Adopted Children with Special Health Care Needs: Characteristics, Health, and Health Care by Adoption Type. The Changing Population of Adopted Children


Within the public child welfare field, finding adoptive families for older children and those with significant emotional and physical needs has been an emphasis in recent years (U.S. Department of Health and Human Services [US DHHS], 2005). Increasing numbers of older children and children with special health care needs are being adopted from other countries as well (Immigration and Naturalization Service 2000; Department of Homeland Security 2008).  Although these children were once considered “unadoptable,” policy and practice have evolved to seek homes for every child in need of a family (Bower, no date).

There have been significant changes in the sources from which children have been adopted in recent years.  The number of adoptions from foster care and international sources grew substantially, while domestic adoptions from other sources declined (Child Welfare Information Gateway, 2004b; U.S. Department of State, 2008). As a result, between 1992 and 2001, private, independent and kinship adoptions declined from 77% of all new adoptions to 46%, while public agency (i.e., foster care) adoptions grew from 18% to 39% and international adoptions grew from 5% to 15%.  Approximately 127,000 children were adopted in each year (Child Welfare Information Gateway, 2004b).  Other sources, categorizing adoption types somewhat differently and comparing different years, show a similar change in distribution among adoption types, with foster care and international adoptions making up a much larger share of all adoptions than they did previously (Placek, 2007).

The changing mix of adoption types has been accompanied by changing demographic characteristics of the children adopted.  Children adopted internationally and from foster care are more often from minority groups and are older than children adopted domestically from sources other than foster care (Howard, Smith and Ryan 2004).  Children adopted internationally are divided approximately evenly between infants and children between the ages of 1 and 4 at the time of the adoption (40% and 43%, respectively, in 2007), although the proportion of children adopted annually at age 6 or older increased from 11% to 17% of international adoptions between 1998 and 2007 (Department of Homeland Security, 2008; Immigration and Naturalization Service, 2000).  In contrast, children are adopted from foster care at a median age of 6.6 years old (US DHHS, 2008). Private domestic adoptions, other than step-parent adoptions, which are excluded from consideration here, almost always involve infants (Evan B. Donaldson Adoption Institute, no date; Child Welfare Information Gateway, 2003). 

Adoption practice has adapted to this new situation with increased attention to families’ needs for pre-adoption preparation and post-adoption services, particularly with respect to children with special health care needs (Wind, Brooks and Barth, 2007; Grogg and Grogg, 2007). Access to mental health services for children adopted from foster care has been of particular concern (Raghavan, Inkelas, Franke, and Halfon, 2007).  Families frequently report difficulties identifying mainstream service providers familiar with the issues and needs of adopted children and adoptive families (The Casey Center for Effective Child Welfare Practice, 2003a; The Casey Center for Effective Child Welfare Practice, 2003b; Gibbs, Siebenaler and Barth, 2002).

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