Predictors of Access, Use, and Satisfaction with Adoption-Competent Mental Health Services Among Sexual Minority and Heterosexual Adoptive Parents

Background and Purpose: Despite increased acceptance of families formed by adoption, including by sexual minority (SM) parents or via transracial adoption, adoption stigma continues to persist in subtle forms. Stigma has long been associated with poorer mental health (MH) outcomes, especially for children and families possessing a minority identity status. Children adopted by SM parents may be particularly at-risk for receiving lower quality MH services based on discrimination related to their family composition. Limited research has examined SM parents’ MH experiences, despite prior research indicating SM individuals are more likely to receive poorer healthcare and are also more likely to adopt, as compared to their heterosexual counterparts. Moreover, social workers and other MH providers, are often not adequately trained in treating adopted children, transracial adoptive families, or SM-headed families.

Our study addresses this gap by examining 1) use of MH services, 2) access to adoption-competent services, and 3) satisfaction with MH services, by SM families and transracial families.

Methods: Participants were from a subsample of the Modern Adoptive Families study, an online survey of adoptive parents (N=1360 parents; 1109 heterosexual, 148 lesbian, and 103 gay; M_age = 45 years). Adopted children had been placed early in life (M_age=1.68 years, SD=2.36) and were an average of 8.47 years during data collection (SD=4.77, [<1-17]). Most respondents were White (87%), transracial families (66%), and college-educated (83%).

Participants self-reported their use of MH services, access to an adoption-competent provider who they felt understood adoption, and satisfaction with their MH services. Linear and logistic regression analyses were conducted.

Results: Among the 64% of parents in our study who sought MH services, 62% reported access to an adoption-competent provider and 51% reported satisfaction with services. Regression analyses showed being a lesbian mother (B = 1.00, p <.01), having a child ≥ 6 years (B = .41, p <.001), or having an African American child (B = .08, p <.05) was positively associated with seeking MH services. Having a child ≥11 years (B = .12, p <.03) was positively associated with access to an adoption-competent provider. Logistic regression showed being a gay father (Adjusted Odds Ratio [AOR]: 2.13, 95% CI: 1.12-4.12, p <.02), annual income >$100,000 (AOR 2.55; CI= 1.41-4.63, p <.001), a college degree (AOR 1.60; CI= 1.00-2.57, p <.05), and having an Asian child (AOR = 1.96; CI= 1.01-3.79, p <.04) was positively associated with satisfaction with MH services.

Conclusions and Implications: These findings support past research that pathways to quality healthcare continue to differ for families, with parents’ report of satisfaction with MH services and providers varying based on family type and demographics. Moreover, because associations between parental sexual orientation and use, access, and satisfaction with services differed significantly, this may suggest to practitioners, policy-makers, and researchers that as family structures become increasingly diverse, intervention efforts should focus on developing inclusive practices to reduce preventable healthcare disparities. Future research should examine the protective strategies parents may be employing to help manage or reduce bias, which may buffer the potential negative effects of stigma.