- Literature Review
- Case Studies of PAS Programs
- Evaluation Issues
- Secondary Data Analysis
- Conclusions and Future Directions
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.
This summary report presents a brief description of each study component, with a concluding discussion of the current status of PAS and strategies to move the field forward.
The literature review described information available from reports and professional literature and gaps in the literature with respect to the studys research questions.
Adoptions have generally been quite stable and successful. Four studies using different methods and samples estimated disruption rates between 10 and 16 percent of adoptions. Although there has been concern that recent growth in adoptions of children from foster care will increase disruption rates, there is no evidence to support this. Most children adopted in recent years receive some form of adoption subsidies, including cash assistance, payments to service vendors, or access to health and educational services. State policies on subsidies vary widely, and there is little information on how families use subsidies to meet their needs.
Recent state-sponsored surveys suggest that substantial proportions of families adopting from foster care have relatively low incomes and that school problems are consistently rated among the most significant concerns. Researchers have identified several factors associated with increased risk of disruption, including higher parental education, higher current age of child, and childrens behavioral or emotional problems. However, most adoptive families, even those that have experienced disruptions, reported positive feelings about the adoption. Services desired by adoptive families include information, clinical services, respite care and material services such as adoption subsidies. Many parents utilize available support groups or rely on informal mentoring.
Three program models for public agency-supported PAS were identified. Ongoing involvement by a public agency adoption worker, using either child welfare or Temporary Assistance to Needy Families (TANF) funding, has the potential benefit of continuing a relationship with a worker who knows the family. However, that individual might not still be with the agency when post-adoption services are needed, and he or she may not be a specialist in providing such services. A second approach is to develop specialized post-adoption service units within the public agency to which cases can be referred. These public PAS workers can collaborate closely with the adoption worker, have excellent access to the case history information, and have access to public agency resources. A third, and increasingly widely used, model is to develop interdisciplinary teams to provide services and to provide training that improves community response. This model typically involves contracting with service providers outside the public agency.
Three federal funding streams are available to support PAS programs. The Promoting Safe and Stable Families program allows states to use up to 25 percent of their Title IV-B, Subpart 2 funds for adoption support and preservation. States that increase adoptions of children from public child welfare systems are eligible for bonuses under the Adoption Incentive Program, which can be used to increase services for adoptive families. Finally, the Adoption Opportunities program awards grants and contracts to public and private nonprofit agencies, with PAS as one of the major program areas.
Only five projects were identified as having formally assessed the performance of post-adoption services, and many of these were limited by small sample sizes and nonrandom sampling. The diversity of programs, services, and evaluation methods represented makes it impossible to generalize any assessments except to note that well-designed and evaluated programs can demonstrate positive effects.
Case studies, conducted in five states, included semistructured interviews with adoption program managers, PAS coordinators and services providers, as well as focus groups with adoptive parents.
Parents and PAS coordinators generally agreed on the type of services needed. These included respite care, information about available services, and training on adoption issues for parents and professionals, as well as mental health services with providers of parents choice. Parents also wanted comprehensive assessments with assistance in interpreting clinical information. Adoptive parents were generally satisfied with the PAS program, but they felt more was needed.
Each of the case-study PAS programs was contracted out rather than provided by public agency staff, although program structures varied. Program goals across all sites included preserving adoptive families, providing statewide services, delivering family centered services andin one statefacilitating recruitment of adoptive families. Eligibility criteria were defined in terms of adoption type. Each state served children adopted from its own public child welfare system, but states varied in eligibility for children adopted from other states, in legalized guardianship, in pre-adoptive placements, and private or international adoptions. Funding levels varied widely, with state funds and Title IV-B Subpart 2 the most common funding sources.
Each of the case-study states offered information and referral, case management, training for parents and professionals, advocacy and support groups. All states but one offered counseling and crisis intervention. Services offered by only one state program included tutoring, residential treatment, and a flexible fund that provided up to $500 to pay for services such as respite.
Each of the five states offered deferred subsidies and the opportunity to renegotiate subsidies if circumstances changed. However, many families expressed considerable frustration and confusion related to subsidies.
Conclusions based on the case studies include the following:
- Better data are needed to support planning for PAS, through either a national survey of all adoptive families or improved state-level needs assessments. Planning will be more effective if it encompasses subsidies and services provided by health, mental health, and educational systems.
- Federal funding has encouraged the growth of PAS programs, but advocacy by adoptive parents and champions within state agencies and legislatures has been critical to their development.
- States have chosen diverse strategies with which to address common goals of PAS programs. Case-study states, and many others, have chosen to contract out their PAS programs. There is not yet evaluation data to support comparisons of program models and service delivery strategies.
- Eligibility restrictions limit the potential impact of PAS programs on preserving adoptive families and reducing the need for high-cost services. They also create disparities in service access among adoptive families in different states.
- Adoptive parents appear to be satisfied with PAS programs in the case-study states, but challenges and unmet needs remain. These include service delivery in rural areas, provision of respite care, improved responsiveness by staff within child welfare agencies, and access to services before problems reach crisis proportions.
The assessment of evaluation issues drew on the literature review and case-study data to examine how PAS programs monitor their effectiveness.
The types of evaluations conducted reflect a greater emphasis on program planning and documentation than on assessment of effectiveness. Needs assessments are commonly done, although rarely published outside the sponsoring state. Most programs document the characteristics of children and families served and services delivered to some extent. Client satisfaction surveys, although frequently conducted, are subject to biased responses.
Outcome evaluations are hampered by the difficulty of demonstrating effects, the lack of clear time points at which to measure outcomes, and the lack of consensus on outcomes and measures to be followed. Outcome evaluations were most often conducted for crisis intervention and counseling, rather than less intensive services such as information and referral, or comprehensive PAS programs.
PAS evaluations have employed a variety of data collection methods. While needs assessments and satisfaction studies typically rely on surveys, documentation of clients served and services delivered is often based on case management systems, some of which are computer based. Outcome evaluations used diverse methods, including clinical instruments and assessments by parents and PAS workers.
Some evaluation barriers observed in the case-study states are similar to those seen in other service delivery arenas. These include limited funding, lack of evaluation expertise, concerns about interference with program activities and skepticism regarding the value of evaluation to program design and operation. Other barriers may be specific to PAS programs:
- limited statistical power due to the small number of families served in many programs, the rarity of outcomes such as adoption dissolution, and confounding with developmental changes as children reach adolescence;
- a philosophical preference for comprehensive, family-centered services, which are inherently more challenging to evaluate than are stand-alone, standardized interventions;
- limited data from existing administrative data systems, with no linkages to data from child welfare case records or subsidy data;
- rapidly evolving approaches, so that program refinements may be inconsistent with existing evaluation efforts; and
- lack of demand from funding agencies for evaluation and use of evidence-based practice.
Although barriers appear to predominate, some facilitators to evaluation were noted. These include providers enthusiastic commitment to program improvement, the likelihood of cooperation among adoptive families in evaluations, and the availability of applicable findings from other areas of child and family services.
Recommended strategies for improving PAS evaluation include the development of fundamental evaluation tools to reduce evaluation costs and increase data comparability. A second set of recommendations addresses strategies to reduce barriers to evaluation within PAS programs.
This portion of the study explored whether administrative data from two states could be used to better understand the patterns of subsidy use and to describe the disruption, dissolution, and displacement of adoptions.
Our understanding of the relationship between adoption subsidies and other post-adoption services is limited. Little is known abut pathways on and off subsidies, and reasons for subsidy changes. States and localities vary in the organization of subsidy data, as well as in subsidy policy. Although administrative data rarely address disruption, dissolution, and displacement, earlier work matching adoptions to foster care entries provided a model for work in this study.
Adoption dissolution was examined by tracking adopted children to see if they experienced out-of-home placement, and by examining foster care entries for previously adopted children. Although neither approach supported estimation of a dissolution rate, they suggest that dissolution risk is greatest within three years of adoption and for older children. Foster care records were also examined to identify adoption disruptions among children who were placed for adoption but ultimately not adopted. Limited data on case disposition and the lack of identification of children adopted by foster parents made it impossible to estimate disruption rates.
Analysis of adoption subsidies and vendor payments for services received by adopted children show that nearly all children with adoption assistance received subsidies, and 61 percent also received vendor payments. Nearly all subsidy payments began within six months of the adoption decree, and subsidies increased as children aged. Slightly more than half of children had no change in their subsidy amounts. Children under five years of age were most likely to have increases. Vendor payments typically occurred soon after finalization, with an average of four post-finalization payments in amounts ranging up to $2,000.
Data from a longitudinal survey of adopted children showed that subsidies were related to behavioral problems. Youth receiving subsidies throughout the study period were more likely to have Behavior Problem Index (BPI) scores in the clinical range than were those who did not receive subsidies.
Analysis of administrative data from the Adoption Assistance Program showed that subsidies are generally stable. Nearly three-quarters of cases had one or two payment changes during the 11 years analyzed; most of these were associated with required biannual recertifications. The average amount of payment change was $95 monthly, with average payment changes increasing in amount as the number of payment changes increased. Payment changes for residential care generally occurred only after several payment changes for needed services.
Multivariate analyses of payment changes found that the likelihood of a payment change and the amount of increase are associated with higher maternal education and income in the middle neither the lowest nor the highest range. These models did not include data on child problems, which should be strongly related to payment increases.
These analyses serve several purposes. They offer (1) a sample of the kinds of administrative data that are available to better understand post-adoption services and supports, (2) some ideas about the kinds of analyses that can be done to bring meaning to these data, and (3) some substantive findings about adoption subsidies and how they are used. Finally, they offer ideas about modifications to administrative data systems that could improve their information yield about adoption.
Considering the rapid and ongoing development of the field of post-adoption services, none of the inquiries conducted within this study can be considered definitive. Many promising programs have yet to be documented, our case studies included only a few of the well-regarded programs in operation, and administrative data have not yet achieved their potential value. From this preliminary assessment, however, we suggest a framework of strategies to move the field forward: research, policy, and practice directions for consideration at the federal, state, and program levels.
- Compile better information about patterns of disruption, dissolution, and displacement to help PAS programs reach out to, and tailor their services for, those most at risk.
- Develop a minimum program data set and standardized needs assessment instrument for voluntary use by states and programs, to facilitate data collection start-up and improve data comparability.
- Improve data on the use of adoption subsidies, including how they are adjusted in response to family needs and how they interface with PAS programs.
- Explore adoptive families perspective on the range of services they receive, including those supported with adoption subsidies, those provided by PAS programs, and those received through other service delivery systems.
- Build a base of lessons learned to facilitate sharing of knowledge among programs and to guide new PAS initiatives.
- Expand the knowledge base on the needs and experience of all adoptive families, including those formed by adoption foster care, relative adoptions, private adoptions, adoptions from overseas, and those not yet legally finalized.
- Document the mix of federal, state, and private funding streams being used to support PAS, and their relative advantages in terms of availability and sustainability.
- Develop effective strategies, including the use of newer technologies, for putting families in touch with existing resources and linking to services before problems reach crisis proportions.
- Select evidence-based intervention models for adaptation to the needs of adoptive families and tested with rigorous evaluations.
- Track the impact of efforts to increase the adoption competence of providers in health, education, and mental health settings, in terms of adoptive families perceptions of service and the shift in demands on PAS programs.
- Improve evaluation of PAS programs by providing tools and resources for programs use and incentives to increase evaluation efforts.
The questions and tasks outlined in the previous sections, although ambitious and broad-ranging, could be addressed with a fairly modest set of interrelated research and evaluation activities:
- a population-based survey of adoptive families, including data on family functioning and needs within the full range of adoptive families;
- an evaluation tool kit, including standardized service classifications, model data sets, and recommended measures and instruments;
- evidence-based models based on interventions proven effective with similar populations;
- in-depth evaluations of well-regarded PAS programs using qualitative and quantitative analysis of program organization, cost, and effectiveness;
- evaluation incentives and technical assistance to reduce the burden of evaluation while building staff capacity; and
- a web-based compendium of PAS activities across jurisdictions, tracking services, program models, funding streams, and promising developments.