Research: Institute Research

Title: Keeping The Promise: The Critical Need for Post-Adoption Services to Enable Children and Families to Succeed

Author: Susan Livingston Smith
Published: 2010 October. New York NY: Evan B. Donaldson Adoption Institute
Document Type: Policy Brief (99 pages)
Availability: PDF Full Report | Executive Summary | Web Page | Press Release I

An extensive examination of adoptive families in the United States, concludes that too many are not receiving the essential services they need, and calls for a reshaping of national priorities and resources to develop and provide such services.

In an effort to demonstrate the breadth of professional support for a "paradigm shift," major child welfare and adoption organizations across the country joined in endorsing the 116-page report, which was researched and published by the Evan B. Donaldson Adoption Institute and is entitled "Keeping the Promise: The Critical Need for Post-Adoption Services to Enable Children and Families to Succeed."

The report stresses that the vast majority of adopted children function normally — and their parents are highly satisfied with their families. But it also points out that just over the past 15 years, nearly a million boys and girls were adopted by Americans from foster care in our country and from orphanages abroad, and the majority of U.S. adoptions continue to be of those types (by far, mostly from state child welfare systems).

"What it means is that these children live with the emotional, psychological and developmental consequences of having been abused, neglected or institutionalized before they were adopted," said Adoption Institute Executive Director Adam Pertman. "The good news is that most of them, and their families, are doing just fine; the bad news is that the ones who need help too often aren't getting it."

The Adoption Institute report, which is the most comprehensive compilation of knowledge about post-adoption services to date, recommends that "the paradigm has to shift" from simply forming families to providing the supports needed to raise children to healthy adulthood. Among its recommendations are to:

• Convene a national leadership task force to shape/ promote changes in policy and practice.
• Develop public-private partnerships and dedicate federal funding for post-adoption services.
• Make such services a routine part of federal, state and local child welfare planning/financing.
• Fund and conduct critically needed research to develop/ assess the most effective services.

------------------

Executive Summary

Several months ago, when the media focused the nation's attention on yet another sensational adoption story - this time about a Tennessee mother who put her 7-year-old son on a plane back to Russia – all sorts of disquieting questions flowed through people's minds. They ranged from the rhetorical ("What kind of mother would do such a thing?") to the important ("Are children in orphanages being adequately cared for before adoption?") to the inadvertently stigmatizing ("If a child can be so easily `returned,' is adoption really permanent?").

Most child welfare and adoption professionals watched the drama with better-trained, more-experienced eyes, however, and so they raised very different questions. For example: "Did the mother get accurate information about the boy before adopting, as well as training and education, so she would be prepared for the challenges of parenting a child who had been institutionalized?" And, most pointedly: "Were post-adoption services readily available to her so that she could help her son, and herself, rather than giving up?"

Over the last two decades, our nation has seen steep increases in the number of adoptions from foster care in the United States and from orphanages abroad – which, combined, make up the vast majority of non-stepparent adoptions; i.e., we have made considerable progress in finding enduring families for girls and boys who have suffered from abuse, neglect, multiple placements, institutionalization and other pre-adoption experiences that can cause them physical, psychological, emotional and developmental harm. Now the paradigm has to shift, and our priority must be not only to achieve permanency, but also to assure that adoptive parents receive the supports they need to raise their children to healthy adulthood.

This research-based report by the Evan B. Donaldson Adoption Institute represents the most extensive compilation of knowledge in the area of post-adoption services to date, and it's goal is unambiguously ambitious: It is to broaden the understanding of this critical issue by the public, professionals and policymakers – and to promote a commensurate realignment of state and national priorities and resources – so that effective, accessible supports for sustaining and strengthening adoptive families become a routine, ongoing reality. The bottom line is that best practices should entail not only helping to form families, but also enabling them to succeed.

In an overwhelming majority of cases, adoption is genuinely beneficial and permanent; it's important to remember that "man bites dog" is a story and so, by definition, accounts such as the one about the boy sent back to Russia are the exception rather than the rule. That is the good news. The bad news is that, when adoptions do fail, the economic and social costs to our country are considerable, and the toll on the children and families involved is even greater. Furthermore, for every adoption that doesn't work out, there are many more – though it must be stressed, still a minority – in which the families struggle every day to address the often-serious, sometimes-unnerving problems their children developed before they were adopted.

In addition to assistance for adopted children and their families, post-adoption services for birthparents and their families also are vitally important, although much less developed. A few adoption agencies and foundations have devised supports to meet the needs of birthparents, but there is no research on how well they work, so this is an area that requires far more attention. The Adoption Institute has done some work relating to women and men who relinquish their children – including our 2006 report "Safeguarding the Rights and Well-Being of Birthparents in the Adoption Process" – and we are currently engaged in additional research on the subject. This current publication, however, centers solely on supports for families after adoptions take place, with particular emphasis on those adopting boys and girls who have suffered early adverse experiences.

It is important to underscore the breadth and depth of sentiment in the fields of adoption and child welfare regarding the need for heightened attention to post-adoption services in national and state policy, in professional practice, and in families' everyday lives. Toward the end of demonstrating this consensus, this paper – including its findings and recommendations – is being endorsed by major organizations and agencies including: the Child Welfare League of America, the North American Council on Adoptable Children, the Dave Thomas Foundation for Adoption, Voice for Adoption,¹ the American Academy of Adoption Attorneys, the National Council for Adoption, the Joint Council on International Children's Services, the Adoption Exchange Association, the Kinship Center, Lutheran Social Services of New England, Spence-Chapin Services to Families, The Cradle, Bethany Christian Services, the Center for Family Connections, the Center for Adoption Support and Education, the New York State Citizens' Coalition for Children, Wide Horizons for Children, Adoptions Together, Children's Home Society of North Carolina, and Adoption Resources of Wisconsin. Additional organizations support this work and plan to utilize and disseminate it, but are constrained by governmental or other regulations from becoming official "endorsers." All these organizations, and many others across the U.S., recognize that the development and use of post-adoption services is a critical need to sustain adoptive families and are united in advancing the recommendations below.

PRIMARY FINDINGS

"Keeping the Promise" examines the range of service needs for adoptive families. It describes the challenges faced by these families, examines the research on adoption outcomes, and discusses the risk and protective factors for children and families that predict more positive, as well as more negative, adjustments. To date, there has not been a synthesis of knowledge in the field of post-adoption services that surveys the many clinical and family-support approaches being used and derives insights from research and program evaluations. This report by the Evan B. Donaldson Adoption Institute seeks to provide such a synthesis and to identify key directions for the future development of post-adoption services. Our primary findings include:

• Most adopted children, because they suffered early deprivation or maltreatment, come to their new families with elevated risks for developmental, physical, psychological, emotional, or behavioral challenges. Among the factors linked with these higher risks are: prenatal malnutrition and low birth weight, prenatal exposure to toxic substances, older age at adoption, early deprivation, abuse or neglect, multiple placements, and emotional conflicts related to loss and identity issues.


• Protective factors in children and families (such as the child's easygoing temperament, parents having realistic expectations and thorough adoption preparation, open communication and warm, positive parenting style, as well as support from extended family and others) can buffer the impact of adverse beginnings, help prevent and resolve problems, and promote resilience. Indeed, the majority of adopted youth are functioning within the normal range, including those who came from adverse situations, and well over 90% of parents in every type of adoption are satisfied with their adoptions.


• The utilization of clinical services by adoptive families is about triple the rate reported by birth families (Howard, Smith, & Ryan, 2004; Vandivere, Malm, & Radel, 2009). Part of this difference is due to a greater willingness or desire to seek help, but it also is related to a greater need for assistance. Adopted children also are more likely than their non-adopted peers to score in the clinical range on standardized behavior problem measures.


• The layers of issues and dynamics present in complex, chronic adjustment difficulties are often not understood by adoptive parents or the professionals they contact - i.e., teachers, school personnel, pediatricians, and others. The type of help parents seek most is adoption-competent therapy, but research indicates that most mental health professionals lack relevant training. Furthermore, additional types of services shown to be most effective in meeting the needs of many families are not readily available.


• The development of specialized post-adoption supports began primarily in the late 1980s and 1990s, but it has slowed considerably over the past decade. These services include information and referral, education and training, support groups and mentoring, respite care, advocacy, crisis intervention, search/reunion services, and therapeutic counseling.


• Many exemplary services have been developed, primarily through federally funded demonstration projects and initiatives supported by state child welfare systems, but funding constraints have led some to be terminated, others to be scaled back, and yet others to be offered on very limited bases. In addition, many such services are available only to families who adopt from foster care and not to others, regardless of need.


• Research on post-adoption programs is scarce, and few, if any, studies rise to the level of rigor needed to substantiate empirically based effectiveness. This is an area of critical need for the development of services that will help the greatest number of children and families.

RECOMMENDATIONS

Creating effective post-adoption services and making them accessible to all families who need them are the primary challenges in the field of adoption and child welfare to assure permanency for children who cannot live with their birth families and to help them develop to their fullest potential. In order to promote progress in these areas, based on the year-long research for this report, our recommendations include:

• Create a national task force to provide strategic planning and legislative leadership for the development of post-adoption services – composed of representatives from the U.S. Children's Bureau and the U.S. Department of State, as well as post-adoption experts, practitioners, and researchers. The task force needs to collect information, discuss key issues, and draft proposals/legislation to promote additional funding, policy changes, and practice improvements. This needs to be a long-term, sustained initiative to ensure that the effort is not ephemeral, but brings about continuing progress.


• Develop private and public funding partnerships to maximize services and access to them for families, including a dedicated federal funding stream for post-adoption services. Providing consistent support from the top would not only create a reliable financial base, but also would serve as a clear message – or even a mandate – about the import of such supports.


• Public policy and child welfare officials at every level – federal, state, county and local – should re-examine their current budgets, staffing and other resources to determine whether sufficient priority is being given to helping families succeed as well as forming them. Going forward, post-adoption services should become a clearly defined, integral operational and programmatic component of adoption-related planning and financing at all levels. In conjunction with other stakeholders, each state should develop a strategic plan for developing and delivering a comprehensive continuum of post-adoption services.


• The amount of funded research on post-adoption interventions should be increased significantly in order to create an evidence base on services that are most effective, and the resulting findings and information must be systematically disseminated to adoption practitioners. Creating a workgroup of multiple federal research entities, including experts in this field, would provide leadership for promoting such research.


• " University, graduate and continuing education curricula on adoption issues need to be created for and provided to the professionals who work with adopted children and their families. Teachers, school counselors and psychologists, medical professionals, social workers and other mental health professionals would all benefit from training in this area.

Additional recommendations, as guidance for professionals and policy-makers, include:

• Minimize damage to children in the child welfare system and elsewhere. Providing sensitive nurturance after separation from birth families, minimizing moves in care, finding the right home as early as possible, and giving support through transitions are all aspects of this goal.


• Prepare parents to expect some ongoing challenges and to understand the benefits of post-adoption services. Parents need help to understand the specific children they adopt, including the needs they may have because of the personal histories they bring with them.


• Identify children at high risk of developing later difficulties and provide their families with early intervention services and linkage with ongoing resources. Supports for these families are essential to help them gain a firm foundation and optimize their prospects for success.


• Halt reductions in subsidies and post-adoption services, and raise them wherever possible by realigning priorities. Such cutbacks only serve to discourage families from adopting, resulting in greater expenses for foster care and higher costs to the state in other areas.


• " End state policies that effectively force adoptive parents to relinquish their children to the child welfare system in order to receive services they need. Everyone's interests are better served when these children and youth are permitted to get services, such as residential treatment, while remaining as members of their families.

CONCLUSION

This report's title, "Keeping the Promise," refers to the covenant that is inherent between parents and children when adoptions take place: to become a safe, permanent family. In practice, however, the covenant is far broader – and should be. It is also between adoption professionals and the families they serve, and between state or federal governments and the families they help to create. Over the last 15 years alone, Americans have provided families for over a quarter of a million children who had been relegated to institutions abroad. Through legal and policy changes during the same period, the federal government has aggressively supported the adoptions of close to three-quarters of a million children from foster care, and now it needs to act just as forcefully to sustain them. We have a long way to go on the road toward finding safe and loving homes for the most vulnerable members of society, but we have made honest progress. Now it is time to refocus our attention and broaden our priorities if, as a culture, we are to move beyond well-intentioned rhetoric – and be good to our word.

¹The Voice for Adoption is a coalition whose Board is composed of Adoption Advocacy, Adopt America Network, Adoption Exchange Association, Adoption Exchange Inc., Casey Family Services, Child Welfare League of America, Children Awaiting Parents, Family Builders Network, Kinship Center, Lilliput Children's Services, National Adoption Center, New York Council on Adoptable Children, North American Council on Adoptable Children, Spaulding for Children, and Michigan Three Rivers Adoption Council.