Clin Child Psychol Psychiatry 2007 Sturgess 13 28

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Clinical Child Psychology and
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DOI: 10.1177/1359104507071051
2007 12: 13 Clin Child Psychol Psychiatry
Wendy Sturgess and Julie Selwyn
Supporting the Placements of Children Adopted Out of Care
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Supporting the Placements of Children
Adopted Out of Care
WENDY STURGESS & J ULI E SELWYN
University of Bristol, UK
ABS TRACT
This article reports the ndings related to adoption support of a Department of
Health-funded study: Costs and Outcomes of Non-infant Adoptions. This is the
rst UK study to comprehensively examine the support provided by Social
Services Departments (SSDs), Health, Education, and Child and Adolescent
Mental Health Services (CAMHS) beyond the rst year of the adoptive
placement. The services provided to 80 children, before Adoption Orders were
granted, were examined from SSD records. Interviews with 54 adoptive parents
then investigated the services provided to 64 of the 80 children post order. Families
were initially supported primarily by Social Services but, post order, Health,
Education and CAMHS shouldered most of the support responsibilities. A high
proportion of the children were seen by these professionals over the course of the
adoptive placements but many adopters felt that the services provided had been
too little, too late. While there were assessments of childrens difculties, main-
stream services typically failed to provide what adopters considered sufcient or
effective support. This was also largely true of the services provided by SSDs and
is an important message for practitioners if they are to succeed in improving
adoption support services.
KE YWORDS
adoption, assessment, intervention, multidisciplinary, support services
Clinical Child Psychology and Psychiatry Copyright 2007 SAGE Publications
Vol 12(1): 1328. DOI: 10.1177/1359104507071051 www.sagepublications.com
13
WENDY STURGESS was a Research Associate and is now a Visiting Fellow at the School for
Policy Studies, University of Bristol. Both she and Julie Selwyn have worked for a number of
years in the childcare eld. This is one of a number of publications expected from their
recently completed Department of Health-funded research project, Costs and Outcomes of
Non-infant Adoptions.
J ULI E SELWYN is a Senior Lecturer and Director of the Hadley Centre for Adoption and
Foster Care Studies at the University of Bristol.
CONTACT: Julie Selwyn, School for Policy Studies, University of Bristol, 8 Priory Road,
Clifton, Bristol BS8 1TZ, UK. [E-mail: j.selwyn@bristol.ac.uk]
02 071051 Sturgess (to_d) 25/1/07 1:05 pm Page 13
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DURI NG THE 1970S there was great optimism expressed by social workers that any
child could be placed for adoption and that the favourable environment of adoption
would undo any early disadvantage (Parker, 1991). Since then, however, as a result of
research ndings and practice experience, there has been growing recognition that early
adverse experiences and maltreatment often continue to impact on a childs develop-
ment, however auspicious their new home (Cicchetti & Toth, 1995; Skuse & Bentovim,
1994). Indeed, most of the UK and USA studies (Kadushin, 1970; Quinton, Rushton,
Dance, & Mayes, 1998; Rosenthal & Groze, 1992, Rushton, 2000; Rushton, Dance,
Quinton, & Mayes, 2001) highlight the persistence of emotional behavioural problems
among adopted children. Commonly cited are attachment difculties, hyperactivity,
problems with friendships and poor concentration. Such problems can make adoption
problematic (Ivaldi, 1998; Lowe et al., 1999; Parker 1999).
Nevertheless, since 1998, due to concerns about poor outcomes for children who grow
up in the care system (Stein & Wade, 2000), the government has been keen to increase
the use of adoption for children unable to return to their birth families. The Local
Authority Circular Achieving the Right Balance (Department of Health [DoH], 1998)
encouraged agencies to review and improve their adoption services and was quickly
followed by the Prime Ministers Review of Adoption (Performance and Innovation Unit
[PIU], 2000), the Adoption White Paper (DoH, 2000) and the Adoption and Children
Act (DoH, 2002a), all paving the way for a greater use of adoption. Local Authorities
performance in this respect was encouraged by the use of Public Sector Agreement
(PSA) targets, aiming to increase by 40% nationally the number of children adopted out
of care by March 2005. Consequently, there has been a dramatic rise in the adoption of
looked-after children from 2200 in 19989 to 3700 in 20034, or approximately 6% of
the total population of looked-after children.
At the same time, the government acknowledged that children adopted from care
formed a distinct subset of the overall childcare population (PIU, 2000) and accepted
that promoting more adoption would mean nding more families for particularly vulner-
able children. Consequently, the issues of adopter recruitment and support featured
prominently on the policy agenda and a number of initiatives were introduced to
underpin the increased use of adoption. These included the National Adoption
Standards, the Adoption Register and, more recently, the Adoption Support Services
Regulations (DoH, 2003). We shall return to these in the Conclusion.
These promising policy advances were welcomed by practitioners, families and
academics who had been calling for improvements in adoption services for years,
particularly since the increase in the number of special needs and open adoptions
(Argent, 1987; Beek, 1999; Logan & Hughes, 1995; Mather, 2001; Mulcahy, 1999;
Rushton, Quinton, & Treseder, 1993). A few voluntary agencies (for example the Post
Adoption Centre in London) had been leading the way but, without ring-fenced funding,
postadoption services had, on the whole, failed to develop. Most agencies had simply
introduced adoption allowances or responded in an ad-hoc way to individual requests
for support. An SSI (Social Services Inspectorate, 2000) survey of adoption support
services in 34 local authorities concluded that there is little in place to assure the
necessary support and assistance to adoptive families in the long-term (p. 5) and that
this is clearly not an acceptable way to support the placement of some very damaged
and vulnerable children (p. 61).
This is in contrast to the situation in America where, since the Adoption and Safe
Families Act 1997, most adoptions from care (88%) now merit an adoption subsidy,
which in some states exceeds the foster care payments (AFCARS, 2003). Adoption can
also be supported by tax benets or specialist adoption services provided by designated
CLINICAL CHILD PSYCHOLOGY AND PSYCHIATRY 12(1)
14
postadoption centres or wraparound teams (Selwyn & Sturgess, 2001). Early ndings
(Barth & Berry, 1988) suggest that the provision of such support reduces the risk of
adoption disruption. While such links are not established in the UK, practice wisdom
would suggest such a relationship and Lowe et al. (1999), in their national study of post-
adoption support, noted that several adoption workers identied lack of support as a
contributory factor to disruptions (p. 223).
That study focused on postadoption support a year after placement. It highlighted
how hard adopters had found it to access services or nd information about the support
available. Although there were some examples of well-supported placements, they
concluded that generally good quality adoption services were a lottery (Lowe et al.,
1999, p. 400). More widely, research on postadoption services nationally has been sparse
and the literature characteristically describes gaps in services or best practice examples
(for a detailed review of postadoption services see Rushton & Dance, 2002). Only one
study, Adopted Children Speaking, has sought the views of adopted children on the
services and support they have received (Thomas, Beckford, Lowe, & Murch, 1999) and
only one English study, conducted in the late 1980s and early 1990s, has examined
support beyond the rst year of placement (Rushton et al., 1993). That study found that
none of the families were in receipt of a social work service by the 5-year follow-up point,
although by the 8-year follow-up point some adoptive parents had secured psychiatric,
educational or psychological help for their child.
Since then the need for support to continue beyond the making of the Adoption Order
has become more widely recognized. Indeed the Minister for Healths introduction to
the Providing Effective Adoption Support consultation document (DoH, 2002b) stated
that adopted children and their new families should be able to access a planned package
of adoption support services when they need them and for as long as they need them
(p. 1). Yet research to date tells us little about the changing needs of adoptive families
over time or about the services they need over the course of the placement.
This article aims to ll that gap in the literature by reporting the ndings from a
Department of Health-funded study, Costs and Outcomes of Non-infant Adoptions. This
is the rst UK study to comprehensively examine the support provided to adoptive
families by Social Services Departments (SSDs), Health, Education, and Child and
Adolescent Mental Health Services (CAMHS) beyond the rst year of placement and
will be of value to professionals in each of these elds. The study followed up 80 children
who were all approved for adoption in the early 1990s and were still in their adoptive
placements at the start of the new millennium. Details of the childrens experiences prior
to the adoption best interest decision, and the extent of their special needs at that time,
were recorded from case le information. Fifty-four adoptive parents caring for 64 of
the 80 children were then interviewed during 20012002 about their experiences of
adoption and the support they received from SSDs during the rst year of the adoptive
placement and in the 12 months preceding the interview, which was typically 7 years
later. Respondents also lled in detailed questionnaires about the services the children
had received from Health, Education, and CAMHS since the making of the Adoption
Order and commented on those services.
Method
Sample
The study investigators took the opportunity to follow up a complete epidemiologically
based sample of 130 children who were all approved for adoption in the early 1990s aged
between 3 and 11 years. The sample was drawn from a former two-tier authority, which
STURGESS & SELWYN: SUPPORTING ADOPTIVE PLACEMENTS
15
later became four unitary authorities. The same paediatrician conducted a preadoption
medical for all the children and checks between her records and those of the local
authorities conrmed the completeness of the sample.
It quickly became evident from SSD case les that not all of the children had been
placed for adoption. Of the 130 children, 104 had been matched with prospective
adopters and 96 had been placed. By the follow-up in 20012002, due to placement
disruptions, only 80 children were still with their adoptive families. Pertinent character-
istics of these children are shown in Table 1, alongside current national data.
There are some similarities and differences in the two sets of data. Ethnic-minority
children were underrepresented in our sample: Although there were 10 ethnic-minority
children, 5 of whom were matched with adoptive families, only 1 was still with his
adoptive family at follow-up. The most conspicuous differences, however, are in the
childrens mean ages at the different stages of the adoption process. This partly reects
the older age of our children at approval but also reects recent changes in adoption
practice. It is noteworthy, however, that children in our sample were only a year older
on average at placement than the current national norm even though they were just over
3 years older by the time they were adopted. Given that adopters in this study reported
particularly on the rst year and last year of the adoptive placements these differences
should not affect the generalizability of the ndings.
Procedure
The 80 children were adopted into 66 families and all but one of these were traced and
invited to take part in the study. Fifty-four families (82%) agreed to be interviewed. The
64 children living in those families were, by that time, aged between 8 and 18 years of
age (mean age 13.5 years), and had been adopted for, on average, 7 years (range 210
years). It is important to note that the childrens different ages, different developmental
stages and different lengths of time in placement are likely to have inuenced their
psychosocial functioning at follow-up and thus their need for services. Ideally we would
have followed all the children through to adulthood, but this was not possible within the
remit of this study. The data reported are therefore under-representative of the likely
support services needed and provided over the whole course of the adoptive placement.
Measures
All of the 80 childrens social work case les were read and data gathered on the
childrens family background and use of services prior to adoption. Details about their
16
Table 1. Characteristics of the study children compared with national data
Sample children National data
(n = 80) (DfES, 2004)
Gender 52% boys 53% boys
48% girls 47% girls
Ethnicity 99% White 87% White
*
1% Ethnic Minority 13% Ethnic Minority
*
Time in care before Adoption Order M = 4 years 9 months M = 2 years 7 months
Age at placement M = 4 years 3 months M = 3 years 3 months
Age adopted M = 7 years 5 months M = 4 years 3 months
Foster carer adoptions 21% Foster Carer Adoptions 16% Foster Carer Adoptions
*
Ivaldi (2000).
special needs, at the time the adoption panel decided that adoption was in their best
interests, were also taken from all assessment material on le (e.g. reports from
educational psychologists, psychiatrists, the Adoption Medical Advisor or other
professionals). Researcher ratings, based on the developmental dimensions from the
Assessment Framework (DoH, 1999), were then made of the childrens psychosocial
development at that time.
Interviews with the adoptive parents focused on the impact of adoption on their lives,
particularly during the rst year of the adoptive placement and in the year prior to the
interview. Questions about the support and services they had received or would like to
have received were included. A questionnaire was also sent out to adopters in advance
of the interview, which asked about use of Health, Education and CAMHS services since
the making of the Adoption Order.
Results
The childrens early experiences
Many (82%) of the 80 children had been referred to Social Services under the age of 1.
They often came from families characterized by domestic violence (72%), drug or
alcohol abuse (50%), or severe parental mental health problems (41%). Only 17% of
children had not experienced any of these adversities. Environments were impoverished,
with the majority (82%) of the children neglected and three-fths (62%) suffering
multiple forms of abuse. There was sufcient evidence on le to be condent that over
half (52%) of the children had been physically abused. Broken bones, head injuries,
cigarette burns and bite marks were among the injuries reported. Ten per cent of the
children, mainly boys, had been persistently rejected by their parents. Sexual abuse was
also proven in 14% of cases with no gender differences in occurrence. Many of the
children (40%) had had multiple early carers, having been passed around family
members or spending short periods in foster care.
Entry to care and planning for permanence
Rising concerns, or clear evidence of abuse or neglect, led to the children being received
into care. Some children entered long-term care quite quickly after they were rst
referred to Social Services but many (65%) stayed at home for a year or more before
action to remove them was taken. Once in care the decision that adoption was in their
best interests was made quickly for the majority of children, but a quarter (26%) waited
3 years or more for a permanency decision. During that time (on average 2 years and 3
months) many children experienced several placement moves, with only a third (36%)
of children remaining in the same placement. Disruptions (30%), attempts at reuni-
cation (30%) and planned moves all contributed to further instability. By the time the
adoption panel considered the childrens futures they were aged 310 years, with the
average age being 3 years and 8 months.
Prevalence of special needs at the time of the adoption best interest decision
When the adoption best interest decision was made most of the children had been
assessed as having special needs (only 3 children had none) and almost half (47%) had
four or more difculties. Common problems included emotional-behavioural difculties
(55%), attachment problems (46%), peer problems (26%), learning difculties (19%),
developmental delay (19%), hyperactivity (15%), sexualized behaviour (14%) and
chronic health conditions (6%). Despite these difculties few of these young children
had received additional services while they were looked after.
17
Joining new families
It was from this backdrop that the children (except those adopted by their foster carers)
joined their forever families, with each party usually having only a month to prepare
for the change. This was frequently an emotional time for both adopters and children,
with only 7% of adopters not experiencing difculties at some point during the rst year
of the adoptive placement. Many felt unprepared for the extent of the childrens
difculties and found managing them very challenging.
Adopters initial attitudes to help seeking
Consequently, many families had been aware of their need for support but their attitudes
towards asking SSDs for help varied. Almost a third of adopters (30%) had been pleased
to use any services provided and had felt encouraged by their social worker to do so.
Sixteen per cent had been aware of services but didnt approach their SSD because they
had wanted to tackle the problems themselves. These families often turned to
professional friends or the Internet for help or advice. Six families (11%) had just
wanted to be free of SSD involvement by that stage. The remainder (43%) were not
expecting ongoing support from SSDs and had thought that, apart from adoption
allowances, no additional services were available. Not all would have used services if
they had been aware of their existence, but 13% said they had been reluctant to ask for
help for fear of appearing a failure; of being blamed for the childs difculties; or of the
child being removed:
Youre very conscious of putting on a good front and initially dont want to ask for
help because it would seem like a bit of a failure, an admission that youre not
coping . . . and you desperately want to be coping.
Support provided by Social Services in the rst year
During the rst year of the placement all of the families were supported by at least one
social worker and most of these relationships were described as satisfactory or good
(75% childs social worker and 90% family placement worker). The majority thought
the visiting frequency had been about right, but a fth felt that they had not been seen
enough. Particularly praised were social workers who were seen to be champions for the
child, who were knowledgeable and who listened respectfully to the adopters views:
Our support worker was one in a million, she was fantastic, and we had the same support
worker from beginning to end.
Adopters were generally less complimentary about the quality of behaviour-manage-
ment advice given by social workers or the help offered in crises. Over half had been
dissatised with this aspect of the social work service. Many also wanted a quicker and
more responsive service. They complained that social workers were often unavailable
when they needed them or had not helped them to liaise with the school or other
agencies.
SSD support in the rst year of placement was not, however, only provided by social
workers. Additional support was provided for 69% of the children in the form of
adoption or fostering allowances (68%), respite care (6%) and childminding services
(4%). Adopters were often pleasantly surprised that they were eligible for an allowance
or felt slightly uncomfortable about it. Once expenditure began to mount up, however,
many felt that it had been indispensable, especially those who had given up work or
reduced their hours prior to the placement (48% of mothers and 10% of fathers). Costs
were incurred as adopters bought essential items such as clothing, toys, bedroom
furniture and car seats and also as they tried to compensate for the childrens early
18
deprivation by going on outings or buying expensive educational items. Many ate into
their savings to cover these costs and a fth got into debt. Those who had received no
or only a low allowance because of means testing were often disappointed: Money wise
we were broke, because Social Services said I couldnt work and I accepted that like a
fool. Its your life in their hands.
Those struggling with difcult-to-manage children also complained about the lack of
practical support. A few (especially those adopting sibling groups or children with a
disability) would have valued help with their domestic chores to enable them to focus
on the children. More wanted help with childminding. As the children were still looked
after, babysitters needed to be social-services approved but these could be difcult to
come by and in some cases repeat bookings were refused because of the childrens
behaviour. This made it difcult for some parents to attend adoption support groups or
spend time together as a couple. A tiny proportion of the children (4%) were found
places with approved childminders during the rst year by Social Services but many
more families would have welcomed this support: We didnt go out for 18 months . . . It
would have been helpful if social services could have provided someone who was police-
checked to baby-sit.
With an absence of breaks many adopters admitted that the rst year of placement
was more difcult than they had expected. Several had wanted to get away during the
early months of the placement but some worried that if they did the children would
perceive it as rejection. Consequently, the adopters of only six children (6%) received
respite care during the rst year of the placement, three trying to salvage placements in
difculty (one of which did subsequently break down) and three foster carer adopters
with existing respite arrangements.
Support provided by Social Services after the Adoption Order
After the Adoption Orders were granted, all social work visiting ceased very quickly for
the majority of adoptive families. Some were glad to be free of social services by that
stage, but others felt abruptly abandoned: Her social worker said, Ive been told Ive
got to nish with you, I dont envy what youre doing, I think youre very brave,
goodbye.
By the time of the follow-up interviews in 20012002 the families of almost three-
quarters of the children were either no longer in receipt of any support at all (59%) or
were receiving only an adoption allowance (13%). Only 28% had received a post-
adoption service from social workers in the year prior to interview and this was more
likely to be children adopted by their foster carers.
1
This may have been because foster
carer adopters felt less inhibited about seeking support or because they were more
visible to SSDs if they had continued to foster.
Other families had had to be in crisis before a social work service was offered. The
placement had been under threat in a number of cases or the adopters had experienced
growing or new difculties of an intense nature as the children entered adolescence.
Most of those seeking help in difcult circumstances were not very positive about the
services they had received. They felt that SSDs were slow to respond to their concerns
and had not really helped them manage some very challenging behaviour. Consequently
they often had poor relationships with their social workers:
One day I rang up duty social services and said, He is having a huge tantrum, I
cant cope with this child. Youve got to help or Im going to do something to him.
They said, Can you ring me back next Tuesday, I thought, Oh Ill kill him by next
Tuesday . . .
19
Conversely, families receiving support because of the childs physical health or disabil-
ity, or because of supervised contact, generally felt that they had received good support
and advice and had better relationships with workers.
Often it was the families who were still in touch with social services who were also
receiving an adoption allowance at follow-up, but overall the number of allowances paid
had reduced from 68 to 30%. Less than half of the foster carer adopters were still in
receipt of an allowance, although almost 10% of these placements had been delayed
while issues around continuing nancial support were resolved: Looking back now I
wish wed long-term fostered her instead of adopting her because they dont give you
nothing nancially and as shes getting older we could have done with it.
Several adopters felt that this drop in their income had had a detrimental effect on
their quality of life and the kind of compensatory experiences they could offer their
children. Especially affected were those who had been unable to return to work because
of their childs ongoing medical or behavioural needs (33%), although overall, 44% of
the families interviewed described themselves as struggling nancially by that stage.
They complained that they still had much larger household bills because of, for example,
their childs enuresis/encopresis or destructive behaviour, or because they had tried to
bypass waiting lists by paying for services such as speech therapy, educational assess-
ments or home tutors when these were not forthcoming publicly (20%). Some were very
angry that they had to deal with nancial worries on top of the childrens difculties.
Because of these challenges, by follow-up, many adopters attitudes towards respite
care and childminding had changed. Half now wanted access to a childminding/babysit-
ting service but none had received such support during the 12 months prior to interview.
Several recounted how they had quickly used up the babysitting goodwill of family and
friends, and a handful had not been out at all since the children were placed. Adopters
in this situation could become very isolated. A third would also have appreciated respite
care in the year prior to the interview but only ve families (9%) had received this
service and all except one of those families had come close to breakdown. Two had been
subject to child protection investigations and three had children with ADHD:
I would love respite care, it seems unfair that if you long-term foster children you
get it, but when you adopt them you cant have it. David [not his real name] is an
ADHD child and is quite intense, way over the top half of the time, and you do
need it. Just a weekend off every now and again.
Many adopters complained that, after the making of the Adoption Order, their needs
had not been met by social services and they had had to look beyond social workers for
help. Several had clear ideas about services they would have valued and we shall return
to this in a later section. Most joined parent support groups such as Adoption UK or
sought referrals to other agencies as we shall see next.
Support provided by Health, CAMHS & Education
Figure 1 shows the very high percentage of children who had been seen by Health,
CAMHS or Education professionals after placement but prior to the making of the
Adoption Order (pre Order) and between that and the follow-up interview (post
Order). The Police or a Youth Offending Team had also been involved with 30% of the
young people by the time of the interview.
It was not the case that the same children had been referred to all of the agencies. Pre
Order two-thirds (64%) of the children had been seen by professionals from at least one
agency, rising to over four-fths (84%) of the children post Order. Many children,
however, had received services from more than one agency as shown in Figure 2.
20
Post Order the overlap in service use had increased such that almost 1 in 5 children
(19%) had been involved with Health, CAMHS, Education and the Police. Even given
the extent of the childrens special needs this level of service use was surprising as
adopters frequently complained about the difculty they had securing services for their
children. This discrepancy however was explained a little when we looked in more detail
at the services provided.
Health service provision
Details about childrens contacts with various health professionals (paediatricians,
Clinical Medical Ofcers, physiotherapists, occupational therapists, hearing specialists,
speech therapists and consultants) were recorded. Pre Order the childrens health needs
were diverse, but it was surprising how little of this health provision (6%) was for phys-
ically disabled children. The majority was for assessment or treatment connected with
the childrens emerging difculties and tended to be a consequence of schools or
adopters increasing concerns about the childrens health or developmental delay.
Hearing specialists (19%) and speech therapists (16%) were the most frequently seen.
A further 6% of children saw occupational therapists or physiotherapists because of
problems with motor development.
The children seeing paediatricians or Clinical Medical Ofcers (15%) tended to have
complex combinations of difculties, for example learning difculties alongside health
conditions such as ADHD or epilepsy. Consequently, several of these children had also
been referred to consultants for assessment or monitoring of their health conditions.
Adopters often found the childrens health conditions difcult to deal with, especially
21
40
59
26
55
43
67
0
20
40
60
80
% of children
Health CAMHS Education
Pre Order
Post Order
31
20
22
20
11
25
0
19
0
10
20
30
40
% of children
One Two Three Four
Pre Order
Post Order
Figure 1. Health, CAMHS and Education Service Provision.
Figure 2. Number of agencies providing a service.
when the prognosis was uncertain or when they had been unprepared for the difculties
they encountered:
The worst thing was his epilepsy. He was tting up to 11 times a day sometimes. I
used to have to go down the school a couple of times a day to look after him and
then hed usually t again in the evening . . . so it was 24-hour care, you couldnt
leave him, full stop.
In these circumstances adopters would have welcomed the opportunity to request a full
health assessment. These would have been particularly helpful in the small number of
cases where health conditions were not identied for many years.
Post Order, health service provision for children with recognized physical disabilities,
such as sight or hearing loss or a diagnosed syndrome, had almost doubled (11%) as
more disabilities were diagnosed. The majority of the services, however, were still being
provided because of the childrens emerging or continuing difculties. The number of
children seeing hearing specialists (30%) and speech therapists (23%) had increased as
had the number visiting occupational therapists or physiotherapists for problems with
motor development (10%). This may reect late assessment of developmental delay or
long waiting lists.
A third (36%) had seen a paediatrician or the Adoption Medical Advisor post Order.
This was sometimes in connection with health concerns, but more often was because of
ongoing emotional or behavioural issues or concerns about the possibility of ADHD or
an autistic spectrum disorder:
We knew we had a big problem on our hands from the start. He would continu-
ally self-harm, he would pull his toenails out if he was upset and would crack and
crack his head on the pavement. He was a very vicious and violent child . . . I asked
for help right from the beginning, but we were just told he was a lively child . . . It
was another 2 years before he was diagnosed with ADHD and we actually got
some help.
All except two of these children had also been referred to another health specialist.
Some saw consultants for common health conditions, such as heart or skin complaints,
but several children had seen enuresis or bowel-dysfunction consultants when problems
with wetting or soiling persisted:
We sought help in the end . . . we went to the enuresis clinic . . . they gave us an
alarm, which did work for about a month, and then it started again. In the end the
doctor put her on tablets and that sorted it out. But the problem with that is that
it treats the symptoms and not the cause.
Much of this service use may be attributable to the childrens difcult early experiences.
Adopters often did not know who to turn to about these problems and would have
welcomed easier access to health and mental health professionals.
Education service provision
All of the children had started school before the Adoption Orders were granted. In that
time, 29% had received support from a Special Needs Teacher or Classroom Assistant,
26% had been referred to an educational psychologist, 17% had been issued with a
Statement of Special Educational Needs (SEN) and 14% attended a special school or
special unit within a mainstream school. Additionally, 5% had received support from
either an Educational Social Worker or a School Nurse/Counsellor on account of their
emotional or behavioural problems.
22
Despite these seemingly high levels of service provision, many adopters complained
that they had really struggled to get this support or that they had not been able to secure
additional classroom support or a Statement of SEN despite their best attempts. The
prevailing view among adopters was that education services were withheld unless there
was very compelling evidence for provision: I was up against it, the school didnt think
there was anything wrong with Caroline [not her real name] . . . the teachers havent had
any training on children in care.
Some protested that even with the provision of services there was no improvement:
He couldnt add two plus two and he was 8 years old. He couldnt count to 10, but
he was learning about the Egyptians. We thought, this kid needs help. He was
getting substantial help, he was getting speech therapy, physiotherapy and a
learning support assistant . . . but there was no progress.
By the time of the follow-up (i.e. at some point since the making of the Adoption Order)
50% of children had seen an educational psychologist, 44% had received additional
classroom support, 25% had been issued with a Statement of SEN and 20% attended a
special school or special unit within a mainstream school. In addition, 14% of children
had received support from an Educational Social Worker or School Nurse/Counsellor.
These high levels of service provision in part reect the fact that 48% of the children in
our sample had learning difculties. Yet many adoptive parents still complained that the
system was confusing and unresponsive to their needs. They clearly felt there was a
greater need for services than had been provided. Notably, while 50% of children had
seen an educational psychologist and presumably been assessed, only 25% had been
issued with a Statement of SEN. Without that, adequate services were generally not
forthcoming and several adopters had resorted to the private sector to help their
children reach their potential.
CAMHS provision
A quarter (26%) of the children were referred to CAMHS pre Order and over half
(55%) post Order. Pre Order these referrals were occasionally for psychiatric assess-
ments ordered by the court to aid decision making about birth-family contact, but more
usually they were because of the childs concerning behaviour. Over half of the children
referred preadoption had learning difculties. Others displayed sexualized behaviour or
severe internalizing or externalizing behaviours. A fth were later diagnosed with
ADHD. Some problems had emerged only after the child moved to the adoptive
placement, such as particularly rejecting or difcult behaviour. In these cases CAMHS
support could be timely and essential:
The rst two days were ne, but when different people turned up that really
freaked him out. He was a very angry, very scared, very distressed child, hiding
behind the sofa and refusing to come out. Poor kid, it was very distressing to see
. . . there were a lot of problems and we just didnt know if we were dealing with
them alright. When we did contact SSD we were able to see a clinical psychologist
very quickly. If that wasnt available I think the placement would have been in real
jeopardy.
More generally, there were mixed views about the quality and helpfulness of CAMHS
services. Some adopters felt that they just got tea and sympathy when they were looking
for solutions: I went through lots of things about her behaviour but they just said, Carry
on with what you are doing. At the time that felt good but then I felt, Oh no, that was
no help at all. Others felt criticized: The only thing we got was Ritalin and criticism.
23
Pre Order the contacts with CAMHS were typically only short term and only 16% of
the children received long-term support from a mental health professional. Some of
this support was routine monitoring of Ritalin or other prescribed drugs with very few
children receiving ongoing therapeutic help. By the follow-up year 31% of children were
receiving long-term input, but again adoptive families often described having to ght
to get therapeutic help for their child or feeling discouraged and disappointed by their
experience of CAMHS: We did go to the CAMHS clinic but they were useless. She used
to ask us questions and I said, Were coming to you for answers. They didnt help.
Some families did, however, nd CAMHS helpful and felt that they had seen real
improvements in the childs behaviour or emotional functioning:
The doctor [CAMHS] . . . did some one-to-one work with him that had a really
positive effect. He can now talk and consider things and his behaviour at home
and at school is really improving. We just feel that if only wed had the right advice
5 or 6 years ago it would have all been so much easier.
Upon closer examination it appeared that where the children had received ongoing
therapeutic support, usually from a clinical psychologist or art or play therapist, the
families had found CAMHS most helpful. Thus it was not that therapeutic interventions
had been unsuccessful, but that many adopters had found it difcult to secure this kind
of sustained support.
Desired support
Support for adoptive placements from the various agencies was, therefore, considerable.
Adopters responses to the services, however, were mixed and overall, 58% of adopters
described feeling inadequately supported by them at some point since their child was
placed. A third felt that way during the rst year of the placement and 37% in the follow-
up year. Needs changed over the course of the placement and as some families settled
down, others began to experience problems. In general, at any one time, about a third
wanted only an adoption allowance, a further third wanted social work support and
advice and the nal third wanted a multidisciplinary service. During the interviews
adopters highlighted four areas they felt were key to adequate service provision in
addition to those already highlighted. They were: Better information provision, better
behaviour-management advice and support, ongoing nancial support, and an easily
accessible responsive multidisciplinary service.
Better information provision Sixty-eight per cent of parents interviewed felt they had not
received adequate information about their child. Some acknowledged that they may
not have heard the information given during the exciting introductory period or had
been reluctant to ask questions, and E Forms
2
had often been so sanitized that the
extent and impact of the childs maltreatment was concealed. As the placement
progressed the desire for information grew, and adopters stressed that helping them
access and understand the available information should be a key component of a post-
adoption service and not just a one-off occurrence for matching purposes. Families
wanted an in-depth history, including details about all family members, reasons for care,
placement changes, medical and educational records and a summary of the childs
emotional/behavioural difculties. Some parents also wanted to know when new
children were born to the birth family. Where terms such as learning difculties were
used, adopters wanted clearer explanations of the terms and a balanced assessment of
the lifelong impact.
24
Better behaviour-management advice and support Adopters also wanted better support
with handling difcult behaviour. Social workers often looked to CAMHS to provide
help, but it seemed particularly difcult to get help for children with conduct disorder
and/or attachment difculties, the two most common problems. Parents would have
welcomed additional behaviour-management training, particularly where they could talk
about their child and the way his or her past experiences may affect the present. Brieng
notes describing ways to tackle common problems and including further sources of
advice were also suggested, as was a directory of all local/national support services.
Rapid response services were also highlighted as necessary and adopters suggested a
national 24-hour crisis line manned by experienced adoption professionals and giving
sound on-the-spot advice and suggestions about who to turn to for further help. One
adopter also suggested that experienced adopters mentor new adoptive families and act
as a rst port of call in times of crisis.
Ongoing nancial support Many adoptive parents felt that the prevalent societal view
was that they did not need nancial help. This was reinforced by means testing testing
that took no account of the evolving needs of the child. Adopters complained about this
attitude and the severity of means testing and wanted fair ongoing allowances that
reected the changing nature of the challenges they faced with the child. Some also
commented on the discretionary nature of initial set-up grants and suggested that a
statutory one-off payment be introduced for all adopters.
An easily accessible, responsive multidisciplinary service Because of the childrens evolving
and overlapping difculties adopters wanted to be able to request a multidisciplinary
assessment at any point in the placement and then have fast easy access to services that
could address the problems holistically. Therapeutic services appropriate for adopted
children were highly sought after as were intensive educational interventions.
Conclusion
This study clearly identied that the needs of adoptive families changed over time. The
predominant early needs were for behaviour-management advice and nancial support.
Over time, as problems emerged or subsided and most families lost social worker
support, needs changed. Placements could be in crisis at any stage and not all survived.
In this study, a fth of the placements (20%) had broken down by or immediately after
the follow-up interviews. Children needed help not only from Education and CAMHS
but also Health Services, an area that has received far less attention. Adopters needed
ongoing support from SSDs to understand and manage the childrens difculties and to
access the various agencies. Some problems intensied as the children grew older yet
the success with which support was provided varied greatly.
After the Adoption Orders were granted only a minority of families received any
support from SSDs. Three-fths received no support at all and a further 13% received
only an adoption allowance. Of the 28% who received a social work service post-
adoption, none received a comprehensive postadoption support package comprising,
for example, an adoption allowance, further child-specic advice/training and the
option of respite care/childminding. Yet three-quarters of the adoptive families had
experienced some form of crisis, triggered by an event such as the childs permanent
exclusion from school, violence in the home or involvement in criminal activity. Not all
of these crises had threatened the stability of the placement, but some had, and these
placements were often only preserved by sheer perseverance on the part of the
25
adopters. The tenacity of adopters is noteworthy given the well-documented instability
of the foster care system.
Timely and effective ongoing postadoption support services could go a long way towards
alleviating these situations situations that todays adoptive parents are just as likely to
experience as the families in this study. Those families identied the support services they
would have appreciated: Responsive behaviour-management support and advice, ongoing
provision of information, consistent nancial support, and prompt multidisciplinary assess-
ment and intervention when needed. Half of the adopters would also have added to this
list guaranteed access to good quality childminding or respite care services.
In response to these issues, the government has recently gone further than ever before
in acknowledging that their responsibility for children adopted out of care should not
end with the making of the Adoption Order. The Adoption and Children Act (DoH,
2002a), National Adoption Standards for England (DoH, 2001) and the Adoption
Support Services Regulations (DoH, 2003) all underline the need for continuing services.
There has also been increasing recognition that children adopted out of care are vulner-
able to developing emotional behavioural problems and other difculties. The Adoption
Support Services Regulations stress the importance of multiagency working and highlight
the requirement for all agencies to consider adopted children when developing service
provision. In Health, the new National Service Framework for Children, Young People
and Maternity Services is being implemented. This sets standards for the provision of
Health and CAMHS services to children, including those adopted, and includes specic
reference to swiftly conducting assessments and providing services to support parents of
children with behavioural difculties. Local delivery of these standards is being managed
through the Every Child Matters: Change for Children Programme (Department for
Education and Skills [DfES], 2005b). Recently CAMHS funding to CSSRs (Councils
with Social Services Responsibilities) was also increased substantially to reect the
governments commitment to radically improve the level of provision.
It remains to be seen, however, how much all of this will actually improve the lot of
adopted children. Early indications are promising but, as so often has been the case,
improvements in service provision seem to be patchy. Much relies on the increased
responsiveness of the mainstream services to the needs of adopted children or on the
introduction of lower thresholds for service provision. The majority of children in this
study had received some level of service from health specialists, CAMHS or Education,
or several of these. Many adopters, however, had found the agencies difcult to access
and when they did manage to access them, adopters generally felt that the services
provided were too little, too late. While there were often assessments of childrens dif-
culties, agencies on the whole failed to provide effective support or interventions or they
came too late. Some adopters complained that agencies had little understanding of the
needs of adopted children, or that long waiting lists, various forms of gate keeping or
very high thresholds excluded many children from adequate service provision.
This is a key nding from the study. It shows that simply raising the prole of adopted
children and making it easier for adopters to access mainstream services, as currently
provided, will not address the need. Increased demand where there are still inadequate
resources may in fact only aggravate the difculties. Assessments need to be followed
by appropriate support or interventions if more adopted children are to be helped to
work through their problems and reach their potential. The new guidance may otherwise
only result in adopters feeling more frustrated as their children are referred to
professionals only to be denied what they perceive as adequate services.
This is an important message for SSD professionals who may see increased referrals
to the other agencies as the way ahead. As the rst port of call, the quality of their
26
adoption support services will be crucial to the success of the adoption initiative. To assist
councils to review their services and identify possible areas for development the
Adoption and Permanence Taskforce have produced a comprehensive Audit Tool. Many
of the services highlighted in this article feature in that Audit Tool and are included in
the Adoption Support Services Regulations (DoH, 2003). Indeed, local authorities are
expected to have been providing a full range of adoption support services since
December 2005. Early indications are that individual local authorities have made inno-
vative advances in this respect.
These developments are very encouraging and will hopefully result in improved
support and services for adoptive families, especially as the government has shown its
commitment to improving adoption support services by ring-fencing 70 million to
ensure that progress is made. However, it is important to realize that this is only the
beginning of the journey. Problem recognition has resulted in policy initiatives but
service implementation is only at the edgling stage. Continued monitoring of service
development and evaluation of the effectiveness of new services and approaches will be
imperative to ensure that there are genuine proven benets to adopted children and
their families. Otherwise it will have all been just a cacophony of good intentions.
In this respect it is of particular concern that the regulations currently only give
adopters the right to request an assessment of their need for services, and the Practice
Guidance (DfES, 2005a) majors on supporting adoptive families to access mainstream
services. If SSDs are really going to help adoptive families they will need to improve the
quality of the information they provide; focus their energies on good quality responsive
behaviour-management advice; nancially commit to adoptive families for the long haul;
and make great efforts to ensure that sufcient childminding and respite services are
available as well as do their utmost to facilitate access to multidisciplinary services.
Otherwise the end result for adoptive families may prove unsatisfactory just more tea
and sympathy.
Notes
1. Thirty-six per cent of children adopted by their foster carers compared with 10% of
children adopted by strangers:
2
= 5.49; df = 1; p < 0.05.
2. A standard form (the British Agencies for Adoption and Fostering Form E) is routinely
used by SSDs to describe the children and their histories. It typically contains details about
their tastes and hobbies, and should also include details of their emotional, behavioural
and developmental problems.
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