Post-Adoption Services

This paper developed for her training workshops for child welfare professionals is related to material from Dr. Fahlberg’s book A Child’s Journey through Placement Those reading a print-out will find this article and others on the internet at http://www.perspectivespress.com/ourfactsheets.html

Caseworkers often perceive placement of a child in an adoptive family as the end of the work. Although placement may signal the end of the child’s sojourn within the child welfare system, in reality it is the beginning of a life-long journey that, hopefully, will lead to overcoming the effects of whatever traumas led to the child entering the system as well as the negative impact of experiences he may have experienced while in care.

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

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

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

Child risk factors include

• survival behaviors which originated when they lived in dysfunctional families and a dysfunctional system
• individual vulnerabilities
• previous traumatic events
• unresolved separations or losses

Parent risk factors may include:

• lack of empowerment and entitlement
• “echoes” from their past
• unrecognized or unresolved losses -
• unrealistic expectations for child or self

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

1. distortion of family life cycle: adoptive families begin with distance and are expected to move toward closeness; birth families start with symbiosis and are expected to move toward individuation
2. stress on family boundaries caused by agency intrusiveness; by lack of family’s empowerment by society and agency; and by child’s conflicted loyalties.
3. individual issues of the child and echoes from the past for the parents.

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

The family

• provides the foundation on which the child’s continued development is dependent
• provides the environment for change
• provides continuity and commitment
• the fact that the family needs help in meeting the child’s needs does not mean that they do not care or that they are incapable of participating in decision making.
• if the family is made to feel impotent it is harmful to the overall treatment.
• if the family is recognized as doing the best they can in difficult circumstances and as having an important role in any change process, they can be stronger partners.
• unfortunately, families may not seek help until they feel overwhelmed and desperate and at that point in time they will present themselves at their worst. Many times it is difficult to have a solid assessment at that time of the parents’ long range capacities.

Social workers

• have knowledge of how the system works
• are more likely than others to know how to access information about the child’s specific past history, information that may be critical to providing adequate treatment
• can help families locate and access the specific services that they need (i.e support services, respite care, therapists knowledgeable about adoption)
• can provide information to therapists about common behaviors seen in “systems” children
• predict times that will be difficult for child and family (based on developmental information and knowledge about anniversary reactions, etc.)

Mental health professionals

• may provide assessments of families and children, both before and after placements
• may be able to intervene early enough that they can help prevent problems from becoming entrenched
• may help families connect with support groups
• do direct work with children and families when there are ongoing problems
• provide information as to when families might anticipate future problems
• be involved in crisis intervention
• may help determine if out-of-home care is necessary and the level of care that would be most useful.

Post-adoptive services need to be provided by individuals who:

• understand adoption related issues
• understand the social service and legal systems and their impact on the child prior to placement
• re supportive of the adoptive family’s role and importance in the child’s life
• include the parents in the assessment, planning and treatment
• will work with parents to develop strategies for behavioral interventions
• will collaborate with others who are involved with this child and family (i.e. schools etc.)

Post-adoptive services may take a variety of forms:

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

Support services: Families who were prepared for adoption using a group process frequently use other group members as an informal support system. Agencies may provide parent support groups; or help individual families connect with others who have had a similar problem; may provide parent education presentations. Even those families who need more intensive services, view support services as helpful. Respite care can be a very useful service, but unfortunately families are frequently left to their own devices in terms of providing it on a regular basis.

The PARTNERS project in Iowa arranged respite care for special-needs children one weekend per month at a local camp. This was combined with a week long summer camp as well.

Even those families who need more intensive services, still tend to view support services as helpful.
Initial post-placement services aimed at helping the child and family come together as a unit. The emphasis is on resolving current separation and loss issues, addressing current behavioral problems and facilitating the attachment process. The focus is primarily on the present. According to Linda Katz, the client is neither the child nor the parents, but rather the relationship. During this period the provider should prepare families and children for identifying times that preventative work might be undertaken and for times that old problems are likely to re-emerge.

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

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

Crisis intervention with threatened families: Kay Donley and Maris Blechner identified threatened families as usually being those with a long-term adoptive relationship in place; with evidence of repeated self-destructive or violent behavior by the child; these episodes of problem behaviors are intensifying; the parents may have made a variety of unsuccessful efforts at obtaining help; the parents feel that the situation is out of control.

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

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

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

Intensive adoption preservation services are called for. These include all aspects of support services, including short-term out-of-home placement. The overall goal at this time is to engage the families in treatment and to help them see the problems in a realistic context. During the provision of these intensive services, it may become apparent that the young person needs out-of-home care. It is important that this be provided in a timely enough manner that the family continues to be available as a long-term resource for the youngster.
TRADITIONAL THERAPY APPROACHES ALONE HAVE NOT BEEN PARTICULARLY
SUCCESSFUL WITH THIS POPULATION

Individual non-directive therapy with the child:

• frequently never addresses the issues of abuse or neglect if the child does not introduce these topics
• rarely focuses on the behavioral issues that ultimately will determine whether the child remains in the placement
• tends to disempower the family and distance them; does not focus on family relationships
• may never identify the child’s misperceptions

Traditional family therapy

• views the child’s behavioral problems as a manifestation of the overall family dysfunction
• does not take into account the concept of imported pathology (child bringing pathology into family
• may view parent as more part of the problem than part of the solution

Adoptive families, who represent the source of real change and remediation, must be actively involved in the healing strategies
BELIEFS IN FAMILY SYSTEMS APPROACH TO TREATMENT IN SPECIAL NEEDS ADOPTION

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

WHEN OUT-OF-HOME PLACEMENT IS NECESSARY:

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

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

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

Grotevant and McRoy in their research on adopted children in residential treatment found that although adopted and non-adopted youth in residential treatment had similar behaviors and diagnoses, there were significant differences as well. When compared with the control population, the parents of adopted youth had less mental health pathology and more stable marriages. Of the 50 adopted individuals studied in 33 cases the adoption played a major role in their emotional disturbance; in 9 cases it played a minor role and in 8 cases it seemed to be playing no role.

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

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

Bibliography

Barth, R., Berry, M., Goodfield, R. and Carson, M.L. OLDER CHILD ADOPTION AND DISRUPTION. Washington D.C.: The Children’s Bureau, April, 1987.Research findings on adoption disruption. Also contains an annotated bibliography and information on a residential treatment center approach to working with an attachment model.

Bourguignon, J.P. and Watson, K.W.: AFTER ADOPTION: A MANUAL FOR PROFESSIONALS WORKING WITH ADOPTIVE FAMILIES. Springfield, Ill. Illinois Department of Children and Family Services, 1987. Available from National Resource Center for Special Needs Adoption; Crossroads Office Center; 16250 Northland Dr. Ste 120; Southfield MI 48075. Identifies how adoptive families differ from other families; the purposes of therapeutic intervention; seven areas in which adoptive families most often experience difficulties; a framework for a post-adoptive diagnostic assessment and interventions which look at barriers to adjustment posed by child, parents, and the environment.

Brodzinsky, Schechter and Henig. BEING ADOPTED: THE LIFELONG SEARCH FOR SELF. New York, Doubleday, 1992.A developmental approach to the lifelong impact of being adopted. The information is very useful in developing both supportive and preventative services for adopted individuals and their families.

Busch, L. editor: THE MENTAL HEALTH CHALLENGE OF SPECIAL NEEDS ADOPTION: A Resource Book for Professionals Working with Adoptive Families. May be obtained by contacting: Adoptions Unit; Children’s Services Division; 198 Commercial Street S.E.; Salem, OR 97310-0450. Contains some of the same articles as those in the book edited by Pam Grabe plus some others. Donley’s Post-Placement Services Analysis which is to be used ahead of crisis time and which addresses the child’s capacity for attachment; the child’s resolution of separation and loss issues and the family stresses which may affect adjustment are of a size for easy duplication. I also found From Caregiving to Parenting: Family Formation with Adopted Older Children by Margaret Elbow (originally published in Social Work, Vol 31, no 5, 1986, pgs 366-370) to be excellent in looking at how family issues are different in adoptive vs birth families and in identifying the developmental tasks of the adoptive family as a whole. Another additional, and helpful article in this book is by Patrick J. Koehne and is entitled Adoption Process of Special Needs Children: A Family Therapy Perspective.

Grabe, P.V. editor: ADOPTION RESOURCES FOR MENTAL HEALTH PROFESSIONALS. New Brunswick: Transaction Publishers, 1990. Contains a variety of articles by many contributors. Helping Threatened Families by Donley and Blechner and Donley’s Post-Placement Services Analysis were particularly helpful articles when I was preparing for this presentation.

Groze, V.; Young, J; and Corcran-Rumppe, K. PARTNERS: POST-ADOPTION RESOURCES FOR TRAINING, NETWORKING AND EVALUATION SERVICES. WORKING WITH SPECIAL NEEDS ADOPTIVE FAMILIES. Available from Four Oaks, Inc.; 5400 Kirkwood Blvd, S.W.; Cedar Rapids, Iowa 52404. Presents a five phase treatment model comprised of screening, assessment, treatment planning; treatment phase and termination. Outlines a variety of support services; identifies adoption preservation services and on-going services. In this project a multidisciplinary Clinical Review Team was used in the treatment planning phase.Explains use of Placement Genogram which incorporates information not only about birth and adoptive families, but also about child’s placements in between these two. This technique helps both family and therapists understand the uniqueness of each child’s situation. Appendix includes a very complete assessment questionnaire; and formats for assessing family communication patterns; family cohesion and family flexibility vs rigidity.

Prew, C; Suter, S; and Carrington, J. POST-ADOPTION FAMILY THERAPY. Another publication available from the Adoptions Unit in Salem Oregon.Provides information from a project which used a treatment team comprised of a family therapist and an adoption worker as co-therapists. Excellent, and fairly detailed, information on identifying common problem behaviors and on developing intervention strategies. Appendix includes useful questionnaires, especially an Adoptive Family Risk Assessment Scale and a Child Behavior Checklist.

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

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