Assessing the Field of Post-Adoption Services: Family Needs, Program Models and Evaluation Issues: Case Study

11/01/2002

Contents

Although most adoptions have positive outcomes for the children and their families, many families need supportive services during some part of their childs development. In response to these needs, many states have developed post-adoption service (PAS) programs and other supports for adoptive families. The U.S. Department of Health and Human Services contracted with RTI International to examine these rapidly growing and evolving programs. Research questions covered the need for PAS, characteristics of existing programs, and strategies used to assess program effectiveness. RTI, in collaboration with the University of North Carolina at Chapel Hill School of Social Work, conducted a literature review, case studies of five PAS programs, analysis of secondary data, and an assessment of evaluation issues affecting PAS.

The case study component of the study, described in this report, used interviews with state adoption program managers and PAS coordinators/providers as well as focus groups with adoptive parents. The RTI team conducted site visits in five states  Georgia, Massachusetts, Oregon, Texas, and Virginia  between October and December 2001. Sites were selected to include well-regarded programs that varied in structure and services offered. The case study was designed to address the following research questions:

  • What are the service needs of families following adoption of a child from the public child welfare system?
  • What are the characteristics of existing PAS programs?
  • How are PAS programs monitoring and assessing their effectiveness?

This case study report focuses on services that fall within each states definition of its PAS program, although these boundaries vary somewhat across states. Also examined are how states use subsidies and other forms of support to assist adoptive families. Evaluation issues within PAS programs, described here in the context of activities in the case-study states, will be discussed in greater depth in a forthcoming report.

NEED FOR POST-ADOPTION SERVICES

The variation in service offerings and program structures among the five states is evidence that states tailor their program to family needs and existing service delivery systems. However, better information is needed to support estimates of the number of families needing services and when the various services are most likely to be needed in relation to the childs age or time since adoption.

As PAS programs increase their visibility within states and communities, they are better situated to monitor families needs by compiling information on client characteristics and services needed. These data can become a valuable tool for ongoing planning and program development.

The parents who participated in case study focus groups confirmed the usefulness of services offered by PAS programs, especially information and referral, respite, advocacy, crisis intervention, and counseling. They also identified additional respite care, information about subsidies, and information and assistance in understanding their childs history and development as critical unmet needs.

While only a small portion of adoptive families used PAS at any given time, many families purchased services with their adoption subsidies. At-risk children who need high-cost services might be identified early through requests for increased adoption subsidies that may signal the need for more intensive PAS support.

PROGRAM STRUCTURE AND SERVICES

Program Development

Case-study states described the importance of advocacy by adoptive parents and leadership in key state agencies and the legislatures in prompting development of the PAS program. While federal funding has been available for PAS since the late 1990s under the Promoting Safe and Stable Families Program (Title IV-B, Subpart 2), those resources alone did not lead to program development. However, states with weak or nonexistent PAS programs may have been encouraged to improve or initiate services by the availability of increased federal funding.

Stronger measures to encourage all states to support more extensive PAS available may be timely. There is strong evidence that some adoptive families will need specialized supports for part or all of their childs development and that PAS programs are effectively providing these supports. To the extent that PAS programs and subsidies do meet the needs of adoptive families, disparities in their availability will mean that childrens long-term outcomes might vary according to their state and county of adoption and residence.

Program Goals and Eligibility

All of the programs studied share a common goal of keeping adoptive families intact through a similar core group of services. Although only one state identified service system change as an explicit goal, all programs offered training for mental health, education, and legal professionals likely to serve adoptive families.

Three of the five states in the study restricted eligibility for at least some of their services to families who had adopted from the states child welfare system. Some states opened services to all adoptive families in the hopes of preventing future need for high-cost services or placement in foster care or a residential treatment facility.

Program Structure

Each of the case-study states contracted out its PAS program to providers, who delivered services either statewide or regionally. States identified the following advantages of contracting out: better protection against fluctuations in state agency budgets, the ability to standardize services in county-administered systems, and the avoidance of the stigma that adoptive parents might feel when approaching the child welfare system for PAS.

The parent focus groups suggested that that some level of post adoption support should be maintained within public child welfare agencies. Because most states expected adoption workers to be accessible to adoptive families for at least a limited time, and because of their association with the child, adoption workers were likely to be contacted as the first responder for families in need. However, families participating in focus groups reported that adoption workers often lacked interest in their ongoing welfare and expressed surprisingly negative attitudes when they returned with difficulties. Some PAS programs were addressing this problem by offering training in adoption issues to public agency workers.

Several of the case-study states consciously worked to make their PAS program consumer-driven, and all provide families with an array of services from which to choose. Although adoptive parents did not specifically mention these efforts, it was clear that they had taken advantage of the flexibility. Parents in the focus groups cited using a variety of PAS.

Although programs shared the goal of making services available statewide, each state reported on the challenges of making services truly accessible in rural areas. Regional service models may be somewhat better suited to this challenge. However, considerable barriers remain to delivery of services in rural areas. These include the scarcity of mental health services, difficulty in gathering adequate participation for a training or support group, and increased travel time for program staff. PAS programs might want to consider new communication technologies for parent support and perhaps for training needs.

Services Offered

Across the five case-study states, core services showed some consistency; most included information and referral, respite, counseling, support groups, and education and training for parents and professionals. Tutoring and residential treatment were offered in only one of the five states. The variety with which states addressed these core services reflects considerable creativity in program design and commitment to adapting service delivery to local conditions.

Both cost and the difficulty of finding adoption-competent providers limited the provision of respite care and therapeutic counseling. Providers tried increasing the types of respite, from weekend outings to simultaneous support groups for parents and children. However, parents reported that their children might need more specialized attention depending on their age or special needs. Providers also encountered difficulties in finding and paying for family-specific respite care acceptable to parents and funding agencies.

SUBSIDIES AND OTHER FORMS OF SUPPORTS

A planning process that encompassed subsidies and existing service delivery systems as well as PAS programs would be challenging, requiring coordination among agencies involved in health, mental health, education, and post adoption services. However, comprehensive planning could offer states more efficient use of their resources while improving the delivery of services to adoptive families.

EVALUATION

Due to several hurdles, formal evaluations of PAS programs were not commonplace. While states were collecting data on the number of clients served and service usage, evaluations of client characteristics, satisfaction with services, and PAS outcomes were more limited by inadequate methods, concerns about burden on staff and families, and lack of set-aside evaluation resources from program funders. The most rigorous evaluations were those conducted by external evaluators.

The newness of PAS as a service delivery model is a challenge to evaluation. In a new arena, program models, service offerings, and service delivery strategies are subject to ongoing adaptation based on experience. Tailoring the program takes precedence over maintaining consistent implementation. As the field matures, however, the potential usefulness of evaluation increases. With data from strong evaluations, the experience of these five states could provide needed guidance to other jurisdictions currently considering or developing PAS programs.

CONCLUSION

This case study highlighted the capacity of states to develop PAS programs and to serve adoptive families with a wide array of services. Critical to state planning for formal PAS are data on the estimated level of need and an understanding of the relationship between PAS and existing systems of supports and services  including adoption subsidy  available to these families prior to and after finalization of the adoption. Analysis of client tracking and service usage at the regional and state level also is important to planning after programs are operational. Overcoming barriers to formal research and evaluation of PAS programs would greatly increase a foundation of model programs and best practices.