Friday, February 22, 2008

Workshop 2.5: Supporting Adopted Children After Adoption: What are Their Post-Placement Needs?

Ethics and Accountability Conference
Sponsored by Ethica and Evan B. Donaldson Adoption Institute
October 15-16, 2007

Bullet points for discussion during Workshop 2.5:

  1. What are the most important needs of adopted persons after adoption – both in the short and long term?

  2. To what extent to current practices and policies respond effectively to these needs?

  3. What new services and supports are needed to ensure that the needs of adopted persons are met?


Carrie Kent is the Director of Research for Ethica, Inc. and an adoptive mother of two children, Jack and Desiree. She is active both locally and nationally in issues related to openness in adoption, as well as transethnic placement. She has been co-owner of the XcultureAdopt list for four years and has spoken at the 1999 Traverse City Open Adoption Conference, the fall 2000 LifeGivers Workshop at Higgins Lake, Michigan, and the 2003 Open Door Society spring conference. In her “day job,” she is head of Research Services at Harvard University’s Widener Library, and is an as-of-yet unpublished novelist.

Joyce Maguire Pavao, Ed.D., LCSW, LMFT, is the Founder and CEO of Center For Family Connections, Inc. (CFFC - est. 1995) in Cambridge, MA and New York. Dr. Pavao has done extensive training, both nationally and internationally. She is an adjunct faculty member in psychiatry at Harvard Medical School, and has consulted to various public and private agencies, schools, and the court system. She works closely with individuals and families created by adoption, foster care and other complex blended family constructions. She has developed models for treatment and training using her systemic, intergenerational, and developmental framework, The Normative Crises in the Development of the Adoptive Family. Her book, The Family of Adoption, has received high acclaim. Dr. Pavao has received many awards and honors, including the Adoption Excellence Award for Family Contribution (2003) and the Angels in Adoption award (2000).

Debbie B Riley is Executive Director of The Center for Adoption Support and Education, Inc. (C.A.S.E.), an independent post-adoption organization in the Baltimore-Washington area and co-author of Beneath the Mask: Understanding Adopted Teens. Since 1993, her work has focused exclusively on the field of adoption. She has created a continuum of post-adoption programs in the Washington, DC area and a variety of innovative and effective programs to address the complex needs of families with a variety of adoption backgrounds, including public and private, international and domestic. Ms. Riley presents both locally and nationally on numerous topics related to adoption and adolescent mental health. She serves on the Research and Practice Committee of the Evan B. Donaldson Adoption Institute, the Editorial Committee for the Adoptive Families Magazine, and the Children’s Agenda Advisory Committee of the Montgomery County Collaboration Council for Children, Youth, and Families. Ms. Riley holds a Master’s degree in Marriage and Family Therapy from the University of Maryland. She is the adoptive mom of a teenage son.

Indigo Willing OAM, is a doctoral student at The University of Queensland, Australia. Her research interests include transnational families and migration, as well as links among race, culture and child welfare services. Her thesis focuses on the experiences of Australian parents who have adopted children from Asia and Africa. Ms. Willing was adopted from Vietnam into a white Australian family in 1972, and as a young adult, she received a Medal in the Order of Australia in 2006, in recognition of her work in developing the Adopted Vietnamese International community network. This network is dedicated to assisting adopted people from the Vietnam War and their adoptive families to develop stronger connections to Vietnamese culture, history and surviving/missing relatives. The network works closely with a range of adoption groups in Australia.

Debbie Riley

  • When she thought about what are the most important needs of adoptees post-adoption and what extent current practices and policies respond effectively to the issues discussed by this panel, she came to the realization that adoption professionals know that there are normal but complex issues facing adopted persons, many of whom will seek professional services in charting their adoption journey.

  • Adoption is not a one-time event but a lifelong process that warrants specialized support upon the way.

  • Most important need of adopted persons is the funding, availability, accessibility and quality of adoption-competent mental health services. Current socio-political factors don’t ensure the availability of these services. It is the ethical and legal obligation of her field to ensure all adopted persons have access to competent mental health services. Why are the children with the most complex adoption and mental health needs being referred and seen by the least qualified experienced clinicians?

  • The Code of Ethics of the National Association of Social Work states that when generally accepted standards do not exist with respect to an emerging area of practice, then they should exercise careful judgement and take responsible steps with respect to education, training, consultation and supervision to ensure competency in their work and to protect clients from harm.

  • We must join together to expand the knowledge base of practitioners set the standards for competency through federal, state and local collaborations and advocate for flexible funding streams to sustain the services. Adoption competent providers can be instrumental in ensuring positive outcomes for adoptees and their families.

    It is our ethical responsibility to ensure that adoptive families have access to high quality adoption services.

Indigo Willing

  • Shared insight from the Australian perspective.

  • Since 2000 she has been working with adopted Vietnamese war orphans. She runs a search registry for people looking for relatives and notes the paucity of resources. Her doctoral studies focus on the identity construction of adoptive parents and how they negotiate problems of adoption.

  • Australia is undergoing several adoption legislation reviews at the state level and has just had a federal inquiry into the adoption process. People are speaking up and saying things need to be changed, but who are being heard?

  • Adoptees are highly experienced adoption educators and run excellent support groups among themselves, but they are rarely funded and rarely heard.

  • Most common issues adopted people are focusing on with respect to post-adoption needs:

    1. Representation – the need for adoption institutions, agencies and groups etc. to allow for adult adoptee perspectives to illuminate both the strengths and weaknesses of the practices. Also a push to call for adoptee inclusion on more boards, committees and forums.

    2. Administration – need for tighter record keeping, inclusive fees planning for services such as searching for birth parent assistance, return visits and counseling support. A lot of uproar in Australia at the moment for fees to adopt. None of those fee increases are covering post-adoption services other than 2,000 per year for a festival where children can dress in their national costume.

    3. Transnational planning – providing guidance and services relating to assisting adoptees who embark on return trips. A lot of adoptees travel independently and find themselves thrown in the deep end. They are left in an incredibly vulnerable place. If so much preparation goes into bringing these children overseas, surely some preparation could exist to help them return to explore birth countries.

    4. Cultural strategies – offering of programs dedicated to issues such as language and cross-cultural competency. For example, the documentary Daughter from Danang illustrated a cross- cultural collision.

    5. Ensuring emotional and psychological capital – relates to making sure there are suitable programs and appropriately educated counselors who can assist adopted people manage issues related to their emotional well being and mental health. There is no post-adoption training for people like psychologists and family health practitioners in Australia.

  • Education, if it does exist, generally consists of getting volunteer adoptees to speak about their life story. Would like to see stronger programs being built.

Joyce Maguire Pavao

  • What adoption is not: adoption is not a problem, illness or a bad thing though it stems from what many think are problems. Society tends to view adoption as a problem. It’s very important to realize that pathologizing leads to pathology and a lot of that goes on in adoption and is that ethical?

  • Adoption is taking on and extending or making of family by admitting others to the clan and claiming them as relatives as in marriage. It is a lifelong process and it affects the generations before and after in many direct and indirect ways. It is complex, it is never simple.

  • Cannot focus on post-adoption needs of the child without focusing on the parents. If you don’t take care of the adults, the child isn’t taken care of. We need to provide more support and services to foster families.

  • With respect to birth parents, it is important to pay attention not just in the moment, but post-adoption these issues go on. There’s a developmental process for birth parents. We are not doing enough for birth parents, they are hardly considered. If you care about the child, you care about all of their parents. This includes parents whose children were removed – the children are in permanent homes and messages they give those children will make a huge difference in the emotional stability of their child.

  • For adoptive parents, there are ongoing needs. Often it comes in the guise of the children’s needs, but parents have developmental issues, including in and out of doubt about feeling genuine.

  • Therapy is not the answer to everything. Need to provide consultations and programs and not necessarily be in therapy.

  • Developmental issues for children – many points in time where things will come up that are quickly pathologized. Under anger lies sadness or fear. Larger community needs to have education e.g., schools where learning disabilities diagnosed are in fact teaching disabilities; medical and health professionals – rampant medications and crazy therapies done in the name of attachment, bizarre overdosing of adult medications for kids is unethical. Need to have extended family educated

Discussion from Workshop 2.5

Question 1.A person from CASE raised concerns with other mental health professionals. Instead of pathologizing adoption, they minimize and fail to recognize normal reactions to adoption. They suggest other things are going on instead of validating what is happening is normal. Are there more ideas of how to educate other professionals?

Riley: It’s been a delicate balance for many years of how much to attribute to adoption. Education is important.

Willing: She is a sociologist by training, but sees attachment come up a lot. It’s important to remind parents to keep a critical mind and do research.

Question 2. An adoptive parent/adoption worker referenced developmental stages members of the triad undergo and requested references.

Pavao: A lot of the grass roots organizations can be helpful. For example Lee Campbell of Concerned United Birthparents put together material on developmental issues of birthparents; she has a long vision of birthparenthood. There is also Romanchik’s organization. For adoptive parents, there are wonderful adoptive parent networks. Always go to the elders, parents whose children are in 30's and 40's and who have kept up with the times. Some people are better at some stages than others. The family is an organism, so it is important to see how everyone is relating to each other. Adult adoptee groups are incredibly important for people to listen to. Find people who can reflect on things.

Willing: Sometimes the diagnosis of adult adoptees is wrong. For example, low-self esteem is attributed to being separated from mothers. That may be true, but a more well rounded approach needed, for example, an examination of what else is going on in their lives like racism. Look at studies by adoptees in addition to personal narratives.

Question 3. Another adoptive parent/adoption worker wondered how we can help better prepare families in adoption by saying that post-placement services are more likely than if they had given birth to a child because there will be an added layer of issues.

Pavao: People should be trained to provide them. Important the services not all be therapy, but often need consultation and support.

Riley: We need to start advocating for the funding and that these services are accessible.

Question 4. An adoptive parent and educator said he tried to start a club for adoptees at his high school but he ran into confidentiality laws. Doesn’t know how to go about it.

Pavao: Suggest normalize it by expanding it, for example, to kids who live in complex families. Emotional and psychological issues are the same even if the legal situation is different. The kids may feel pathologized if limited to adoptees.

Riley: Look at the environment. A lot of adoptive parents don’t want their children to share they are adopted because of the stigma attached to them. See how one can create adoption sensitivity among peers.

Willing: As a teen, there might be issues of gender. At an adoption camp in Australia they showed a video with stories by intercountry adoptees who were a little older. Accompanying that they showed the movie Transformers and lots of boys came. Adoptive father groups have football days.

Question 5. Someone from Open asked what if you have parents who are in denial or who are reluctant? How do you draw these parents in?

Pavao: Help isn’t help unless you want it. No one starts out gung ho understanding all of this, but opens up along the way. Pre-adoption, prospective adoptive parents may not be interested even if they attend pre-adoption education, but they will have the information to get more help when needed. Sometimes information doesn’t take seed for awhile.

Willing: There is a real need for this. Can’t adopt in Australia without going through a state agency. Reasonably good program in the pre-adoption stage where prospective adoptive parents needs to go through education sessions, provide a life storybook, and undertake home studies. Adoptive parents have to compete for children so they join networks to learn how to get through the system and make friendships that way and then are keen to learn more, but there are not enough professionals to do the training.

Question 6. A mother said she runs an online support group for individuals who worked with her network of agencies she lost her daughter to. So she is in a position to help even though she is not a professional. What other things can she do besides recommend books?

Pavao: Suggests reading, going to conferences and lectures, support groups. Worry about the word “support groups” sometimes. Some like the information but don’t like the name. Hearing other people normalizes experiences.

Riley: Something she has found useful is journaling.

Question 7. An adoptive parent/adoption social worker asked whether there is a need for more professional standards when it comes to adoption social work in schools of social work. Should there be more standards of practice across the board?

Riley: Yes, there should be. What is an adoption-competent therapist? There is no standardization of knowledge base or core competency. It is important that we come up with standards before an outside entity does.

Pavao: Post-graduate programs are great but they are not nearly enough. Supervision is a key factor, for example, in the child welfare system people often become supervisors if they are near retirement and are going part time. There should be a lot more done to make sure people are trained.

Question 8. Adoptive parent/adoption worker ask about the importance of providing services to siblings, both biological and adoptive.

Pavao: Siblings really need support. We don’t do enough work with siblings before a placement or before removal.

Riley: Do siblings get to be a part of the process? Doesn’t want to see the child as separate from everyone else and usually siblings are left out entirely.


Republic of Togo Suspends Child Adoption

On February 7, the Togolese government suspended all forms of child adoption due to problems in its adoption system. According to the government, courts granted adoptions on the basis of "abandonment judgments without any social inquiry" while overlooking adoption procedures. The President of Togo, Faure Gnassingbe, asked the Minister of Social Actions and Minister of Justice, to create order in child adoption procedures, settle adoption within Togo in the interest of parties outside the country and clarify legal procedures for children’s law.


Togo Suspends Child Adoption, Mathaba News Agency, February 11, 2008

Togo: Togolese Government Suspends Child Adoption,, February 8, 2008

Monday, February 04, 2008

Book Review: Once a Mother: Relinquishment and adoption from the perspective of unmarried mothers in South India by Pien Bos

Pien Bos is an education specialist and anthropologist who worked in the adoption field before becoming a researcher in 2001. Once a Mother is her dissertation published resulting from two years of field work in South India with mothers, families and social welfare NGOs. Pien Bos defended her dissertation on January 10, 2008 for which she received a PhD with distinction from Radboud University, Nijmegen, The Netherlands.

The subject of the book is the mostly unheard “supply side” of the adoption equation: first mothers in India. The goal of Bos’ research was to fill this knowledge gap and document and probe the process of child relinquishment from the perspective of their mothers. In this respect, Once a Mother is equivalent to The Girls Who Went Away: The Hidden History of Women Who Surrendered Children for Adoption in the Decades Before Roe v. Wade in that Bos documents present-day relinquishment practices in South India which are in many ways reminiscent of the Baby Scoop Era in the United States.

Bos interviewed 36 mothers whose factual circumstances varied widely, both in their socioeconomic station in life as well as the circumstances of their children’s conception. Seven of these mothers had relinquished their child at least 15 years earlier. The other 29 were in the process of relinquishing. In addition, Bos interviewed 16 other mothers who decided not to relinquish and were raising their children on their own.

From her fieldwork, Bos developed three main findings:

1. Many mothers who relinquished their children considered themselves married, not unmarried.

The social stigma of unwed motherhood is generally assumed to be the primary reason why children are surrendered for adoption in India. However, Bos notes that many of the mothers she interviewed adopted a more flexible and informal definition of marriage, specifically the tying by a man of a “tali” to a woman without regard to other ceremonies and formalisation. The varying interpretations of marital status tended to be denied by institutions.

2. Blood bond in general, and the blood bond between mother and child specifically, has an extremely significant cultural meaning in Tamil culture. The cultural significance of motherhood, in combination with the meaning of the notion mother in its broader cultural sense implies that motherhood is irreplaceable and life-long. Despite the legal significance of relinquishment, mothers continued to view themselves as their children’s mothers who handed over care of their children to others, but not their motherhood.

Although care of the child was transferable, motherhood is not. According to Bos, “[b]iological mothers of surrendered children still felt and eventually claimed to be the only true mother, and this aspect explained feelings, hopes and eventual expectations after adoption, for instance with regard to possible future reunions with their children.” Bos found that some mothers tended to relinquish out of a sense of gratitude to the NGO for taking them in: “[K]eeping the baby would imply the breach of an informal agreement and some mothers also assumed they would be charged an amount comparable to adoption fees for reclaiming their child.”

Reunion with a surrendered child was a recurring theme in Bos’ research. For this topic, in particular, differences in the individual perceptions and processes of mothers emerged. Whereas one mother raised the issue spontaneously as a consolation after surrendering her beloved baby; for another, the idea of reunion appeared a worse-case scenario. Bos discovered that time was an influential factor in a mother’s attitude towards a potential reunion. Some mothers who took into account their circumstances decades after relinquishment did not immediately reject a future reunion. Married mothers in particular expressed a strong urge to meet their surrendered children again. Despite the interest of many adoptees and biological mothers in reuniting, Bos found that adoption agencies typically do not seriously cooperate in searching for biological families to the point of actively obstructing such searches. The people working for NGOs typically assume that secrecy is demanded to protect the lives of mothers, without regard to the circumstances of the actual mother sought to be traced.

3. The relinquishment process is the equivalent of a “fyke” (a funnel-shaped net used to trap fish) where women who enter the social welfare system upon an unexpected pregnancy are set on a single-minded trajectory toward relinquishment.

Bos writes:
“From the moment of admission in a licensed agency, the internal flows and
forces, determined by prevailing dominant discourses, isolation, hierarchy,
loyalties and money are pushing her deeper inside the fyke. She is trapped
until the day she signs a surrender deed. On that day, the mother is
released from the institution and the child receives the status of ‘parentless
child’ until it is placed into an adoptive family.”

Bos finds the discrepancy between the stated objectives of formal adoption rules and daily practices “shocking.”

Bos notes that the consequences of a premarital pregnancy and the decision to relinquish expands beyond the mother and also encompasses her family and community. Hierarchically, mothers are not in a powerful position owing to their youth, lack of money, education and opinion that they “went astray” through engaging in premarital sex. Like mothers in Western countries, particularly during the Baby Scoop era, Indian mothers are strongly influenced and at times completely overruled in their decision of whether to relinquish by family members and/or staff of institutions. “Counseling” of unwed mothers by NGOs typically means advising relinquishment; other options are more commonly explored in the case of married mothers. Some mothers acknowledged the desire to hand over the decision-making process to others, however, Bos met other mothers who revealed that they were manipulated and essentially forced to relinquish against their will. Bos felt that good communication between mothers and their relatives would be beneficial, however, during her field work she discovered that pregnant women or new mothers more often than not were isolated with limited contact with family since they were sequestered through institutionalization or hospitalization. Input in the decision-making process by relatives was often conducted outside the presence or prolonged time spent with the mothers themselves. Bos pleas for informed decision-making; a transmission of cumulative knowledge and sharing with mothers who did or did not surrender.

Bos does an excellent job of noting the inherent conflicts on the part of NGOs that engage in adoption:

“My conclusion is that people on the work floor, practitioners and counselors
working in or for NGOs work with extremely complicated dilemmas. They
balance on a continuum with the voice of their personal conscience, their
perception of acceptable and suitable solutions for women on one side and
financial responsibilities on the other. On the one hand, they need to act
according to the politically correct conventions concerning mothers and their
children; on the other, they need to ‘sell babies’ to adoptive parents to be
able to run their agencies. NGOs are trapped by the construction of an
adoption field where financial income and the placement of children in adoptive
families are intertwined.”
Although legal adoptions are painted as a non-profit endeavor, the fact is that adoption is a lucrative financial means to maintain a flow of money from adopters to licensed NGOs. Bos cites the deleterious impact institutionalization has on the health and welfare of children, and therefore acknowledges that the outflow of children from institutions into foster or adoptive family care can upgrade their lives. However, her research examines how adoption simultaneously “sucks children into residential care” by putting pressure on women to supply babies. Bos concludes that “adoption, as it is legally organized, induces a flow of children towards institutions.”

Bos’ thesis is valuable because it offers a unique exploration voices of the mothers we in the West do not have the opportunity to hear while simultaneously affirming common place present-day attitudes and procedures that conflict with ethical adoption practices.

Once a Mother can be ordered by contacting Pien Bos at The price is 15.00 euro plus postage.


Once a Mother: Relinquishment and adoption from the perspective of unmarried mothers, Pien Bos, ISBN 978-90-9022453-4, 2007

Indian women giving up their children for adoption affected by lack of information, Radboud University, Nijmegen, The Netherlands, January 15, 2008