Parent perspectives on adoption preparation: Findings from the Modern Adoptive Families project

Preparing prospective adoptive parents for receiving a child into their family is an important task for child and family professionals. This study uses data from the recent Modern Adoptive Families survey to understand parent perspectives on their preparation for adoption. Logistic regression (n = 917) and qualitative thematic analysis of adoptive parents' comments about their adoption preparation were conducted to understand aspects of the preparatory experience that were satisfactory (n = 623) or dissatisfactory (n = 283). Child emotional and behavioral problems significantly predicted parent dissatisfaction with adoption preparation. Major themes for satisfactory aspects of preadoption services included receiving information about adoption in general and, more specifically, about clinical and special populations, and parenting tools and strategies. In addition, parents identified opportunities to connect with others touched by adoption and access to specialized post-adoption services as helpful. Conversely, parents expressed dissatisfaction when information was lacking or withheld, when they had quality concerns with the worker or agency, and when there was a dearth of services and supports following adoption. Implications of these findings include the need for adoption mental health competent training for adoption professionals to better support families preparing for or experiencing adoption.     

Preparing and Partnering with Families to Support the Adoption of Children from Foster Care

ABSTRACT

This investigation evaluated the effectiveness of a pre-placement education and preparation curriculum (PREP) for prospective foster/adoptive parents in improving attitudes toward children with prenatal substance exposure and their substance-using birth parent and increasing willingness to adopt these children. Participants included 1,836 prospective parents seeking adoption through foster care who received three 3-hour sessions of PREP. Prospective parents completed questionnaires assessing their knowledge about important issues involved in adopting a child from foster care, attitudes, and willingness to adopt children with a variety of characteristics. Changes from pre- to post-intervention were examined. Results indicated significant increases in self-reported knowledge; significantly more positive attitudes toward substance-abusing parents and children with prenatal substance exposure; and significantly increased willingness to adopt children with a variety of potential difficulties, including children with serious behavior problems, attention deficit hyperactivity disorder, and a biological history of mental illness. In sum, findings suggest that prospective adoptive parents who attended the PREP sessions felt better prepared by the end of training with regard to issues related to adoption of high-risk foster children with special needs, particularly those with prenatal substance exposure.     

Mental health services for children and caregivers remaining at home after suspected maltreatment

ObjectiveBehavioral problems are common among children remaining at home after suspected maltreatment, but the effectiveness of current mental health services to improve these behavioral problems is unknown. The objective was to determine whether receipt of child and caregiver mental health services was associated with improvements in behavioral problems in maltreated children remaining at home.MethodsWe retrospectively analyzed Second National Survey of Child and Adolescent Well-being data. We included 1117 children ages 2–17 remaining at home after a maltreatment investigation, excluding children with missing outcome, covariate, or survey weight data. We compared mean Child Behavioral Checklist (CBCL) change scores from baseline to 18 months between children who did and did not receive mental health services, before and after adjusting for child, caregiver, and child welfare agency factors using survey-weighted linear regression.ResultsNearly one-quarter (22.6%) of children and 16.0% of caregivers received mental health services. Children receiving services had worse unadjusted baseline and 18-month CBCL scores than children not receiving services (all P < 0.001). Adjusted CBCL change scores revealed behavioral worsening among children receiving services but improvement among children not receiving services (all P < 0.001). However, children had improved behavior, regardless of their own service receipt, if their caregivers received services and reported an absence of depression at 18 months.ConclusionsChildren receiving mental health services had worse behavioral changes than children not receiving services. Caregiver receipt of services was associated with improved child behavior, suggesting that a family-centered approach may be most influential in improving behavioral outcomes among this population.     

Adoptees' and Birth Parents' Therapeutic Experiences Related to Adoption

ABSTRACT

This study examined adoptees' and birth parents' experiences in therapy, including the perceived level of helpfulness and preparation by therapists relating to adoption issues as a function of the year these experiences occurred. Participants consisted of 152 adoptees and 66 birth parents, with the majority (78%) of the respondents being female. Overall, adoption inquiry, addressing adoption issues, helpfulness, and preparedness by therapists increased from 1965 though the 1990s. Therapists who inquired about adoption (54%) or addressed adoption (72%) were perceived as being significantly more prepared and helpful compared to those therapists who did not inquire about or address adoption issues.     

Inter-rater agreement of scores to assess quality of care in public sector primary health care facilities – A pattern of performance

PurposeTo determine if the scores obtained from the Ideal Clinic Assessment Tool (ICAT) used to assess the quality of care in public Primary Health Care facilities in South Africa showed inter-rater agreement between self-assessments, district peer reviews and cross-district peer reviews. The ICAT scores obtained in the three types of reviews were paired as follows: self-assessments/district peer reviews, self-assessment/cross-district peer reviews and district/cross-district peer reviews. The global scores and averages of the Vital elements for the three paired reviews for 587 facilities across the country were compared using Bland-Altman plots.ResultsThe Bland-Altman plots showed no inter-rater agreement between the global scores and averages of the Vital elements for the facilities in any of the paired reviews (n = 1 761 reviews). Similarly, there was no inter-rater agreement between the global scores of the three paired reviews in any of the nine provinces in the country.ConclusionThere is still a need to continue to conduct both district and cross-district reviews despite the substantial cost of doing so. Further studies are required to determine what factors contributed to the disagreement in scores between the different types of reviews despite the preparatory training of reviewers.     

Supporting families throughout the international special needs adoption process

Due to changing trends in international adoption, a greater number of placements are now special needs. While most special needs adoptions are successful, they do present a higher risk for placement instability. Thus, adoptive parents and children are faced with an increasing need for support services. This article explores literature related to support throughout the international special needs adoption process including medical, information/education, social support and direct intervention both pre- and post-adoption. While many support strategies, both formal and informal, are utilized by families and adoption professionals, and some are promoted in policy related literature, few have been validated through empirical evidence. Findings reveal a need for further research around effective pre-adoption training programs for parents, preparation tools for children, and larger scale studies to evaluate post-placement services for each sub-group of international special needs adoptees.     

Changing Agency Practices Toward Openness in Adoption

Abstract

The impact of openness in adoption on private adoption agencies' practices and services was examined. In 1987-89 and 1993 staff from private agencies participated in structured interviews concerning their current practices regarding openness and the services offered by the agency. Over time, agencies tended to offer a greater range of openness options. Agency personnel reported that client demand, changes in agency philosophy, and competition from independent or private adoptions were among the most salient reasons for this change. Compelled to adopt new roles in response to openness, many agencies now offer mediation services to help address requests for information or problems within the adoptive family-birthparent relationship. The perspectives of adoption staff regarding the main advantages and disadvantages of each type of openness are explored, and implications for practice are discussed.     

Faith-Based Programs and the Role of Empirical Research

Abstract

After some decades of being subject to neglect or contempt, faith-based social care programs are receiving increased attention and resources enabling them to undertake a greater role in the national network of human services. Faith-based programs receiving public support can expect to be rightly scrutinized by the public, in terms of their ability to attain professed program goals. The tools of conventional empirically-oriented program evaluation research have tremendous potential to help demonstrate the effectiveness of faith-based programs, which will justify their receipt of ongoing support from public funds. Negative research findings can be properly scrutinized by the faith-based community of service providers to help make tough, data-based, decisions on funding priorities. Several examples are described, illustrating how various types of faith-based programs have profitably participated in program evaluation studies.     

Legal Parenthood and Continued Parent-Child Relationships—The Moral and Experiential Aspects of Parenting

ABSTRACT

This paper presents a construct of parenting which provides criteria for differential solutions in cases of child protection, i.e., confidential adoption, adoption with contact and out-of-home placements. It is proposed that the moral aspect of parenting be central in judicial proceedings regarding the protection of the child. In addition a distinction between the moral and the experiential aspect of parenting should be made. The presentation of this construct is based on the author's assessments of parents when acting as an expert witness to the court (in Israel), in three cases in which compulsory adoption was petitioned by the state. The assessment of the moral aspect of parenting is based on the parent's own evaluation of his/her own parenthood, and the assessment of the experiential aspect is based on the parent-child relationships with a particular emphasis -on the child's responses to the parent. This construct may allow experts to tread the fine line between assessing parents and accusing them and provides a base for negotiation between parents' conceptions of their parenthood and the court's.     

Actual Versus Perceived Risk of Cervical Cancer Among College Women Smokers

Cervical cancer is a well-established smoking-related illness, but many at-risk women are unaware of this link. Objective: The authors designed this study to (1) investigate the relationship of smoking behavior with the history of abnormal Pap test results, sexual history, and perceived risk of cervical cancer and (2) determine whether self-classified smoking status (and hence perceived risk) corresponds with actual smoking behavior in a college student population. Participants and Method Summary: College women students (N = 135) completed a survey assessing smoking history, health history, sexual risk behavior, and risk awareness. Results: Relative to those who had not smoked in the past month, current smokers (n = 36, or 27% of the total sample) perceived themselves to be at higher risk for developing cervical cancer, but did not demonstrate increased awareness of specific cervical cancer risk factors, including smoking. Twenty-eight percent (10 of 36) of past-month smokers did not define themselves as current smokers. Conclusion: The authors conclude that antismoking and health-related messages targeting smokers may misfire for individuals who do not define themselves as smokers but are nonetheless at risk for smoking-related consequences and escalating use.     

Missing from the Conversation: Sexual Risk Factors Across Young People by Gender Identity and Sexual Orientation

Abstract

Objectives: Lesbian, gay, bisexual, and queer/questioning (LGBQ), and transgender/nonbinary (trans/NB) youth experience health disparities. Much research combines gender identity with sexual orientation or siloes them, ignoring intersections. Methods: Logistic regressions with representative data from 2015 Healthy Kids Colorado Survey (n?=?15,970) explores sexual risk. Results: Findings indicate LGBQ and trans/NB youth have differential levels of sexual risk (drugs during sexual interactions, not using condoms) compared to cisgender heterosexual peers. Other identities, mental health, and bullying are also related. Conclusions: There is a need for culturally responsive bullying prevention, mental health support, education, and sexual health services for marginalized populations.     

Preparation for Adoptive Parenthood with a Special-Needs Child

ABSTRACT

Mothers of 86 adopted special-needs children were surveyed regarding the tasks they undertook to prepare for parenthood. They engaged in tasks related to learning about the child most often and stated participating in training to be adoptive to be most helpful. Overall preparedness, more so than either the number or type of adoption preparation tasks (APTS) completed prior to the adoptive placement, was found to be positively associated with assessment of child and family functioning. Implications of these findings for the delivery of adoption preparation programs are discussed.     

EDITORIAL

ABSTRACT

This paper presents the results of an exploratory study that examined the preparation of children for adoption from the perspective of 55 adoptive parents and 26 caseworkers. Results indicate little consistency in practice and highlight the pivotal role of the adoptive parent. From the caseworker perspective, preparation for adoption is often seen as a process that ends at placement with the adoptive family. Adoption issues often arise at developmentally significant times in a child's life and adoptive parents may need to continue working with the child, building on the foundation of preparation work done by the child's caseworker or therapist. If the preparation work is insufficient or ineffective, adoptive parents may face greater challenges as they help the child resolve issues related to their past, present and future.     

Examining rates and risk factors for post-order adoption disruption in England and Wales through survival analyses

PurposeThis paper reports findings from two research studies that set out to calculate the rate and predictors of post-order adoption disruption in England and Wales.MethodsAll available national level administrative data on adopted children in England and Wales were analysed, supplemented by national surveys adoption managers. Complete national datasets were available 12 years in England and for 11 years in Wales.ResultsOf the 36,749 and 2,317 adoptions considered, 565 in England and 35 in Wales had disrupted over the follow up period. Kaplan-Meier analyses indicate that cumulative post-order adoption disruption rates were 3.2% and 2.6% respectively for England and Wales. Cox regression models indicate that being older than four years adoptive placement, adoptive parents taking longer than a year to legalise the adoption, being a teenager and previous multiple placements in care were risk factors for post-order adoption disruption.ConclusionThe post order adoption disruption rate is low. Implications for policy and practice are discussed.     

Interventions for Internationally Adopted Children and Families: A Review of the Literature

Internationally adopted (IA) children are at increased risk for health-related, developmental, and behavioral difficulties. This article reviews the literature on various interventions currently used with IA populations; including health-related interventions provided by medical specialists, preparation programs provided by adoption agencies and other social service organizations, treatments for attachment and behavioral disorders, psychoeducational services, programs designed to improve children’s care prior to adoption, and parent-based initiatives. Surprisingly, very little systematic information exists regarding the effectiveness of interventions designed to prevent and remediate these difficulties in IA children. Recommendations for future research activity and for best practice approaches to intervention are discussed.     

Early care and education arrangements and young children's risk of foster placement: Findings from a National Child Welfare Sample

A primary goal of the U.S. child welfare system (CWS) is to maintain children investigated for maltreatment in their parents' homes whenever safely possible. This study explores the possibility that early care and education (ECE) services (e.g., child care, preschool, day care) can help the CWS achieve this goal by using a nationally representative sample of children referred to CWS for suspected maltreatment to measure the relationship between ECE receipt and the likelihood that 0–5 year olds in the CWS will be placed in foster care approximately 18 months later. Specifically, logistic regression analyses explore the relationship between: (1) regular ECE participation (yes/no), and (2) type of ECE arrangement (Head Start, other center- or home-based ECE, family/friend/relative ECE, other ECE, and multiple types of ECE) and foster placement risk. After controlling for multiple socio-demographic characteristics and foster placement risk factors, children who received ECE (yes/no) were no less likely to be placed in foster care than children who received no ECE. However, when exploring type of ECE arrangement, children who received Head Start were 93% less likely to be placed in foster care than children with no ECE. Children who participated in multiple types of ECE were almost seven times more likely to be placed in foster care than children with no ECE. These results suggest that Head Start may help maltreated children avoid foster placement and that experiencing multiple types of ECE is a risk factor for foster placement. It is recommended that caseworkers routinely assess the ECE service history and needs of families with young children who come in contact with the CWS, paying attention to the type and number of ECE services used.     

Setting Performance Goals for Adoption Services

ABSTRACT

Adoption is one of the several goals for child welfare services when children cannot remain at home. Adoption does not, however, become a goal of child welfare services unless family reunification cannot occur. Further, adoption is also not always the appropriate goal when children are living with relatives available to reunify. Yet, President Clinton's Adoption 2002 initiative offers incentives for adoptions that only depend on the number of adoptions, not on their relationship to reunifications. California's adoption initiative takes a different but also oversimplified approach to setting adoption standards by basing them on the number of adoptions per adoption worker. Under these approaches, agencies that increase their reunifications and keep their adoptions constant are not rewarded and agencies that decrease their reunifications and increase their adoptions are rewarded. This can create a misunderstanding of the program as antifamily and resentment toward adoptions. Agencies' adoption rates should be rewarded only after estimating the pool of adoptable children and taking the likelihood of reunification into account. A model for estimating these factors is presented.