The National Quality Improvement Center for Support and Preservation (QIC-AG) is a five-year, federally funded project designed to promote permanence when reunification is no longer a goal and to improve adoption and guardianship preservation and support. The QIC-AG is built on the premise that child welfare agencies need to provide a continuum of services to increase permanency stability, beginning when children first enter the child welfare system and continuing after adoption or guardianship has been finalized.
Over the past decade, hundreds of thousands of children have left foster care to join adoptive and guardianship families. But for these children and their families, their journey is not over when they exit foster care. It is imperative that we continue to support these families throughout and after their journey to adoption or guardianship.
The National Quality Improvement Center for Support and Preservation (QIC-AG) has developed a permanency continuum framework to guide this work of helping children and families transition from foster care to adoption or guardianship and then helping families maintain stability and wellbeing after adoption or guardianship has been achieved.
Starting while a child is in foster care, the first intervals of the continuum framework—stage setting, preparation, and focused services—focus on moving the child and family toward finalization. The next intervals—universal, selective, and indicated services—are preventive and occur after permanence has been achieved. The last two intervals focus on addressing intensive services and maintenance of permanence.
To learn more about what services can increase permanency for children, improve children’s behavioral health, and advance the well-being of children and families, the QIC-AG is working with eight partner sites offering services on the continuum:
- Focused Services—Texas and the Winnebago Tribe of Nebraska: It can be difficult to find permanent families for children who are experiencing challenging, emotional, behavioral, or mental health issues. Focused services and interventions address a child’s specialized emotional, behavioral, or mental health needs and prepare adoptive or guardianship families so they are confident in their ability to meet the needs of children both pre- and post-permanence. Texas and the Winnebago Tribe of Nebraska are implementing interventions that fall into the focused interval of the continuum, providing families and caregivers with services that can help them increase their capacity to care for children with specific needs.
Texas is implementing Pathways to Permanence 2: Parenting Children Who Have Experienced Trauma and Loss, a seven session (21-hour) interactive series for caregivers who are parenting children who have experienced trauma and loss.
The Winnebago Tribe of Nebraska is implementing Family Group Decision Making (FGDM). FGDM will be used to engage the tribal family in identifying the best permanency resources and determining whether the preferred permanency option is customary adoption, permanent legal guardianship, or other forms of tribally recognized family restoration.
- Universal Services—Vermont: Universal prevention efforts target the general adoption/guardianship population with interventions designed to educate families on best practices and accessible support services. Vermont is implementing a post-permanency survey designed to help the system understand the strengths and protective factors associated with families who are struggling or facing elevated challenges post-permanence.
- Selective Services—Illinois and New Jersey: Selective prevention efforts target families who are at a high risk for post-permanency discontinuity based on factors present at the time of finalization. These services are preventive, offered before the family perceives an issue or asks for assistance, and designed to mitigate the risk factors present at the time of finalization that could result in discontinuity if left unaddressed.
To provide selective services to families, Illinois is implementing Trauma Affect Regulation: Guide for Education and Therapy (TARGET), a series of workshops to teach teens and parents how to talk about everyday events that can be stressful at school and at home. TARGET teaches youth and parents how to understand and change their reactions to stress. Illinois offers TARGET to eligible youth with a finalized adoption or guardianship. Eligibility is based on residence and age: in Cook County, the program is offered to youth ages 12-16 years, and in specified counties within the Central Region, the program is offered to youth ages 11-16 years. Further, to be eligible for TARGET, the youth must be living in the home of their adoptive parent or guardian.
New Jersey is also implementing selective services in a program called Tuning into Teens (TINT), a seven-session emotion coaching program designed to increase parents’ capacity to understand and respond effectively to their child’s emotions, thereby helping their child to develop and improve emotional competence. New Jersey offers TINT statewide to adoptive and guardianship families (i.e., families with a child they adopted or for whom the parents assumed Kinship Legal Guardianship) whose children are aged ten to thirteen years, and who are receiving an adoption/guardianship subsidy. In addition, families eligible to participate in TINT must meet one of the following criteria:
- At the time of the adoption or Kinship Legal Guardianship (KLG) finalization, the child was between six and thirteen years old;
- While the child was in the foster care system, the child was placed in group care.
- Indicated Services—Catawba County, North Carolina and Wisconsin: Indicated prevention services target families who request assistance to address an issue that has arisen after permanence has been achieved but before significant deterioration occurs in family functioning. North Carolina’s Catawba County has developed Reach for Success, a two-part intervention designed to provide early outreach to county families who are receiving adoption assistance. Part one involves mailing a self-report survey to the target population. Part two involves phone calls to families who responded to the survey and whose responses indicated they might benefit from the Reach for Success support services.
Wisconsin implemented Adoption and Guardianship Enhanced Support (AGES). AGES assesses the needs, strengths, and goals of individual families before offering personalized assistance with navigation of pre-existing resources and services and targeted advocacy in areas as requested by the family. The AGES team of professionals work with families to build supportive relationships by offering individual skill-building and educational materials.
- Intensive Services—Tennessee: Intensive services target families who are experiencing severe challenges and are seeking immediate services. These families may be at imminent risk of experiencing a crisis or may already be in a crisis. Tennessee is implementing the Neurosequential Model of Therapeutics (NMT) to help these families. NMT is a developmentally informed, biologically respectful approach to working with at-risk children that helps to organize a child’s history and current functioning.
Over the course of the last several years working to promote permanence and improve adoption and guardianship preservation and support, the QIC-AG has gained several insights about what systems need to do:
- Support families who provide permanence. Given the number of children who live in adoptive and guardianship families, resources must be provided to ensure the stability and wellbeing of the children. Families need support not only as they transition to adoption or guardianship but also throughout their entire adoption or guardianship journey. Given the body of scientific evidence regarding the long-term effects of trauma on child development, child welfare systems must offer children and families a robust array of post-permanency supports and services.
- Empower families to seek support. Child welfare systems should send families a clear message that seeking assistance after permanency is normal. We must combat the long-standing misconception that once children obtain permanence through adoption or guardianship, any previous trauma the child may have experienced would no longer cause challenges. This misconception means there has been too little post-adoption support and, when it was offered, parents may have been reluctant to reach out because they saw their challenges as failures. Now we know that adoptive and guardianship families may need support as their children reach different milestones and transitions in their life. The professionals working closely with families should talk transparently about the challenges that may arise and encourage parents to seek support before and after legal permanence is achieved. Normalizing this potential need and empowering families to seek assistance when needed can help families feel more comfortable reaching out for supports and services throughout their journey.
- Respond quickly to families’ unique service needs with evidence-based services and support. By engaging families in services early in the permanency process, we can ensure children and families feel supported, strengthen caregiver competency, mitigate caregivers’ feelings of lack of preparedness and doubt, and create lasting social supports that can be leveraged long after permanency has been attained. No single response will meet the needs of every family. Regardless of when families request services, systems need to respond quickly and offer an array of evidence-based services and supports to meet the unique needs of each family. Specifically, post-permanency services and supports need to be:
- available when needed, without waiting times to obtain services
- responsive to the particular needs of each individual family
- supported by policy at federal, state, and local levels
- delivered by staff with the expertise and training to adequately meet the unique needs of adoptive and guardianship families
- Allocate resources to engage families in services and supports. It is important for child welfare systems to link families to services before legal permanence and continue to offer supports and services after permanence has been achieved. Once permanence has been achieved, investment in low-cost outreach strategies should facilitate ongoing support and connections with families. These strategies are designed to inform families of services and supports that can be accessed when a family identifies an immediate service need.
- Remember that not every family will have an unmet service need. Child welfare systems need to counter concerns that proactively discussing the need for and offering services to adoptive and guardianship families that will lead to an overwhelming demand. Research tells us that only a moderate proportion of adoptive and guardianship families will need to seek services from the child welfare system. Results from a survey of adoptive parents and guardians in Illinois found that 85 percent of these families said they were doing well with the supports and services they currently had and did not need additional supports or services (Fuller et. al, 2006).
In Tennessee, post-adoption services are available to all adoptive families in the state who are receiving a subsidy. Between July 1, 2016 and June 30, 2017, of the approximately 5,500 adoptive families eligible for services, only 353 (6 percent) used the services. Data from several of the QIC-AG sites further supports that offering services to adoptive and guardianship families will not lead to an overwhelming demand. Parents and guardians with teenagers in New Jersey were offered a group-based intervention aimed at helping them respond effectively to their child’s emotions. Of the 653 families offered the service, 11 percent have participated. In Illinois, the QIC-AG project offered families with teenagers living in one region a trauma-informed home-based intervention. Of the 353 families offered the service, 6 percent have participated.
- Ensure supports are available to families who adopt children privately (through either domestic or intercountry adoption). Families who adopt children through intercountry and private domestic processes need supports and services similar to those provided to families who achieve permanence through the public child welfare system. While most adoptees are physically and emotionally healthy, adopted children are more likely than non-adopted children to have significant physical health problems as well as difficulties with emotions, concentration, and behavior. Most often, this increased risk is due to adoptees’ exposure to adverse experiences before coming to their adoptive families. Children who are adopted through intercountry and private domestic processes are likely to have been exposed to many of the same adverse childhood experiences as children adopted through the public child welfare system. For families formed through intercountry or private domestic adoptions, cultural differences, language barriers, and the negative effects of children being placed in institutional settings may compound the typical issues associated with adoption. Unfortunately, some child welfare systems do not allow families formed through intercountry or private domestic adoptions to access post-permanency services, while other systems allow these families to access services but may charge a fee.
In addition to the work at the eight partner sites, QIC-AG has also produced a rich array of practical resources that are available here, including:
- QIChats that highlight site-specific interventions in connection with a partner site
- Video series for adoption service providers covering key programs from partner sites
- Annual lessons learned, an aggregate of key elements of the annual gathering
- “Ask about” series of factsheets offering concrete tips for allied professionals that work with children and families.
The QIC-AG project is funded through the Department of Health and Human Services, Administration for Children and Families, Children’s Bureau Grant #90C01122. The contents of this article do not necessarily reflect the views of the funders, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Department of Health and Human Services. This information is in the public domain. Readers are encouraged to copy and share it but please credit QIC-AG. The QIC-AG is funded through a five-year cooperative agreement between the Children’s Bureau, Spaulding for Children, and its partners the University of Texas at Austin, the University of Wisconsin-Milwaukee, and the University of North Carolina at Chapel Hill.