A Multi-Informant View on the Supports and Challenges for Adoptive Families of Children with Mental Health and Trauma-Related Needs

Purpose:  Successful adoption from foster care is characterized by timeliness, stability, and lifelong enduring relationships. Despite policies to improve adoption practices, too many children and families experience long waits to finalize adoption, intermittent and temporary re-entry into foster care, and adoption dissolution. Growing awareness of the impact of complex trauma has further elevated the needs of adopted children. As the field moves toward addressing children’s trauma-related and mental health problems to improve well-being and permanency, it is necessary to understand the needs of children and families as viewed by the stakeholders who may affect changes in service delivery. Including key informants from multiple systems, this study sought to describe various perspectives on how to promote successful adoption for children with trauma-related and mental health needs.

Method:  Semi-structured, individual interviews were conducted with 23 adoptive parents and 40 professionals knowledgeable about pre- and post-adoption services. The sample included individuals who adopted as foster parents, relatives, and strangers as well as professionals from court, child welfare, and mental health systems. Participants were recruited statewide to obtain insight from multiple systems, private and public organizations, urban and rural communities, and new and experienced professionals and parents. Transcripts were coded and analyzed using theoretical thematic analysis (Braun & Clarke, 2006). Member checking was used to confirm identified themes across interviews.

Results:  Results revealed several major themes. 1) Supportive factors: Effective communication, supportive systems, access to resources, and strong bonds between children and adoptive families are key characteristics of successful adoptions. 2) Children’s needs: Trauma-related and mental health needs are under-identified and undertreated at younger ages, but they often emerge at later developmental stages and pose challenges in child behavior and adjustment. Trauma, grief, loss, and attachment issues are widespread among adopted children. Common diagnoses include depression, bipolar disorder, reactive attachment disorder, ADHD, PTSD, and fetal alcohol syndrome. 3) Adoptive parenting: Necessary preparation and support for parents includes setting realistic expectations; openly sharing information about children; providing robust training on adoption processes and children’s trauma and mental health issues; and, ensuring timely and ongoing access to family-based interventions and peer support.  Effective caseworkers (collaborative, honest, highly communicative, and who provide trustworthy guidance) are considered the adoptive parents’ main source of support throughout the process. 4) System barriers: Up-to-date trauma training is needed across systems. Delays in legal processes and cross-system communication are problematic for timely adoption. Chief among policy issues are families’ financial concerns and availability of mental health providers who accept Medicaid.

Conclusion: This study contributes to the field by providing a cross-system approach to understanding children’s and families’ needs for successful adoption. Substantial consensus existed among stakeholders representing various types of systems, geographic regions, and both urban and rural communities regarding the need to improve services and systems that support adoptive families of children with trauma-related and mental health needs. The results demonstrate and justify the need for evidence-based interventions that address trauma, promote well-being, engage parents, and enhance cross-system collaboration. Policy and practice implications are discussed.