Maine Adoption Guides: Making the Case for Family-Driven Post-Adoption Services
from Winter 2005 Adoptalk
by Michel Lahti*
Dr. Lahti is an assistant research professor in the Edmund S. Muskie School of Public Service at the University of Southern Maine (USM) whose interests include special needs adoption and evaluating programs for youth and families. A 15-year veteran in the field of youth development and behavioral health services, Dr. Lahti is also the principal investigator evaluating the Maine Adoption Guides program. Below he shares findings about the program.
In the mid-1990s, Maine's parents and child welfare agency recognized that a growing number of families needed good, reliable post-adoption supports. At the time many adoptive families felt that, after adopting, they were cast adrift with little support. Encounters with the mental health system left parents feeling blamed and misunderstood. In April 1999, with help from a federal Title IV-E child welfare waiver, the state set out to test a service model for adoptive families. Called Maine Adoption Guides, the program that just ended in December 2004 taught us a lot about serving adoptive families.
Finding the Trail
Leaders of the initiative that became Maine Adoption Guides (including an advisory group of parents) named the project for those who lead expeditions into Maine's woods and on Maine's waterways. The project's spirit was intended to be one of mutual discovery with educated adoption guides leading adoptive families to destinations the families choose.
To address adoptive families' concerns, initiative leaders pursued policy and program options that would result in:
- professional development: adoption-competency training for community providers and educators
- family-driven services: adoption-competent clinical services based on each family's needs
- support: parent and youth group services as well as other informal family support networks
The hope was that this course of action would produce adoption-competent clinical service providers, supported and strengthened families, and stable or even enhanced child well-being within adoptive families. We also hoped to reduce the number of adoption dissolutions.
Supports and Services: Walking Sticks and Shelter
When setting out on a long hike, travelers must prepare for expected as well as unexpected events along the trail. At its core, as fundamental to hikers as water and a compass, the Maine Adoption Guides program believed that families need both formal clinical services as well as less formal educational and consultation services. The program was also designed to focus service intervention on the entire adoptive family's needs, not just the needs of the adopted child. Based on this foundation, the intervention model came to be described as clinical case management services.
Starting in 1999, caseworkers approached families just before finalization to offer them a chance be part of the Maine Adoption Guides research study. Only families with children who had special needs and were enrolled in the Maine DHHS adoption assistance program were eligible. Each family was then randomly assigned to either the Guided Services or the Standard Services group.
Families in both groups received subsidy benefits, as well as standard services and supports available to all families who adopt from foster care. Both groups also completed evaluation surveys every six months during the study.
Families in the Guided group, however, had access to an Adoption Guide: a master's level, adoption-competent social worker employed by Casey Family Services. Access was available 24 hours a day, every day, and was provided to any member of the familynot just the adoptee or parents. Families also had to meet with their Guide at least every six months. The model included these elements:
- clinical case-management services by the Casey Adoption Guide
- in-home family services and supports
- therapeutic services for the whole family, focused primarily on parent-child relationships
- enrollment in parent and youth support groups
- limited financial help for activities to support child well-being (such as recreational activities)
To coordinate services for families, Casey Adoption Guides met regularly with state adoption case workers. Project management staff provided to all stakeholders at least quarterly updates about project outcomes. Electronic newsletters, biannual conferences, other meetings, and video presentations also helped to get the word out about the program and generate feedback to fuel practice improvement.
There were many rough spots in the private and public agency collaborationlike the challenges of washed out bridges and biting flies on a long hikebut both the state agency and Casey Family Services evaluated project implementation positively. The professionals' ability to develop personal relationships and trust in each other was crucial in the effort to not lose anyone on the trail.
A Look at the Families
To assess the obstacles that adoptive families were facing, the state partnered with researchers from USM's Edmund S. Muskie School of Public Service. Key findings reveal what services adoptive families most often seek and acknowledge why the journey of families who adopt from foster care is sometimes so difficult.
Demographics: A total of 499 children in 273 families were enrolled in the study278 (149 families) in the Guided group, and 221 (124 families) in the Standard group. In addition:
- On average, children in the study were seven years old.
- Close to 90 percent were adopted by foster parents with whom they had lived for at least three years.
- Most parents were married and the same race as their children.
- Of children in school, 47 percent had a special education services plan.
- At finalization, 25 percent of children ages 1 to 5, and 68 percent of children 6 to 18 scored in the clinical range (indicating a need for behavioral health services) on the total problems scale of the Child Behavior Checklist.
- Per parents' reports, 25 percent of the children had a clinical diagnosis, and 30 percent were taking some form of psychotropic medication.
Why parents adopted: The top two reasons parents in the study decided to adopt were, "wanting to make the relationship legal," and "wanting to make the child feel more secure." Parents also consistently suggested that their other children's attachment to the adopted child was a strong factor in their decision to make things permanent.
Parents also experienced concerns about adoption. Key questions included: "How [can I] bestÉmeet the child's needs?" "How [will] the child accept me as a parent?" and "How [will] other children in the family react to the adoption?"
Services parents sought: After adoption, the most commonly sought services were:
- individual child counseling services
- respite care
- adoption support groups
- services from behavioral and other specialists
In the Guided Services group, families chose the support services workers provided. Services were offered in the home, at the community agency, and through regular phone contact between the parents and the Guide. Parents, ultimately, received the bulk of services. On average, Adoption Guides workers spent about 65 hours each year with each family, but in reality, a relatively few families with very serious challenges accounted for the majority of service time logged.
The Path Taken: Guided versus Standard Service Groups
Project outcomes were considered for children, families, and program costs among families who were in the study for at least 24 months. At baseline, there were no significant differences between the groups on any child characteristics. After 24 months in the study, families reported these outcomes:
- While children in both groups scored in the clinical range on the total problems scale of the Child Behavior Checklist, children in the Guided Services group scored, on average, significantly lower on this measure over time.
- Parents reported that Casey Family Services workers were more family centered in their approach than regular caseworkers.
- Guided Services parents reported a higher level of trust in their relationship with their adopted child.
- Parents also said they obtained services from the Guides program that they requested; the model seemed to meet all different kinds of families' needs.
- Adopted children in the Guided Services group had significantly lower physical and behavioral health care costs. In particular, costs for general outpatient and physician services, as well as prescriptions, were lower.
Happily, parents in both groups reported positive levels of satisfaction with the adoption process and rated their overall quality of life as very positive. The project also met Title IV-E cost-neutrality waiver requirements. After five years, Title IV-E costs for children in the Guided Services group were no greater than costs for children in the Standard Services group.
On the Trail to Success
Tammy and Steve head one of the first families to participate in the project. When they were referred to the program, Tammy and Steve had three birth children (with a fourth on the way) and were about to finalize the adoptions of Matthew, 7, Amethyst, 5, and Christopher, 4. Though Tammy and Steve were experienced and resourcefuland had a background in special educationthe new children presented many challenges.
Over four years, this family accessed many services through the Adoption Guides program and other community programs. About the Maine Guides program, Tammy comments, "The fact that we are treated as a whole family and are supported so much as a whole is different from any other program we've been involved with.Éthat feeling of unification is especially important when you have eight children with individual needs and issues."
Ellen Kornetsky, LCSW (the family's Casey worker) states, "
what makes a difference is how flexible my role in their family can be
Also, the amount and variety of resources that I can focus on parents is somewhat unique to this program and, in my view, is what brings about the most lasting changes. The adoptive parents I work with aren't just parenting kids, they're actually re-parenting them, and while I can offer some useful tools to work with
, I think I make the greatest impact by simply bearing witness and helping them fully appreciate the complexity and enormity of their task."
The Path Ahead
In partnership with other agencies, Ginny Marriner (Maine's state adoption specialist) is looking ahead to implementing Maine Guides statewide. The goal is to establish a group of community agencies that can support the implementation of this family-driven, clinical case management model for all of Maine's adoptive families. An updated training program was piloted in January 2005 and new policies and procedures are incorporating lessons learned. In addition, MaineCare (Medicaid) Targeted Case Management is expected to support this form of clinical case management.
The Maine Adoption Guides model offers the following trail markers for others:
- Most children leaving foster care have significant behavioral health needs that do not diminish as they grow older. Their families, as a result, need specialized support after legalization.
- Families want therapeutic support, education, and other services based on their children's needs and in ways that support the family. Flexible, available services and supports based on the family's needs appear to result in better outcomes for children and families in some of the areas measured in this project.
- The case management model had an adoption-competent, master's degree level social worker who could function as a case manager and provide direct services. This family-driven model was less costly to the MaineCare system than the standard post-adoption service arrangements most families receive.
Perhaps the most important finding is that most families are reportedly satisfied with their adoptions and overall quality of life. The trail these families have chosen is a good one, and for those who need it, the added supports from their Guide has made the going even better.
* The author wishes to recognize those who helped with the article and who work with families to nurture children adopted from foster care. Sincere thanks are due to Ginny Marriner (Maine's adoption specialist), Lee Spanger and Heather Stephenson (Casey Family Services, Portland), Leslie Rozeff (Child Welfare Training Institute, USM), and Amy Detgen and Donna Cote (evaluators at USM).The author is also deeply appreciative of Maine families who graciously participated in this important study.