The provision of mental health services to support adoption has always been patchy. However, as Camilla Pemberton finds out, sometimes the biggest problem is persuading parents to admit they need help in the first place
The difficulties many adoptive families face in the years after a placement can be hidden. There are no official figures, but Adoption UK estimates that as many as one-third of adoptions break down, while the British Association for Adoption and Fostering (BAAF) estimates that one in five fall apart even before an adoption order is granted.
“People often think adoptions happen and everybody lives happily ever after,” says Sue, an adoption support social worker. “But things have changed over the decades. Now, a significant proportion of the children are older, have been in care and have had profoundly negative early experiences. It’s often hard preparing parents for the mental health problems their children may have.”
According to statistics for England and Wales, 57% of all children adopted in 2008 were aged one to four, compared with 34% in 1998. Research by child and adolescent mental health services (Camhs) has shown that older children, adopted from care, are more likely to have experienced multiple placements and to have entered care because of abuse or neglect.
“Adoption provides some of the best outcomes for looked-after children,” says Jonathan Pearce, director of Adoption UK, but “good post-placement support is essential”. Yet eight years after the Adoption and Children Act 2002, access to support, particularly mental health services, remains inconsistent.
John Simmonds, policy director at BAAF, believes there is far to go. “We haven’t yet fully understood the impact of early neglect and abuse or developed a sufficiently robust and sensitive framework to recognise, describe and treat these problems,” he says.
Recently, a consortium of agencies in north London and East Anglia – including Coram, Adoption UK and BAAF – explored post-placement support and the links between local authorities and Camhs when identifying and meeting need.
Mental health services
A survey of 23 Camhs clinics revealed that, although some had specialist teams for adopted and fostered children, others were not “adoption aware” and 36% had no agreed referral protocol with local authorities. An Adoption UK survey – concerning 123 adopted children – revealed that adopters’ experiences of Camhs varied greatly.
Families are also only entitled to an assessment of their eligibility for support and Andrew Lister, a clinical psychologist, points out that not all families with needs will hit Camhs’ thresholds. Lister works for Bristol Council children’s services, so families who are not referred to Camhs – about half – can still receive therapy and support from a multi-agency team.
The consortium recommended that all practitioners look at their systems and challenge what “does not work well for families”, and that social workers seek more consultations from Camhs and “start more conversations”.
Simmonds says: “We must see clearer working between Camhs and children’s services regarding referrals, assessments and interventions.”
However, Jane Drew, a senior social worker in an East Sussex adoption team, points out that, because adoption is a private arrangement, families are not obliged to keep in touch with social workers. “After the adoption order is grantedwe would not know whether families are struggling unless the parents themselves approach us.” She says it is important that social workers “help parents understand that [needing support] doesn’t represent failure”.
But it can be difficult preparing parents for challenges because they are “at their most hopeful” at this stage, one social worker says. Adopter Sam McCoy from London agrees. “So much optimism surrounds the process. I wasn’t ready to accept that I may need to employ a more therapeutic, but in retrospect just as special, form of parenting.”
“It’s often difficult to encourage hopefulness, while being realistic,” adds Simmonds. He advises practitioners to involve previous adopters and adopted children into the process. Jean Milstead, adoption team manager for Buckinghamshire Council, says: “Our message to adopters is that everyone may need help at some point. It’s routine.”
Simmonds also points out that all children living permanently in a non-birth family, along with their families, need to be assessed and supported appropriately.
“Caring for an adopted child is more difficult than most people imagine, says John Timpson, a businessman and an adoptive parent who has fostered 90 children. “A lot of adoptive parents experience the fear of failure and the guilt that follows when their adopted child tests them to the limit by unbelievably bad behaviour.”
Timpson values skills-based training, such as learning about attachment disorders. “We discovered everything as we went along, [trailing] from one expensive psychologist to another, but even that didn’t provide an answer. If we had known about attachment problems at an early age it would have been so much better for him and us.”
GOOD PRACTICE PROJECTS
SafeBase: After Adoption has developed parenting programme SafeBase, which helps parents separate bad behaviour from the child and improves relationships.
The scheme, which is being rolled out in England and Wales, aims to teach parents about attachment difficulties and techniques to help overcome them. It consists of an assessment and feedback of family dynamics as well as a four-day training course for prospective and existing adopters, which incorporates structured play therapy, Theraplay.
There are also follow-up quarterly support groups with parallel children’s activity groups, a private web forum for advice and a training manual.
Participants are usually referred by social workers; those interested should contact their local authority for a referral. Every course run so far has been full.
Buckinghamshire: A designated Camhs adoption lead attends monthly case consultations with a multi-agency team, including social workers, a play therapist, an educational psychologist and a clinical psychologist. The team also runs a weekly surgery, where families can meet a social worker and a play therapist, and a twice-weekly advice line. Adoption team manager Jean Milstead says families have benefited from a more sensitive and responsive service, while social workers feel more contained and supported.
Coram: Charity Coram runs a 12-week support programme on managing challenging behaviour for adoptive parents with children up to 10. Weekly classes, based on the Webster-Stratton Incredible Years parenting programme, focus on play, praise and communication. Families are recalled after six months for follow-up support.
Adoption broke down after referral refused
When Jill* adopted a four-year-old who had been in care for two years “it was love at first sight”, she says.
“I’d been told about Eddie’s* early life, which included sexual abuse, chronic neglect and maternal drug abuse in utero, but I thought my love would protect him for ever.”
Eddie couldn’t settle at school, was violent towards other children and displayed over-sexualised behaviour. After years of Eddie’s violent outbursts at home, self-harm and criminal behaviour, Jill contacted her GP for a referral to Camhs.
After a lengthy wait, she was told that, without a “diagnosable mental health problem”, Eddie was not eligible for Camhs treatment.
“But we both needed treatment,” Jill says, “and I needed advice about how to manage his behaviour.”
Jill says she was “too ashamed” to seek help from her adoption team. She reached breaking point and Eddie was taken back into care aged 14.
This article is published in the 18 February 2010 issue of Community Care under the headline “No shame in seeking help”