post-adoption support: recommendations for practitioners ... · post-adoption support:...

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Post-adoption Support: Recommendations for Practitioners & Organizations

Written by: Eavan Brady, M.S.W.

This PARTicle highlights key issues for consideration for practitioners and organizations providing post-adoptive support to families.

2Post-adoption Support: Recommendations for Practitioners & Organizations

How to use this PARTicle PARTicles are concise and practical literature reviews covering challenging child welfare issues. They provide practitioners with up-to-date research on substantive topic areas and capture client, practitioner, and academic perspectives.

§ Read this PARTicle individually and then discuss it with your Supervisor. § Recommend that your team read this PARTicle and discuss it at your next team

meeting. Use the Discussion Questions to begin and guide conversations. § Provide this PARTicle to the families you are working with. Use it to start discussion

around issues clients are facing at your next meeting. § Think critically about this PARTicle and the research it contains; what additional

questions do you have after reading it? What more do you want to know? § Explore the PART website for other evidence-informed resources related to this

topic, e.g. search the E-library for related material; explore the PART webinar archives for past webinars on similar topics.

Three Key Points: 1) There is currently no single evidence-based, post-adoption service model

available in the literature. Organizations draw from diverse service and support approaches and tend to tailor post-adoption programs to reflect family needs, existing service delivery systems, and available resources.

2) Key recommendations for practitioners supporting families post-adoption relate to capacity building, provision of information, and reducing isolation.

3) Adoption knowledge and competency among mental health professionals and community partners is vital to the provision of effective support and intervention for families post-adoption.

Discussion Questions 1) What is your experience of providing support to families post-adoption? What

have been the key issues faced by these families? How have you helped them to overcome identified issues?

2) What impact does openness in adoption have in your practices of support for families post-adoption?

3) How could your organization promote adoption competency among community partners?


Introduction While most adoptions succeed and adoptive families stay together23 the issue of post-adoption support affects many adoptive families.10 Far less is known however, about effective intervention methods to increase placement stability.26 We are beginning to understand ‘what works’ in helping adoptive families but currently do not know enough to tailor interventions to address specific needs. While some program evaluations have been conducted, our knowledge is still limited with regard to service effectiveness and the appropriate mix and delivery of services to best meet a family’s needs. Currently, there is no single evidence-based, post-adoption service model.10 Rather, organizations draw from diverse service and support approaches and tend to tailor post-adoption programs to reflect family needs, existing service delivery systems, and available resources.7, 10

This PARTicle will highlight some of the key strategies that have been identified in the research for supporting families post-adoption. At its heart, supporting adoptive families appears to be about building family and community capacity to be adoption-competent.3

Recommendations for Practitioners Identifying children and parents with characteristics that can be associated with higher levels of difficulty during the adoption process may be a helpful strategy for targeting adoptive families who may need more comprehensive pre- and post-placement services.4 For example, child characteristics (e.g. older age at time of placement), parent characteristics (e.g. high parental expectations, lack of experience with adopted children or children with disabilities), and family characteristics (e.g. higher socioeconomic status) have all been associated with negative post-adoption outcomes.16 The following can be used to guide practitioners in supporting adoptive families:

§ From early in the process of assessment, provide information regarding adoption support and preservation services available in the community;

§ Discuss and describe the adoption support and preservation services families and children request most often according to the research literature;

§ Be mindful of language used when supporting parents transitioning to adoptive parenthood: referring to ‘adoption adjustment’ versus ‘adoption probation’ will likely help parents see their adoption practitioners’ role to be related to provision of support rather than surveillance;17

§ While some families will welcome and seek services, many may be reluctant to do so. Outreach and normalization of services may be required to reach families, particularly those in more isolated rural communities;16

§ Ensure families understand the funding sources and resources for all possible


services; § Make information and resources easily accessible for parents;29 § Help parents to understand ongoing needs of children and youth who have

experienced trauma; § Provide families with information regarding the potential effects on later mental

health of early maltreatment along with information about expected continuing needs of adopted children;

§ Help families to understand adoption developmental stages, survival behaviours, and their effects on adoption preservation;

§ Help families to understand and view crisis as a normal part of the adoption process; § Engage families in developing an individualized plan for family support; § Provide families with information and tools to help them during a crisis; explain the

importance of having a contingency plan to support stabilization of the family during the time of crisis;

§ Reduce isolation as much as possible by connecting adoptive parents and children to peer support groups and/or other adoptive parents and children in their community;

§ Implement voluntary post-placement mentorship programs for prospective or recent adoptive parents and evaluate the influence of the program;17

§ Encourage families to take the time to discuss adoption disruption and dissolution and their impacts on children/youth, parents, and other family members;17

§ Consider developing a plan for respite with adoptive parents and families;2 § Plan recreational activities – where the goal is simply to have fun – for children in

order to normalize adoption and decrease isolation;6 § Post-adoption support comes in many forms, e.g. educational seminars, webinars,

online chat groups, direct therapeutic intervention. Encourage families to use these supports as much as they need and in the format they feel comfortable, to keep their family healthy;8

§ The child’s former foster parents may be able to offer support; they too know what it is like to live with the child. If they live close by and still have a relationships with the child, foster parents can be great respite care providers.24

Adoption practitioners are well placed to train community service providers who may work with adoptive families in order to enable them to understand and effectively address unique issues experienced by adoptive children and their families. This type of training may potentially improve clinical services.25


Prenatal Exposure to Substances (e.g. drugs, alcohol)

Significant obstacles exist to the adoption of children exposed prenatally to alcohol and/or other drugs. Many prospective adoptive parents are frightened by the uncertainties regarding the long-term outcomes of substance exposed children. Potential adoptive caregivers fear that children may be unmanageable, experience long term developmental challenges, or that the resources needed to meet the children’s needs will not be available.15 It is recommended that parents are supported in grappling with the uncertainties related to parenting a child who has been prenatally exposed to alcohol and/or other drugs before they accept a child for adoption. Adoptive parents require ongoing information about the effects of prenatal substance exposure on children and the opportunity to discuss the information and their concerns after the adoptive placement. Pre-placement education sessions, support groups, individual parent counselling, psychotherapy with the child, and consultation with other professionals have been found to be particularly helpful along with support from friends, extended family, and written materials about parenting suggesting that families can benefit from a continuum of services.15

We asked three adoption practitioners their thoughts on key post-adoption issues. Here is what they had to say:

The main challenges facing adoptive families post-adoption are:

§ Managing child behaviours; § Finding time: for themselves, to spend time with other kids in the home; § Finding people that are willing/capable of looking after the children with challenging

behaviours; § Ensuring that families are adequately prepared for the challenging aspects of adoption; § Making sure all necessary support services are in place form the beginning.

Strategies used in practice to help parents through these challenges include:

§ Reinforce that caregivers and family members are doing a good job even though they may feel they are not;

§ Connect families with other adoptive families; § Establish a rapport with parents, get to know them, help them to understand their child’s

behaviours, what are helpful and non-helpful responses to their child’s behaviour.

Main barriers to adoptive families accessing support services are:

§ Cost and availability of services; § Lack of existing services, e.g. respite; § Ensuring access to attachment and adoption competent practitioners in the community; § Accessing mental health and psychiatric service in a timely fashion.


Barriers to accessing post-placement services can be overcome by:

§ Training of child welfare workers in adoption issues; § Having child and youth counsellors involved with adoptive families from the time of

placement; § Making support available to families around the clock; § Including post-adoption support services as part of the service provided, normalize the

process.

Support needs* at different stages of the adoption process include:

§ Initial support needs relate to transitioning, managing losses for the child, focusing on attachment, helping parents to implement strategies for child that are not too overwhelming, and establishing family rituals and traditions, e.g. first birthdays;

§ Later during the adoption process, loss and grief issues with adoption parents may arise as they come to realize that this parenting may be quite different to what they had expected;

§ During adolescence some youth may struggle with their identity. Support needs may relate to helping youth and their family to understand that while this experience is similar to that of many other adolescents, there may differences for those who have been adopted.

*This will be different with every family.

In an ideal world, post-adoption support for adoptive families would include:

§ Ongoing and timely access to support/training at no cost or low cost; § Formal and informal training; § Parenting groups; § Peer support groups; § Play groups; § Information nights/workshops in the community where people can come and hear about a

topic and have the opportunity to meet others in the same boat; § Adoption competent mental health professionals and community partners; § Education for families encouraging them to get help earlier; § Tracking statistics and outcomes of services accessed, e.g. reasons for call, patterns of

struggles; § Virtual forum/resource centre.

Recommendations for Organizations Developing Post-adoption Support Services A family systems orientation is seen as essential to effective post-adoption services. Post-adoption service programs can best serve adoptive families when they recognize that the adoptive family’s needs do not arise solely from challenges the adopted child


may face or from the family’s concerns about the child, but they instead view these concerns as extending more broadly to the entire family system.28 Post-adoption services are more effective when they recognize that different types of adoptive families (e.g. kin, foster families who adopt, and families who are recruited and matched with children) may have different concerns and need different types of services and supports.11 Critically, services more effectively meet the needs of adoptive families when they offer a broad range of clinical and other services and provide continuing supports over time.14 Adoption professionals will benefit from being keenly aware of the danger of defining post-adoption service needs according to the services organizations have available, rather than a broader array of family needs.11 Recommendations for organizations noted across the literature include:

§ Parent preparation, education, and support should utilize a combination of individual and group approaches and be guided by adult learning theory, which emphasize the efficacy of an active, multi-source, multi-method strategy of instruction.

§ Opportunities for adoptive parents to interact with peers, especially those who have already successfully parented adopted children, as well as with adult adoptees and birth parents, are highly recommended, i.e. community building within and among adoptive families.

§ Use web-based resources, especially for adoptive families who are geographically isolated, or who utilize adoption professionals who do not provide appropriate training themselves.

§ Provide a balanced and realistic view of adoption during pre-adoption preparation and education. For example:

o Help parents understand and manage their vulnerabilities and/or defensiveness, which may interfere with receptivity to the information provided;

o Emphasize both benefits and risks associated with adoption in general, and with the child’s unique history in particular;

o Emphasize that risk associated with specific biological and/or pre-placement experiences only means that the child is more likely than the average child to have adjustment difficulties; it does not necessarily mean, however, that the child will have these problems;

o Emphasize the role played by high-quality caregiving in the amelioration of early developmental problems.9

§ While the child’s transition from an out-of-home placement to a pre-adoptive home is a period of vulnerability, it can also be used as an opportunity for children and parents. Parents and children may be particularly open to information, support, and helping relationships during this time.15

§ Build organizational commitment to children and families: Each organization must commit to providing support to adoptive families when issues arise, even long after an adoption has been finalized. Along with its community partners, organizations


must stand ready to assist families when children’s emotional and behavioural issues affect the child’s and family’s well-being,20 no matter the region the child lives in.2

§ Provide services that are specific to the histories and needs of adoptive children and their families.7

§ Be sensitive to the role of culture, ethnicity, and race in adoptive family dynamics. Culturally competent practice involves respect for people of all cultures, languages, classes, races, ethnic backgrounds, sexual orientations, and other diversity factors.7

§ Engage adoptive parents and adopted persons in the planning and development process: Getting input from service users through advisory boards, surveys, and focus groups will help develop client-driven services that better meet needs and also will promote engagement of families in services when delivered.7

§ Participate in advocacy and outreach regarding adopted children’s educational and learning needs, e.g. promote knowledge and awareness of adoption-related issues among school communities.2

§ Collaborate: The multi-faceted nature of adopted children and youth and their families requires collaboration across multiple systems (e.g. child welfare, family support, mental health, education), which can create a continuum of appropriate services for adoptive families while also leveraging available resources.7

Child welfare organizations are well positioned to develop effective strategies for meeting gaps in post-adoption service provision. For example, given the pronounced behavioural challenges and disabilities of some adopted children, it is often difficult to find respite care and baby-sitting services. Specialized and trained providers are often needed to meet this ongoing need. Child welfare organizations could develop a local/community-based master listing of in-home and out-of-home respite services that are available to families. Child welfare organizations can take the lead in developing and nurturing informal supports, which can be especially important given the limited availability of formal services.22

Adoption Competency for Mental Health Professionals The majority of children who are adopted through the child welfare system will have experienced abuse, neglect, or abandonment before entering out-of-home care.20 Children living under the care of the child welfare system often endure adjustment difficulties including academic, social, behavioural, and psychological problems,12, 13, 30, 31 which may lead to increased involvement with mental health professionals. In Ontario, approximately one in five children in the general community has a mental health challenge.18 For children with a foster care background however, it has been reported in the U.S. that nearly half (47.9%) of youth were found to have clinically significant emotional or behavioural problems (NIMH, 2006) and that over half of children entering


foster care exhibit life-time rates of behavioural or social competency problems that warrant mental health services.5

Adopted children face identity formation and other developmental tasks in addition to the normative tasks of their non-adopted peers. As more and more children are past infancy when placed with adoptive families, the family tasks and challenges for caring and supporting their adoptive children become more complex, warranting a specialized set of skills and insight for professionals to successfully treat and support these families.19 Today’s adoptive families need professionals and treatment specialists who understand the unique nature of family building by adoption, the complications of relationship connections and shifts, and the impacts of traumas on the child and their adoptive family.19 In a recent survey of 445 adoptive families, the Adoption Council of Ontario found that 86% of respondents felt that it is very important that mental health professionals be adoption competent. Indeed 99% believed that more adoption related training of mental health professionals would be of benefit to adoptive families.1

When asked about the mental health services they need for their children, adoptive families identify a range of services including in-home counselling, community-based and outpatient mental health services, and residential treatment.20 The toll on children and adoptive families when they cannot obtain needed mental health services is enormous; children’s mental health problems may intensify; the mental health of the parents and other family members may deteriorate; and families may face the prospect of relinquishing custody to obtain intensive mental health services for their children.20 Effective adoption and permanency competent therapy focuses on the ‘core issues’ in adoption, educating family members in a psycho-educational manner about those issues and their potential impact on the individual’s and family’s life cycles development.27 The Adoption Council of Ontario is in the process of developing an adoption competency training program for mental health professionals. One of the primary goals of this training program is to convey to mental health professionals that the goal of clinical support is not to "cure" the children and families that they work, but rather to provide ongoing competent care for children, families, and their relationships in order that families and children get the help they need and families can stay together.2

Adoption-Competent Services include:

§ Understanding the importance of defining the adoptive families, relatives, or near-kin strengths from the first contact

§ Providing family treatment, not child-centred, individual therapy § Including all family members as part of the treatment team § Understanding the potentially profound impact of placing children, especially older

and possibly traumatized, into an established family structure § Empowering the parent(s) and the family as agents of change § Defining treatment with the adoption/permanency issues as being of paramount


importance § Remaining flexible and creative in their approach § Combining clinical treatment with services that can easily accommodate to

situational/developmental crises § Linking interventions to the family’s and the adoption community’s resources § Being committed to permanence for all children § Persevering to maintain the child in the adoptive family setting § Creating services available as needed over time § Providing services in the context in which the family lives and communicated.21

Special Thanks Special thanks to the three adoption practitioners who participated in interviews for this PARTicle. Very special thanks also to Kathy Soden, Pat Convery, and Elaine Quinn of the Adoption Council of Ontario for their insightful and invaluable comments on this PARTicle prior to publishing.

PARTiculars. 1. Adoption Council of Ontario (2013). Notes from Adoption Competency Training Program

for Mental Health Professionals Report on Phase I: Needs Assessment & Information Gathering [April, 2013].

2. Adoption Council of Ontario (2014). Personal Communication, March 31st, 2014 [email].

3. Atkinson, A. & Gonet, P. (2007). Strengthening adoption practice, listening to adoptive families. Child Welfare, 86(2), pp. 87 – 104.

4. Barth, R. (1994). Adoption of drug-exposed children. In R.P. Barth, J.D. Berrick, & N. Gilbert (Eds.), Child Welfare Research Review (vol. 1) (pp. 273-294). New York: Columbia University Press.

5. Casey Family Programs (2008). Mental Health, Ethnicity, Sexuality, and Spirituality among Youth in Foster Care. Retrieved from: http://www.casey.org/Resources/Publications/pdf/MentalHealthEthnicitySexuality_FR.pdf

6. Chaffkin, B. (n.d.) Post-adoption Services Work in Many Ways. Retrieved from: http://www.nacac.org/adoptalk/pasarticle02.html

7. Child Welfare Information Gateway (2012). Providing Postadoption Services. Retrieved from: https://www.childwelfare.gov/pubs/f_postadoptbulletin/f_postadoptbulletin.pdf

8. Child Welfare Information Gateway (July 2012). Selecting and Working with a Therapist Skilled in Adoption. Retrieved from: https://www.childwelfare.gov/pubs/f_therapist.pdf


9. Evan B. Donaldson Adoption Institute (2008). Adoptive Parent Preparation Projects, Phase I: Meeting the Mental Health and Developmental Needs of Adopted Children. Retrieved from: http://www.adoptioninstitute.org/publications/2008_02_Parent_Preparation.pdf

10. Evan B. Donaldson Institute (2010). Keeping the Promise: The Critical Need for Post-adoption Services to Enable Children and Families to Succeed. Retrieved from: http://nysccc.org/wp-content/uploads/EBDKeepingThePromise.pdf

11. Festinger, T. (2002). After adoption: Dissolution or permanence. Child Welfare, 81(3), pp. 515-533.

12. Fong, R., Schwab, J., & Armour, M. (2006). Continuity of activities and child well-being for foster care youth. Children and Youth Services Review, 28(11), pp. 1359-1374.

13. Heflinger, C. A., Simpkins, C. G., & Combs-Orme, T. (2000). Using the CBCL to determine the clinical status of children in state custody. Children and Youth Services Review, 22(1), pp. 55–73.

14. Lenerz, K., Gibbs, D. & Barth, R.P. (2006). Post-adoption services: A study of program participants, services and outcomes. In M. Dore (Ed.), The Postadoption Experience: Adoptive Families’ Service Needs and Service Outcomes (pp. 95–110). Washington, DC: CWLA Press.

15. McCarty, C., Waterman, J., Burge, D., & Edelstein, S.B. (1999). Experiences, concerns, and service needs of families adopting children with prenatal substance exposure: Summary and recommendations. Child Welfare, 78(5), 561-577.

16. McDonald, T.P., Propp, J.R. & Murphy, K.C. (2001). The postadoption experience: Child, parent, and family predictors of family adjustment to adoption. Child Welfare, 80(1), pp. 71 – 94.

17. McKay, K. & Ross, L.E. (2011). Current practices and barriers to the provision of post-placement support: A pilot study from Toronto, Ontario, Canada. British Journal of Social Work, 41(1), pp. 57 – 73.

18. Ministry of Children and Youth Affairs (2006). A Shared Responsibility: Ontario's Framework for Child and Youth Mental Health. Retrieved from: http://www.children.gov.on.ca/htdocs/english/documents/topics/specialneeds/mentalhealth/framework.pdf

19. National Child Welfare Resource Center (2007). A Guide to Developing an Adoption Certificate Program for Mental Health Practitioners. Retrieved from: http://www.nrcadoption.org/pdfs/practicetools/Adoption%20Competence%20Toolkit%20for%20Mental%20Health%20Providers%2011-07.pdf


20. North American Council on Adoptable Children (2007). Post-adoption Services: Meeting the Mental Health Needs of Children Adopted from Foster Care. Retrieved from: http://www.nacac.org/adoptalk/postadoptpaper.pdf

21. Ornelas, L.A., Silverstein, D.N., & Tan, S. (2007). Effectively addressing mental health issues in permanency-focused child welfare practice. Child Welfare, 86(5), 93-112.

22. Reilly, T. & Platz, L. (2004). Post-adoption service needs of families with special needs children: Use, helpfulness, and unmet needs. Journal of Social Service Research, 30(4), pp. 51 – 67.

23. Riggs, D. & Boo. M. (n.d.). Disruption Support is Crucial. Retrieved from: http://www.nacac.org/adoptalk/disruptionsupport.html

24. Riggs, D. (n.d.). Plan, Prepare, and Support to Prevent Disruptions. Retrieved from: http://www.nacac.org/adoptalk/planpreparesupport.html

25. Ryan, S.D., Nelson, N. & Siebert, C.F. (2009). Examining the facilitators and barriers faced by adoptive professionals delivering post-placement services. Children and Youth Services Review, 31(5), pp. 584 – 593.

26. Selwyn, J., del Tufo, S., & Frazer, L. (2009). It’s a piece of cake? An evaluation of an adopter training programme. Adoption & Fostering, 33(1), 30-43.

27. Silverstein, D.N., & Kaplan, S. (1988). Lifelong issues in adoption. In L. Coleman, K. Tilbor, H. Hornby, and C. Boggis (Eds.). Working with Older Adoptees: A Sourcebook of Innovative Models pp. 45-53). Portland: University of Southern Maine.

28. Smith, S. (2006). The nature of effective adoption preservation services: A qualitative study. In M. Dore (Ed.). The Postadoption Experience: Adoptive Families’ Service Needs and Service Outcomes (pp. 159-195). Washington, DC: CWLA Press.

29. Stevens, K. (2011). Post-adoption Needs Survey Offers Direction for Continued Advocacy Efforts. Retrieved from: http://www.nacac.org/adoptalk/postadoptionsurvey.html

30. Taussig, H. N. (2002). Risk behaviors in maltreated youth placed in foster care: A longitudinal study of protective and vulnerability factors. Child Abuse & Neglect,26(11), pp. 1179–1199.

31. Trout, A. L., Hagaman, J., Casey, K., Reid, R., & Epstein, M. H. (2008). The academic status of children and youth in out-of-home care: A review of the literature. Children and Youth Services Review, 30(9), pp. 979–994.

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