|How are PAS programs working to change the larger service delivery system?|
What we know: In addition to services provided by PAS programs, families may be involved with contract agencies, private clinicians contracting with the public agency, mental health clinics, or private-sector providers. Many PAS programs are attempting to improve the adoption competence of community providers who interact with or treat adoptive families.
Training may be designed to increase the sensitivity of professionals such as school or medical personnel who come into contact with adopted children and families. More intensive efforts involve training mental health workers to increase their competence in working with adoptive families. The University of Washington, in collaboration with the state, offers a postgraduate certificate for mental health professionals working with adoptive families, and Casey Family Services provides extensive training to professionals in New England states. Other states offer training in specific therapeutic approaches, such as Georgias training for mental health professionals in attachment therapy. However, public agencies may hesitate to train private providers whose fees are not reimbursable by Medicaid. Some may also question whether turnover in county mental health agencies limits the impact of staff training.
States may also influence the service delivery system by their choice of which services are delivered through the PAS program. Oregon has elected not to provide counseling through its PAS program, in part because county mental health offices are intended to be the point of entry for mental health services.
Moving forward: To inform system change efforts, information is needed on how families experience services they receive from community resources, in general, and from clinicians with experience and training in adoption issues. Understanding the stability of efforts to sensitize communities and mental health systems will be necessary in assessing the impact of training efforts. Questions in this area include the following:
- Do professionals being trained find the effort useful?
- Can the impact of training be quantified in terms of increases in referrals or families served over time?
- Do families perceive a difference in their treatment when working with practitioners who have received training in adoption issues?
- Does training reduce the need for PAS programs to provide certain services, such as advocacy on behalf of parents at schools or adoption-specific therapy?