Caseworkers often perceive placement of a child in an adoptive family as the endof the work. Although placement may signal the end of the child's sojourn withinthe child welfare system, in reality it is the beginning of a life-long journey that,hopefully, will lead to overcoming the effects of whatever traumas led to the childentering the system as well as the negative impact of experiences he may have experiencedwhile in care.

Children who join adoptive families after experiencing abuse,either physical or sexual, neglect, parental separation and loss bring with thema legacy of failed family relationships. Their new family provides a new hope, andpossibility, for them to more successfully experience the intricacies and benefitsof family life.

Although previous life experiences may have led to emotionalinsults that may benefit from formalized therapeutic interventions, primary healing,if it is to occur at all, will occur within the contexts of day-in, day-out familylife. It is the result of the interface between the characteristics of the childand family that leads either to healing for the child or to disruption of the placement.According to Barth and Berry the characteristics of the child, his behaviors, temperament,habits, and academic skills are important only in relation to family characteristicsand patterns.

Children and parents alike come to adoption with some addedrisk factors when compared with children joining their permanent family at the timeof birth.

Child risk factors include

• survival behaviors which originated when they lived in dysfunctional familiesand a dysfunctional system
• individual vulnerabilities
• previous traumatic events
• unresolved separations or losses

Parent risk factors may include:

• lack of empowerment and entitlement
• "echoes" from their past
• unrecognized or unresolved losses -
• unrealistic expectations for child or self

Elbow identifies three facts in older child adoption that contribute to difficultyin mastering family developmental tasks.

1. distortion of family life cycle: adoptive families begin with distance and areexpected to move toward closeness; birth families start with symbiosis and are expectedto move toward individuation
2. stress on family boundaries caused by agency intrusiveness; by lack of family'sempowerment by society and agency; and by child's conflicted loyalties.
3. individual issues of the child and echoes from the past for the parents.

Because of the nature of special needs adoption, involvement with post-placementservices and mental health resources should be considered a normative part of thisadoptive family's experience. Adopted children and their families are best servedwhen there is collaboration between the family, social service agencies, and mentalhealth resources. Each recognize not only what they, but also what the others, haveto offer.

The family

• provides the foundation on which the child's continued development is dependent
• provides the environment for change
• provides continuity and commitment
• the fact that the family needs help in meeting the child's needs does not meanthat they do not care or that they are incapable of participating in decision making.
• if the family is made to feel impotent it is harmful to the overall treatment.
• if the family is recognized as doing the best they can in difficult circumstancesand as having an important role in any change process, they can be stronger partners.
• unfortunately, families may not seek help until they feel overwhelmed and desperateand at that point in time they will present themselves at their worst. Many timesit is difficult to have a solid assessment at that time of the parents' long rangecapacities.

Social workers

• have knowledge of how the system works
• are more likely than others to know how to access information about the child'sspecific past history, information that may be critical to providing adequate treatment
• can help families locate and access the specific services that they need (i.esupport services, respite care, therapists knowledgeable about adoption)
• can provide information to therapists about common behaviors seen in "systems"children
• predict times that will be difficult for child and family (based on developmentalinformation and knowledge about anniversary reactions, etc.)

Mental health professionals

• may provide assessments of families and children, both before and after placements
• may be able to intervene early enough that they can help prevent problems frombecoming entrenched
• may help families connect with support groups
• do direct work with children and families when there are ongoing problems
• provide information as to when families might anticipate future problems
• be involved in crisis intervention
• may help determine if out-of-home care is necessary and the level of care thatwould be most useful.

Post-adoptive services need to be provided by individuals who:

• understand adoption related issues
• understand the social service and legal systems and their impact on the childprior to placement
• re supportive of the adoptive family's role and importance in the child's life
• include the parents in the assessment, planning and treatment
• will work with parents to develop strategies for behavioral interventions
• will collaborate with others who are involved with this child and family (i.e.schools etc.)

Post-adoptive services may take a variety of forms:

• supportive services (groups for parents, children, respite care, training andeducational services) can meet the needs of many adoptive families.
• services aimed at helping the child and family come together soon after placement
• intermittent preventative therapy which is instituted as children reach certaindevelopmental levels that are likely to lead to retriggering old issues (i.e. sexualabuse, loss, identity, etc.)
• intermittent short term problem focused therapy aimed at interrupting problembehaviors
• crisis intervention with threatened families

Support services: Families who were prepared for adoption using a group processfrequently use other group members as an informal support system. Agencies may provideparent support groups; or help individual families connect with others who have hada similar problem; may provide parent education presentations. Even those familieswho need more intensive services, view support services as helpful. Respite carecan be a very useful service, but unfortunately families are frequently left to theirown devices in terms of providing it on a regular basis.

The PARTNERS projectin Iowa arranged respite care for special-needs children one weekend per month ata local camp. This was combined with a week long summer camp as well.

Eventhose families who need more intensive services, still tend to view support servicesas helpful.
Initial post-placement services aimed at helping the child and familycome together as a unit. The emphasis is on resolving current separation and lossissues, addressing current behavioral problems and facilitating the attachment process.The focus is primarily on the present. According to Linda Katz, the client is neitherthe child nor the parents, but rather the relationship. During this period the providershould prepare families and children for identifying times that preventative workmight be undertaken and for times that old problems are likely to re-emerge.

Preventativework: New cognitive skills, combined with current life experiences, will lead torepeated opportunities for reintegrating the effects of earlier life experiences.Understanding the developmental tasks presented at various ages helps professionalsand family members alike to understand the impact of pre-adoption events and to makeuse of opportunities provided to overcome these effects. When adoption issues arenot addressed at these developmental times, it will be difficult for the adoptivefamily and young person to master the developmental tasks at hand.

Intermittentshort-term problem focused therapy: When families are faced with living with childrenwith disturbing behaviors, they are looking for therapy with goals and timelinesthat they and the therapist agree to. Parents tend to abandon therapy when they arenot included and when the therapy does not address the behavioral concerns that initiatedthe parental request for intervention.

Crisis intervention with threatenedfamilies: Kay Donley and Maris Blechner identified threatened families as usuallybeing those with a long-term adoptive relationship in place; with evidence of repeatedself-destructive or violent behavior by the child; these episodes of problem behaviorsare intensifying; the parents may have made a variety of unsuccessful efforts atobtaining help; the parents feel that the situation is out of control.

Accordingto Pam Grabe, this is not the time to question to family's commitment, the size oftheir family or their motivation to adopt. It is a time to offer some initial reliefthat will help the family hang together until substantive improvements in the relationshipscan be achieved. This will include a more complete assessment and being flexiblein providing services that can help this family unit.

Donley and Blechnerpoint out that it is very important that the intervenors not mistake these familiesfor chronically troubled families who have never experienced a period of relativelycalm adjustment. Many times these are very competent parents who may have difficultyconvincing others of the seriousness of the problem. They may be more skilled thanthe people they are turning to for help, who in turn may be intimidated by the parents.

Ingeneral these parents either didn't expect the adolescent to have as severe behaviorproblems as are evident or they misperceive the long-range prognosis. The familymay be under a variety of current stresses. The young person's individual pathologymay be becoming more evident.

Intensive adoption preservation services arecalled for. These include all aspects of support services, including short-term out-of-homeplacement. The overall goal at this time is to engage the families in treatment andto help them see the problems in a realistic context. During the provision of theseintensive services, it may become apparent that the young person needs out-of-homecare. It is important that this be provided in a timely enough manner that the familycontinues to be available as a long-term resource for the youngster.

TRADITIONAL THERAPY APPROACHES ALONE HAVE NOT BEEN PARTICULARLY
SUCCESSFULWITH THIS POPULATION

Individual non-directive therapy with the child:

• frequently never addresses the issues of abuse or neglect if the child does notintroduce these topics
• rarely focuses on the behavioral issues that ultimately will determine whetherthe child remains in the placement
• tends to disempower the family and distance them; does not focus on family relationships
• may never identify the child's misperceptions

Traditional family therapy

• views the child's behavioral problems as a manifestation of the overall familydysfunction
• does not take into account the concept of imported pathology (child bringing pathologyinto family
• may view parent as more part of the problem than part of the solution

Adoptive families, who represent the source of real change and remediation, mustbe actively involved in the healing strategies

BELIEFS IN FAMILY SYSTEMS APPROACH TO TREATMENT IN SPECIAL NEEDS ADOPTION

• Although the adoptive family is not the source of the child's problems, it iswithin the context of family relationships that primary healing occurs
• It is the result of the interface between the characteristics of the child andfamily that leads either to healing for the child or disruption of the placement.
• Many children are internally driven to reenact their earlier life experiencesin the new family setting
• The reenactment may lead to the adoptive parents looking quite dysfunctional bythe time they seek help)
• It is more important that the non-helpful patterns of family interactions be interruptedand new interactional behaviors be learned than that either parent or child be seenas the "cause" of the problem
• Therapists need to empower the adoptive parents by including them in the therapeuticinterventions
• When under stress, and feeling vulnerable, individuals (parents and children alike)become more defensive, resistant and frequently more rigid
• Although neither the adoptive parent nor the therapist can undo the early damagefrom inadequate nurturing or abuse, they can minimize the scarring and help the adoptedindividual compensate by learning new skills.
• Any intervention that threatens the parent-child relationship undermines the goalof preserving the family as a resource for the child.
• Although we might prefer the "best interests of the child" standard,in reality we must frequently invoke "the least detrimental alternative available"standard.
• Decisions must be made considering not only the identified child's needs, butalso the interests of the family as a whole, as they will impact parents, siblingsand extended family members as well.

WHEN OUT-OF-HOME PLACEMENT IS NECESSARY:

Out-of-home placement may beindicated in a wide variety of circumstances ranging from brief respite to lengthyresidential treatment; from assessment to treatment. Special needs adopted childrenhave many reasons for possibly needing the most intensive therapeutic interventions.

Out-of-homeplacement should not be considered an adoption failure. Indeed, it may be a strongindicator of an adoption success when the family recognizes that their young personneeds more help than they alone can provide and they are willing and able to advocatethat their child receive this help.

Children who are not experiencing successin any of the major arenas of their life--family, school and peer relationships--arefrequently candidates for out-of-home placement. Family and professionals shouldalso be assessing the child's functioning within the community and his/her more personalfunctioning. Looking at these areas in detail frequently help determine the mostbeneficial type of placement.

Grotevant and McRoy in their research on adoptedchildren in residential treatment found that although adopted and non-adopted youthin residential treatment had similar behaviors and diagnoses, there were significantdifferences as well. When compared with the control population, the parents of adoptedyouth had less mental health pathology and more stable marriages. Of the 50 adoptedindividuals studied in 33 cases the adoption played a major role in their emotionaldisturbance; in 9 cases it played a minor role and in 8 cases it seemed to be playingno role.

The intensity of family life at the period when the young personis reintegrating earlier life experiences and redoing the tasks associated with individuationand identity formation may interfere with successful achievement of the tasks athand. Some youth are able to make much better use of their family when they are notliving with them. The family may be able to be more emotionally supportive, becausethey are less drained, in this situation as well.

Summary: The goal of allpost-placement services is to aid in maintaining the long-term commitment and accessibilityof the family as a positive influence in the adopted individual's life.

Bibliography

Barth, R., Berry, M., Goodfield, R. and Carson, M.L. OLDER CHILD ADOPTION ANDDISRUPTION. Washington D.C.: The Children's Bureau, April, 1987.Research findingson adoption disruption. Also contains an annotated bibliography and information ona residential treatment center approach to working with an attachment model.

Bourguignon, J.P. and Watson, K.W.: AFTER ADOPTION: A MANUAL FOR PROFESSIONALSWORKING WITH ADOPTIVE FAMILIES. Springfield, Ill. Illinois Department of Childrenand Family Services, 1987. Available from National Resource Center for Special NeedsAdoption; Crossroads Office Center; 16250 Northland Dr. Ste 120; Southfield MI 48075.Identifies how adoptive families differ from other families; the purposes of therapeuticintervention; seven areas in which adoptive families most often experience difficulties;a framework for a post-adoptive diagnostic assessment and interventions which lookat barriers to adjustment posed by child, parents, and the environment.

Brodzinsky, Schechter and Henig. BEING ADOPTED: THE LIFELONG SEARCH FOR SELF.New York, Doubleday, 1992.A developmental approach to the lifelong impact of beingadopted. The information is very useful in developing both supportive and preventativeservices for adopted individuals and their families.

Busch, L. editor: THE MENTAL HEALTH CHALLENGE OF SPECIAL NEEDS ADOPTION: A ResourceBook for Professionals Working with Adoptive Families. May be obtained by contacting:Adoptions Unit; Children's Services Division; 198 Commercial Street S.E.; Salem,OR 97310-0450. Contains some of the same articles as those in the book edited byPam Grabe plus some others. Donley's Post-Placement Services Analysis which is tobe used ahead of crisis time and which addresses the child's capacity for attachment;the child's resolution of separation and loss issues and the family stresses whichmay affect adjustment are of a size for easy duplication. I also found From Caregivingto Parenting: Family Formation with Adopted Older Children by Margaret Elbow (originallypublished in Social Work, Vol 31, no 5, 1986, pgs 366-370) to be excellent in lookingat how family issues are different in adoptive vs birth families and in identifyingthe developmental tasks of the adoptive family as a whole. Another additional, andhelpful article in this book is by Patrick J. Koehne and is entitled Adoption Processof Special Needs Children: A Family Therapy Perspective.

Grabe, P.V. editor: ADOPTION RESOURCES FOR MENTAL HEALTH PROFESSIONALS. New Brunswick:Transaction Publishers, 1990. Contains a variety of articles by many contributors.Helping Threatened Families by Donley and Blechner and Donley's Post-Placement ServicesAnalysis were particularly helpful articles when I was preparing for this presentation.

Groze, V.; Young, J; and Corcran-Rumppe, K. PARTNERS: POST-ADOPTION RESOURCESFOR TRAINING, NETWORKING AND EVALUATION SERVICES. WORKING WITH SPECIAL NEEDS ADOPTIVEFAMILIES. Available from Four Oaks, Inc.; 5400 Kirkwood Blvd, S.W.; Cedar Rapids,Iowa 52404. Presents a five phase treatment model comprised of screening, assessment,treatment planning; treatment phase and termination. Outlines a variety of supportservices; identifies adoption preservation services and on-going services. In thisproject a multidisciplinary Clinical Review Team was used in the treatment planningphase.Explains use of Placement Genogram which incorporates information not onlyabout birth and adoptive families, but also about child's placements in between thesetwo. This technique helps both family and therapists understand the uniqueness ofeach child's situation. Appendix includes a very complete assessment questionnaire;and formats for assessing family communication patterns; family cohesion and familyflexibility vs rigidity.

Prew, C; Suter, S; and Carrington, J. POST-ADOPTION FAMILY THERAPY. Another publicationavailable from the Adoptions Unit in Salem Oregon.Provides information from a projectwhich used a treatment team comprised of a family therapist and an adoption workeras co-therapists. Excellent, and fairly detailed, information on identifying commonproblem behaviors and on developing intervention strategies. Appendix includes usefulquestionnaires, especially an Adoptive Family Risk Assessment Scale and a Child BehaviorChecklist.

This paper developed for her training workshops for child welfare professionalsis related to material from Dr. Fahlberg's book AChild's Journey through Placement.

© Vera I. Fahlberg, M.D.