Plan, Prepare, and Support to Prevent Disruptions
by Diane Riggs
Richard Barth and other researchers report that the rate of adoption disruption* falls between 10 and 15 percent. Researchers also say that age at placement is the best predictor of disruption; the older the child is, the more likely it is the placement will disrupt. Given the severity of problems among children being adopted today and the pressure states feel to place more children for adoption, many fear that disruptions are rising and will rise more. We can, however, ensure more stable placements by paying closer attention to children´s and families´ needs. In fact, keys to preventing disruption lie in every aspect of the adoption processfrom a prospective parent´s first inquiry through the first decades of a child´s life.
To prevent disruptions, agencies, states, and provinces must not only learn why placements disrupt, but what workers, agencies, legislators, and individuals can do to keep adoptive families together. Research and experience show that careful matching, adequate preparation, thoughtful transitions, and abundant family support after adoption can make the difference between adoptive family stability and yet another move for a hurt child.
The Art of Matching
From the time people step forward to foster or adopt, agencies should learn as much as they can about them. Families, in turn, should be educated about the challenges of foster care and adoption and assess their own ability to parent children with certain disabilities. The better workers know families (and families know their own strengths and limitations), the easier it is to match families with children whose needs they can meet.
Fortunately, much of the art of matching is good common sense. A medically fragile child should be placed with a family who is familiar with pediatric disorders and has access to medical facilities. Seriously disturbed children should never be matched with parents whose other children are vulnerable to abuse. When a child new to the family abuses other children, parents often feel they have little choice but to disrupt the placement.
Particularly when an older child is involved, placement with a person already connected to him or her is likely to be the best fit. For instance, many studies have found that disruption rates tend to be lowest for kin caregivers and foster families who adopt. Both kin and foster families have a strong pre-existing commitment to children in their care that seems to sustain them through the hard times.
Preparing Children and Families
When it comes to adopting children with special needs, most of us think first about preparing parents to adopt. At the same time, howeverbecause children in foster care are often the product of chaos, trauma, and losschild preparation is equally important. If a child has never experienced stability or safety with birth family members, or has been bounced between foster placements, how can he or she know or even begin to understand or trust what life with a normal and permanent family should be like?
The primary goal of preparing children is to help them live safely in a new, permanent family. One difficult step toward achieving that goal is helping children to grasp why they cannot cannot go back to their birth families. If a child has not been able to process the painful reality of early abuse or abandonment, he will find it harder to accept a new family.
One good tool, says Peter Winkler (retired director of adoptions for New York State social services) for helping children explore the past is an honest lifebook. Taking the child´s developmental level into account, lifebooks should candidly outline the child´s historygood and badand emphasize that the child bears no blame for bad things that happened. Done with care and support, notes lifebook expert Beth O´Malley, Lifebooks can help foster children pull together the pieces of their past so they can hold them, grieve them, and move on.
As Winkler also observes, it is most important that agencies recognize the need to provide adoption preparation services even in cases where a child has lived in the same foster home for many years. For children with attachment disorder, as Deena McMahon (lead therapist at Therapeutic Services Agency, Inc. in Minnesota) points out, transitioning from a comfortably temporary foster placement into the frightening closeness of a permanent adoptive family (even with the very same family) can compel children to act out and reject the family.
To begin to accept a new family, children must know what to expect. What´s the family like? If a child has siblings placed elsewhere, contact and visitation must be discussed. If the child wants to keep in touch with a foster family, ongoing communication should be arranged. Children must be honestly told what lies ahead for them; nothing is more frightening and unsettling than not knowing.
To not prepare a family, observes one experienced adoptive father, greatly increases the chance of disruption. Ideally, adoptive family preparation should arm prospective adopters and their other children with information and support to maximize the chances that parents will be able to parent effectively and others in the home can live safely with the new family members.
When a child and family are matched, the family deserves to know everything possible about the child. From the time a child comes to the attention of child protection, workers should gather details about the child´s experiences, the birth parents´ and siblings´ histories, and subsequent experiences with different foster families. The child´s complete medical history should also be disclosedincluding assessments, diagnoses, and treatments.
Though some workers fear that complete disclosure will frighten adoptive parents away, incomplete disclosure can be the catalyst for disruption. Parents who lack the knowledge to help their children are much more likely to end an adoption with a sense of failure and frustration. Conversely, parents who know a lot about their new children have a chance to go into the adoption with realistic expectationsa key ingredient for adoption success.
Published in a 2003 issue of the Children and Youth Services Review, the results of a survey of 249 adoptive families in Nevada showed that realistic parental expectations had the greatest effect on the quality of parents´ relationship with their children, parenting partners, and the family as a whole. Parents should know what to expect from the children they agree to parent, and understand how best to relate to specific youth. For instance, adopters:
- should know how the child is expected to function in the future. Can the child live on her own as an adult?
- should learn what to expect as a result of diagnosed disorders. Strategies for raising a child with fetal alcohol syndrome or attachment disorder are quite different than those for parenting a child without special needs. If children have specific disabilities, parents should receive extra training on how to best meet the children´s unique needs.
- need to know what services and supports (adoption subsidy, medical benefits, respite care, etc.) they can expect.
- may need lessons on how to be mentors and guidesrather than stereotypical parentsto older children and teens who join the family.
While workers can convey such information, parents may be more receptive to hard truths delivered by experienced foster or adoptive parents who have survived the tough times. How?
- Many agencies have started to use foster and adoptive parents in orientation trainingsas co-trainers and on panels.
- Other programs use foster and adoptive parents to both recruit and support prospective fosterers and adopters.
- Parent support groups offer would-be adopters insight into day-to-day life with children who have special needs.
Experienced foster and adoptive families can also advise parents on ways to prepare other children in the family for new additions. Like parents, children in an adoptive family need to know what to expect. How might their role in the family change? How might they help the new child to adjust? What if they don´t like the new child? Again, nothing is scarier than the unknown.
Transitioning from Foster Care to Adoption
Transitions are hard for many childrenespecially those whose lives have been punctuated by a series of frightening changes. Asking some children to immediately move to a new family is like demanding they hang over the edge of a cliff and let go. To minimize stress, transitions to a new adoptive family should be made with each child´s needs in mind.
Virginia Sturgeon, a child welfare consultant and adoptive parent from Kentucky, supports extended pre-placement visitation schedules. Instead of suddenly immersing children in a new environment, she says, an extended visitation schedule allows them to gradually get used to new people and places. Initial visits should take place where the child is most comfortable (usually the foster home), and the current caretaker should support the child´s visits with the new familythereby giving the child permission to move on to the adoptive family.
Based in Queens, New York, Family Focus Adoption Services believes that waiting children should visit with adoptive families until both the children and the families are ready to move forward. When the family is ready to claim the child and vice versa, the agency performs a commitment ceremony during which parents and children sign a covenant recognizing the newly formed family. The agency´s disruption rate, reports Family Focus´ executive director, is very low because its transition practice gives families time to fully commit to a child before adoption.
Other factors to consider:
- Timing. Especially when a child must move to a different city or state, plan to make the placement during a natural break in the child´s life (for instance, when school is out for the summer). Whenever possible, avoid disrupting a child´s school year, sports season, or other important activities.
- Constants. Keep as many constants in the child´s life as possible. If the former foster family is supportive, maintain contact. Learn about the child´s favorite foods and restaurants, games, even the type of soap or toothpaste to which the child is accustomed. Familiar smells, tastes, and activities will help a child feel more at home in a new family.
- Supports. Before a child with special needs enters a new home, agency staff should work with parents to get support services in place. If the child needs a personal care attendant for home or school, one should be available. Individualized education plans should be set up with the child´s school. Therapy appointments should be scheduled and medications tracked. Services should continue as seamlessly as possible.
Life for the Adoptive Family
Once a waiting child moves in with an adoptive family, the equation changes for both the child and family. Everyone assumes new roles and responsibilities, and the success of the adoption now balances on the health of the entire familynot just the child. For that reason, post-adoption services should be geared toward keeping the entire family intact.
When an agency places a child in adoption, observes Ken Watson, it implicitly enters into a contract with that family quite apart from the legal contract that consummates the adoption. An adoption expert who worked in child welfare for decades, Watson further explains that the contract is based on the premise that the family accepts the child as a permanent family member (no returns), and in turn, the agency obligates itself to provide, or make certain others provide, services to help the family handle its stress.
Agencies can facilitate post-adoption services by negotiating adoption subsidy agreements, offering guidance about health care benefits, and making referrals to other adoption professionals or adoptive parents. Workers can also provide pivotal support for parents. As one adoptive mother writes, Having a social worker who was there and believed in me saved our family. The worker helped the mother to see how far her son had come over time, and accept the realities of the boy´s future. When the boy was an adult, the mother adds, the worker helped me to let go when I could do no more.
When problems arise, adoptive families can also benefit from good family therapy. As therapist Deena McMahon asserts, while children with attachment issues may need individual therapy to resolve issues from the past, they should not receive individual attachment therapy; individual therapy does nothing to promote family attachment or healing for hurt children. Watson adds, Since the issue is a family issue, all members of the adoptive family should be seen as a family unit, preferably in the family´s home.
Watson also suggests that family therapists´ first task is to validate the adoption decision. Therapists must focus on helping families to stay together, and giving families tools to help adopted children.
Well-trained therapists can also remind parents that children behave certain ways for a reason. As Watson points out, Children who enter an adoptive family bring with them past fears, past unmet needs, and past ways of coping with life. To reverse negative behaviors, parents may need to make the child feel more safe, adjust their parenting to match the child´s emotional age, and devise means for the child to cope with troubling feelings using the child´s and family´s strengths.
If a family, despite services and interventions, cannot live safely with an adopted child who has serious mental health problems, agencies must allow for out-of-home therapeutic placements without asking the family to end the adoption. Even if children and teens can´t live at home, they still need to know that their family is there to support them. Why would a child even try to get better if they have no one to go home to?
This October, Congress introduced identical House and Senate bills (HR 3243/ S 1704) to help families whose children cannot live safely at home. If enacted, the Keeping Families Together Act would award grants to states willing to ensure that families do not have to relinquish legal custody to access mental health services for their children. The Act would also allow states to use the Medicaid home- and community-based services waiver to provide local mental health services to youth as an alternative to inpatient psychiatric hospitals.
Professional help is essential for troubled adoptees and their families, but families can also help themselves to better weather the highs and lows of parenting a child with special needs. For one thing, adoptive families must be willing to seek support from the communityand fight the impulse to bear burdens alone. One adoptive mother wisely recommends that other adoptive parents talk to friends, pastors, and counselors in good times and bad, and accept the support they offer.
Adoptive parent support groups are another natural place to turn. Where else can you find a group of parents who understand so well the realities of parenting children who have special needs? The child´s former foster parents may also 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 relationship with the child, foster parents can be great respite care providers. A needed break for the adoptive parents could be a welcome visit to old friends for the child.
Adoptive parents should also take advantage of opportunities (through trainings, books, articles, and other parents and professionals) to learn more about the challenges their children face. The more a parent knows about the child´s capabilities and limitations, the easier it is to keep expectations realistic and celebrate more subtle signs of progress. Keeping a written record of the child´s behaviors and responses is also useful for tracking situations that trigger certain behaviors and for helping parents to see how the child has developed over a longer period of time.
Finally, parents must also reserve quality time for themselves and their other relationships. A parent´s love and nurturing is no less valuable for children who cannot reciprocate, but it is hard to keep giving and giving without receiving in return. Parents need affirmation too. They need to keep their own interests alive, maintain a good sense of humor, and find enough personal fuel to keep facing challenges that may arise on a daily basis.
No two adoption journeys follow precisely the same path, and because every family situation is unique, parents who adopt children with special needs must have access to a wide array of affordable, effective, and ongoing pre- and post-adoptive services and supports. Each family also needs the strength to define success on its own terms. For one youth, earning a GED at 28 might qualify as a miracle. For another, accepting professional help could be a major breakthrough. Adoptive parents deserve the chance to move forward with hope while working to make a significant difference in the lives of our most vulnerable children.
* The term disruption is used broadly in this article to mean a child´s removal from an adoptive home either before or after finalization.