The ties that bind

Neglect of the therapeutic needs of adopted children is one  of the factors that leads to placement breakdowns, experience has taught Rene Potgieter

Adoption breakdowns are sadly all too common. Most children who are adopted have previously been in local authority care. They have often suffered neglect and abuse prior to being taken into care. These experiences, as well as losses suffered in the past, are bound to affect them after being placed for adoption.

Children act out their internal distress with multiple emotional and behavioural difficulties which have a huge impact on their relationship with their adopters.1 Although adoption support services are available, delays and inefficient help can cause more intense problems. Very often, despite all these resources, adoptions still break down, adopters are left hurt and disillusioned and children are returned to the local authority with even more intense emotional and behavioural problems.

To combat these problems, our adoption team at Doncaster undertook research to determine the problems responsible for the adoption breakdowns and several were identified. We found that children were placed for adoption with the expectation that they would form attachments to their adopters, but without any assessment as to whether they would be able to cope with committing to a long-term relationship.

Adopters were not sufficiently trained to prepare them for the reality of parenting a child with emotional and behavioural difficulties who had suffered from abuse, had multiple losses and might present attachment problems. Adopters were ill-informed about the realities of the abuse that children had suffered and would often comment after the breakdown that they were not fully aware of the child’s background.

Most adopters were unaware of the child’s therapeutic needs and were oblivious to the fact that they would need therapy. Unfortunately the child’s social worker was often also unaware of the therapeutic needs that surfaced post-placement. And once the child started to display difficult behaviour in the adoptive placement, there were long delays in gaining the help of effective therapeutic services.

The Doncaster team introduced several measures to address these problems. As adoption is different from normal parenting, an advanced training course was devised to prepare adopters for dealing with attachment problems, as well as previous trauma the child may have suffered as this is likely to resurface once the child feels safe within the adoptive family. They are trained, not to be the parents of the adoptive child, but to commit to the task of reparenting the child.(1),(2)

An in-house therapeutic team was established as part of the adoption support service to carry out a therapeutic assessment of the needs of each child prior to finding a family. This also determines whether the child would be able to commit to the expectations of the adopters on an emotional level. Some children can be placed, with no problems, some children should not be adopted, some children need therapeutic input before being placed for adoption, and some children need therapeutic input starting during introductions and continuing post-placement. It also indicates whether a child needs to be placed on their own or with siblings.

The therapeutic needs of the child are also determined through the therapeutic assessment and this has resulted in a more accurate profile. Consequently, there have been fewer inquiries per child, but more devoted, realistic and committed adopters for that specific child.

An adoption forum was established to do the matching with the most suitable adopter(s) prior to going before the adoption panel. The forum consists of the adoption team and the therapist as well as the child’s social worker.

All the needs of the child are identified and written down. If possible, information on at least three adoptive families is written down alongside the child’s needs. The child is matched by excluding families that would not be best suited to meet their needs.

Life Appreciation Days are now held. All professionals who had contact with each child over the period that they were looked after by the local authority would be invited to this day to share their personal experiences and perceptions about the child. Each participant shares information and is encouraged to give a realistic picture of the child, including any negative information. After all the information is shared, any significant information that could adversely have an impact on the adoptive placement is discussed in the light of the child’s known therapeutic needs.

The adoption support plan now includes ways of addressing the child’s therapeutic needs post-placement. Therapeutic services in the placement area are identified so that they can start immediately post-placement.

If the type of therapy recommended for a child and adopters is attachment therapy and that is not available in the area, the adopters are excluded from the beginning. Adopters in the local authority’s vicinity have access to the in-house therapeutic service. This therapeutic input will start pre-placement in order to provide the adopters with knowledge of therapeutic parenting and therapeutic preparation of the child pre-placement.

During the adoption review, the therapist gives feedback on the relationship between the adopters and the child. Any further concerns on a therapeutic level are addressed immediately.
A recent review of the service has indicated that no adoption breakdowns have occurred for children placed during the past two and a half years. It is evident that adopters are now well prepared, particularly through the realistic information they receive at the Life Appreciation Day, and the therapeutic assessment that prepares them for the reality of the task at hand.

Early therapeutic input helps children understand that the adopters have a better understanding of their needs and this encourages attachment. This intervention also prevents resentment building up that would inevitably cause more damage in the relationship and would take a more intense therapeutic input to rectify.

Rene Potgieter is the manager of the therapeutic team for the adoption team at Doncaster Council. She has a background in social work, training and therapy and has worked with children and families for 23 years.

Training and learning
The author has provided questions about this article to guide discussion in teams. These can be viewed at www.communitycare.co.uk/prtl and individuals’ learning from the discussion can be registered on a free, password-protected training log held on the site. This is a service from Community Care for all GSCC-registered professionals.

Abstract
Groundbreaking work has been done by an adoption team to reduce adoption breakdowns at one local authority. Changes to practice were based on research into previous adoption breakdowns. A recent review of this new way of working indicated a reduction in breakdowns from 10 in one year to none.

References
(1) M Hirst, Loving and Living with Traumatised Children, BAAF, 2005
(2) H Van Gulden, L M Bartels-Rabb, Real Parents, Real Children – Parenting the Adopted Child, Crossroads, 2002

Further information
C Archer, Trauma, Attachment and Family Permanence, Jessica Kingsley Publishers, 2003
K Cairns, Attachment, Trauma and Resilience, BAAF, 2002
C Keck, R M Kupecky, Parenting the Hurt Child, Helping Adoptive Families Heal and Grow, Pinon, 2002
B Keefer, J E Scooler, Telling the Truth to your Adoptive or Foster Child – Making Sense of the Past, Bergin & Garvey, 2000

Contact the author
reneepmarks@yahoo.co.uk