Federal funds necessary but not sufficient for PAS development. There is no doubt that the growth in PAS programs has been encouraged by the recent availability of federal funding for this purpose. In the case-study states, however, advocacy by adoptive parents and program champions within state agencies or legislatures appeared to have been even more influential than the influx of federal funds. The experience for this limited set of states suggests that while federal funding may be necessary for PAS programs development, these resources did not by themselves lead to program development.
Adoptive families face disparities based on residence. Available research strongly suggests that some adoptive families need specialized supports for part or all of their childs development. However, the availability of both PAS programs and support to families through adoption subsidies varies widely among states. It does not appear that states with strong PAS programs provide less generous subsidies, or vice versa. Disparities in subsidies and services mean that childrens long-term outcomes may vary according to their state and county of residence/adoption.
Common goals, diverse strategies. All of the programs studied shared the common goal of keeping adoptive families intact, although the services they delivered in working toward this goal varied across states. More variation was seen in the ways in which programs worked to influence the service delivery environment. Most programs offered training for mental health, education, and legal professionals likely to serve adoptive families. These efforts to change delivery systems also are necessary to increase the extent to which other service delivery systems can meet the needs of adoptive families.
Eligibility restrictions limit program impact. Three of the five states in this study restricted eligibility for at least some of their services to families who had adopted from their states child welfare system. Although restrictions may be necessary to conserve scarce program resources, this policy raises two concerns. First, the effort to increase the rate of adoptions from foster care will be hampered to some degree if families who subsequently move across state lines know they will have limited access to PAS. Second, limiting services for families who have adopted privately or from other states may increase their eventual risk of needing high-cost services. PAS programs may be more effective in both preserving adoptive families and encouraging adoptions from foster care if they are able to serve all adoptive families. Only one of the case-study states offered PAS to families prior to legal adoption, although many providers and parents identified this as a need.
Most programs contracted out by states. Each of the states in the case study contracted out its PAS program to providers who delivered services either statewide or regionally, and the ILSU survey suggests that this is the dominant model nationally. State adoption program managers identified several advantages to this model, including better protection against fluctuations in state agency budgets, the ability to standardize services throughout the state, and the avoidance of the stigma many adoptive parents feel in approaching the child welfare agency for PAS.
Serving rural families remains challenging. States consciously worked to make their PAS programs consumer-driven, providing families with an array of services from which to choose. Although adoptive parents did not specifically mention these consumer-driven efforts, it was clear that they had taken advantage of the flexibility. Although PAS programs shared the goal of making services available statewide, coordinators reported difficulty in making services truly accessible in rural areas. Barriers to delivery of services in rural areas include the scarcity of mental health services, difficulty in gathering participants for trainings or support groups, and increased travel time for program staff. New communication technologies, such as the online support group in Virginia, may be a useful strategy.
Support needed from child welfare system as well as PAS providers. While many states choose to contract out PAS services, some level of post-adoption support should be maintained within public child welfare agencies. Adoption workers typically remain accessible to adoptive families for some time after finalization, and many families will turn to adoption workers as the first responders. However, adoptive families reported that adoption workers often lacked interest in their ongoing welfare or expressed surprisingly negative attitudes toward families who returned with difficulties. Some PAS programs in the case-study states were addressing this issue by offering training in adoption issues to public agency workers. If families are to feel confident about support from the system, system support should be consistently communicated to them at any point of entry to PAS, even if the content of the interaction consists only of a referral to the PAS program.
Services adapted to local conditions. The case-study states were fairly consistent in offering a core set of services (information and referral, education and training, support groups, respite, and counseling). Within this core, the variety with which states addressed these core services reflects considerable creativity in program design and commitment to adapting service delivery to local conditions. It also suggests the potential usefulness of systematic program evaluation in shedding light on which service delivery approaches work best under various circumstances.
Respite care highly valued but difficult to provide. Respite care appears to be a particularly challenging need to address. Families consistently reported it as a need in the literature, in state needs assessments, and in these focus groups and states have tried a variety of approaches in providing respite. Two states offered respite in congregate settings, but this model may not meet the needs of many children whose parents were most in need of respite. States struggled with the challenges of finding or training providers who were acceptable both to parents and funding agencies. For the most part, limitations on funding meant that only a very limited level of relief was available for parents who were dealing with extremely challenging children.
PAS often used in crisis mode. Both PAS providers and focus group participants reported that PAS programs are more often used during times of crisis than as a preventive measure. A better understanding of the type of need and extent of need for both preventive and crisis services could improve service planning and provide impetus for better coordination and referral systems between adoption workers and PAS providers.
PAS planning must encompass subsidies and existing services. Adoptive parents often face a patchwork of services and supports, from which essential pieces may be missing. A comprehensive approach to serving adoptive families would encompass subsidies and existing service delivery systems, as well as PAS programs. Such a network would be challenging to develop, requiring coordination among agencies involved in health, mental health, education, and child welfare. However, comprehensive planning eventually could offer states more efficient use of their resources while improving the delivery of services to adoptive families.
(3) RTI spoke with Susan Smith, faculty and co-director, Center for Adoption Studies, ILSU; Jane Morgan, adoption specialist, U.S. DHHS, Administration for Children and Families; and Kathy Ledesma, Oregon state adoption coordinator and chair, National Association of State Adoption Programs.
(4) The 32 adoptive families represented in the focus groups had adopted 76 children, 66 of whom were from the public child welfare system.
(5) Virginia did contract separately with two providers for PAS in addition to funding a network of providers. One provider offered professional training, and the other developed respite resources.
(6) Although Oregons PAS program did not include counseling, one of the states service areas used state funding to support a Post-Adoption Family Therapy (PAFT) unit whose staff provided counseling and crisis intervention to families who adopted from the state and live in the Portland area.