Removing the Cloak of Secrecy: Understanding the Clinical

Needs of Adoption and Guardianship Families

Karen Gunderson, California Department of Social ServicesDebbie Schugg, Kinship Center/ Seneca

Carol Bishop, Kinship Center/Seneca

Ruth McRoy, Boston College

Presenter BiosKaren

GundersonChief, Child & Youth Permanency Branch, California Department of Social Services

Debbie Schugg

Consultant, National Center on Adoption and Permanency, Parent Recruiter & Coach, Kinship Center

Ruth McRoy

Ruth G. McRoy is the first holder of the Donahue and DiFelice Endowed Professorship at Boston College Graduate School of Social Work.  Previously, Dr. McRoy was a member of the University of Texas at Austin School of Social Work faculty for 25 years and held the Ruby Lee Piester Centennial Professorship.  She received her BA and MSW degrees from the University of Kansas and her PhD degree in Social Work from the University of Texas at Austin.

A practitioner, academician, researcher, trainer and lecturer in the field for over 30 years, her research has focused on such topics as culturally competent service delivery,  family preservation, open adoptions, post adoption services, sibling placements, and older child adoptions.  She has served as PI or Co-PI on over 70 federal, foundation, state and local research and evaluation projects over the years.  McRoy has published over 100 articles and ten books.  

Carol Bishop

Carol J. Bishop is a co-founder of Kinship Center, a member of Seneca Family of Agencies, California.  She has worked in both the public and private sectors for 48 years. She has worked in adoption and foster care for 44 years, and is currently Statewide Adoption Policy Director for Seneca Family of Agencies. Carol has participated in development of curricula for parents and professionals, notably ACT – An Adoption and Permanency Curriculum for Child Welfare and Mental Health Professionals. She is currently on the NTI team as a curriculum developer under a Federal Grant to develop adoption competency training for mental health and child welfare professionals.

Legislation passed to provide non-mandatory recommendations to counties for adoption competent services for foster children transitioning into adoption or legal guardianship.

Formed a Work group that began meeting in January 2015, comprised of many stakeholders

Three subcommittees formed to address: ◦ Clinical capacity ◦ Access to services for Children, Youth and Families◦ Systemic and Funding Issues

Currently working on a report that will be presented January 2016

AB 1790

TestimonyBy

DebbieSchugg

Consultant, National Center on

Adoption and Permanency, Parent Recruiter & Coach,

Kinship Center

Overview of Presentation

• AB 1790• Ethical Issues• Adoption Clinical Competency• Post Adoption Needs

• Primary Sources: Smith, S. (2014) Keeping the Promise: The Case for Adoption Support and Preservation (Donaldson Adoption Institute)

• Brodzinsky, D. (2013) A Need to Know Enhancing Adoption Competence among Mental Health Professionals (Donaldson Adoption Institute)

AB 1790: Adoption Clinical Competency (2014)

ISSUE: Without the support of adoption-competent clinicians, children adopted from foster care are at unnecessary risk for disruption from their adoptive family and return to foster care-one more devastating loss in a litany of preventable losses.

◦ In the state of California, AB 1790 was passed which improves stability of adoptive and guardianship families by increasing the pool of adoption/permanency competent mental health professionals.

Need for Adoption Competent Practitioners

“Too often, adoptive parents seeking mental health services for their children and families find that clinical providers do not understand the unique complexities associated with their life experiences and/or often intervene in ways that are unhelpful and that sometimes even compounds their problems (Brodzinsky, 2013; Smith, 2014)

Problems with Services

“When you find a counselor or a therapist that is coming to deal with behavioral problems, but they don't understand the grass roots of adoption— the children that have come from the system have so many losses in their lives. That's really hard.” (Adoptive Parent)

Need for Post Adoption Services

Many problems experienced by adoptive families do not manifest until several years after the adoption is finalized (Smith, Howard, & Monroe, 1998)

“While fewer than 10 percent of children in the general population receive mental health services (National Survey of Children’s Health, 2007) the National Survey of Adoptive Parents reported that 45 percent of children adopted from foster care, 35 percent adopted internationally and 33 percent adopted as infants, had received mental health services” (Vandivere et al., 2009, Smith, 2014).

There is a higher rate of service usage for boys (52%) than girls (36%) and for those older at placement and at assessment (Vandivere et al., 2009)

Adoptive Families Seeking Services

Recent studies (Howard & Smith, 2003, Vandivere, Malm & Radel, 2009) have found that 40-50% of children adopted from foster care will have ongoing behavioral and emotional problems and these families need support and specialized services designed to meet their needs.

Research suggests that adoptive families are three to four times more likely to seek counseling for their children, and five to seven times more likely to seek residential treatment (Smith, 2014, Price&Coen, 2012, Vandivere, et. Al., 2009, Howard, et. al, 2004)

Need for Adoption Competent Clinicians

Adoption Issues:

◦ Not typically included in the education of psychologists and marriage and family therapists, and these issues are given relatively limited attention in the training of graduate level social workers.

◦ There are few adoption/permanency competent clinicians with demonstrated competency to meet the needs of former foster children now in adoptive and guardianship families.

Clinical Training Programs

Weir, Fife, Whiting and Blazewick (2008) surveyed 224 directors of clinical training programs in marriage and family therapy, social work or counseling and found that only between 4.8% to 16.3% of programs offered specific coursework in adoption or foster care (2.6% to 22.1%).

Henry, Pollack and Lazarre (2006) “reported finding no evidence in the literature of adoption related curricula in the training of medical students, despite the fact that pediatricians (and presumably many other physicians) routinely work with adoptive families as part of their practices” (Brodzinsky, 2013).

Medical Training Programs

ETHICAL ISSUE:

Despite the increase in the numbers of children in foster care achieving permanence through adoption,◦ placement of a child into a stable and motivated family is

not sufficient to compensate for psychosocial problems related to prior trauma and chronic maltreatment.

Adoption brings with it unique issues, which if not understood by the clinician, can result in ineffective or even damaging treatment.

Adoption Competent Practitioners are Needed

WHO:◦understand that adoption is a lifelong process◦ recognize that adoption impacts members of

the adoptive family in multiple and complex ways

◦can assess client needs using an adoption-sensitive lens

◦are knowledgeable about core issues in adoption including loss, rejection, guilt and shame, grief, identity, intimacy, and control

(Atkinson & Gonet, 2007)

Post Adoption Issues For Children and Families (Smith, 2014)

Factors to consider:• Age at adoption• Experiences before adoption

• Adverse prenatal conditions (malnutrition, low birth weight, exposure to toxic substances such as alcohol and drugs, inadequate health care

• Early deprivation and neglect• Physical, sexual and/or emotional abuse• Exposure to violence toward others• Multiple placements, interrupted attachments and

traumatic grief and loss

Post Adoption Adjustment Issues for Children and Families

◦ Type of Adoption Foster Parent Older child adoption Relative/Non-Relative Placement Transracial Intercountry Single parent adoption LGBT adoption Open/Mediated/Closed Placement with siblings or without Non-adopted siblings in the home

Post Adoption Issues for Children and Families

Loss and Grief Understanding Adoption Trust and Attachment School Problems Post Institutionalization Issues and Behaviors Identity Birth Relative Contact Medical Concerns Racial/Cultural Issues

Source: Child Welfare Information Gateway

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Specific Issues Related to Kinship Adoptions

Joe Crumbley (www.drcrumbley.com):

◦ Pre-existing relationships and family dynamics◦ Ongoing relationship with the child’s birth parent◦ Lack of preparation for caregiver role◦ Loss of existing relative role (not just uncle, aunt,

or grandparent anymore)◦ Guilt over birth parents’ problems◦ Worry about child’s birth parent◦ Divided loyalties

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Factors Associated with Disruptions (Smith, 2014; Coakley & Berrick, 2007)

Child Related Factors: ◦ Older age at removal and at adoptive placement◦ Higher incidence of various types of maltreatment (physical,

sexual and emotional abuse)◦ ‘Challenging emotional and behavioral problems◦ More previous placements◦ Unresolved feelings about separation from first/birth parents

Parent Related Factors◦ Matched adopter rather than relative or foster parent

(different expectations and reality) Agency Related Factors

◦ Inadequate disclosure of information about the child◦ High personnel turnover or inexperienced staff ◦ Inadequate parental preparation and support

AdoptUSKids Success Factors Study(McRoy, 2007)

Family Perspectives

Interviews and surveys with 161 families throughout the U.S. who had adopted children from the foster care system

Most Helpful Services

144 families identified the most helpful post adoption services as follows:

Day care (in-home or out of home), counseling for transracial adoption, or legal services

Financial supports such as adoption subsidies Counseling on issues such as abuse, separation,

and parenting skills Spending time with other adoptive families

Most Helpful Services - Quotes

“Probably the mentor program where we were paired with that other family. That probably was the single best thing that we did.”

“We’ve just started respite the last couple of months, and now I have a weekend where my son goes to someone else’s house. And it’s good for him– he loves to go. And it’s really wonderful. The last two times he’s gone I’ve just slept the whole weekend away.”

Unmet Service Needs

Families identified the following unmet service needs:

◦Respite care (overnight)

◦Adoption issues counseling◦Support group for adopted child◦Daycare: in home◦Tutoring Services for Child

Problems with Services (n=144)

Problem(s) Number , Percentage

Finding service providers that understood their unique issues

(n=60, 42%)

Lack of confidence in service providers (n=59, 41%)

Insurance doesn’t cover services (n=51, 35%)

Unable to find the right services (n=46, 32%)

Family doesn’t know where services are located

(n=35, 24%)

Problems with Services

“You know, the one social worker which was their (children’s) social worker when they came has sent me a few things over the email, but that's all we've ever heard…No, it just, it was like all of a sudden there was nobody; we were on our own. Like, ‘whoa’. We'd had twenty-seven new people in our lives and all of a sudden there was nobody... Like ‘wow, they just dumped us’.”

Most Common Advice to Agencies

Provide:◦ adequate resources and services for BOTH family

and child (e.g., subsidy, respite, support groups, counseling)

◦ information about adoption process and child’s background/referrals for services

◦ timely and honest communication with families◦ realistic information about child’s potential

outcomes

Advice to Agencies

"Um, be honest about the child's past, be totally honest, because the more information the adoptive parents have the better it is. Give post-adoption support. I think that is so lacking, and I think it's so important even though as an adoptive parent you may not think you need it, you're going to and it needs to be there."

Strategies for Promoting Permanence

Post adoption services needed throughout child’s life cycle

Improve communication with agencies Increase financial subsidies Parental education on special needs children Children need better preparation-may improve

outcomes (Hanna, 2006) Respite care-Greatest unmet need (Walsh, 1991;

Rosenthal et.al, 1996, McRoy, 2006) Addressing youth needs/challenges: New friends,

family integration, loss, adjustments (Ryan & Nalavany, 2003)

Need for More Clinical Training Most mental health professionals themselves report that

they lack “adoption competency” so they are not able to address the complexity of issues present in many adoptive families (Smith, 2014, Smith, 2013, Brodzinsky, 2014)

More evidence-based practices are needed which address the nature of complex trauma as well as attachment and identity issues and other co-existing developmental challenges confronting these children (Smith, 2014, p. 75)

Adoption competency training of community mental health professionals as well as clinicians in specialized service programs and residential treatment centers is needed .

Permanency and Family Connections

We must hold the same high hopes for youth in foster care as we do for our own children in terms of connections, living situation, and hopes for their future (Louisell, 2002).

We can find and support families that work!

Is it ethical for families to be recruited to adopt children in

care, but not be provided ongoing support and adoption competent

counseling related to the needs of the child throughout childhood,

adolescence and beyond?

What is Available in California?

What there is and what we needby Carol Bishop

Support Groups Adoption-themed Camps Psycho-education for parents Short term crisis intervention Resource and Referrals

Post Adoption Supports

ACT: A Permanency and Adoption Curriculum for Child Welfare and Mental Health Professionals – Kinship Center/Seneca Family of Agencies

TAC – Training in Adoption Competency - Center for Adoption Education and Support (CASE) – Lilliput Children’s Services

Permanency Clinical Training

National Adoption Competency Mental Health Training Institute (NTI)

Two online curricula – Child Welfare and Mental Health

Address the complex mental health needs of children with adoption and guardianship goals, and children who have already achieved permanency with adoption or guardianship families

Will include tribal considerations

Federal Grant

Kinship Center – permanency specialty mental health clinics in Monterey, SLO, Orange counties

Sierra Forever Families – community-based mental health services in Placer, Sacramento and Nevada counties

Family Builders By Adoption – counseling for adoption constellation with limited funding

Public/Private Partnerships

Encourage Public/Private Partnerships in your community

Take advantage of Education available now www.kinshipcenter.org and www.lilliput.org

under Education and Training links Stay tuned for CDSS’s report to the

legislature due January 31, 2016.

What Can You Do Now?