Assessing the Field of Post-Adoption Service: Family Needs, Program Models, and Evaluation Issues
Submitted to: Laura Feig RadelDepartment of Health and Human ServicesOffice of the Assistant Secretary for Planning and Evaluation Hubert H. Humphrey Building 200 Independence Avenue, S.W. Washington, DC 20201
Developed by: Richard P. Barth, Deborah A. Gibbs, and Kristin Siebenaler Research Triangle Institute and University of North Carolina School of Social Work
Contract No. 100-99-0006 RTI Project No. 7578.004
April 10, 2001
This report is available on the Internet at:http://aspe.hhs.gov/hsp/PASS/lit-rev-01.htm
- Need for Post-Adoption Services and Supports
- Studies of Adoptive Families
- Demand for Post-adoption Services and Supports in Adoptive Families
- Post-adoption Services and Supports Programs in Operation or Development
- Pre-Adoption Services
- Evaluation of Post-Adoption Services and Supports Programs
- Discussion: Challenges to Designing and Evaluating Post-Adoption Services and Supports
Post-adoption services and supports (PASS) are a growing component of services provided to children and families. PASS typically include adoption subsidies but also may include information, peer support, therapy, and case management. These supports initially consisted almost exclusively of the provision of state adoption subsidies, which now date back nearly 40 years. The services aspects of PASS began to emerge in the 1960s, but have accelerated in the last decade as a result of federal funding for demonstration projects, state efforts, private agency initiatives, and newer sources of funding for PASS. These include bonuses to states for increasing the number of children adopted and other funds from the Safe and Stable Families Program.
In general, adoptions are highly successful at least as judged by their low disruption rates. Yet, even among adoptions that do not disrupt, some proceed under difficult circumstances. Adopted children in these families may be experiencing significant functional impairments at home, in school, or in the community (Howard and Smith, 1995). Their families may draw on a variety of services, including special education, outpatient mental health services, hospitalization, and temporary residential placement (Barth and Berry, 1988; Groze, Young, and Corcran-Rumppe, 1991). Although they may benefit from services designed with a specific sensitivity to adoption-related aspects of these problems, many families will not have access to post-adoption services, which are relatively new and rare.
Whereas post-adoption service users might include persons who are searching for their biological parents or who are looking to provide anticipatory guidance to help their child with the adjustment to adoption (Brodzinsky, Smith, and Brodzinsky, 1998; Casey Family Services, 1998), this report focuses on PASS that are designed to help families with adopted children who are maladjusted or are in high levels of conflict with their parents.
This literature review is part of a project titled "Assessing the Field of Post-Adoption Services," which will address three research questions:
- What is the extent of need for PASS?
- What are the characteristics of existing post-adoption service programs?
- How are post-adoption service programs monitoring and assessing their effectiveness?
As the initial component of the assessment, the literature review describes information available from reports and professional literature, and gaps in the literature, with respect to the above-mentioned research questions.
The literature review also includes a discussion of the challenges to designing and evaluating PASS that will provide guidance for subsequent activities within the assessment, including secondary data analysis and case studies of existing programs.
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II. Need for Post-Adoption Services and Supports
In the absence of any formal mechanism for monitoring the well-being of adoptive families, indicators of their needs can be gleaned from several sources. This section reviews data on adoption success and the use of adoption subsidies to support services for adoptive families in an effort to identify the need for PASS.
2.1 Indicators of Adoption Success
Adoptions have generally been quite stable and successful despite the lack of post-adoption services development. Relatively low adoption disruption rates reflect this success. This suggests that many families will not need PASS in order to keep their adoptions intact. Three federally funded studies completed in the late 1980s and one completed more recently used different methods and samples, but all arrived at similar conclusions about the approximate rates of disruption; for special needs children (generally children adopted after age 3), somewhere between 10 and 16 percent of adoptions will disrupt (Barth and Berry, 1988; Goerge, Howard, and Yu, 1996; Partridge, Hornby, and McDonald, 1986; Urban Systems Research and Engineering Inc [USR&E], 1985). There are no comparable figures for children adopted prior to age 3, because this has been fairly rare due to the length of time required for the adoption process. Each of these studies relied on existing agency data to determine the overall disruption rates. The duration of time since the adoption varied by child and, in the case of the USR&E study, by state. Rates were computed on a maximum of 5 years of post-adoptive placements. Overall, the disruption rate of between 10 and 16 percent over a period of time between 3 and 14 years indicate that adoption disruptions are lower than disruptions of guardianships that appear to occur with approximately equal frequency but within a shorter time frame, or long-term foster care placements that occur at a greater than 20 percent rate over a 3-year time frame (Berrick et al., 1998).
As a result of federal and state efforts, adoptions of foster children have increased sharply in recent years, with an apparent growth from 24,000 in 1996 to 36,000 in 1998 (Kroll, 1999; DHHS, 2000). There is currently substantial concern that this growth will increase adoption disruption rates. Part of this concern is based on the assumption that older children will quickly be moved into homes that have not been well chosen for them. However, Goerge, Howard, and Yu (1996) concluded that since the passage of PL 96-272 (The Adoption Assistance and Child Welfare Reform Act [AACWA]) in 1980, the number of special needs children who were adopted increased but "the percentage of failures from adoptions and adoptive placements has declined" (Goerge, Howard, and Yu, 1996, p. 6). Indeed, the proportion of adoption disruptions fell in Illinois from 21.1 percent prior to AACWA to 9.9 percent after permanency planning was implemented. This decline suggests that changes in policy that result in additional adoptions of foster children need not result in higher levels of adoption disruption.
2.2 Use of Adoption Subsidies for Services and Supports
Our understanding of the relationship between adoption subsidies and other post-adoption services is limited. Several earlier studies and reviews have concluded that adoption subsidies are associated with adoption stability (Barth, 1993; Sedlak, 1991). Other assessments have indicated that the subsidies are set at least as much on the basis of geopolitical boundaries as on the familys ability to meet a childs needs (Avery and Mont, 1992). According to Bower (1995), the majority of adoption assistance administrators and adoption workers concluded that "services provided through adoption assistance programs were insufficient to meet the needs of special needs children and families who adopt them" (p. 25). Available subsidy studies cannot provide us with much guidance about the most efficacious approaches to providing subsidies and conditioning increases in subsidies to service use.
Administrative data and surveys indicate that adoption subsidies are commonly used, although it is not clear if many of these adoption subsidies are set at a very low rate, intended to trigger eligibility for Medicaid (under prior IV-E program rules, some subsidy was required in order to obtain Medicaid) rather than to provide meaningful support. Preliminary Adoption and Foster Care Analysis and Reporting System (AFCARS) estimates on just 16 states indicate a 73 percent increase in the number of children receiving subsidies between 3/30/95 and 9/30/99 (Penelope Maza, personal communication, December 12, 2000). Some of these children are not getting cash benefits and are only receiving deferred subsidy agreements that will allow families to obtain a cash benefit should they be able to document such a need at a later time. In California, preliminary data for FY 1999-2000 suggest that of all public agency adoptions, 86 percent have an ongoing subsidy in the form of a cash payment, 6 percent have no agreements (probably because counties place some healthy infants), 6 percent have deferred payment agreements, and 2 percent have Medi-Cal only agreements (Joseph Magruder, personal communication, January 4, 2001). Parents in six states (Arizona, Florida, Nebraska, New Jersey, South Dakota, and Wyoming) are not able to obtain deferred adoption assistance agreements (i.e., an agreement with an initial monthly maintenance amount of $0), and they are available to families without qualification in only 41 states (National Adoption Assistance Training, Resource, and Information Network [NAATRIN], 1999/2000). To our knowledge, there is no research on when and why deferred agreements are activated by families requesting a cash assistance payment.
States and localities are likely to vary in the assumptions that underlie design of their subsidy programs. Some will consider that subsidies should be set at a rate sufficient to provide general support for needed services. Others will set subsidy amounts at a level that can only support the basic care for a child, unless there are specific time-limited requests for subsidy funds to address specific problems.
There have been a few systematic efforts to keep track of the ways that subsidies support families. NAATRIN was established by the North American Council on Adoptable Children in 1994 as a response to the need for education and awareness about adoption subsidies for waiting children. NAATRIN maintains a database on various aspects of each states policies. The NAATRIN (1999/2000) survey data from states reveal that roughly 23 states require specific documentation of subsidy use that is for the amelioration of problems requiring services like counseling or respite. Another 14 states require that additional subsidy expenditures be justified in more general terms, and 14 states do not require that the services purchased by the subsidy be explicitly identified in the adoption assistance agreement. That is, these states provide the basic foster care rate as the basis for the subsidy and only provide additional funds if there is a specific problem that those funds are identified to address via the purchase of services. In some states, these problems have to be specified at the outset; in other states, there is a mechanism to request the addition of funds to address specific problems that later arise.
Ohio has an innovative subsidy/service approach, the Ohio Adoption Services Subsidy (OASS) program, that has an unambiguous commitment to the idea of providing funds directly to the adoptive parents to have them purchase the services they need. However, families are required to document the need for these funds, to find the service provider, and to document that the services were received. Ohios second program, Post-Adoption Special Services Subsidy (PASSS) was created in 1992 to provide payments of last resort for adoptive families whose needs may not have been identified at the time of adoption; PASSS is also available to children adopted privately, including children adopted through international adoptions. Ohios PASSS funds are flexible and can be used when there is no other payment source to secure services that, if unavailable, could cause the breakup of the family. A family can receive up to $20,000 annually.
Illinois takes a different approach and has generated a network of adoption preservation services that are contracted to private agencies. Some of these agencies are in their second decade of providing services to any adoptive family who requests them. (Unlike Ohio, Illinois limits their provision of cash assistance to meet exceptional needs to $500 a year.). Services are time-limited to 18 months, although they are sometimes resumed following case closing.
More than half of the states indicate that they provide residential treatment as a post-adoptive service, according to the American Public Human Services Association (APHSA)/Interstate Compact on Adoption and Medical Assistance (ICAMA) survey (Oppenheim, Gruber, and Evans, 2000). The NAATRIN survey indicates that 27 states have a provision for providing residential care, although the procedures may set reimbursement levels to those set by the Medicaid program, which makes finding a residential provider very difficult. The remaining states indicate that there are no provisions for purchasing residential services for adoptive families, although interviews indicated that at least one of those states will make exceptions under extraordinary circumstances.
The funding mechanisms for providing residential treatment vary. Current IV-E regulations prohibit using funds for residential treatment for children receiving adoption subsidies. Although it might be possible for states to seek a waiver of this restriction, no state has yet done so. As described above, residents of Ohio can request a special allotment of funds each year to help pay for these costs. In California, state funds can be approved for placing a child in group home care for up to 18 months if the purpose of that placement is reunification with the adoptive family. A recent description of the uses of that program indicates that about 6 percent of children who were adopted between 1988 and 1989 used group home services for some period of time since their official adoptive placement (Allphin, 2000). The 6 percent group care use rate may be an overestimate, because children with many changes in rate which may presage group home care use may be more likely to have information in the database because they have had more opportunities for a worker to enter their records. Thus, some families who have stable subsidy funding may be excluded from the count of families who did not have a group care experience. At the same time, when all the children have "aged out" of the subsidy program, the percentage who had experienced group care users is very likely to have increased. There appears to be substantial demand for this resource, yet there is no information available on the duration of those spells in group care and whether these placements are achieving their reunification goals.
When compared to African-American children, white children are overrepresented in post-adoptive group care, although this may be attributable to a younger age at placement for African-American children. Among children adopted by kin, only 2 percent have experienced group home care, compared to the overall rate of 6 percent. Additionally, the children who experienced group home care entered out of home care at a later age (3.3 years of age) than those who did not (less than 2 years of age) and began living with their adoptive parents at a later age. Children who have spent time in group home care were also somewhat less likely to be from the group of deferred Adoption Assistance Program (AAP) cases who later became active cases (9 percent of children who entered group homes were previously deferred, as compared to 16 percent of children in the nongroup home population).
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III. Studies of Adoptive Families
Although it should not be assumed that all difficulties in adoptive families will require post-adoption services, clearly some may. Characteristics of adoptive children and their families, and familys satisfaction with the adoption, may help predict families needs for services and supports and the types of services and supports they desire.
The emerging field of post-adoption services requires better theoretical and empirical guidance if these families are to obtain the assistance they seek.
3.1 Characteristics of Adoptive Families
The picture of families who adopted children from foster care and are likely users of post-adoption services is beginning to get clearer. Statewide surveys of families who adopted children through the child welfare agencies in Illinois (Howard and Smith, 2000) and Oregon (Fine, 2000) offer clues about the pool of families who are, or might become, post-adoption service users. The Oregon survey achieved a 50 percent response rate and the Illinois survey achieved a 36 percent response rate. About 40 percent of the Illinois families were single parent-headed households a rate significantly higher than in the Oregon samples. Similar proportions of households had one adopted child in Oregon and Illinois samples (ranging from 42 to 46 percent). In Illinois, many (42 percent) had birth children as well as adopted children. Foster children were present in 21 percent of the families. Twelve and one-half percent of families had other children, typically grandchildren or other relatives. About 40 percent of the children in the Illinois sample were adopted by relatives, which is a larger percentage than in the Oregon sample (18 percent). In both states, the typical age of the responding parents was about 46. The median age for adoption finalization in Illinois was 6 years.
Substantial proportions of families in both states have relatively low incomes. In Illinois, parents were asked to report their yearly income, exclusive of Adoption Assistance. Family income was less than $25,000 in 41 percent of the families and less than $35,000 in 56 percent of the families, suggesting that adoptive families were far more likely than other families to be low-income. Because the mean household size among adoptive families is nearly twice the statewide average 2.6 persons, Adoption Assistance appears to be an important source of support for many families raising adopted children (Howard and Smith, 2000). These findings may indicate a substantial change in the material circumstances of adoptive families during the last decade in comparison to earlier research, which tended to describe adoptive families as more affluent than the general public (c.f., Barth and Brooks, 2000). This may be partly attributable to the growing rate of adoption by relatives who do have fewer financial resources (Magruder, 1994). Yet similar patterns exist in Oregon, where only one in five adoptions is by relatives 48 percent of families earned less than $40,000 a year (Fine, 2000).
School problems are consistently rated as the most significant concerns for adoptive families. In the Oregon sample, 43 percent of families indicated that at least one of their adopted children had received special education services during the prior year. In the Illinois sample, about 40 percent had received some special education services (usually for learning disabilities) and 26 percent had repeated a grade, although a substantial proportion of students (47 percent) were receiving As or Bs. About one-fourth had been suspended or expelled at least once. Not surprisingly, support for tutoring was the reason given most often to explain the need for a increase in subsidy (by 29 percent of the families indicating the need for a higher subsidy).
These surveys are not exclusively of families receiving post-adoption services. Depending on the breadth of post-adoption services delivery, the families involved may look quite different. For example, only about half (53 percent) of the families described in the Casey Family Services (CFS) data as having received post-adoption services delivered in New England (Gibbs, Barth, and Lenerz, 2000) had been involved with public agency adoptions. The children in families served by CFS were adopted younger the median age at finalization was 4.1 years as contrasted to Illinoiss 6 years of age.
Several risk factors for disruption have been identified in adoptive family characteristics. Being adopted by strangers or by families with no prior adoptive or foster care experience seems to heighten the risk for disruption (Barth et al., 1988; Berry and Barth, 1990; Partridge, Hornby, and McDonald, 1986; Smith and Howard, 1991). Several studies (Berry and Barth, 1990; Groze, 1986; USR&E, 1985) have found that younger adoptive parents are more likely to disrupt, but this conclusion is not unanimously supported. Partridge, Hornby, and McDonald (1986) did not find parental age to be a significant risk factor.
One of the more disquieting findings in the disruption literature is that more educated parents, particularly mothers, are more likely to have troubled placements and are more likely to disrupt (Barth et al., 1988; Barth and Brooks, in press; Boyne, et al., 1984). Whereas Partridge, Hornby, and McDonald (1986) did not find education significant in predicting disruption, the studies that did find a difference theorize that this could be in part because of the heightened expectations which more educated parents may place on their children, as well as the lack of community resources equipped to handle children with special needs (Barth and Berry, 1991).
Taken together, these findings indicate that adopting families are likely to be pressed to make ends meet and to address the special needs of their adopted children and the other children in their households.
3.2 Satisfaction with Adoption
Many children and their families undergo periods of difficulty that are often associated with the ages of the children. Many of these difficulties are resolved without services. Adoptive families are not very different in this regard. Most have positive experiences, which vary somewhat with age, and do not use substantial amounts of services to achieve those good relationships (Brooks, Allen, and Barth, 2000). Brooks and Barth (1999) found that the proportion of parents who felt "somewhat to very" warm and close to their child hit a low of 59 percent between ages 13 and 18, and then rebounded to 80 percent for "children" older than 19. In a study comparing adoptions of children with prenatal drug exposure to those without, about 95 percent of parents reported being "somewhat to very" satisfied with how affectionate or tender their child is and 97 percent reported feeling "somewhat to very" close to their child at 8 years post-adoption (Barth and Brooks, 1999). Using similar items for their general survey of families receiving adoption subsidies, Howard and Smith (2000) found that 83 percent of families indicated feeling very close, 15 percent indicated feeling somewhat close, and 2 percent indicated feeling not at all close to their child. Even among families who experience an adoption disruption, 86 percent stated that they would definitely or most likely adopt again and 50 percent indicated that they would adopt the same child (but with more awareness of what adoption required of them at different stages in the adoption) (Barth and Berry, 1988).
3.3 Child Characteristics
Whereas most adoptions have been successful, there is a growing body of evidence that they are also unusually challenging. Concern that adopted youth are at risk for psychological disorders has persisted for several decades, although there is certainly no consensus that adopted children have unusual levels of problems (Bohman, 1981; Haugaard, 1998; Zill, 1996). Among those who believe that adopted children have higher levels of problems, different explanations for those problems have been proposed. During the 1940s, mental health professionals speculated about the potential genetic defects of adopted youth (Wegar, 1995). In recent years, genetic considerations were largely ignored and have only recently arisen in conjunction with efforts to understand the interaction of genetics, prenatal environments, and post-natal environments (Cadoret and Riggins-Caspers, 2000; Plomin, Fulker, Corley, and DeFries, 1997). At least as early as the 1960s, attention began to turn to the role of adoption and the adoptive parents in the psychopathology of adopted youth. Judgments were made about families "readiness" to adopt and the psychological implications that lack of readiness or resentment about being an adoptive parent (rather than a biological parent) may have had on the adopted youth (Wegar, 1995).
By the 1970s, the focus was beginning to shift to issues such as acknowledging differences between adoptive families and birth families (Kirk, 1964). Part of this effort focused on the importance of helping children resolve the "loss and grief" that occurs from the experience of separation from their biological parents, (Nickman, 1985; Offord, Aponte, and Cross, 1969) a loss that is thought to be diminished with open adoptions (Baran and Pannor, 1993; Sorosky, Baran, and Pannor, 1975). Problems with attachment became the most accepted explanation for the possible problems associated with adopted children in the 1990s (Johnson and Fein, 1991; Levy and Orlans, 1998; Rutter, 1995). Other proposed models endeavor to explain evolving dynamics in adoption families and child outcomes based on family systems theory (e.g., Ward, 1997); stress and coping theory (e.g., Barth and Berry, 1988; Brodzinsky, Smith, and Brodzinsky, 1998); and developmental psychopathology and behavioral genetics (e.g., Rutter et al., 1997).
The extent and nature of the need for post-adoption services will depend in large part on two factors: (1) whether adopted children have unusual needs by virtue of the amount or type of problems they have and (2) whether these needs can be met by existing approaches to service delivery. The research on whether children who have been adopted are at greater risk for emotional, academic, and behavioral difficulties than nonadopted youth is widely discussed in the adoption literature (Berry, 1992; Brodzinsky, Hitt, and Smith, 1993; Haugaard, 1998; Lindholm and Touliatos, 1980; Warren, 1992; Wierzbicki, 1993). Several studies of clinical samples have demonstrated significant disparities in the number of adopted youth in psychiatric or other mental health settings (Dickson, Heffron, and Parker, 1990; Kim, Davenport, Joseph, Zrull, and Woolford, 1988; Rogeness, Hoppe, Macedo, Fischer, and Harris, 1988). Surveys of nonclinical community populations composed of adopted and nonadopted youth also reveal similar patterns. These surveys find adopted youth either in or near the clinical range for behavioral disorders at rates beyond those of nonadopted age-mates (Brodzinsky, Schecter, Braff, and Singer, 1984; Lipman, Offord, Boyle, and Racine, 1993). An analysis of the National Health Interview Study found that adopted children have poorer outcomes than children raised by their own parents in by two-parent families but somewhat better outcomes than children raised by their own parents in single-parent households. Outcomes for the adopted children most closely resemble those of children raised by grandparents (Zill, 1996). This comparison is particularly apt in light of the increasing frequency of relatives as adoptive parents, although relatives remain a minority (generally not more than 20 percent) of adoptions. Among adopting relatives, many will be grandparents.
Problems in adoptions whether manifested in troubled behavior or adoption disruptions are highly associated with certain characteristics of adopted children. The most predominant factor influencing disruptions is the childs age. Zills (1996) analysis of data from the National Health Interview Survey of Child Health found that "when parents reported on the specific problem behaviors their teenagers were displaying, the teens adopted in infancy showed somewhat more problems, on average, than those living with both biological parents, but nowhere near as many as teens adopted after infancy nor teens who lived with unmarried mothers" (p. 110). Numerous studies have supported the conclusion that the older the child, the more likely the risk of disruption (Barth and Berry, 1991; Festinger, 1986; Goerge, Howard, and Yu, 1996; Groze, 1986; Partridge, Hornby, and McDonald, 1986; Smith and Howard, 1991; Urban Systems Research and Engineering, 1985). Older children, who are also more likely to have been older when separated from their biological families, have had time to absorb the deleterious effects of abuse and neglect. Additionally, they may have closer ties to biological parents and may have developed more resistant habits that make integration into a new family more difficult (Smith and Howard, 1994). Older children are more likely to have spent time in foster care and to have had previous placements (Barth and Berry, 1991).
Families in which children display behavioral or emotional problems are also more likely to disrupt, particularly when those problems are of an externalizing nature (such as violation of family norms, sexual acting out, defiance, cruelty, or physically harming others) (Barth and Berry, 1991; Partridge, Hornby, and McDonald, 1986; Smith and Howard, 1994; Smith, Howard, and Monroe, 1998). In the USR&E study, which was a survey of states about their experiences with disruption, children with emotional problems represented 19 percent of total placements but 39 percent of disruptions. This is in sharp contrast to children with physical or mental handicaps, who accounted for 21 percent of total placements but only 13 percent of disruptions (USR&E, 1985).
A small body of research has centered on the disproportionately high prevalence of externalizing disorders such as Attention Deficit and Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD), conduct disorders, and antisocial behaviors in adopted youth. Deutsch et al. (1982) investigated the backgrounds of a sample of children who were diagnosed with Attention Deficit Disorder (ADD), the precursor diagnosis to ADHD. Among these children, researchers noted an eight-fold greater likelihood of being adopted when compared to children in a non-ADD comparison group and to children in the general population. Brodzinsky and colleagues (1984) concluded that adopted children have somewhat higher ratings by parents and teachers on Child Behavior Checklist (CBCL) items related to social and academic performance. Zill (1996) also noted that adoptive parents rated their adolescent children higher on the Behavior Problem Index (a shorter CBCL-like parent report instrument) than did respondents from households with two biological parents. Adoptive parents who also have biological children rate those children as having better developmental outcomes (Barth and Brooks, 1997) than their adopted children. None of these studies which are based on parental reports controls for the possibility that adoptive parents may over-assess the childrens problems because of their own high expectations.
Researchers from the Colorado Adoption Project (Coon et al., 1992) detected that adopted boys were significantly more at risk for conduct problems than a nonadopted cohort. Simmel et al. (1999) found that adopted children had parent-rated levels of ODD and ADHD that were substantially greater than the base rates reported in epidemiological studies. While they recognize that adoptive parents are highly vigilant about child behavior problems and their self-reports should not naively be compared to those from the general population, the findings are still provocative.
One explanation for these higher reported rates of externalizing problems is that the demographics of adoptive families who are more educated, more likely to be involved in human services, and wealthier than the average family (Zill, 1996) result in "informant bias." For instance, Warren (1992) suggests that many adoptive parents, by virtue of their higher socioeconomic status, have greater awareness of and access to mental health services. In addition, these adoptive parents may also be more vigilant about potential mental health difficulties in their children, particularly if they were adopted from public agencies (Brodzinsky, Hitt, and Smith, 1993; Haugaard, 1998; Wegar, 1995), and are therefore more apt to detect and report atypical behaviors. Hence, Warren suggests that the skewed numbers of adopted youth in mental health settings may reflect a labeling bias in that both parents and professionals could attribute childrens distress to adoption and refer them for treatment as a result of minimal manifestations of problematic behaviors. Yet, whether the problems are real or perceived, these referral patterns suggest that many parents of adopted children are experiencing high levels of problems with their children, which is likely to create distress. When combined with the studies on the influence of genetic risk on children and parent-child interactions (Plomin et al., 1997), these studies also suggest that the challenges of adoptive parents are substantially different from those of biological parents.
Adoption of children with prenatal alcohol exposure appears to be particularly challenging, as shown by Cadoret and Riggins-Caspers (2000), who found that children with this history have a higher likelihood of having multiple psychiatric symptoms as adults (especially if these children were raised in families who had at least some difficulties, ranging from parent-child conflict to divorce). A biological parents history of antisocial behavior may also result in child behaviors that evoke a more negative parenting style from the adoptive parent, thereby creating more coercive parent-child interactions with some attendant negative implications for child behavior (OConnor et al., 1998). Raising adopted children whose biological parents have low cognitive ability is also challenging as the divergence between the adoptive parents and childs cognitive ability gets larger as maturity extends (Plomin et al., 1997). This is not to suggest that these challenges cannot be managed. There is evidence of substantial success with adopting drug-exposed children at least in the first 8 years (Barth and Brooks, 2000) although they have not yet reached an age when their longer-term outcomes are more predictable. Supportive educational services particularly special education and private education seem to be contributors to successful adoption in general (Barth and Berry, 1988; Nelson, 1985; Walsh, 1991).
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IV. Demand for Post-adoption Services and Supports in Adoptive Families
Although there is little empirical evidence about the effectiveness of services, adoptive parents are clear about what they want to be included in the service mix when surveyed. Given the limited information available about the outcomes of post-adoption services, a reasonable premise for program planning is to design programs that address the expressed needs of adoptive families. The handful of studies that have asked adoptive families about their service needs provide important information for planning purposes.
Data from the Casey Family Services (CFS) program suggest that families make extensive use of services from other public and private resources within their communities prior to joining a post-adoption service program. Nearly all of the families entering the CFS program reported having used services elsewhere, most commonly adoption education and information and counseling for children, parents, or the family. For the most part, these services were described as helpful. However, CFS parents participating in focus groups described community providers as lacking in the understanding and skills needed to address the particular issues of adoptive children and families (Gibbs, Barth, and Lenerz, 2000).
PASS fit into four basic categories: (1) educational and informational, (2) clinical, (3) material services, and (4) support networks. Educational and informational services include providing adoptive parents with information through literature, seminars, or the adoptive agency itself about their child or about various aspects of the adoption process (e.g., financial costs, special services offered, and explaining adoption to extended family). Clinical services span a broad range and include individual, marital, and family counseling, as well as intensive crisis counseling (among others). Families also request material services, which include adoption subsidies, health benefits, respite care, and support for temporary placement of children into residential care. Finally, many national organizations and state and local governments sponsor support networks through which adoptive families can share experiences and ideas in self-help or professionally facilitated support groups.
4.1 Educational and Informational Services
As mentioned previously, parents in numerous studies have stressed the importance of full disclosure of information about their child, including the childs social, medical, and genetic history (Barth and Berry, 1991; Berry and Barth, 1989; Brooks, Allen, and Barth, 2000; Commonwealth of Kentucky, 1993). In addition, parents requested literature in the form of pamphlets, books, and articles to help them better understand their adopted child and deal with issues surrounding adoption. Lectures, seminars, workshops, and classes were also mentioned as helpful.
4.2 Clinical Services
While many adoptive families indicated a desire for counseling for the child, couple, or family, few actually utilized these services. With the exception of the Commonwealth of Kentucky study, in which 50 percent of families reported using individual counseling for their child, only a small fraction of parents surveyed in any of several studies sought counseling for themselves or their children (Brooks, Allen, and Barth, 2000; Commonwealth of Kentucky, 1993; Howard and Smith, 1993; Walsh, 1991).
Parents often request respite care in general surveys of their needs, but seem unsure as to how to access it in reality. Walsh (1991) found that, while 26 percent of parents reported respite care as a need, only 6 percent actually used it. Findings from the Commonwealth of Kentucky (1993) can at least partially account for this discrepancy: parents either do not believe that respite care is available or cannot find someone willing or qualified to provide it. When provided, it has been lauded by parents and has reduced the experience of objective burden (Owens-Kane and Barth, 1999). The NAATRIN survey asked states if respite care is provided through the adoption assistance program 19 states gave an unequivocal yes, six said that it was available in specific situations, and three said that it was available in a few places.
4.3 Material Services
Parents also want material services for their children, such as adoption subsidies, medical care, and special education options. Adoptive families often struggle under the financial burden of another child in the house and request assistance to offset that childs expenses (Berry and Barth, 1990; Brooks, Allen, and Barth, 2000; Commonwealth of Kentucky, 1993; Frey, 1986; Rosenthal, Groze, and Morgan, 1996). Berry and Barth (1990) compared stable to disrupted placements and found that the amount of the monthly subsidy check differed, with stable placements receiving greater subsidies. They also found that families who did not receive subsidies had a higher likelihood of disruption than other factors would predict. Children who are adopted often enter placement with special medical and/or education problems which require additional care, and by extension, additional money (Brooks, Allen, and Barth, 2000; Commonwealth of Kentucky, 1993; Howard and Smith, 1993; Howard and Smith, 1997; Kramer and Houston, 1998; Partridge, Hornby, and McDonald, 1986; Walsh, 1991).
4.4 Support Networks
Many adoptive parents utilize available support groups or rely on a more experienced adoptive parent as a mentor (Barth and Berry, 1991; Berry and Barth, 1989; Brooks, Allen, and Barth, 2000; Daly and Sobol, 1994). A growing number of support groups are available to adoptive families. Parent groups typically provide support in dealing with the variety of issues facing adoptive parents, including inter-country adoptions; special needs adoptions; future reunification with birth parents; and emotional, social, and educational assistance pre- and post-adoption. Parent support groups can be organized by parents or through support networks sponsored by community, state, and national-level public and private agencies. There does not appear to be any research that specifically evaluates the effectiveness of these support groups.
Networks operate at many levels in helping parents locate and start parent support groups. On the national level, more well-known organizations offering such services include the North American Council on Adoptable Children (NACAC), Adoptive Families of America (AFA), Families Adopting Children Everywhere (FACE), Latin America Parents Association (LAPA), Committee for Single Adoptive Parents, National Adoption Center (NAC), and National Adoption Information Clearinghouse (NAIC) (Debra Smith, NAIC, 1994). Many of these organizations have web pages with information on how to find and establish parent support groups. Additionally, several of these organizations actually operate parent support groups in chapters across the country.
On the state level, networks also operate with direct state support. The Illinois Department of Children and Family Services established the Adoption Information Center of Illinois to serve as a state network and resource for post-adoption through a Post-Adoption Information and Referral Services Program. The program provides information on parent and child support groups, among other post-adoption services and information. The Oregon Post-Adoption Resource Center (ORPARC) has been recently established with support from Oregons State Office for Services to Children and Families. Services are targeted to families who have adopted children from the state foster care system. Networks for parent support groups also exist at the community level, such as the Center for Adoption Support and Education (CASE), a private nonprofit community organization in the Washington, D.C. metropolitan area
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V. Post-adoption Services and Supports Programs in Operation or Development
Post-adoption services have been in operation to support troubled adoptions for more than half a century. As early as the 1940s, they were provided to support older child adoptions (Weeks, 1953). The Child Welfare League of America included this simple phrase about post-adoption services in its 1971 adoption guidelines: "After legal adoption is concluded, the agency should make continuing help available to the adoptive family, including group meetings and individual counseling" (Ford, 1971, p. 15).
Most states currently have some post-adoption services in place (Howard and Smith, 1997). However, the full array of services described in Section 4 are often not available to families. The ICAMA survey (Oppenheim, Gruber, and Evans, 2000) shows that many services are not available statewide, or that statewide service networks provide only some of the desired services. However, the field is evolving rapidly and there is no current and comprehensive inventory of existing programs in terms of their sponsorship, organization, target population, or service offerings. This section provides illustrative examples of various approaches to their provision, and discusses the impact of recent federal funding changes.
5.1 Public Agency-Supported Services
Services delivered or supported by public child welfare agencies are of at least four types:
- Those funded as part of the workload of the typical adoption worker,
- Those funded as part of a special unit of service providers,
- External contracts involving multidisciplinary collaboration and training, and
- Networks of family resource centers.
5.1.1 Services Provided by Adoption Workers
In some areas (e.g., California), the adoption program includes an appropriation for post-adoption services as part of the reimbursement to the public agency for the completion of the adoption. In other states (e.g., North Carolina), Temporary Assistance to Needy Families (TANF) or Title IV-B (child welfare service) funds are provided to the public agency to underwrite post-adoption services activities that had previously been unfunded. Thus, those funds are generally blended into the cost of the adoption workers salary and are used to help provide services to families who subsequently required post-adoption services.
Although this model has received the least attention in the adoption evaluation literature, an apparent benefit of this approach is that a worker who knows the family and was involved in the original placement will provide the services in many cases. An apparent deficiency of this approach is that the worker might not still be with the agency when post-adoption services are needed which may average 5 years after adoption finalization (Gibbs, Barth, and Lenerz, 2000) and the worker may not be a specialist in providing such services.
5.1.2 Special Post-Adoption Units
A second approach is to develop specialized post-adoption services units within the public agency to which cases can be referred. An apparent advantage of this approach is that these public PASS workers can collaborate closely with the adoption worker, have excellent access to the case history information, and have access to public agency resources (e.g., referral to intensive in-home services or temporary foster or group home care). Oregons Post-Adoption Family Therapy (PAFT) model and Californias Santa Clara County post-adoption services unit are examples of this model in action.
5.1.3 Multi-Disciplinary Collaboration
A third, and increasingly widely used, model is to develop interdisciplinary teams or provide training to other public and private agency personnel to improve the level of community response. These models typically involve contracting with service providers outside the public agency.
El Paso County, Colorado has developed more interdisciplinary support for adoptive families by engaging public community mental health programs and hiring a highly qualified adoption specialist, located in the DSS office, to serve as a single point of contact. El Paso County had been completing about 50 adoptions annually until they underwent substantial adoption reform in 1997. In the subsequent 2.5 years, only one of El Paso Countys 500 placements has disrupted before finalization and only one completed adoption has not worked out after legalization (Berns, 2000).
The Arizona State Adoption Programs Post-Adoption Services Project began a 3-year agenda in 1992 to address the problems of special needs adoption placement (Morse and Lussiere, 1995). Training programs for mental health professionals and adoptive parents, as well as crisis prevention services, were developed and offered to adoptive families. Over 1,600 mental health professionals and staff members attended at least one of the 12 workshops. Among them, 200 mental health professionals were eventually approved to provide services to 100 faimilies in need of post-adoption services (services were limited to families receiving an adoption subsidy). Pre- and post-assessements of adoptive families satisfaction with support services indicated a modest improvement in satisfaction, although a low response rate at post-test complicates the interpretation of the findings. The project was discontinued following the end of demonstration program funding.
In 1991, the Rocky Mountain Adoption Exchange received federal demonstration grant funding for a 2-year project to develop a collaborative model of interdisciplinary teamwork for serving families who had adopted children with special needs (Naylor, 1993). Teams were formed in Colorado, New Mexico, Nevada, and South Dakota. Mental health, social service, developmental disabilities/education professionals, and adoptive parents were incorporated into each team. The project objectives were to improve collaboration among existing professional and parental supports, adapt existing services for special needs adoptive families, increase treatment skills of service providers, identify service gaps and barriers for families, successfully serve 175 adoptive families in crisis, and develop additional post-adoption legal services in each state. A total of 168 families were served over the 2-year period. The teams developed adoption resource manuals at each of the four sites, and the project staff members produced a "how-to" manual for other groups who might utilize this model. The project was less successful at utilizing needs assessment results and evaluation data for improvements during the course of the project and securing on-going funding.
Vermont and Florida use a multidisciplinary model of post-adoption services delivered by contracted service providers. Vermont uses contractors to provide services that include assessments, crisis intervention, and respite care targeted to families with children eligible to receive a subsidy. The state also contracts with a private agency to assist Department of Social and Rehabilitation Services staff in finalizing adoptions. Contract staff members conduct casework, prepare the court reports, and appear in court on behalf of the public agency. Broward County, Florida uses a private contractor to provide intensive services to preserve adoptions of special needs children, including case management, home visiting, crisis intervention, counseling, and links to other support services (Karl Ensign, personal communication, February 12, 2001).
5.1.4 Family Resource Centers
Spencer (1999) describes what she considers to be an optimum approach to post-adoption services, involving comprehensive "Post-Adoption Service Centers." The centers should be triad focused and equally address the long-term needs of all adopted children. The proposed centers would have enough service volume to support the delivery of quality services by trained staff. The centers would also provide training and technical assistance in remote areas of the state. In Spencers vision, the centers would be organized into statewide networks and generate post-adoption services councils. However, such an organizational structure does not build on existing mental health and childrens services resources or expertise and requires separate dedicated sources of funding that may be difficult to obtain and maintain.
Alabamas Department of Human Resources (DHR) has developed an approach to post-adoption services that involves the establishment of a system of family resource centers for adoptive families (NACAC, 2000). The project was developed during 1999 by examining other states post-adoption models and programs and by surveying Alabama families who had adopted foster children. The DHR sent a survey to 740 Alabama families who receive adoption subsidies to determine the most desired services. The 200 respondents indicated high value on information and referral resources, and crisis intervention services were the highest priority. The focus of the Alabama program is two-fold: family support and family education and empowerment. A request for proposal was issued to locate a licensed child-placing agency to operate a state-wide resource center and the manage a statewide network of post-adoption support services.
Oregon has initiated a statewide Post-Adoption Services Program (Hutchison and Ledesma, 2000) following a 120 percent increase in adoption assistance since 1997, which has resulted in the state having more children on adoption assistance than in foster care. Their request for proposal process to purchase these services was initiated late in 1998 and requested outreach and information and referral for adoptive families, a resource library, adoption support groups, one-to-one family support networks, connections with respite care providers, and quarterly training on adoption issues.
Other states implementing this model include Minnesota, where a post-adoption resource center is run by NACAC and the Minnesota Adoption Resource Network, and Louisiana, where services have included case management and subcontracted centers but now focus on respite (Karl Ensign, personal communication, February 12, 2001).
5.2 Impact of Federal Legislative Changes
Post-adoption programs have gained increased support in recent years by three federal legislative measures. The Safe and Stable Families (SSF) program addresses a broad array of goals, including preventing unnecessary separations of children from their families, improving the quality of services, and increasing reunification and successful adoptions for children in out-of-home care (DHHS, 2001a). Under the terms of the SSF, states are allowed to use Title IV-B, Part 2 funds for adoption support and preservation. A recent review shows that 15 percent of these funds has been used for this purpose nationally, with state allocations ranging from 0 to 25 percent of the funds received. This categorization does not allow identification of the extent to which funds were used specifically for post-adoption support (James Bell Associates, 2001).
The Adoption 2002 Initiative set a national goal of doubling the number of children adopted or placed in permanent homes each year. Among the measures taken in response to this challenge was a system of cash bonuses for states increasing the number of children adopted from the public child welfare system. States may use their bonus funds to increase services, including post-adoption services (DHHS, 1996).
The APHSA/ICAMA survey (Oppenheim, Gruber, and Evans, 2000) and our preliminary contacts with agencies did not identify many new initiatives that are funded solely by Title IV-B, Part 2 or the Adoption 2002 bonuses. More typically, these funds are used to support existing initiatives, to hire a small number of staff, or to contract for community-based services. Given the uncertain duration of the Safe and Stable Families Program and Adoption 2002 bonus funds, it is not surprising that states have decided not to invest in major infrastructure development regarding post-adoption services.
Among post-adoption service programs identified as using Title IV-B, Part 2 funds, it appears that these funds are typically being used for purchasing services from private agencies as opposed to hiring permanent staff. Examples from among the programs discussed in this section include El Paso County, Colorado; Vermont; Broward County, Florida; Alabama; and Oregon.
Finally, the Adoption Opportunities program, which amends Section 205 of the Child Abuse Prevention and Treatment and Adoption Reform Act of 1978, awards grants and contracts to public and private nonprofit agencies that improve permanency for children who would benefit from adoption (particularly children with special needs). The seven major program areas include post-legal adoption services for families who have adopted children with special needs (DHHS, 2001b).
Howard and Smith (1997) have provided a skilled synthesis of the federally funded Adoption Opportunities grants from the 1980s and 1990s. They grouped those projects according to whether they primarily provided training, therapy, education and support, respite care, or planning and resource development. This process should be repeated when the round of PASS projects initiated in the late 1990s are completed.
5.3 Private and International Agencies
At the December 2000 National Conference on Post Adoption Services, there were repeated affirmations of the concept that post-adoption services should be universally available to all adopted children, regardless of any past involvement with the U.S. foster care system. Article 9 of the recently ratified Hague Convention on International Adoption requires participating countries to "promote the development of adoption counselling and post-adoption services in their States." In this country, the Hague Convention is implemented by the Intercountry Adoption Act of 2000 (http://www.jcics.org/ haguetop.html). New Child Welfare League of America standards will include provision of post-adoption services among its criteria for accreditation of private adoption agencies (including those providing international adoptions).
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VI. Pre-Adoption Services
Although this review focuses on issues related to post-adoption services, pre-adoption services should not be overlooked. Several factors relating to the adoption agency have been found to influence disruption. Some agencies have been accused of providing adoptive parents with scanty information about the child, or information which seemed too favorable, perhaps to increase the childs chances of being adopted. In cases that disrupted, parents complained of not knowing the severity of the childs problems and/or the childs history before entering into an adoption contract (Barth and Berry, 1991). Lack of services provided by the agency prior to and during placement may also increase the risk of disruption (Partridge, Hornby, and McDonald, 1986), as do agencies that provide fragmented or disjointed services (e.g., different workers for different aspects of the adoption process) (Ward, 1997). There is some evidence that group (rather than individual) home studies are helpful (Barth and Berry, 1988).
Successful adoption practice whether pre- or post-placement requires that practitioners be realistic about what adoption offers. It has done more harm than good when adoption workers have overpromised the impact of adoption on improving the outcomes for children (Nelson, 1985). Knowing that the risk of a difficult adjustment is a reality can give adoptive parents reasonable expectations, a critical component of successful adoptions (Brodzinsky, Smith, and Brodzinsky, 1998). Quinton and colleagues (1998) found that parents lack of warmth toward foster and adopted children at 1 month post-adoption was predictive of unstable placements at 1 year. The authors readily recognize that this finding could result from childrens indifference or rejection of earlier efforts at giving warmth, but argue that proper preparation to expect such rejections should have steeled parents so that they did not give up the belief that their foster or adopted children would eventually welcome a close, reciprocal relationship.
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VII. Evaluation of Post-Adoption Services and Supports Programs
Available research on post-adoption services and supports is largely descriptive and based on few projects. Indeed, there has been no substantial review of the characteristics or effectiveness of post-adoption services. Only five projects, described below, were identified as having formally assessed the performance of post-adoption services to prevent adoption disruption and dissolution. Though these projects can be considered trailblazers in this relatively unexplored field, like many pioneers, they are not without methodological flaws. The small sample sizes and nonrandom sampling for several of these projects serves as a warning that the results should not be taken as generalizable. Additionally, the length of the service period was rarely clearly specified, although it is often used as a measure of success for disruption rates (e.g., "percentage of families remaining together at the close of the service period").
Although the available evaluation research is unable to offer precise estimates of the effectiveness of post-adoption services, there seems to be some agreement on program elements that are related to the effectiveness of services. Contact with self-help groups or other adoptive parents who can provide respite and support is reported to be helpful (Commonwealth of Kentucky, 1993; Frey, 1986; Nelson, 1985; Walsh, 1991). In contrast, the disappointing results from the evaluations of brief intensive adoption preservation services models suggests that they do not generally fit the needs of adoptive families (Barth, 1995; Howard and Smith, 1995). A less time-limited and more family-focused approach appears more suitable (Howard and Smith, 1995; Prew, Suter, and Carrington, 1990).
Further, a few studies have indicated the challenges of designing services that will engage families. A project of Child and Family Services of Connecticut identified the need for "mentoring families" for special needs families and resulted in the recruitment of 37 families as mentors (Muhammad and Jackson, 1994). Two network groups were then formed, one being exclusive to African-Americans and their families. Each of the two groups served only seven different families. It appears that the resignation of key staff within Child and Family Services had a detrimental effect on the consistency of service delivery and ultimate success of the grant programs.
Overall, due to the lack of systematic evaluation, it is difficult to determine how many efforts to develop post-adoption services have succeeded compared to those that have failed. The evidence is clear, however, that offering post-adoption services is not certain to result in their use, in benefit from their use, or in their enduring after the demonstration phase.
7.1 Illinois: Adoption Preservation Project
In the early 1990s, Illinois attempted to reduce its levels of adoption disruptions by instituting a statewide Adoption Preservation Project, which worked with families who were referred to agency adoption preservation services. Two hundred thirty-four children in 204 families received a variety of services intended to prevent adoption dissolution. The majority of children referred (61 percent) were 12 or over, with 88 percent scoring in the clinical range on the Achenbach Child Behavior Checklist (CBC). Over half of the children had been placed before the age of three, and the children had been in the home for about 9 years on average. Almost half of the families had considered adoption dissolution as an option during the service program families with sexually abused children were most likely to consider dissolution. About one in four children had been placed outside the home for some time prior to referral to adoption preservation services.
Most families were served within the 6-month service period, and 15 percent of families received more than one round of service. Overall, parents reported a significant reduction in their childs CBC scores for each of the summary measures (internalizing, externalizing, and total). Family support groups were reported by parents to be the most beneficial aspect of adoption preservation services. Eighty-two percent of children remained in the home at the end of the service period (the length of which varied from 6 months to longer than a year if services were determined to still be needed) (Smith and Howard, 1994).
7.2 Oregon: Post-Adoption Family Therapy Project
In Oregons PAFT Project, an adoption worker and a family therapist (both of whom were licensed clinical social workers) teamed together to provide services to families struggling with post-adoption issues. Sessions were often conducted in the familys home and focused on helping parents develop better ways of relating to their adopted childs confused belief system, which may be the cause of the childs inappropriate behavior (Prew, 1990). Only 8 percent of the 50 families served by PAFT disrupted by the end of the service period, the median of which was 3.5 months (Prew, Suter, and Carrington, 1990). The authors attribute PAFTs success to the idea of co-therapists, as well as helping parents better understand their childs behavior (Prew, 1990; Prew, Suter, and Carrington, 1990).
7.3 Washington: Medina Childrens Services
In a collaboration between Medina Childrens Services (a well-established special needs adoption agency) and HOMEBUILDERS of Tacoma, Washington, 22 children and their adoptive families received 4 weeks of intensive in-home therapy (three to five sessions of 2 hours or more). Each full-time therapist handled a caseload of two families, allowing them to devote the necessary time to provide these services. One year after these special services were initiated, nine children remained with their adoptive families, nine petitioned for disruption, and four children were not living in the home (either in group home or living on their own) but had not experienced disruptions. The disruption rate for this project ranged from 41 percent to 59 percent, depending on the status of the youth in transition.
7.4 Iowa: PARTNERS
Iowas Post-Adoption Resources for Training, Networking, and Evaluation Services (PARTNERS) program, piloted by Groze and colleagues, provided a continuum of services to adoptive families, including support groups, sustained adoption counseling, and intensive services (Barth, 1991; Groze, Young, and Corcran-Rumppe, 1991). PARTNERS consisted of five phases: screening, assessment, treatment planning, treatment, and termination. While in treatment, the families worked with two therapists who addressed such issues as family integration, normalizing the experiences of the adoptive family, re-parenting, and increasing the familys access to resources. Similar to PAFT, parents were reassured that many of their adopted childrens difficulties arose not from the parents lack of parenting skills, but from the childs experiences prior to adoption (Groze, Young, and Corcran-Rumppe, 1991). Of the 39 families who participated in PARTNERS, 29 percent of the children were in out-of-home placements at the end of the service period. However, the majority of these out-of-home placements were due to sexual offending on the part of the children. Groza cautions not to equate "displacement" with "disruption" and states that the children needed more intensive treatment than could be provided in the home at that time (Victor Groza, personal communication, May 18, 1999).
7.5 New England: Casey Family Services Program
CFS, based in Connecticut, offers post-adoption services in several New England states. Although structure and focus vary among the CFS divisions, the programs offer a broad array of services typically including adoption information and education, counseling, advocacy, workshops, and facilitated support groups open to any adoptive family. In addition, staff members provide training on adoption issues to mental health and education professionals in their regions.
Analysis of data on more than 400 opened or re-opened cases from four divisions found that families served were roughly equally divided between those made through public and private agencies, between first and later adoptions, and between domestic-born and foreign-born children. Although CFS holds an "open-door" policy, services are generally short-term, with a median length of case opening of 5 months and a median of three sessions for families receiving family systems counseling. Based on a counselors assessment of family gains, strongest improvements were found in child behavior, understanding of adoptive issues, and effective communication, with less change in child-family attachment. Gains appear to be greatest among cases with longer duration and more counseling sessions received (Gibbs, Barth, and Lenerz, 2000).
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VIII. Discussion: Challenges to Designing and Evaluating Post-Adoption Services and Supports
The purposes and processes of PASS are widely varied. There is no centralized source of information about which post-adoption services programs are operating with which populations and procedures. A classification scheme for PASS interventions must be established before significant strides can be made in studying the most efficacious approaches. This must then be joined with a consistent means to describe presenting problems of families who might benefit from post-adoptive services.
Families seek post-adoption services for many reasons, including crises that threaten the stability of the adoption; gathering general information about an adoption issue (e.g., open adoption or transracial adoption); normalizing the adoption experience; and searching for biological parents in closed adoptions. Families also bring many differing experiences to post-adoption services. Most of them have already received mental health and educational services from community-based providers, so they will ultimately differ in the total dosage of services. Some have adopted infants from the U.S., some infants from abroad, and some older children from foster or institution care (here or abroad). PASS providers seem to have taken an approach to PASS that embraces this diversity and welcomes "all comers." That is, although Title IV-B, Part 2 provides funding related to adoption preservation for child welfare services families, post-adoption service programs appear to generally accept families for service who have never been recipients of American child welfare services. Whereas there is some evidence that adoptive families created from different circumstances are more alike than different (Groza and Rosenberg, 1998), there is also evidence that the problems of children adopted from foster care are the most substantial (Smith and Howard, 2000).
Further, families created via independent or international adoptions are not likely to ever have their children be placed into publicly supported out-of-home care if the family is no longer be able to care for the child. This results because many states will not voluntarily accept placements of children into out-of-home care and because families often become involved with other systems of care (e.g., mental health services) that provide residential treatment services that are not known to the child welfare agency.
There is little likelihood that modest size studies would be able to determine the effectiveness of PASS for preventing placements of adopted children back into foster care. If agencies were to agree to serve families with a substantial risk of needing foster care placements, this would certainly increase the value of placement prevention as an outcome measure, but is not likely in many agencies and would still not generate sizable samples of cases unless there was a major multisite evaluation. The relatively low-cost strategy of tracking recipients of post-adoption services in child welfare administrative data is not likely to provide information about the impact of PASS.
Assessment of post-adoption services will require more intensive and costly methods. Direct assessments of the well being of children and families and of families expectations for each other are going to be necessary for evaluation. Parent reports on their childrens well-being are insufficient because of the data indicating that adoptive parents have high standards for their children (Barth and Miller, 2000). Randomized clinical trials will be necessary and seem feasible, although they will not be easily achieved because the numbers of similarly situated cases served by most agencies is small and because the culture of PASS is generally distant from such rigorous research methods.
These trials would also need to be based on new developments in interventions on behalf of adoptive families. The adoption field has long been dominated by psychodynamic approaches like attachment theory, which has not received substantial empirical support as the basis for interventions with troubled children and families (Burns, Hoagwood, and Mrazek, 1999; Weisz and Hawley, 1998). Interventions that have demonstrated efficacy with other troubled families (e.g., Huey et al., 2000 ) also deserve testing with adoptive families.
A complementary strategy is to provide information from administrative records about the uses of subsidies to assist families dealing with special post-adoption needs. Additional analyses of administrative records from states like California and Ohio, where they provide substantial levels of support for residential treatment and other needs, would be valuable. Analyses of foster care data from states that have the capacity to determine the levels of adoption disruption would be a useful way to update the outdated research on adoption disruption rates.
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The recommended citation for this report is as follows:
Barth, R.P., Gibbs, D.A, and Siebenaler, K. (2001). Assessing the Field of Post-Adoption Service: Family Needs, Program Models and Evaluation Issues. Literature Review. Chapel Hill and Research Triangle Park: University of North Carolina School of Social Work, Jordan Institute for Families, and Research Triangle Institute.
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