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The views of adoptive parents, state adoption program managers, PAS coordinators,(1) and PAS providers on services needed by adoptive families were more similar than not. Many of the state adoption program managers reported the needs in terms of the services available under their PAS programs. PAS coordinators/providers and parents identified the greatest needs as respite, information and referral, counseling and crisis intervention, advocacy, and access to adoption-competent professionals (especially in mental health). States and PAS coordinators/providers reported that their tracking of client information and cases has guided service delivery. Where client satisfaction survey data were available, adoptive parents reported a high level of satisfaction with the services and their interactions with providers. Although parents generally were satisfied with the PAS they received, they expressed a strong desire for more funded services.
State adoption program managers, PAS coordinators, and PAS providers identified similar family needs. In several states, PAS needs assessments had been conducted. Oregon’s most recent needs assessment, which sampled families receiving adoption subsidies, achieved a 50% response rate (Fine, 2000). Parents were asked about services they had received during the previous year and how important various services might be for their family in the coming year. Counseling for children was the service most frequently described as somewhat or very important, by 49% of interviewees, followed by professional advice about rights and services (46%), support groups (45%), and respite care (42%). Nearly one-third of the families did not view any of the listed services as important. Comparison of service needs to services received suggests a high proportion of unmet needs.
| Service | Described service as somewhat or very important % |
Reported using service in previous year % |
|---|---|---|
| Counseling for children | 49 | 30 |
| Professional advice | 46 | 15 |
| Support groups | 45 | 15 |
| Respite care | 42 | 17 |
| Recreation | 38 | 6 |
| Counseling for adults | 37 | 13 |
| Residential treatment | 21 | 4 |
| Psychiatric hospitalization | 16 | 2 |
| Source: Fine, 2000. | ||
Most coordinators/providers mentioned respite as being a major need. Many also felt that, in addition to providing reimbursement or payment for respite care providers, families needed group respite activities such as camps, trips, and fun days. Coordinators/providers said that families found these activities to be beneficial but that providers were limited in their ability to offer them.
| Respite, mental health services, adoption-competent professionals, advocacy, and residential treatment were needs frequently identified by coordinators and providers. |
Another need that coordinators/providers often cited was mental health services for adoptive families. Although these services were funded through Medicaid, many mental health providers did not accept Medicaid. Oregon’s adoption program manager noted that if any additional funding were to be available, her first priority would be to provide counseling and crisis intervention services in each of the state’s service areas. In Texas, the adoption program manager saw a need for the development of home-based therapeutic services. Coordinators/providers also mentioned that families needed professionals competent in adoption issues, especially in the educational and mental health areas. Families needed educators who were aware of adoption issues as well as advocates to attend education meetings with parents to help ensure that their needs were met.
Several coordinators/providers mentioned advocacy, residential treatment, case management, support groups, and assistance with adoption subsidies as other needs of adoptive families in their state. They also said that parents needed more training about adoption issues before the adoption occurred. Some stressed that this would make parents better able to prevent later problems.
Adoptive parents who participated in the focus groups identified a range of service needs, some of which were services delivered by the state-directed PAS programs. The 32 adoptive families represented in the focus groups had adopted 76 children, 66 of whom were from the public child welfare system.
Respite Care and Activities/Events
Respite care was mentioned most often as a major need of families, across all states visited. Many adoptive parents described a dearth of available respite providers. Others mentioned the lack of respite providers qualified to deal with special needs children. Parents also expressed a need for more group activities for children and families to provide adopted children opportunities to interact with one another. In an evaluation report of Adoption Crossroads by Salem State College in Massachusetts, families noted the “break from parenting” provided by respite as the most helpful aspect of care.
Information
| Parents felt they needed better information about available services. |
Adoptive parents in all five case-study states reported being unclear about what PAS services were available to them, saying they needed more information about services that they could access. As one parent stated, “Services may be there, but parents don’t hear about them.” Another parent said that she did not want to feel “lucky” when she learned about something to help her child. Some parents also felt that they learned about services only in times of crisis and wanted to be knowledgeable about services before crises developed. As one parent said, “I didn’t realize adoption had the potential to be so crisis-laden. Not until a crisis occurred did I realize services were available.” Another parent said, “We shouldn’t have to hit a crisis to get offered services.” Parents in one group recommended establishing an all-inclusive program where adoptive parents could access counseling, advocacy, lawyers, respite, and other adoption-related services “under one roof.”
Parent Training
Adoptive parents in each state felt that training about adoption issues was a critical need. Although some parents mentioned that parent training currently was offered, they often had found that it did not meet their needs. Parents often stated that the training was offered too soon after adoption, before they had had enough experience with the issues to understand the training content. At the same time, however, other parents believed that the state pre-adoption training needed to be supplemented. “I went through MAPP [pre-adoption training] and said that after adoptions they should have RE-MAPP.” Parent training also was thought to be needed for issues such as adopting special-needs children and dealing with cultural issues around adoptions.
Professional Training
Adoptive parents saw education of medical and community professionals regarding adoption issues as extremely important. Most mentioned having trouble finding qualified therapists who were knowledgeable about adoption issues. Parents reported that their children were stigmatized by schools when it was discovered that they were adopted. One parent said, “If the school finds out they are adopted, it’s like they get an X on their back. The school is quick to put the child out or think they will have problems.” They wanted staff training as well as advocacy to help them deal with schools on their child’s behalf.
Mental Health Services
Adoptive parents in most groups said that access to and funding for mental health services for their adopted child was a serious need. Parents were concerned about finding a provider as well as being able to pay for the services when they did find someone with whom they felt comfortable. They noted that many community providers either did not accept Medicaid or were not included among providers that they could use with their insurance.
Child Assessments, Evaluations, and Information
| Parents particularly wanted to have more information about their child’s background, history, and current assessments, and to gain a better understanding of changing needs as their child ages. |
Adoptive parents wanted more comprehensive evaluations and assessments conducted on their adoptive child when they were placed and before finalization. Parents also wanted to know more about the child’s and birth parents’ background before adoption finalization, saying that this information was critical in helping them understand the needs of their adopted children. Parents thought that more information on their child’s background would help them better prepare for future difficulties, recognize problems when symptoms begin to occur, and solve current problems. “Parenting would have been a lot easier if I would have had more information.” Regardless of whether this information was available or would have been helpful, parents were frustrated at not having received it.
Adoptive parents also wanted more information on the physical and mental problems their child might have. In one state, parents suggested that a law be established to require that medical records be given to adoptive parents. Parents also mentioned needing more assistance in interpreting the records they did receive. One parent said that she still was unclear about what the information she had received actually meant. Another noted that when her daughter became a teenager and began severely acting out, she went to a nurse who “translated” the psychological and medical information from the adoption records.
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Each of the states had implemented efforts to monitor the delivery of PAS and client satisfaction. Reports were available only from Oregon and Massachusetts, although other programs appeared to have been collecting comparable information. These reports were consistent with staff assessments in other states of increasing service utilization and high levels of satisfaction with services.
| PAS providers have measured client satisfaction with services through mail and telephone surveys. |
In addition to these utilization data, Oregon surveyed adoptive families’ satisfaction with these services. Fifty-three families who had received “in-depth” services initiated through a telephone call to ORPARC were mailed a questionnaire, and 19 responded (a 36% response rate). Findings included the following:
The Salem State College annually assessed parent satisfaction with PAS provided in Massachusetts. The third-year evaluation report (Hudson et al., 2001) reported satisfaction data across six service areas. Callers were extremely satisfied with information and referral services. For all 12 types of information and referral services, at least 90% of interviewees reported being satisfied. Another 90% of those surveyed rated response team service either as very good or excellent. Of the 22 parents using respite, 18 described the services as very good or excellent. With regard to family support services, 17 out of 22 responding parents rated services as very good or excellent. Training participants were satisfied with the quality of the workshops they attended: 71% gave the training high marks.
Adoptive parents who participated in the focus groups reported high levels of satisfaction with the services provided by their state’s PAS programs, but many felt that additional funding was needed. Parents in several states expressed satisfaction with how effectively and quickly program staff handled crises (e.g., suicidal behavior, hospitalizations, aggressive behavior). “They defused the emergency, got my daughter to agree to go to counseling, and helped steer us to avenues to get long-term services.” Parents in Virginia specifically mentioned that they appreciated the support groups they attended.
| Parents appreciated the prompt response from PAS providers, but expressed the desire for additional funding for services, especially respite. |
Across the five states parents also appreciated receiving appropriate information about adoption issues and referrals to adoption-competent therapists and other service providers. One parent noted that her PAS provider helped the family switch psychiatrists and attended the first two meetings with the psychiatrist. Another parent said that she was “comforted” to know that the PAS provider knew about the range of residential treatment options and knew the facility where her daughter was placed. Another parent liked receiving a video on how to talk to schools about adoption issues, but did not like the suggestion that parents themselves go into schools to train staff. Many parents expressed satisfaction with respite options, such as weekend stays or camp stays, but they also very clearly expressed a desire for more funding for those services.
Regarding program structure, one group of parents recommended that PAS be uniform across state lines to make it easier for families to move to other states. They felt there was too much variability in access to and availability of services from state to state. Another group recommended that services be available not only to the adopted child but also to the immediate family. They considered the well-being of the child to be dependent on the well-being of the entire family.
(1) In both Virginia and Massachusetts, lead service providers subcontracted with other providers and coordinated the overall PAS program.
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