Core Clinical Issues in Foster Care and Adoption

This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during your presentation • In Slide Show, click on the right mouse button • Select “Meeting Minder” • Select the “Action Items” tab • Type in action items as they come up • Click OK to dismiss this box • This will automatically create an Action Item slide at the end of your presentation with your points entered. Core Clinical Issues in Foster Care and Adoption Advanced Practice Certificate Program in Adoption and Foster Care Competency Baton Rouge, LA November 18-19, 2010

Every clinician is in post adoption practice – Ann Hartman

Language in the Context of Foster Care and Adoption • Members of the Foster Care/Adoption Constellation - Birth Parent/Family – Mothers and Fathers extended family, grandparents - Adopted/Foster Person - Adoptive/Foster Parent/Family

An Overview of Some Foster Care Issues • The implications and consequences of abuse, neglect, and placement in foster care on early brain development; • The importance and challenges of establishing a child's attachment to caregivers;

An Overview of Some Foster Care Issues • The importance of considering a child's changing sense of time in all aspects of the foster care experience; • The child's response to stress, especially as related to multiple transitions.

An Overview of Some Foster Care Issues • Parental roles and kinship care; • Parent-child contact/frequency of visits;

An Overview of Some Foster Care Issues • Permanency decision-making/timeliness, • Components of comprehensive assessment and treatment of a child's development and mental health needs.

An Overview of Some Foster Care/Adoption Issues • Careful matching to avoid “detection” • Child’s status hidden as were parent’s infertility issues • Birth mother excluded from knowing where her child was placed – encouraged to “get on with her life” • Needs of birth fathers rarely addressed

An Overview of Some Foster Care/ Adoption Issues • Foster/Adopted parents received very little information about the child or his/her history • Help the family “claim” the child as their own • Workers had to find the “right” family • Many workers used their “own values” to guide this process

An Overview of Some Foster Care/Adoption Issues • Deserving Foster/Adoptive Parents were married couples, infertility issues, financially stable, usually white • Foster parents, single parents, non married couples, relatives not deemed appropriate as adoption resources • Secrecy was key to success

An Overview of Some Foster Care/Adoption Issues • Worker is “expert;” • Birth family is “dangerous or deviant;” • Adoptive family is “appropriate;” • Child is best served as if they were born into the family

Historical ShiftsMyths that Continue • Paradigm shift from secrecy to openness • Foster Care/Adoption is the same as being in a birth family • Triad members need to be protected • Everyone should move on • Win/Win/Win situation • Genetic information is not relevant

Foster/Adoptive Families and Social Services • What happens after finalization? • Is permanency a panacea? • Most commonly cited identified need by professionals and parents was for qualified, adoption sensitive mental health professionals

Adoptive Families and Social Services Services sought in one Illinois study were: • Individual counseling for the child (68%) • Family counseling (35%) • Individual Counseling for the parent(s) (31%) • Parent support groups (15%) • Support groups for children (10%) • 26% of children were hospitalized • 10% had formal placement outside of home

Families Report that Helping Professionals: • View family as pathological, sometimes questioning parent’s motivation in adoption; • Imply that the parent is blaming the child for family problems when the parent raises the need to discuss adoption as part of the treatment; • Lack of awareness of cross racially, older children and those adopted in sibling groups;

Families Report that Helping Professionals: • Advise parents to avoid talking about adoption as it will only “stir things up;” • Address child behavior problems through behavioral methods without exploring how these behaviors may be connected to past deprivation, trauma or adoption; • Urge hospitalization without understanding the underlying effects of separation for children affected by adoption;

Families Report that Helping Professionals: • Failed to understand the child welfare system; • Suggest that the parents “just got a bad one” and urge families to return the child to the state.

Shawn’s Family Adoptive parents (Pete and Mary Simmons, ages 37 & 39 years, married ten years) became foster parents of Shawn when he was twelve years-old, he is now 15 years old. Shawn was born to a young teen-aged mother who left him with her own mother, who cared for him for eight years and then upon her death, he was placed in the foster care system. Timothy was neglected by grandmother who also abused drugs. Many reports of neglect were filed with the parish. At the time of his first placement, Timothy was described by the foster parents as depressed, sad, and anxious – unable to tolerate being hugged. Birth mother voluntarily relinquished her parental rights, and the rights of birth father (who had not been involved in Shawn’s life) were terminated. The first foster parents were unwilling to adopt Shawn, once he had been freed up for adoption. The Simmons family was identified as a good match for Timothy – they were interested in adopting a teen, Mr. Simmon’s knew Shawn from the high school where he taught Science and they had a good relationship.

Shawn’s Family con’t • The Simmon’s are concerned about the recent behavioral difficulties shown by Shawn – initially he seemed to be so happy in his new home, now he is challenging their authority, coming in late, and possibly experimenting with alcohol and other substances. They are particularly concerned about his recent refusal to go to school. • Adoptive Parents’ Brief Report of Recent History: The Simmon’s describe the adoption of Timothy as a “gift” since they had struggled with fertility issues for ten years before becoming his foster parents. Mr. Simmon felt that since he knew Shawn before he came to live with them that Shawn would respond well to their family. They felt that since his life had been so hard, that they would not lay down too many rules for him. • Onset of Problems with Shawn: The problems began when Shawn felt junior high and entered high school. • Therapeutic Intervention:

Shawn’s Family con’t • Therapeutic Intervention: Shawn was referred by a high school guidance counselor to a therapist in the community. The therapist had a psychoanalytical orientation, never asked to see the parents separately or with Shawn, and never asked about Shawn’s birth family. Shawn was referred to weekly drug testing, after school help, and after three weeks of sessions refused to go to therapy.

Family Expectations: • What was the family’s initial experience of adoption? • What were the parent’s dreams? • When did the dreams begin to disintegrate? • How, specifically, did the reality differ from the dream? • What were the consequences of adopting this child?

Family Expectations: • How did Shawn behave in his adoptive family? • How did Shawn’s parents originally interpret this behavior? • How did the first professional react? • How did the parents explain Shawn’s behavior? • What help was offered?

Context of Adoption in Therapy When adoption comes into play • Presenting problem • Not presenting problem but primary issue • Additional layer of complexity to an issue

Pitfalls for Therapists • All or nothing • Therapist’s counter-transference • The best solution is to disrupt the adoption • Adoption work is short-term

Family-Systems Approach • Collaborative • Non-pathological model • Doesn’t foster secret/collusive relationships- in the spirit of full and open disclosure • Includes all triad members: birth and adoptive parents and adopted persons • Includes the family system in the process

Behavioral Issues and Underlying Emotional Issues: • Attachment, Separation, & Grief • Identity Issues and the Need to Search • Depression • PTSD

Core Issues of Adoption • Adoption is Different Than Birth • Adoption is a Life Long Process • The Effects of Loss

Core Issues of Adoption • The Effects of Previous Maltreatment on Family Functioning • Issues in Attachment • Identity Issues • Mastery and Control Issues

Core Issues of Adoption Adoption is Different Than Birth • Challenges to family functioning and child well-being – time, biology, history • “Real” parents verses adoptive parents • Parents need to be seen as allies in the therapeutic process

Core Issues of Adoption Adoption is a Life Long Process • A process is not a one time event, the adoption itself is a one time event, the effects of living with adoption are life long • Adolescence, marriage, child rearing, separation are huge markers

Core Issues of Adoption The Effects of Loss • Central to adoption process • Adoption is not possible without loss • Adopted person has loss – genetic identity, loss of relationships with emotionally significant objects • Adopted family has loss – infertility; loss of continuity with biological lineage; • Birth parents have loss – surrender of child; loss of information about the child

Core Issues of Adoption The Effects of Loss • Loss is healed through grief • Grief is revisited over time • Developmental tasks trigger loss – adolescence, marriage, college, childbirth • Some behavior in adopted persons viewed as pathological may actually be maladaptive grieving – i.e., concepts of rejection

Core Issues of Adoption The Effects of Previous Maltreatment on Family Functioning • Maltreatment, trauma, prenatal exposure to substances, deprivation, lack of stimulation; nutritional deprivation; and many others • PTSD trauma • Sexual abuse • Physical abuse

Core Issues of Adoption The Effects of Previous Maltreatment on Family Functioning “This is my dilemma. When I think of the abuses heaped on my child by her birth parents, and all the struggles she had as a result, it is hard for me not to hate them for the harm they caused. On the other hand, if they hadn’t hurt her, she wouldn’t have been taken away, and she wouldn’t be my daughter. And if it weren’t for them, she wouldn’t look the way she does, have many of the talents that she does. It’s complicated.” – Adopted Mom

Core Issues of Adoption Issues in Attachment • Cycle of need and response • Infant basic needs/keep caretaker close • FAS – attachment challenges • Trust, intimacy, caretaker dependability

Core Issues of Adoption Issues in Attachment • Dependency needs may be greater than parent’s ability – black hole – sieve syndrome • Attachment is on a continuum • Attachment is a two way street • Ability to attach complicated by physical or temperamental differences

Core Issues of Adoption Issues in Attachment Adoptive parents with attachment issues may believe that such a mismatch would never have occurred with a child born to them.

Core Issues of Adoption Identity Issues • Both adopted parents and adopted persons must incorporate “being adopted” into their sense of self. • Who am I? • Where do I come from? • How does this impact on my life? • Openness is key • Be comfortable with ambiguity

Core Issues of Adoption Mastery and Control Issues • Basic need for competence and personal power in one’s life • Control over one’s life; control over creating family; control over one’s child by birth • Control battles are common in adoptive families as each party seeks to gain control over their lives and situations

Adopted Person Fear ultimate abandonment; loss biological, genetic, cultural, history. Issues of holding on and letting go Adoptive Parent Infertility equated with loss of self & immortality. Issues of entitlement lead to fear of loss of child and overprotection Core Issues of AdoptionLoss

Birth Parent Ruminate about lost child. Initial loss merges with other life events; leads to social isolation; changes in body and self-image; relationship losses Core Issues of AdoptionLoss

Adopted Person Personalize placement of adoption as rejection; issues of self-esteem; can only be chosen if first rejected. Anticipate rejection; mis-perceive situations. Adoptive Parent Ostracized because of procreation difficulties; may scapegoat partner; expect rejection; may expel adopted person to avoid anticipated rejection. Core Issues of AdoptionRejection

Birth Parent Reject selves as irresponsible, unworthy because they allowed adoption; turn these feelings against self as deserving rejection; come to expect and causes rejection Core Issues of AdoptionRejection

Adopted Person Deserving of misfortune’ shame of being different; may take defensive stance/anger. Adoptive Parent Shame of infertility; may believe childlessness is curse or punishment; religious crisis. Core Issues of AdoptionGuilt/Shame

Birth Parent Party to guilty secret; shame/guilt for placing child; judged by others; double bind; not OK to keep child and not OK to place them either. Core Issues of AdoptionGuilt/Shame

Adopted Person Grief may be overlooked in childhood; blocked by adult leading to depression or acting out; may grieve lack of fit in adoptive family. Adoptive Parent Must grieve loss of fantasy child; unresolved grief may block attachment to adopted person; may experience adopted person’s grief as rejection. Core Issues of AdoptionGrief

Birth Parent Grief is acceptable only for a short period but may be delayed 10-15 years; lack rituals for mourning; sense of shame blocks grief work. Core Issues of AdoptionGrief

Adopted Person Deficits in identity may impede integration of identity; may see search for identity in early pregnancies; extreme behaviors in order to create sense of belonging. Adoptive Parent Experiences diminished continuity of self; they are not “real” parents. Core Issues of AdoptionIdentity

Identity Adopted Person Issues • More identities to process • Over identifying more with one family • Fantasizing, distracted in school, angry • Feeling marginalized • Lack of identity markers • Complicates independence phase

Control

Core Clinical Issues in Foster Care and Adoption