Adoptive Families Need Ongoing Support
by Susan Livingston Smith and Jeanne Howard
For many year, Susan Livingston Smith and Jeanne Howard conducted research and training on adoption. Together they co-directed the University?s Center for Adoption Studies, a center funded by the Illinois Department of Children and Family Services. Professors Smith and Howard have also completed several studies about post-adoption services and published a book titled Promoting Successful Adoptions: Practice with Troubled Families.
For many years, workers who placed older children for adoption believed that once the children and their families passed through an initial period of adjustment, problems would subside. As we now know, although a large majority of families are satisfied with their adoptions, many adopted children have chronic behavior problems, or have problems that intensify at later developmental stages. Specifically, among adoption assistance-eligible children placed through state child welfare systems (those who have special needs, and who frequently have histories of deprivation and trauma), studies show a relatively high rate of ongoing problems. The question that we must now address is: How can adoption professionals best intervene to help children and adoptive families? Through our research, we believe we have discovered a few preliminary answers.
Families whose adopted children demonstrate significant ongoing behavior problems often report a history of seeking professional help without significant improvement in their situations. Power struggles may escalate as parents exhaust their repertoire of parenting skills in attempts to control their children's behaviors. These types of conflicts can lead to increased strife between parents and siblings, very high levels of stress within the family, a sense of emotional isolation for adopted children, and profound feelings of hopelessness and desperation for both adoptive parents and children.
Adopted children who have histories of loss and trauma often exhibit behaviors that are coping strategies to help them defend against strong negative feelings like powerlessness, fear of closeness, and low self-worth. Adoption experts also refer to these negative behaviors as survival behaviors in that they have helped children to survive in birth homes and in the foster care system. When these behaviors persist long after children are in permanent, safe homes, however, families need specialized interventions to help children address underlying emotional issues and change destructive patterns.
In our own research on adoptive families served by adoption preservation programs in Illinois, we have collected data on approximately 400 struggling families who sought post-adoption services. A majority of the 453 adopted children served were age 12 or older and were receiving adoption subsidies. In total, the children ranged in age from 3 to 18, and had, on average, been adopted at the age of 5.6 years. Of the children served, 91 percent scored in the clinical range on the Child Behavior Checklist (the clinical range represents the top 10 percent of scores of children in the total population on whom the test was normed). Children in our study had lived in their adoptive home for a long time?almost nine years on average.
For families who elect to receive adoption preservation services, a significant part of treatment involves learning about a child?s behavior within the context of their history and developmental stage. To facilitate this learning, workers support parents? efforts to reconstruct the child?s history by obtaining child welfare case records and any other information they can get their hands on. Families also participate in support groups where workers help parents and children individually, as well as together, to address emotional issues?particularly those associated with grief, trauma, and identity conflicts.
Through these activities, workers help parents to identify control problems, step back from incidents that trigger power struggles, and experiment with new ways to resolve conflicts. Parents gain an understanding of their children?s control needs, learn how to give their children choices, and discover how to pick issues on which they will stand firm. In describing the benefits of these services, one adoptive parent reported, "I have learned to pick my battles carefully. Now when I get into a fight with my daughter, I hear my worker asking, ?Will this matter in five years?' "
Children who receive services often express fears and concerns that they have never shared before. Some have ongoing feelings of vulnerability and fear that they will lose their adoptive families. Others worry about their birth siblings? welfare, or struggle to understand past events.
A range of separation and attachment issues arise with both parents and children. Workers help to resolve issues of loss through lifebook work, through communication between parents and children, and sometimes through contacting or revisiting important figures from the child?s past. In one case, a child was confused about why a previous foster family had not adopted him, and missed the family. His adoptive parents contacted the foster parents (who had moved out of state), and were able to visit them on vacation. During the visit, the foster parents explained to the boy that they often thought of him and wondered how he was doing. This reassurance of his former foster family?s concern helped the boy to resolve some of his conflicts.
Many children in our study demonstrated symptoms of post-traumatic stress, and symptoms were most frequent when the children were 12 years old. Some children would report that they remembered upsetting events, but were unsure whether or not the events were real. To address trauma issues, workers help parents to identify triggers that stimulate children?s feelings of threat, and plan ways to support the children?s feelings of safety. Workers help children to process traumatic experiences, put events into a reality-based perspective, and realize that they are not to blame for what happened to them. Workers also help children to cope with feelings related to traumatic past events.
Illinois? adoption preservation services have many of the hallmarks of any good intervention. They are based on an understanding of the family within the context of their environment, are tailored to individual families? needs, are supportive and non-blaming, connect families to resources, and help move families toward improved functioning. Families describe adoption preservation services as something much better than traditional services.
Some of the distinctive characteristics of these services include the following:
Adoption preservation workers are highly available to the family. They can come to the family?s home, respond to a 24-hour-a-day on-call service, and as needed, spend many hours working to de-escalate a crisis situation.
Workers pull together information from many sources to formulate a comprehensive assessment of the child and family situation. During the assessment process they retrieve child welfare case records, talk with teachers and other professionals, procure specialized assessments when needed, and gather the perspectives of all family members. In addition, workers often spend extra time with families at the outset of the assessment process to give them a chance to fully discuss the difficulties they have experienced while raising their child, and what attempts they have made in the past to find solutions. At this stage workers try to be good and truly empathetic listeners so families can vent their feelings with minimal interruption.
Workers use multiple types and levels of interventions. Support groups?which families rank as the most helpful of services?are a commonly offered service. Workers also attend Individualized Education Plan (IEP) meetings at the child?s school (meetings at which parents, school personnel, and other concerned parties discuss educational placement services for a child), participate in other team meetings, and actively advocate for families to obtain needed resources. They offer support and therapeutic counseling to multiple family members in different configurations, and use specialized interventions to address complex issues. For example, workers have been trained in Theraplay techniques for working with attachment difficulties.
Adoption issues are addressed throughout the process. Workers help families to consider how adoption has affected their lives. Families also learn about the effects of loss and trauma, issues involving birth family members or other attachment figures, and the process of family integration.
Workers help parents to take care of themselves and depersonalize children?s behavior. "It's not my fault!" and "My child's behavior is normal in light of her history." are messages parents come to internalize through adoption preservation work.
Prior to receiving adoption preservation services, many parents who adopted older children with special needs felt like failures and felt that other professionals blamed them for their children?s problem behaviors. Services that help parents to understand the context of their children?s problems and obtain support from other families with similar difficulties are extremely powerful in freeing parents from guilt and blame and in instilling hope.