Adoption: A Spiritual Perspective
Moderator: Rev. Rich Buhler, LL.D., Branches Communications, Inc., Orange, CA

I. Father Tom Brosnan, M.Div., M.F.A., Blessed Sacrament Catholic Church, Brooklyn, NY

Intimacy is the place where adoption encounters spirituality. Intimacy means to announce, to make known. When secrecy is used as a means of protecting adoptees who are born illegitimate, adoptees can never announce themselves fully - they are perpetually reticent to make themselves known.

The institution of adoption, intending to protect from the stigma of illegitimacy, sought a solution through the amended birth certificate. With it came the principle of asserted equivalence in which the adopted child would be as if born to the adoptive parents. Illegitimacy is a concept, or in Joan Hollinger's words, a "legal fiction," created by law. Problems occur, however, when such fictions are taken for facts.

The Catholic philosopher and theologian, St. Thomas Aquinas, wrote that "human beings are moved by love and truth. So inherent is this drive for the truth that in human nature it becomes an imperative. To address a human being in any lesser mode is to do his nature violence." Lies do violence to the human person. When fiction is presented as fact, as is the case of the amended birth certificate, legal fictions become outright lies, assaulting the dignity of the people for whom they were created to protect. Lies are illusions and violations of the innate intimacy between body and soul.

In his work, The Future of Illusion, Freud argued that religion is undesirable precisely because it fosters illusion. The task of psychology was to distinguish illusion from truth. Father Brosnan suggests that this is also the task of true spirituality. Each human being has the task of distinguishing truth from reality. This is reflected in the Catholic belief in Purgatory - where souls are purified of life-long illusions, and where they prepare to meet truth face to face.

When Father Brosnan demanded to see his original baptismal certificate (not the amended version), he learned that his birthmother was baptized in the Church of the Holy Souls. With this information, he was eventually able to find his birthmother. Holy Souls - referring to the souls in Purgatory who, even after death, remain in need of prayers for their release to heaven - is an extremely unusual name for a church. Father Brosnan interprets this as prophetic, signifying how the secrecy and lies practiced by the institution of adoption had led both he and his birthmother to join the other suffering souls of Purgatory.

In adoption there remain many illusions to be shed. George Annas contends that the gestational mother should be considered the legal mother, asserting another equivalence that doesn't ring true. It is the genetic contribution that is essential to existence. The gestational mother can be replaced and the child will still exist. However, substitute another's egg or sperm, and the individual is lost. When presented as fact, principles of asserted equivalence and legal fictions are illusions which need to be denounced. Only then can adoptees practice intimacy, announce themselves, and make themselves fully known.

Those working in the field of adoption want to build a house of ethical adoption. Any attempt to build this house - even when fueled by the best intentions - will fail if built on sand. Legal fictions, principles of asserted equivalence, sealed records, amended certificates, secrecy and lies - are all illusions. They are all sand. This ethical "house" must be built on "the hard rock of truth"so that adoptees - those holy souls - can be freed from their time in Purgatory.

II. Pastor Jeff Johnson, M.Div., Calvary Chapel of Downey, Downey, CA and Karyn Johnson, B.S., House of Ruth Adoption Services, Downey, CA

The bible can be used as a code of ethics, particularly to support open adoption. There are many examples of open adoptions in the bible, including Joseph's adoption of Jesus and Jesus' lifelong knowledge that God was his father.

The ultimate open adoption appears in Romans, Chapter 8, Verse 14: "For as many as are led by the spirit of God, they are the sons (children) of God. For you have not received the spirit of bondage akin to fear, but you have received the spirit of adoption." In other words, those who accept God as the Messiah are adopted spiritually into His family. An ethical problem in closed adoptions is the lack of knowledge about genealogy. The importance of genealogy is illustrated in the Bible with the listing of names and birth dates of family members and in Nehemiah 7:5, where God directs Nehemiah to assemble a system of registering families. In another Biblical example, priests whose birth records were lost were deemed ëunclean' and were not allowed to practice their religion.

The importance of genealogical knowledge is also illustrated in the case of Pastor Johnson's biological son who was placed for adoption as an infant. His son reportedly asked himself the question, "Who am I?" throughout his life and felt as though he had finally found an answer to this question when he and Pastor Johnson were reunited.

Karyn Johnson, who placed her daughter for adoption in 1967, tried for many years to gain information about her. She was frustrated by the fact that any individual can order a birth certificate of a non-adopted person, but she, as a birthmother - whose name appeared on her daughter's birth certificate - was denied access to this information. She ultimately paid a private investigator to find the information and was reunited with her daughter.

One adoptee described being adopted as waking up one day with amnesia and being told that who you were before is no longer important - that being adopted gives you membership in a new family and the old one no longer matters. It is for this reason that adoption records should be open.

III. Rabbi Allen Krause, D.D., Temple Beth El, Aliso Viejo, CA

According to Judaism, there are 613 commandments. The first is to be fruitful and multiply. However, this does not condemn a married couple without children because marriage, itself, is considered a holy state that God wants us to be in. Marriage is not considered second best to having children. Therefore, adoption must be a positive way of building a family for those couples who cannot do so biologically.

Adoption was clearly part of the culture in Biblical times, even though it was not legally formalized. In fact, there is no word for adoption in Hebrew. Scripture considers that anyone who raises a child is the parent.

There is, however, a "certain tension" regarding adoption in Judaism. On the one hand, adoptive parents are considered the parents. Birthparents cannot change their minds and take the child back and the child is given the name of the adoptive parents, not the birthparents. On the other hand, the adopted child's religious status is dependent on the religion of the birthparents.

In Orthodox traditions, one can only be Jewish if his/her biological mother is Jewish or if he/she is converted by an Orthodox rabbi. For example, a non-Orthodox couple wanted to convert their adopted child to Judaism. Orthodox rabbis, however, refused their request on the basis of the belief that converting the child of non-Orthodox parents would make the child "a sinner." The couple eventually found a more liberal Orthodox rabbi who agreed to convert their child.

The Reform approach says that the process of raising that child Jewish makes him/her Jewish unless that child decides not to be Jewish later.

Playing devil's advocate, Rabbi Krause questioned whether open adoption is necessarily the "right" choice for every family. The adoption of his daughter, for example, has always been closed, although his wife has maintained contact with their daughter's birthmother. Recalling the difficulties that his daughter experienced during adolescence, Rabbi Krause pondered whether contact with her birthmother might have made this time period even more difficult for his daughter, particularly in light of the fact that the psychological state of the birthmother has always been questionable.

IV. Reverend Katie Lee Crane, M.Div., M.A.L.S., First Parish of Sudbury, Sudbury, MA

What is spiritual? And from whose perspective? From Reverend Crane's perspective, spiritual is "that which animates us, that which is our deepest essence, that which enables us or calls us to be the person that we were born to be." It has a name in many languages and many cultures.

In one of his books, Joseph Amado concluded that "stories are our most important inheritance - the heart and blood of our moral lives." People make meaning from the stories that they are given.

In the Navajo creation story, an infant is found and two men express interest in raising the child. In expressing this interest, they discuss what they think the child will need to eat. Ultimately, they agree to bring her to First Woman. The child grows up to be Changing Woman, the mother of the Navajo clan. From a Western perspective, this as an adoption story. The Navajos, however, who do not have a word for adoption, view this story as a kinship story. From the Navajo perspective, the question is not, Who gets to raise the child? but rather, What are the child's needs?

Every major religion and spiritual tradition has stories that help individuals make meanings and keep meanings alive. Identities, both individual and collective, come through stories. For example, one Native American said that if a child is born into the Bear clan, he has got to be taught what that means and be given a name that will fit with the customs. This is his identity and it goes back to the beginning of time. That is power. That is what makes an individual feel good about him/herself. "If you don't know who you are, you don't know where anything else fits."

Are personal stories shaped by the Judeo-Christian creation story? Is the sense of self influenced by the story that Adam and Eve were banished because Eve wasn't good enough? Reverend Crane answers this question based on her own experiences and shares her realization that this story does influence how she makes meanings and how she lives.

Dr. Ronald Nydam, in an article published in the Journal of Pastoral Care, posed the question, "How do children of adoption design their perceptions of God in light of their lived experiences (extra-familial adoptions)?" The basic questions that human beings ask about the human condition are: Who am I? Where did I come from? These questions can form spiritual identities. Nydam questioned what happens when there is spiritual suffering or abandonment at an early age and whether the child is left, as a result, unable to conceptualize a god in a culture "where the god is a benevolent parent figure." While human beings may reconceptualize their idea of god several times throughout their lives, it may not be the case for adoptees as it may be difficult to get beyond the initial parental image.

Nydam contends that adoptees only find their essential natures when losses are sufficiently mourned. Tillick, a theologian, said, "Self-affirmation requires facing reality with both eyes wide open to the truth." He concludes that a sense of identity is essential "to be" (or to be spiritual) and Reverend Crane wonders if adoptees are at risk of having difficulties in achieving this sense of self. She concludes that when their personal stories are kept from adoptees, they are robbed of their identities. The adoptee is not only capable of facing reality and hearing the whole story, but doing so will enable the adoptee to feel complete.

In order to nurture the spiritual aspects of adoption, Reverend Crane recommends: Keeping both adoptive and biological connections open (as opposed to severing them). Nurturing cultural differences (as opposed to assimilating them). "Everyone has to give a little and give up a little bit more." There is not one way to do it and "let us open our minds and our hearts to creative alternatives." "And let us look back at our stories."

Judith Plasko, a feminist theologian says, "Forgetting the stories is a kind of spiritual injury." Leslie Marmon-Silko, a Native American writer says, "Don't be fooled. You won't have anything, if you don't have the stories."

V. Reverend Rich Buhler

Challenges of adoption problems in the ministry: Helping people understand that open adoption means options Defining the rights and meeting the needs of members of the triad Supporting individuals as they decide to search or not to search Deciding what to do about secrecy both in terms of adoption and the reproductive technologies

While many people might question where God is through the adoption experience, others, like Reverend Buhler himself, feel that the closest connection they have in life is with God.

There are many adopted persons whose paths in life can be attributed to unresolved issues with their adoptions.

The spiritual side of adoption is essential. "If you believe in a personal and purposeful God, then you believe that God had a personal reason for you existing."

Discussion: Points Raised by Conference Participants If a child comes from one religious tradition and is placed into another, what is the spiritual obligation to that child? In the Unitarian Universalist tradition, there is not an assumption that everyone has the same concept of God. The belief system is based on the notion that everyone in the community is involved in an individual search for truth and meaning and all community members support each other during the process. On a spiritual level, the question is, how is the community going to support the child in understanding what his/her spiritual identity is or could be?

How one views their religion and the importance that it plays in life will depend on that individual. For example, some individuals view their religion based on their biological religious backgrounds. Others feel connected to the religion of their adoptive families. Still, others feel most connected to a faith that they learn about later in life. Thus, the judgements of the importance of an adopted child's religion will invariably be based on the religious background and traditions of the person making the assessment.

Some adoptive parents claim that by adopting they are doing God's work or carrying out God's will. Other individuals, in their belief that God has a plan for everyone, indirectly attribute their adoption experiences to that plan. Many people are opposed to this idea because it might imply that God intends for certain people to relinquish their children. Additionally, equating an individual's particular action with God's will is offensive to some individuals.

D) The Ethics of Staffing Adoption Services
Facilitator: Elias Lefferman, Ph.D., Vista del Mar Child and Family Services, Los Angeles, CA

Ethics involve the principles of right and wrong in staffing and training personnel. How do we want to practice? And as new agencies enter adoption - especially in California as foster care agencies become adoption agencies - do they know what they are doing? As we look back on practice in the past - such as telling lies in the belief that nurture was stronger than nature or that negative information would unduly influence adoptive parents' expectations of their children - we see that we did much that would be considered "wrong" from our view today. How do we assess our current practice?

At the societal and cultural levels, we confront conflicting beliefs about adoption as revealed in media coverage: on the one hand, adoption is a warm, fuzzy centerpiece of lovely stories about adoption; and on the other, adoption is pathological, as demonstrated by stories about adoptees who commit crimes. There are schizophrenic feelings about adoption: it is "good" because it provides homes for children but there are underlying feelings because it means taking a risk on an "unknown quantity." Birthparents have not been viewed positively by society, and consistently the "bad seed" theory is injected into media stories [the media often identify a person as an "adopted child" but never, for example, describe someone as a premature of "low birth weight" child]. Those views trickle down to social workers. It is necessary to examine how these societal views affect the people who are hired. There are a number of views of adoption that can influence staff: adoption as "charity" [people are doing a "good deed" in adopting] adoption as a "gift from God" [people who can't conceive are being given a second chance] adoption as a way of reducing abuse [as a society we are particularly outraged by abusive parents] adoption as a "feel good" occupation [society does not want to hear about the loss] the idea that adoption allows problems to be someone else's fault [adoptive parents can explain their children's problems as coming from their birth families]

An important issue is whether it is "good," "bad" or necessary for staff to be members of the triad. Much adoption reform has been driven by triad members, but personal experience can raise issues in the context of being an adoption professional. Are people working out personal issues through agency programs? How can we balance personal issues and agency mission, values and goals? NASW, in its ethical standards (1.06), requires social workers to avoid conflicts of interests that interfere with the exercise of professional judgment. This requires both the professional's internal sense and supervisors' sense of how staff are operating in relation to agency values. In response to these remarks, a participant commented that in New Zealand, there is a deliberate policy of employing triad members as adoption workers and this practice is seen as driving many positive changes in adoption and raising such radical questions as, "Do we need adoption?" There is a need to challenge thinking and triad members can do this, but there are also questions of evenhandedness.

Another issue is confidentiality: Who are our clients? At Vista del Mar Child and Family Services, birthparents and adoptive parents are told that services do not constitute a confidential arrangement and if information is shared that would be important to both parties, the agency will provide that information. This type of approach, however, needs to be clarified at the beginning, with a signed statement reflecting this agreement. Withholding information is not ethical - for example, a birthmother who states that she is only seeking support and does not believe that she wishes to place her child for adoption or a prospective adoptive parent who wants to keep information from a birthparent that would affect her choice. We must anticipate potential conflicts of interest and establish honesty and respect for all parties at the beginning. The same rule applies in foster care/involuntary situations. There may be legal constraints, but a philosophy of respect for a child's entire life and experiences should be implemented throughout. Information can be shared in a respectful way, as when a birth parent did not know how to parent an abused child. Ultimately, children, birthparents and adoptive parents are all clients entitled to rights.

With regard to non-triad staff, how has our culture shaped their views of adoption? They tend to more easily align with adoptive parents - people who are middle class and "doing the right thing." Supervisors must shape and bring their thinking to staff attitudes and practices, helping staff to understand the enormity of creating a new family system by ending the legal rights of the birth family, particularly when there is an involuntary termination of parental rights. Foster care agencies do not typically understand the impact of termination of parental rights as it is outside the range of usual reunification work. New agencies need to understand that there is an obligation for teaching, modeling, and preparing new families, even when the family has fostered the child for years. The change is critical -- two family systems are created. There is a need to build an understanding of "acceptance of differences;" support for openness options; and respect for a child's history and an integrated sense of self.

Training of staff is critical. Training, however, must be integrated into day-to-day work. Cultural biases that may be injected into the work must be examined, including the use of language. Two issues of particular importance are the re-naming of children and the amended birth certificate. Naming raises a number of questions. Do we want to give a 5 year old a new name? Why not a hyphenated name [as in marriage] for children at a certain age? Why is it a given that a child should be re-named? Why not expand the notions of "name"?

With regard to the amended birth certificate, there are a number of alternative approaches, including putting the amended birth certificate with the original birth certificate so that the two are attached. Do staff realize that if the original birth certificate is not obtained before the adoption is finalized, it will be sealed? If we believe in openness, then how do we reconcile sealed original records for any adoptees?

Through education, agencies can help adoptive parents understand the importance of this information and secure it for the child and family and can work with birthparents about any fears of sharing information. However, what if a birthmother or birthfather does not want to have his/her name placed on the birth certificate? Shouldn't their wishes be respected? What about a ten year old who has been abused who is given identifying information - won't that make him a challenging adolescent? What does sealing the records of an older child who already knows his family and where they live accomplish? In light of the fact that visits are increasingly occurring in the homes of foster parents, it is staff, and not always foster parents, who believe that birthparents are "dangerous" or can't be worked with effectively.

Professionals do not want to be scrutinized and secrecy has protected the profession. Triad members are becoming more vocal and the "business"can no longer keep triad members separated. Secrecy in unraveling. An evaluation of biases is needed. This process can be painful. As administrators, we need to look at ourselves before we look at our staff. We need to look at agency policy, advertising, and practice.

What training do adoption staff get on values and anti-discrimination? In Great Britain, this type of training is routinely done. On the West Coast of the U.S., schools of social work do not teach adoption-related issues. Agencies do the training of staff. Historically, the California Association of Adoption Agencies supported such training but with the flood of new agencies, this structure has been difficult to continue. Adoption is a specialty, but there is a cultural and professional denial of the special nature of the work -- a belief that anyone can do it. Adoption has been a relatively small specialty and we tend to think in social work that skills are transferable. We need to make adoption rest on a system of values with accreditation and training to support quality staff in doing adoption work. Values are different in foster care and adoption - staff need to understand that families are "forever." Training is essential but we need to look at how each individual applies that knowledge and skill. CSWE [the Council on Social Work Education] should be supporting national training and accreditation - core competencies need to be recognized and taught. In Ohio, for example, private and public social workers must complete a certain number of hours of training to be able to do home assessments.

Part of the issue relates to the fact that a range of professional groups are coming into adoption - social workers, psychologists, and marriage and family counselors. "Mom and Pop" providers of adoption services are clearly not acceptable but how do we address the range of professionals entering the field? This issue also raises the question of whether we are overspecializing. And how do we allow for differences in service providers? For example, is there room for a religious-based organization that will not allow gay or lesbian adoption? Is such practice "unethical" or is this simply mission-driven?

Another issue is that of collaborative adoption in which agencies and lawyers work together. There has been an abdication of infant adoption to lawyers who have been allowed to control the process. Agency involvement provides aspects of adoption services that lawyers cannot bring -- counseling, preparation, and post adoption services. Why do adoptive families go to lawyers? The reasons range from lawyers' promises of speed in finding a baby to agency's practices [such as refusing to consider applicants of a certain age]. Agencies need to empower birthparents to select adoptive families for their children and not rule out families on the basis of agency biases. Agencies have created many of their own problems through inflexibility. A workshop participant explained how one agency, in an attempt to respond to the ethical dilemmas in the practice of infant adoption, stopped doing them altogether. This decision was based on their beliefs that children in foster care are most in need of services and infant adoption is "bad business" in that it is very expensive to do well and it cannot easily be done ethically. Dr. Lefferman contended that while there are ethical dilemmas associated with the practice of infant adoption, agencies should be doing infant adoptions, particularly to advocate for birthparents and their right to make fully empowered decisions.

Lawyers are where agencies were a few decades ago, in that they generally see adoption as a one-time event. Agencies can provide an understanding of the life-long nature of adoption.

Agencies need to look at their mission and values and professionals need to examine how they may view their expertise as exclusive. Agencies should also consider how economic viability issues impact their practice. Important questions are: how should an agency measure success? Will we be seeing disruption as an overriding outcome? Adoption can be "good" or "bad," depending on what is done at the very beginning.

Recommendations for the future: Certification for adoption practice A review panel for certification Licensure standards A licensing requirement that agencies provide post-adoption services