After Adoption:
The Need for Services
The National
Adoption Information Clearinghouse factsheet
"Adoption
and the Stages of Development: What Parents
Can Expect at Different Ages" discusses
stages of child development in general and
the adoption-related issues associated with
each stage. The factsheet introduces the concept
of postadoption services and explains that
adopted children, as they grow and mature,
sometimes need help resolving the sadness
they feel about not growing up with their
birth parents. Adopted children who were adopted
when they were older, who were adopted after
they experienced abuse or neglect, or who
were adopted from another country may have
other feelings and behaviors that sometimes
become difficult for families to manage on
their own.
Needing outside help after adoption is normal,
and many adoptive families seek postadoption
assistance. This factsheet will continue where
"Stages" left off and discuss in more detail
how adoptive families can get help if they
need it. An appendix to the factsheet includes
listings of (1) national organizations that
provide postadoption services (2) national
professional associations, (3) Federal Government
adoption information sources, (4) current
federally funded postadoption services grantees,
and (5) sources for further reading.
Families can find help even if they live
in a community with few mental health resources.
Generally, there are four kinds of postadoption
services available:
- Outpatient psychotherapy;
- Treatment away from home;
- Educational services; and
- Support groups.
The following sections discuss each of these
services.
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Outpatient Psychotherapy
Outpatient psychotherapy is probably the
most common form of professional help that
a family can use. Therapy can be provided
by a psychologist, psychiatrist, or social
worker.
Finding a Therapist
It is important to locate a therapist who
understands and is sensitive to the unique
dynamics of the adoptive family and who will
neither minimize nor overreact to the fact
that a child has been adopted. If a child
has spent time in the foster care system before
being adopted, it may be helpful to find a
therapist who is familiar with the typical
development of a child who has gone through
separation, loss, and rejection.
Adoptive families who have worked with therapists
emphasize the importance of finding a therapist
with adoption experience. Training of therapists
usually does not include specific instruction
about the unique dynamics of adoption. However,
working with a therapist who knows about adoption
often can make the therapy more productive.
To find a therapist who has experience with
adoption issues, parents can ask for recommendations
from other adoptive parents they know, members
of local or national adoptive parent support
groups, and reputable adoption agencies. Parents
also may inquire at mental health associations,
universities, hospitals, or medical schools
with psychology and psychiatry departments.
In addition, the Clearinghouse maintains a
data base of information on adoption experts,
which is available by geographic location
or by therapeutic specialty area.
A word of advice to families looking for
a therapist is to "trust your instincts."
It is important to feel comfortable with the
chosen therapist. A good therapist strives
to help family members better understand each
other. The therapist also helps parents to
become more effective and helps children to
accept responsibility for themselves. If the
family members do not feel that they are being
understood or cannot develop a rapport with
the therapist, the family should think about
finding another therapist. Not every competent
therapist is a good match for every family.
Here are some questions a family might ask
to help determine if a prospective therapist
will be a good match for the family's needs:
- What are the therapist's credentials (for
example, education and training)?
- Does the therapist have experience in treating
children with a history (either known or suspected)
of sexual and/or physical abuse?
- If the therapist is not a medical doctor,
does he or she have an affiliation with someone
who can prescribe medication, if necessary?
- Does the therapist have a commitment to
a particular "school" or method of treatment?
Therapists generally work either in private
practice or for community mental health centers,
which serve residents within a specific geographical
area. Every community is served by a mental
health center, but families should be aware
that there may be a waiting list for health
center services.
The cost of therapy varies and may be covered
in part by health insurance or special needs
subsidies. Some therapists, and most community
mental health centers, provide services on
a sliding fee scale based on income. Families
should be sure to ask what the costs are and
when payment is expected (after each session,
at the end of the month, or after reimbursement
by the family's insurer).
Approaches to Therapy
There are as many approaches to therapy as
there are practicing therapists. Some therapists
prefer to work with the child alone; others
see the parents or the whole family. If the
therapist is child focused, the therapy may
concentrate on the child's particular behavior
problems, such as stealing or lying. A competent
therapist will recognize that adjustment difficulties
for a child often are related to unresolved
grief. In addition, the child may be dealing
with identity, self-esteem, or peer relationship
problems.
Other therapists may want to work with the
parents alone. After the long, sometimes arduous
process of applying to adopt and waiting for
a placement, parents may need help in adjusting
to the everyday realities of raising a child.
Tensions also may surface in the marriage
as a result of the challenges of parenting.
Because adoptive families often confront
issues of belonging, loyalty, entitlement,
and attachment, many therapists experienced
with adoptive families prefer to work with
the whole family. These therapists see the
family as a system in which each member has
an impact on every other member. An example
of such a system is a hanging mobile—when
one part moves, every other part also moves.
Family therapy thus acknowledges that everyone
in the family has some responsibility for
how the family functions. Such therapy avoids
placing blame on a single person. Whether
each session includes all family members can
be determined by the therapist, in consultation
with the family.
Whether concentrating on the individual child,
the parents, or the entire family, a therapist
might employ several different methods of
psychotherapy. Below are descriptions of those
most commonly used today.
- Play therapy.—Therapists customarily
use this form of therapy with very young children,
who may not be able to express their feelings
and fears verbally. The therapist will engage
the child in games using dolls and other toys.
Through gentle probing, the therapist will
try to draw the child out. In this way, the
child may be able to act out feelings and
reveal deep-seated emotional trauma.
- Individual psychotherapy.—This
therapy may take many forms. Often the therapist
will work to help the child first express
problems verbally and then find ways to manage
them. This type of therapy tends to stress
that children should assume responsibility
for their own actions and ultimately for their
emotional well being. The therapist will offer
challenges, interpretations, support, and
feedback to the patient.
- Group therapy.—Therapists usually
favor this therapy for a group of patients
with similar problems. This type of therapy
allows a small group of patients to discuss
problems in an organized way. Group therapy
is an efficient use of a skilled therapist's
time and offers the extra advantage of feedback
from peers. Occasionally family members may
be asked to join the group. Group therapy
frequently is used with adolescents and usually
is the treatment of choice for substance abusers.
- Family therapy.—Increasingly
popular over the past two decades, family
therapy is based on the premise that all psychological
problems reflect a dysfunction in the "family
system." The term "dysfunction" means that
members of a group or system are working together
in a way that is harmful to some or all of
its members. The therapist requires the active
participation of as many family members as
possible and focuses on gaining an understanding
of the roles and relationships within the
family. Family therapy seeks ways to achieve
a balance between the needs of the individual
and those of the larger family system.
- Behavior modification.—A commonly
used form of therapy, behavior modification
has many practical applications. The basic
approach in behavior modification is to use
immediate rewards and punishments to replace
unacceptable behavior with desirable behavior.
The therapist will identify specific changes
desired and will establish a system of rewards
and punishments. The reasons behind objectionable
behavior are seen as irrelevant; the focus
is on change. This therapy is especially useful
with children who may not be inclined or able
to examine and understand their inner feelings.
The therapist may suggest that rewards be
given to children even for little things such
as talking with their adoptive parents or
becoming involved in activities instead of
withdrawing to their rooms. Most children
respond enthusiastically to getting these
rewards.
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Treatment Away From
Home
Occasionally problems may escalate to the
point that a short stay away from the family
home is warranted. In general, there are two
options available to families in this situation:
a psychiatric hospital or a residential treatment
center.
Psychiatric Hospital
Most children's problems do not become serious
enough to require psychiatric hospital treatment.
But sometimes children with serious emotional
problems that cannot be modified through outpatient
therapy may need to be hospitalized. Hospitalization
may be necessary especially for children who
become suicidal or dangerous to themselves
or others. In these cases, it is important
that parents stay involved; in fact, most
child and adolescent units of psychiatric
hospitals insist that parents participate
in family meetings or therapy. It is essential,
of course, to share with the hospital staff
that the child has been adopted.
When a child enters the hospital, he or she
will be evaluated, and treatment goals will
be set. Parents should ask to see their child's
treatment plan and ask clear questions about
how it will be accomplished.
Residential Treatment Center
Sometimes a child does not need hospitalization
but can best be treated with the firm limits
and structured environment that a residential
treatment center provides. Behavioral therapy
often is practiced in such residences; that
is, the child's good behavior will bring him
or her appropriate rewards and privileges.
Residential treatment usually is provided
in community homes where 8 to 12 children
live with "house parents." The children usually
attend a community school and have regular
visits with their parents. Sometimes a campus
setting—cottages located in a cluster
and run by house parents—is preferable.
Children may go to a school run by the residential
treatment center or to a school in the community.
No matter what the physical layout of the
facilities, when a child is in a residential
treatment setting parents need to stay involved.
Family connections are critical to a child
and help motivate a child's behavior so that
he or she can return home.
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Educational Services
There are many opportunities for adoptive
parents who want to learn more about a particular
aspect of adoption or who want to keep abreast
of the most current adoption information.
Below are descriptions of some of these opportunities.
Conferences
Local and national conferences on adoption
are held each year. Some target specific groups.
For example, Resolve, an infertility support
group, holds an annual conference in the Philadelphia,
Pennsylvania, area for prospective adoptive
families. The North
American Council on Adoptable Children
(NACAC) sponsors a national conference every
August covering many topics. The Clearinghouse
publishes—and you may order—the
National Adoption Training and Education Directory,
which lists all the national and regional
adoption conferences that are held each year.
Workshops
Adoption agencies, family service agencies,
hospitals, and parent groups often offer evening
or weekend workshops on different subjects,
including "Living With Adolescents," "Parenting
the Sexually Abused Child," or "Adoption
and School Issues." Keep your eyes and
ears open and you are bound to hear of opportunities
to learn more about adoption through workshops
in your community.
Books
There are many helpful books on adoption
for children and adults. Many of the children's
books explain the "whys" of adoption. Some
may help children begin to question and discuss
their own adoptions as they understand that
adoption is one of the many ways that families
are created.
A wealth of informative adoption books exists
for parents as well. Some of these books help
parents look at the unique aspects of adoptive
parenting. Others are written specifically
for those who have adopted children with special
needs or who are parenting children from other
cultures. The books and articles listed in
the appendix are some of the most widely used
sources for this kind of help.
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Support Groups
Parent groups and children's groups are the
two typical kinds of support groups related
to adoption that you will find. They operate
on the age-old concept that people with common
circumstances often can provide the most help
to each other.
Adoptive Parent Groups
Adoptive parent groups are a valuable resource.
Through such groups the family can find a
support system, friendship, and a base for
group action, if any is felt to be needed.
Parents can relate easily to the advice and
experience of those who have "been there."
Adoptive parent groups usually focus on a
variety of social, educational, and support
activities. A group's focus is determined
by the interests and needs of its members.
In some cases, groups include only single
parents or parents of children from a certain
country.
Parent groups often offer specialized services
to prospective adoptive parents and to those
who have already adopted. Some of these services
include the following:
- Telephone warm lines.— Telephone
warm lines allow parents to call a special
telephone number and speak with another adoptive
parent. Parents take turns answering the calls.
Adoptive parents can ask for advice on a wide
range of adoption-related topics and receive
support if they are dealing with a difficult
situation.
- Buddy system.—Some parent groups
offer a "buddy family" to a new adoptive family
seeking advice and support. The more experienced
family shares what it has learned from its
own adoption experience. For many families
new to adoption, having such a family available
for support is a help and comfort. Occasionally
a more experienced adoptive family that is
having a crisis also may request a "buddy
family" that has gone through a similar situation.
- Respite care.—Respite care is
a service that offers parents a temporary
break from their parenting responsibilities.
It is meant for families with children who
have special needs and require more skilled
care than a babysitter can provide or for
parents going through a crisis of their own.
Respite care can be in-home, meaning the respite
worker comes to the house and stays with the
child(ren) while the parents go out. Out-of-home
respite, where the parents take the child
to a designated place, also may be available.
Respite care can be provided for a few hours
every week or for a whole week once a year.
Other arrangements also can be made as needed.
Some adoptive parents exchange respite care
with one another on an informal basis.
- Lending library.—Some parent
groups maintain a library of adoption-related
books, newsletters, and other materials for
sharing. Other groups arrange for parents
of older children to share with parents of
younger children the clothes, toys, furniture,
books, etc., that the older children have
outgrown.
Adolescent/Children's Groups
In some communities there are peer groups
available for adopted children and adolescents.
These groups may be run by adoption social
workers, mental health professionals, adoptive
parents, adult adoptees, or any combination
of the above. The groups help to reduce a
child's or adolescent's feelings of isolation
by providing a chance to meet with other adoptees
and discuss mutual concerns. Groups for younger
children usually involve play activities that
are both fun and geared to encourage understanding
and discussion of adoption. There are also
some groups available with a specialized focus—groups
for sexually abused children, children adopted
from other countries, or birth and adopted
siblings.
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Areas With Few
Postadoption Services: What You Can Do
Adoptive parents living in a city or metropolitan
area of any size may not find it too difficult
to locate some of the postadoption services
discussed above. However, parents who live
in a rural or sparsely populated area may
indeed have some problems finding help. Even
in a major metropolitan area, convincing an
adoption agency to provide postadoption services
may be difficult.
If you have investigated your area and found
no active adoptive parent support group, start
one! The following two large national adoptive
parent groups can provide you with materials
and technical assistance to get you going:
NACAC
970 Raymond Ave., Ste. 106
St. Paul, MN 55114
651-644-3036
Adoptive
Families of America (AFA)
New Hope Communications LLC
2472 Broadway, Suite 377
New York, New York 10024
1-800-372-3300
(note: as of Jan. 2000 AFA went bankrupt
and the magazine was purchased by New Hope.
Some of the services proivided by AFA in the
past may or may not be offered by New Hope
Communications.
If you are already a member of a group, your
group may want to sponsor an educational workshop
or conference or find other local groups with
which to form a coalition in order to sponsor
such an event. NACAC and AFA can advise you
on this subject also.
If you have tried unsuccessfully to find
a therapist with expertise in adoption issues
in your area, there are several courses of
action you can take. You can work with local
chapters of the national psychiatric, psychological,
and social work organizations to sponsor a
workshop or conference to train interested
mental health professionals in adoption issues.
A selling point to make this idea attractive
to mental health professionals is the chance
to increase their incomes. Call the national
headquarters of these organizations, listed
at the end of this article, for names of local
contacts. The Adoption Opportunities Branch
of the Children's Bureau also provides grant
money for such training to organizations that
apply for it through their regular annual
discretionary grants process. You can encourage
appropriate adoption or mental health agencies
to apply for these grants. The address and
telephone number of the Adoption Opportunities
Branch are provided at the end of this article.
A third strategy is to contact the Clearinghouse
for the names of therapists who are willing
to give brief telephone consultation to your
child's therapist to help him or her get on
the right track in therapy. These therapists
also might know of a colleague in the field
in your area whom you did not know.
If you really want to hone your advocacy
skills, you can lobby your State legislature
for monies to enable your local public agency
to provide postadoption services. You also
can raise money from private businesses or
philanthropists. Think creatively and you
may find other sources for funding. NACAC
and AFA can help you in your search for training
funds as well.
Your State Adoption Specialist may know of
either public or private adoption agencies
in your area with postadoption programs. Contact
the Clearinghouse for his or her name, address,
and telephone number.
Conclusion
Because so many services are available for
families created through adoption, no family
needs to feel that it is "on its own" when
confronted with perplexing or worrisome issues.
And families need not wait until a major problem
has occurred before asking for help. Postadoption
services are not an "extra"—they are
a critical ingredient of a successful adoption.
Parents should use them freely and productively.
Written for the National Adoption Information
Clearinghouse by Elaine Frank, M.S.W., cofounder
of a Philadelphia program that specializes
in postadoption services; Gloria Hochman,
Director of Communications, National Adoption
Center (NAC); Marty Jones, a writer for NAC;
and Julie Marks, who has developed NAC's program
on postadoption services, 1991. Revised by
Debra G. Smith, ACSW, National Adoption Information
Clearinghouse, May 1994.
Internet links added by Adoptions.com
2000 - 2003
National Organizations That Provide Postadoption
Services
Adoptee
Liberty Movement Association
The ALMA Society
P.O.Box 85
Denville, N.J. 07834
Adoptive
Families of America (AFA)
New Hope Communications LLC
2472 Broadway, Suite 377
New York, New York 10024
1-800-372-3300
(note: as of Jan. 2000 AFA went bankrupt
and the magazine was purchased by New Hope.
Some of the services proivided by AFA in the
past may or may not be offered by New Hope
Communications.
American
Adoption Congress
1025 Connecticut Avenue, N.W.,
Suite 1012
Washington, DC 20036
(202) 483-3399
Concerned
United Birthparents
2000 Walker St.
Des Moines, IA 50317
(800) 822-2777 or (515) 263-9558
The Musser Foundation
1105 Cape Coral Parkway
Cape Coral, FL 33904
(813) 542-1342
National
Adoption Center
1500 Walnut St.
Suite 701
Philadelphia, PA 19102
(800) TO-ADOPT or (215) 735-9988
National
Resource Center for Special Needs Adoption
16250 Northland Dr., Ste. 120
Southfield, MI 48075
(810) 443-7080
North
American Council on Adoptable Children
970 Raymond Ave., Ste. 106
St. Paul, MN 55114-1149
651-644-3036
Resolve
1310 Broadway
Somerville, MA 02144-1731
(617) 623-0744
National Professional Associations
American
Association for Marriage and Family Therapy
1133 15th Street, NW
Suite 300
Washington, DC 20005-2710
(202) 452-0109
American
Psychiatric Association
1400 K St., N.W.
Washington, DC 20005
(888) 357-7924
American
Psychological Association
750 First Street, NE
Washington, DC 20002-4242
(800) 374-2721
National
Association of Social Workers
750 First St., N.E., Ste. 700
Washington, DC 20002
800-638-8799
Federal Government Adoption Information Sources
Children's Bureau
Department of Health and Human Services
P.O. Box 1182
Washington, DC 20201
(202) 205-8671
National
Adoption Information Clearinghouse
330 C Street, SW
Washington, D.C. 20447
(703) 352-3488 or (888) 251-0075
National
Resource Center for Special Needs Adoption
16250 Northland Dr., Ste. 120
Southfield, MI 48075
(810) 443-7080
Federally Funded Postadoption Services Grantees
These mental health agencies, adoption agencies,
and parent groups, presented in alphabetical
order by State, have received Federal Adoption
Opportunities grants and are currently offering
postadoption services in their locations.
However, any individual or agency is welcome
to contact them for suggestions about designing
a postadoption services program. In addition,
former postadoption services grantees can
provide help in this area. For their names
and addresses, contact the Clearinghouse.
Arizona
Adoption Connection/Post-Legal Adoption Service
Project
Aid
to Adoption of Special Kids
234 N. Central Ave., Ste. 127
Phoenix, AZ 85004
(602) 254-2207
California
Adoption Training Course for the Kinship
Alliance
Kinship Alliance
513 East First St., 2nd Floor
Tustin, CA 92680
(714) 573-8865
Project In Touch
Black
Adoption Placement and Research Center
125 Second Street
Oakland, CA 94607
800-299-3678
Idaho
Idaho Post-Adoption Project
Lutheran Social Services
420 W. Bannock
Boise, ID 83702
(208) 344-0094
Maryland
Project Succeed
Adoptions
Together, Inc.
10230 New Hampshire Avenue, Suite 200
Silver Spring, MD 20903
(301) 439-2900
Massachusetts
Department of Mental Health Training and
Adoptive Family Stabilization Project
Massachusetts Dept. of Mental Health and Project
Impact
c/o 25 West St.
Boston, MA 02111
(617) 451-1472
Michigan
I Care Services Network
(Interagency Committee for Adoption Resources
and Education)
Detroit/Wayne County Community Mental Health
Board
1249 Washington Blvd.
10th Floor, Book Bldg.
Detroit, MI 48226
(313) 224-2830
Nebraska
Post
Adoption Service Teams
Nebraska
Dept. of Social Services
P.O. Box 95044
Lincoln, NE 68509-5044
(402) 471-2306
New Jersey
Adoption Commitment Team
Family Service of Burlington County
Sharp's Run Plaza
Unit 3A, Jennings Road
Medford, NJ 08055
(609) 953-5714
Ohio
Continuum of Post-Legal Services for Adopted
Children with Emotional and Behavior Problems
and Their Families
Beech Brook Spaulding Adoption Program
3737 Lander Road
Cleveland, OH 44124
(216) 831-2255
Post Legal Adoption Services for Ohio's Special
Needs Children
Athens County Children Services
P.O. Box 1046
Athens, OH 45701
(614) 592-3061
South Dakota
Services for Adoptive Families of Special
Needs Children
South Dakota Dept. of Social Services
Child
Protection Services
Pierre, SD 57501
(605) 773-3227
Vermont
Lifetime Adoption Project
Vermont
Children's Aid Society, Inc.
P.O. Box 127
Winooski, VT 05404-0127
(802) 655-0006
Washington
Special Needs Adoption Group Therapy
Children's Home Society of Washington
P.O. Box 15190
Seattle, WA 98115-0190
(206) 524-6020
Sources For Further Reading
Books for Children
Banish, Roslyn (story and pictures) with
Jordan-Wong, Jennifer. A
Forever Family. New York: Harper Collins,
1992.
Blomquist, Geraldine M. and Blomquist, Paul
B.; Lemieux, Margo, illustrator. Zachary's
New Home: A Story for Foster and Adopted Children.
New York: Magination Press, 1990.
Brodzinsky, Ann Braff. The
Mulberry Bird: Story of an Adoption.
Fort Wayne, Indiana: Perspectives Press, 1986.
Freudberg, Judy, and Tony Geiss. Susan
and Gordon Adopt a Baby. New York:
Random House, Inc., 1986.
Herbert, S. Latisha (also illustrator); Herbert,
Shaun, illustrator. The
Visit. Washington, DC: Child Welfare
League of America, 1991.
Herbert, Stefon (also illustrator); Herbert,
Shaun, illustrator. I
Miss My Foster Parents. Washington,
DC: Child Welfare League of America, 1991.
Herbert, Stephanie (also illustrator); Herbert,
Shaun, illustrator. Being
Adopted. Washington, DC: Child Welfare
League of America, 1991.
Kremetz, Jill. How
It Feels To Be Adopted. New York:
Alfred A. Knopf, 1988.
Nerlove, Evelyn. Who
Is David? Washington, DC: Child Welfare
League of America, 1985.
Wickstrom, Lois; Marden, Priscilla, illustrator.
Oliver:
A Story About Adoption. Wayne, PA:
Our Child Press, 1991.
Books for Parents
Delaney, Richard J., and Frank R. Kunstal.
Troubled
Transplants: Unconventional Strategies for
Helping Disturbed Foster and Adopted Children.
Portland, ME: University of Southern Maine,
1993.
Dorris, Michael. The
Broken Cord. New York: Harper &
Row, 1989.
Jarratt, Claudia Jewett. Helping
Children Cope With Separation and Loss.
Boston: The Harvard Common Press, 1994.
Kirk, David. Shared
Fate: A Theory and Method of Adoptive Relationships.
Port Angeles, WA: Ben Simon Publications,
1984.
Magid, Ken, and Carole A. McKelvey. High
Risk: Children Without a Conscience.
New York: Bantam Books, 1987.
Melina, Lois. Adopted Child Newsletter.
Moscow, Idaho: published monthly.
Melina, Lois. Making
Sense of Adoption. New York: Harper
& Row, 1989.
Melina, Lois. Raising
Adopted Children: A Manual for Adoptive Parents.
New York: Harper & Row, 1986.
Minshew, Deborah and Chrisan Hooper. The
Adoptive Family: The Healing Resource for
the Sexually Abused Child. Washington,
DC: Child Welfare League of America, 1990.
National Committee for Adoption. Adoption
Factbook. Washington, DC: National
Committee for Adoption, 1989.
Schaeffer, Judith, and Christina Lindstrom.
How
To Raise an Adopted Child. New York:
Copestone Press, 1989.
Schooler, Jayne E. The
Whole Life Adoption Book. Colorado
Springs, CO: Piñon Press, 1993.
Van Gulden, Holly and Lisa M. Bartels-Rabb.
Real
Parents, Real Children. New York:
Crossroads, 1993.
This material may be reproduced
and distributed without permission, however,
appropriate citation must be given to the National
Adoption Information Clearinghouse.
Internet links added by Adoptions.com
2000 - 2003
For more information, contact the National
Adoption Information Clearinghouse at naic@calib.com.
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