Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Thursday, December 1, 2011

Prevention v. Cure in Adoption Services

In a recent publication, the Evan B. Donaldson Adoption Institute commented on the need for post-adoption services, and cited the comments of parents and professionals in two focus groups (http://adoptioninstitute.org/publications/ParentFocusGroup2.pdf and http://adoptioninstitute.org/publications/ProfessionalFocusGroup.pdf). These focus group summaries make interesting reading and make it clear that in spite of hybrid parent-professional organizations like ATTACh, the goals and attitudes of parents and professionals overlap only partially.

One parent is quoted as saying, “It’s very difficult because there’s a lot of biases built into how the professionals see our children. One of the things I’ve often seen is that the first thing that is asked when the child has a problem is ‘What’s going on in your home?’ There’s no thought given to this child’s history, the child’s background. There’s got to be something wrong with you in your home, and it’s a frustrating situation to be in when you’re trying to get assistance for the children.” It’s not surprising that parents resent feeling “blamed” for children’s problems, and they appear to find it very hard to see the situation from the professional’s perspective. What if the caseworker immediately focused on the child’s history, and neglected to ask whether there had been a change in the family-- to find out later that it was the family’s alteration that had triggered the child’s problem behavior? Finding out first what is happening right now is common sense, especially because the present events may be open to change, as the past cannot be. A well-known case in the infant mental health field involved a child’s inexplicable behavior that turned out to result from a conflict between a grandfather and grandmother, and the resulting changes in the family system.

One of the real – possibly insoluble-- problems with adoption services is that parents and professionals do have different goals and viewpoints. The parent focuses on personal experience and wants to settle into life with a family as he or she expects it to be (and these expectations may or may not be realistic, as Rachel Stryker and others have pointed out). The professional has many other families to consider, and wants to minimize both adoption disruptions and abuse of any kind, even though there may be a paradoxical relationship between these two events. In addition to these differences in perspective, parents and professionals are different in the power they are perceived to have and actually do have. The adoption professional has the power to disrupt an adoption under certain circumstances and to require parents to follow directives in order to avoid disruption or to get the services the parents ask for; the parents have no similar powers, but if they do not do well as a group, the caseworker does not look good either. The relationship between the parent and the professional thus has the makings of a sort of mini-Stockholm syndrome, or alternatively various levels of conflict and resentment.

It’s possible that adoption services will not be genuinely effective until the ambivalence and conflict between parents and professionals is settled. I would speculate-- without any real evidence-- that this may not occur as long as parent support groups are encouraged. These groups, like all that have spun off various 12-step programs, are much loved by their members, but may serve primarily to establish a perception of the parent group as supportive and knowledgeable in comparison with professionals, thus worsening the existing conflict.

The unfortunate conclusion to be drawn here is that until such time as parents and professionals can work out their differences, the chances are that post-adoption services may not be very effective. This leaves us with two possible ways to improve the experiences of adopted children and adoptive families. Both are preventative approaches rather than “cures”: pre-adoption services like parent education, and improved screening of adoption applicants.

A good deal is known about the process of adoption and the important characteristics of both parents and children. But both the Evan B. Donaldson focus groups express pessimism about the possibility of training adoptive parents before the child comes into the family. One professional said, “Although we give parents a lot of information in preparation, obviously they don’t hear it because they’re thinking about their goal of having a child.” People in the parent focus group agreed with this: “Yes, I went through training, but it wasn’t the right training, and I don’t think it was really the right time, because when you’re [becoming] an adoptive parent, you’re excited, you have these children…” “Let’s face it. When you’re just coming into being a foster or adoptive parent, you don’t know anything, so you’re all excited and you only remember a quarter of what’s being said in that training. It’s too much information all crammed into one, and you’re just thinking about getting that cute little child.”

We seem to be left with improved screening of adoptive parents as a possible preventative of some problematic adoption situations. This approach, of course, will be abhorrent to many adoptive parents-- in particular those who might be excluded by screening. Increased screening may not be welcomed by some adoption professionals, either, as they are often much concerned with getting children placed in homes. However, as it happens, there is a good deal of relevant information that might help a screening process.

Some of this information contradicts common assumptions about the kind of person who would make a good adoptive parent. For instance, the developmental psychologist Mary Dozier’s work has demonstrated that people who have fostered many children are less capable of forming an attachment relationship with a child than those with fewer of these experiences. Other work (like the suggestions by St-Andre and Keren [Infant Mental Health Journal, 2011, pp. 694-706] that I mentioned a few days ago) emphasizes not only problems of the individual like a history of depression, but also the social environment-- depression or bipolar disorder in the adoptive parent’s family, and a lack of social support existing even before the adoption. (As the Evan B. Donaldson parent focus group indicates, social support is often lost after the adoption has occurred and difficulties are manifested.) St-Andre and Keren also note the force of the interaction between existing parent characteristics and problems associated with the child, such as multiple simultaneous adoptions. Screening to prevent parents with certain histories from adopting more than one child at a time (or perhaps even successively) might be a service of great help to a child’s developmental outcome.

St-Andre and Keren made another suggestion that is of great interest, but not necessarily supportable. They referred to the use of the Adult Attachment Interview as a way of predicting the capacity of applicants to function well as adoptive parents. The AAI is a structured interview that classifies adults as secure or troubled in their own attachment concepts. St-Andre and Keren described a woman applicant as appearing “pleasant and motivated for the adoption”, but as giving contradictory statements about her childhood and becoming “derailed” when talking about the early loss of a child. As a result of these responses on the AAI, she was excluded as a candidate for adoptive parenthood. However (and this is my comment, not St-Andre’s), the AAI, like many tests of its kind, was designed for research purposes and for guidance of treatment, not as a way to predict an individual’s personal life.

6 comments:

  1. I joke around with my friends that every would-be parent should own a dog (from a puppy) for a few years before having children. Real life experiences with a dog in the home prepares people for the challenges that come with children.

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  2. Cats don't do the job... is that your position?

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  3. Dr. Deborah Mark, a pediatrician from Mt. Juliet, Tennessee, was convicted of first degree murder in the death of her four-year-old adopted daughter, Kairissa XingJing Mark, on Friday, December 2, 2011. Kairissa was adopted from China in April 2010 and died less than 90 days later. Deborah Mark faces life in prison for what prosecutors called severe and prolonged beating of little Kairissa.

    What's interesting is that Deborah Mark was a pediatrician and had access to more resources than most. She's not a first-time parent, speaks mandarin Chinese, and even if she hadn't bothered to read up on adoption, special needs and attachment issues during the 4-year wait for Kairissa, all she had to do was ask for help... why didn't she?

    http://www.newschannel5.com/story/16176693/guilty-verdict-in-pediatricians-homicide-case

    The final witness of the day was Tammy Bass, of Bethany Christian Services, the adoption agency that the Marks used to adopt Kairisa. She classified Kairisa as a “special needs child” and said the Marks had asked for a special needs child.

    A video was shown from China that depicted Kairisa clapping and playing with a balloon. Bass said the video was used to give “an accurate representation of the child” and was given to the Marks.

    She said the Marks had never called Bethany expressing any problems until June 30, when she said Steven called and he described Kairisa as a “demon child” with self-destructive behavior.

    Bass said the Marks were referred to a counselor but added that after the counselor contacted the Marks the family did not make an appointment to meet with him.

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  4. Unfortunately, nothing seems to prevent some highly-educated parents from falling for mistaken--even superstitious-- beliefs about children. It may only have been a turn of phrase to call the girl a "demon child", but some "exorcists" have been known to claim that adoption opens a door for demonic possession. If the Marks parents had this belief, I can well imagine that they saw no point in seeing an ordinary counselor.

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  5. I know the Marks personally, they are kind and loving people and have been devastated by the tragedy of Karissa's issues. They are bible believing christians who worship the Creator. I'm quite certain they were praying for a miracle healing but perhaps they should of sought out an exorcist , deliverer or healer but it's not like they are listed in the phone book, so many whacko's out there but I assure you the Mark's aren't the evil people the court made them out to be.

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  6. Anon, I appreciate your comment, but I am really uncertain about how to respond. You raise many questions in my mind. Is it your belief that people who share certain religious views can't be wrong about practical matters? Did the Marks believe that the child was possessed by a demon? Do you believe that, and do you consider possession the real problem behind children's disturbed behavior?

    I've always thought of "demonizing" as a metaphor, but perhaps that's not the way you think of it.

    I would like to hear a lot more about this.

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