Research: Institute Research
A NEED TO KNOW:
ENHANCING ADOPTION COMPETENCE AMONG MENTAL HEALTH PROFESSIONALS
Author: David M. Brodzinsky, Ph.D.
Published: 2013 August, New York NY: Donaldson Adoption Institute
Document Type: Policy Perspective (63 pages)
Availability: PDF Full Report | Executive Summary | Press Release
As part of its ongoing efforts to improve the lives of children and families, the Donaldson Adoption Institute issued a new, research-based report today recommending that mental health professionals should receive more and better training on adoption-related issues.
The 63 page report, titled " A Need to Know," points out that one of the most frequent complaints from members of adoptive and birth/first families is an inability to find psychologists, psychiatrists, social workers and related practitioners who understand the unique, adoption-related issues that can affect their identities, their relationships and other important components of their lives.
For a variety of reasons, mental health professionals typically do not receive the training required to fill adoption-related counseling needs and, too often, either do not fully understand why such training is necessary or mistakenly believe the knowledge they already have is sufficient. To address that reality, this report by the Donaldson Adoption Institute seeks to raise the level of professionals' awareness about the nature and importance of adoption clinical competence, heighten their desire to receive such training, and identify various means by which the relevant knowledge and skills can be obtained.
"The negative experiences of some adoptive families in seeking help underscore the reality that therapists lacking adoption competence can, at times, do more harm than good," said David Brodzinsky, Ph.D., the Institute's Research & Project Director and author of the report.
The Adoption Institute's recommendations in "A Need to Know" include:
- Develop certification for adoption clinical competence, so clients know that the professionals with whom they are working have the requisite knowledge, skills and experience to meet their needs.
- Expand training programs nationwide by replicating already effective models and through more use of technologies such as webinars, " flip teaching" and " massive open online courses."
- Develop outreach efforts to inform mental health providers about the need for adoption competency, the opportunities for enhancing their knowledge, and the benefits of doing so.
- Educate insurance providers about the unique nature of adoption issues and advocate for expanded coverage, which would greatly help those who need competent services.
- Encourage graduate training programs and post-graduate clinical training centers to include more information about adoption and foster care in their curricula, since so little currently exists.
Lori and Robert adopted their sons from foster care when they were 1 and 3 years old; they had been removed from their family of origin after being neglected and physically abused by their parents, who are alcoholics, and had lived in three temporary homes before their adoptive placement. The consequences of the boys’ early maltreatment were considerable: defiance, aggression, stealing, attachment problems, learning challenges and more. The succession of mental health professionals from whom Lori and Robert sought help for several years didn’t appear to know what to do; they often blamed the parents for their children’s lack of improvement and didn’t seem to understand the trauma being experienced by all the family members every day.
Adoption issues were seldom raised by any of the therapists – except for one, who suggested the children’s problems could be unresolvable, so Lori and Robert might want to consider returning them to foster care. They loved and were committed to their boys, however, so they never considered that option. Instead, with the help of online advice from other adoptive parents, they found a mental health practitioner with expertise in adoption-related issues, and their sons finally started making substantive progress. "We needed help from professionals who weren't only skilled therapists, but who also knew about adoption," they later reported. “It was difficult to find the help. … Thank God we finally did. … It saved our children and our family."
Every sort of family has its particular dynamics, concerns and complexities, whether related to divorce and blended families; single-parent families; families headed by gay/lesbian parents; etc. Adoption is no different; indeed, while it is an overwhelmingly positive institution for children who need the stability and nurture of permanent families, it can often be complicated, encompassing issues from addressing grief and loss for first/birth parents, to shaping positive racial/ethnic identity for children, to dealing with the impact of early adversity, to navigating relationships between adoptive and birth relatives. For many of the millions of people for whom adoption is part of everyday life, these and numerous other issues can be profound and enduring – and, pointedly, can require counseling and other services from a variety of professionals, including child welfare specialists, mental health practitioners, physicians, educational advisors and teachers. Unfortunately, adoptive parents, adopted individuals (as children and adults) and birth relatives often encounter significant barriers in their efforts to obtain the assistance they seek and need.
One of their most frequent complaints is their inability to find mental health care and ancillary service professionals who are adoption-competent – that is, who understand the unique issues associated with their histories and current lives, and how adoption can color or even shape their views of themselves, their identities and their relationships. This point is reflected in a number of studies over time, including a recent survey on the experiences of adoptive families with mental health professionals (Atkinson, Freundlich, Riley, Gonet, in press). Over 81 percent of the 485 respondents (84% of adoptive parents and nearly 77% of adopted persons) reported working with one or more mental health professionals. Of those who did, slightly fewer than 25 percent believed the professionals were adoption-competent; another 50 percent indicated some of the professionals were adoption-competent but others were not; and 26 percent said none of the mental health providers they saw knew much about adoption. Some respondents reported experiences with therapists that actually damaged their families. Areas in which therapists were viewed as especially insensitive or lacking in adoption knowledge included attachment, trauma, loss and use of appropriate language.
For a variety of reasons, mental health professionals typically do not receive the training required to fill adoption-related counseling needs and, too often, either do not fully understand why such training is necessary or mistakenly believe the knowledge they already have is sufficient. To address that reality, this report by the Donaldson Adoption Institute seeks to raise the level of awareness among mental health professionals about the nature and importance of adoption clinical competence, heighten their desire to receive such training, and identify various means by which the relevant knowledge and skills can be obtained.
Context and Primary Findings
- Successful adoption is tied to good preparation of all parties prior to placement and to the availability and utilization of effective supports and other help, including counseling, afterward. Adoption-competent therapists are high on – and sometimes at the top of – the list of services that members of adoptive and birth families want and need.
- Genetic risk and early trauma (primarily for children adopted from foster care or institutions) do not inevitably undermine development. Two key factors that facilitate their recovery are comprehensive pre-adoption preparation and education of families, along with the availability and utilization of informed mental health services.
- Graduate education in relevant fields does not usually include adoption issues. A survey of directors of clinical training programs in marriage and family therapy, social work or counseling found only about 5-16 percent offered adoption-specific coursework. Two-thirds of licensed psychologists in a national survey reported no such graduate coursework; fewer than one-third rated themselves as well or very well prepared to treat adoption issues, and 90 percent said psychologists need more adoption education.
- The limitations of medical insurance can pose significant barriers to accessing adoption-competent therapists. Most insurance doesn’t provide sufficient mental health coverage to cover the complex, long-term needs of those involved, particularly children who have suffered early trauma and other adversity; and few if any carriers take into account that adoption-competent therapists may not be on their lists of covered, in-plan providers.
- Which practitioners are adoption-competent is not always clear or easy to determine, in part because adoption counseling has not yet been identified as a professional specialty in the health care fields, with clear guidelines for training, practice and credentialing. Without an appropriate process, many individuals and families will continue to be treated by professionals who are inadequately prepared to understand and help them.
Adoption competence begins with a solid foundation of knowledge and clinical skills gained through an approved graduate program in psychiatry, psychology, social work, marriage and family therapy or counseling. Meeting the needs of individuals and families touched by adoption also requires specialized training in assessment, diagnosis and intervention. At each phase of the clinical process, therapists must be attuned to the complex array of historical and contemporary factors impacting the lives of their clients and, specifically, to the ways in which the adoption experience can influence their identity, relationships and development.
- Develop Certification for Adoption Clinical Competence. People want and need to know that the professionals they are working with have the requisite knowledge, skills and experience to meet their needs. This should apply in the adoption realm as much as in any other, so a certification for adoption clinical competence should be developed.
- Expand Adoption Training Programs across the Country. Nearly all existing programs require training in classroom settings, so the number of available professionals is restricted to those who live within commuting distance of current sites. Training needs to expand through more programs and the use of technologies such as webinars, " flip teaching" and " massive open online courses."
- Strengthen the Clinical Components of Existing Training Programs. This can be accomplished by increasing the number of required clinical courses for mental health practitioners; offering additional clinical courses as electives; and/or offering additional clinical courses as stand-alone, post-certificate, continuing education courses. All programs also should offer some type of clinical supervision.
- Develop Outreach Efforts to Inform Mental Health Providers about the Need for Adoption Competency and Opportunities for Enhancing their Knowledge. Broad-based outreach initiatives should be developed to increase awareness on the need for adoption-competence, to identify opportunities for training among mental health professionals, and to explain the benefits of developing this specialized knowledge.
- Educate Insurance Providers about the Unique Nature of Adoption Issues and Advocate for Expanded Coverage. Concerted efforts must be made to educate insurance providers about the unique clinical needs of individuals and families affected by adoption-related issues. This process will be greatly helped if the mental health field overtly recognizes the value of adoption clinical certification and supports its development.
- Encourage Graduate Training Programs and Post-Graduate Clinical Training Centers to Include More Information about Adoption and Foster Care in their Curricula. The better grounding in these areas that professionals receive while in training, the better prepared they will be to serve the needs of adoption kinship members and to seek to expand their expertise on adoption- and trauma-related issues.
- Encourage Research on Training Effectiveness and Outcomes. To better serve the training needs of professionals and the well-being of adoptive kinship members with whom they work, the Institute recommends that researchers examine the effectiveness of training programs in terms of knowledge gained by participants, changes in clinicians' practices as a result of training, and clients’ progress and satisfaction with services.
For a variety of reasons, adopted individuals and their families are more likely to use mental health services than is the general population. Helping adoptive parents manage these life complexities for themselves and their children can be a challenge, often requiring the help of professionals. Adopted individuals, as children and through their life cycles, can encounter a range of concerns (e.g. ones related to identity) with which they want and need professional assistance. Furthermore, birth/first mothers and fathers also frequently need the services of mental health counselors as they struggle to cope with their loss and, for a growing number of these individuals, to find satisfying ways of managing ongoing relationships with their children and their adoptive families. Mental health and allied professionals must be prepared to meet the needs of these individuals and families. They must possess not only the foundations for competent clinical practice, but also a deep understanding of the unique issues involved.