Adoption Policy Implications: Strategies for Improving Behavioral Health Outcomes

1. Adoption Policy ImplicationsPresented at the meeting on Domestic and International Adoption: Strategies to Improve Behavioral Health Outcomes for Youth and Families at the Substance Abuse and Mental Health Services AdministrationAugust 30th, 2012 Richard P. Barth University of Maryland School of Social Work rbarth@ssw.umaryland.edu

2. What Does the Research Tell Us? • The number of domestic adoptions is at historic highs (international adoptions are down in number • Most adoptions are preserved • The most likely outcome for any domestic adoption is that it will be difficult but “successful.” • Many adoptions are troubled • The intersection of the great expansion of adoptions and the level of challenge they represent creates a point of great challenge and expense

3. History of Adoption Disruption Research • 3 Studies were funded in 1984 under a Children’s Bureau RFP • The findings were similar—about 14% of adoptions disrupt within five years • Two better disruption studies have been completed in IL, showing that the disruption rate remains quite consistent despite the growth of older child adoptions from about 20K a year in 1980 to about 50K, now. • Yet, questions about adoption disruptions continue to be VERY common • None of the existing longitudinal studies (i.e., NSFG, NSCAW) will tell us much about adoption disruption; nor will NSAP • A new series of adoption disruption studies needs to be supported with a 30th Anniversary Disruption RFA, PA, or RFP.

4. Concern is Larger than Adoption Disruption: It’s a Wide Array of “Untoward Outcomes” Child and family require intensive clinical services (distressed adoption) Child fails to achieve reasonable developmental outcomes Child “needs” residential treatment (displacement) Child runs away (displacement) Adoption is dissolved after legalization (dissolution) Child is abused by adoptive parent(s) Child harms adoptive parent(s) or family member(s) Child is killed by adoptive parent(s)

5. Types of Research Needed • Simple Description • We do not know the age-at-adoption rates for any of the above listed “untoward outcome” indicators • We do not know how many children who were foster children die after adoption each year (even though we could easily learn that) • Applying Standard EBPs to Adopted Ch/Families • We assume that adopted children are more different than similar to other children and adoption interventions have to be specialized--but we don’t know

6. Mechanisms for the Path to Untoward Outcomes • We have some good ideas about the risk and protective factors regarding adoptions that end in untoward outcomes • We could certainly benefit from better understanding of the rates of adoption displacement, disruption, use of clinical and residential services, dissolution, and early death BUT FAR MORE IMPORTANTLY! • We have almost no intervention science about what will reduce untoward adoption outcomes, per se • This is challenging, because adopted children have diverse characteristics, but could be done based on some promising research on reducing placement instability among foster youth (e.g., KEEP)

7. Residential Post-Adoption Services • Adopted children have high rates of use of residential care and this has a VERY high cost • What benefits accrue from these placements, if any? (Residential treatment research suggests that the average benefit is nil, at best.) • If they are insignificant, what can we do to provide more effective alternatives for adoptive parents and children? • If they are significant can access to them be expanded? • Should the federal government pay for these services, as they do for foster children involved with the Title IVE program?

8. Starting at the Beginning:Improving Adoption Home Studies • Are we permitting an unnecessarily high rate of high risk families to adopt? • Would a more rigorous, common home study process help reduce later untoward outcomes? • Would a common, well-engineered home study facilitate safer inter-county, inter-state, and inter-country adoptions?

9. From Home Study to Placement • Home studies address adoptive applicant risks, interests, and resources • They, largely, generate little useful information to agencies seeking to match children to them • Little attention is paid to applicant’s ability to effectively respond to behavioral health or educational issues or to their expectations for the adoption. • Research needed to “match” families to children is almost totally lacking; the procedures are quite ad hoc. • Standardization of Home Studies is only the beginning of what needs standardization

10. Could we Reduce The Harms To Children With Better Monitoring? • How are the provisions of the Fostering Connections to Success and Increasing Adoptions Act requiring school enrollment (for subsidy renewal) working? • For higher risk placements (perhaps calibrated with SAFE) should we have a Family Check Up procedure?

11. Can We Better Mine CWS & Adoption Data to Signal Disruption Risk:? • How can we better mine existing data to help identify adoptions that should be avoided or supported • Can home study data provide guidance for post-placement services? • For example, if the family just barely met the criteria for a placement could a longer post-adoption supervision period be required? • Is there data from adoption subsidies that could be better mined to understand who is headed for an adoption disruption? • For example, if a family is moving often (as evinced by many address changes), is this a signal of the family’s distress • Are there other data from the foster care records or other records about the family that could help explain whether adoptions will succeed? • E.g., parents who were involved with juvenile services are at elevated risk of killing their children—should this history be understood before a parent with such a history adopts a child?

12. Conclusions • Prevention of Untoward Adoption Outcomes Requires Understanding the Trajectories of those Problems • When do they start? • What seems to interrupt them? • How much do parental expectations influence them? • Are standard preventive interventions effective with adoptive families?

13. Conclusions • Interventions to Reduce Untoward Adoption Outcomes are Nascent • Further expansion of post-adoption services should, largely, wait for evidence that we have effective interventions • The first ones to be tested should be those: • that worked with foster children • based on theories effective in the general population • The outcomes to be studied should be broadly conceived

14. Conclusions The USA is the world leader in adoption—when we fail to protect and promote the well-being of children who are adopted, here, we diminish the opportunities of every child who needs adoption This creates a greater obligation to understand what we are doing and to put our best intervention science to work on this effort

15. Partial References Barth, R. P., & Berry, M. (1988). Adoption and disruption: Rates, risks and resources. New York: Aldine. Barth, R.P., & Hodorowicz, M. T. (2011) Foster and adopted children who die from filicide: What can we learn and what can we do? Adoption Quarterly. 14 (2), 85-106. Crea, T. M., Barth, R. P., Chintapalli, L. K., & Buchanan, R. L. (2009). The implementation and expansion of SAFE: Frontline responses and the transfer of technology to practice. [Article]. Children and Youth Services Review, 31(8), 903-910. Crea, T. M., Griffin, A., & Barth, R. P. (2011). The intersection of home study assessments and child specific recruitment: the performance of home studies in practice. [Article]. Children and Youth Services Review, 33(1), 28-33. Gill, A., Hyde, L., Shaw, D., Dishion, T., & Wilson, M. (2008). The Family Check-Up in Early Childhood: A Case Study of Intervention Process and Change. [Article]. Journal of Clinical Child and Adolescent Psychology, 37(4), 893-904. Price, J. M., Chamberlain, P., Landsverk, J., & Reid, J. (2009). KEEP foster-parent training intervention: model description and effectiveness. [Article]. Child & Family Social Work, 14(2), 233-242. Van Ryzin, M. J., Stormshak, E. A., & Dishion, T. J. (2012). Engaging Parents in the Family Check-Up in Middle School: Longitudinal Effects on Family Conflict and Problem Behavior Through the High School Transition. Journal of 50(6), 627-633.