Bluntly acknowledging the challenges faced by many adoptive families, a coalition of child welfare and adoption groups is appealing for a national reappraisal of how best to provide sustained, effective support and keep grim outcomes to a minimum.
A large majority of adoptions go well, but a few end disastrously, and others entail wrenching emotional and financial struggles for adoptive families as they take in children from U.S. foster homes and overseas orphanages.
In a report being released Thursday, endorsed by many leading players in the adoption community, the Evan B. Donaldson Adoption Institute said too many families are not receiving essential services while raising children who previously had been abused, neglected or institutionalized.
"The good news is that most of them, and their families, are doing just fine," said the institute's executive director, Adam Pertman. "The bad news is that the ones who need help too often aren't getting it."
The report, "Keeping The Promise," links the current challenges to the changing face of adoption over the past two decades. Adoption of relinquished infants has become far rarer, now numbering an estimated 14,000 a year, while adoptions out of foster care _ involving many children who suffered abuse or neglect _ have soared from about 31,000 in 1997 to more than 57,000 last year.
There also were 12,753 adoptions of foreign children last year, many of them with special medical or psychological needs.
"Given the realities of the types of adoptions occurring today ...the majority of children come to their new families from backgrounds that can lead to elevated risks for developmental, health, emotional and/or behavioral issues," the report said.
These include an array of adverse prenatal and early-childhood experiences, such as malnutrition, prenatal exposure to drugs or alcohol, physical or sexual abuse, and multiple placements in orphanages or foster homes.
The Donaldson Institute described its new report as the most comprehensive ever on post-adoption services. Organizations endorsing it include the Child Welfare League of America, the North American Council on Adoptable Children, the American Academy of Adoption Attorneys and the National Council for Adoption.
Among the report's recommendations: Convene a national task force to propose improvements in post-adoption policy, conduct more research to assess effective support practices, and dedicate federal funding for post-adoption services.
Some medical needs of adopted families are covered by Medicaid, although Alan Abramowitz, director of Florida's Family Safety Office, said coverage could be more expansive. Most families adopting from foster care also receive adoption subsidies; amounts vary widely from state to state.
Most states face budget problems, and some have reduced the subsidies or canceled built-in increases that previously came as children grew older. According to the Donaldson report, many foster parents balk at adopting because of fears that adoption subsidies will be inadequate, and some adoptive parents have mortgaged their homes trying to pay for costly mental health care.
The report cited two recent cases in Tennessee that underscored the need for specialized post-adoption services for some families adopting internationally. In one case that made news worldwide, a single mother sent her adopted Russian son back to Moscow unaccompanied; in another case, a pediatrician was indicted for abuse and murder of a daughter adopted from China.
Pam Wolf of Harmony Adoptions, which has a contract with the state to offer post-adoption support throughout Tennessee, said the parents involved in those two cases had not contacted Harmony for help.
Her agency assists roughly 800 families a year _ emphasizing in-home family therapy to address problems with the children's attachment to their parents.
"A lot of them are kids who've been through hell and back," Wolf said.
Kris Faasse of Bethany Christian Services, one of the nation's largest adoption agencies, said some adoptive parents are not prepared to handle the challenges.
"There's sometimes over-optimism," she said. "They hear negative things and say, 'That won't happen to me.'"
Among Bethany's many client families are Bill and Sally Swets of Holland, Mich., who adopted a brother and sister from a Russian orphanage 10 years ago. The children are now 14 and 12, and doing well in school, but for years their emotional and behavioral problems taxed the family. Eventually, Sally Swets worked with the local Bethany office to start a pilot post-adoption support program, and the family also underwent counseling _ which she describes as invaluable.
"Things don't always go perfectly," she said. "It's not if your child is going to need counseling _ it's when, and the earlier the better."
Even when adoptions go smoothly, support services can be a vital boost.
Sue Unkenholz of New York City, who along with her husband, Ward Sutton, has adopted a son and daughter from Colombia, has attended numerous workshops convened by their adoption agency, Spence-Chapin, and also joined a parent support group.
"One reason this has been such a beautiful thing is because of post-adoption support," Unkenholz said.
Rita Taddonio, director of Spence-Chapin's adoption resource center, welcomed the report's call for expanded adoption-focused training for health care professionals and educators.
"Most clinicians aren't trained to handle the issues our children present _ the attachment issues, the severe trauma," she said. "In most schools, they have no idea how to handle these kids."
There are widely varying statistics gauging the challenges faced by adoptive families, with some studies suggesting that 10 percent or more of adoptions are dissolved.
U.S. census data over the past decade shows that the rate of disabilities among adopted children was roughly double the rate of the overall child population. The Search Institute of Minnesota evaluated teens adopted as infants, compared them to birth adolescents in the adoptive families, and found that the adopted youths had higher levels of delinquent behavior and poorer school adjustment.
It's not just the children who are at risk. Dr. Jennifer Payne, a psychiatrist at Johns Hopkins University, said her research indicates that mothers who recently adopted may have higher rates of depression than mothers who'd recently given birth.
The report presented the Donaldson Institute with a tricky balancing act as it sought to highlight the difficulties faced by many adoptive families without dampening interest in adoption. The report cited studies suggesting that more than 90 percent of adoptive parents are satisfied with their experience and would choose to adopt again.
"The last thing in the planet we want is to stigmatize adoption and adoptive families by saying some of them need help," Pertman said. "When a kid has been institutionalized, or abused and neglected, it's our responsibility to help those children. ... Adoption itself is one of the things that helps kids get healthy."
Donaldson Adoption Institute: http://www.adoptioninstitute.org/index.php