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Formal PAS programs were instituted in the 1990s in all five case-study states, Texas being the first. Adoption program managers reported that the development of PAS resulted from a combination of factors, including adoptive parent advocacy movements, state legislative action, and state executive initiative. In Massachusetts and Texas, advocacy by adoptive parents built support for PAS, although in very different ways, as described below. In Oregon, support for PAS was created through a combination of advocacy and activism from both outside and within state government. In Virginia and Georgia, PAS development largely was sparked from within state government.
In Massachusetts, adoptive parents, many of whom were professionals in the child and family services field, formed the Southeastern Massachusetts Adoption Services Coalition in the mid-1990s. The group eventually developed into the statewide Massachusetts Coalition for Adoption. These coalitions engaged the state legislature in meetings and conducted other activities to raise awareness about the needs of adoptive families. The state adoption program manager noted that these parents had felt that they needed resources outside of adoption subsidies, including access to adoption-competent professionals. He also recognized that the influence of advocates had been critical to the legislature’s funding of PAS: “It was only when private agencies, adoption support groups, and individual adoptive parents joined with the Department [of Social Services] that the legislature appropriated the money.” When the state legislature agreed to fund PAS, the state developed a request for proposals (RFP) based on input from advocates and the legislature. Advocates also assisted in the review of applications. In 1997 the state selected Children and Family Services, Inc. as the lead provider of a regional network of providers, establishing the Adoption Crossroads program.
In Texas the state’s decision to provide formal PAS was prompted by a class-action lawsuit in the 1980s by adoptive parents against the state for lack of services. Although the state prevailed in the lawsuit, publicity from the case increased awareness of adoptive family needs, prompting the state legislature to enact legislation to enable PAS funding. The state began funding PAS providers statewide in the early 1990s.
| Parent, advocates, state legislatures, state agencies, and needs assessments influenced the development of PAS in the case-study states. |
The establishment of a PAS program in Oregon resulted from a combination of adoptive parent and professional advocacy, state executive and legislative interest, state needs assessments, and federal funding availability. Adoptive parents and adoption professionals organized around concerns with the ongoing needs of adopted children who had been exposed to methamphetamines and other drugs before birth and with the need for more disclosure about the child’s history at the time of adoption. A legislative task force on adoption issues met in 1997 and gave more formal voice to these issues. In addition, the state conducted several needs assessments. As the state achieved dramatic increases in the number of adoptions, state officials became aware of the potential challenges faced by adoptive families. The state adoption program manager reported that, as a result of all of these influences, the state was “poised” to use Promoting Safe and Stable Families program (Title IV-B, Subpart 2) funds for PAS. Oregon developed an RFP for PAS and selected Northwest Resource Associates to operate the Oregon Post Adoption Resource Center in late 1998. ORPARC began operations in 1999.
In the mid-1990s, Virginia adoption officials collaborated under a grant with their counterparts in other states to discuss needs and strategies for post-adoption supports and services. The National Consortium for Post Legal Adoption Services was sponsored by an Adoption Opportunities grant under the auspices of the U.S. Department of Health and Human Services. Their publication, Adoption Support and Preservation Services: A Public Interest, was issued in March 1996. The adoption program manager noted that her participation in the consortium effort had directly influenced the state’s decision to create a PAS program and the consideration of program design options. As in Oregon, Virginia chose to establish the program using Title IV-B, Subpart 2 funds. The state released an RFP for the Adoptive Family Preservation program and in 1999 selected United Methodist Family Services of Virginia as the lead provider of a regional network of providers.
In 1997, based on recommendations from a legislative study committee on adoption and foster care, Georgia’s Gov. Zell Miller established the Office of Adoption as an entity separate from the Department of Family and Children Services, with its own budget and staff. The Office of Adoption is responsible for the administration and management of the adoption program, while adoption services (not post-adoption services) are provided through the county Departments of Family and Children Services. Oversight and authority for child welfare remain with the Department of Family and Children Services. The Office of Adoption developed the PAS program and oversees the contracts under the program.
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In all five case-study states, PAS are contracted out rather than provided by state child welfare staff. State adoption program managers mentioned a variety of reasons for this approach. These reasons included cost-effectiveness, the difficulties of hiring additional state staff and protecting their positions against budget cuts, and the belief that using external contractors fostered creativity. Families preferred to access PAS “without having to knock on the child welfare door,” according to Oregon’s adoption program manager and others. Using an external contractor also facilitates statewide service delivery in county-administered systems. “Some agencies are large with a number of dedicated adoption staff. Other agencies are very small with only one or two service workers, none of whom are dedicated to adoption,” reported a Virginia state official.
Adoption program managers and PAS coordinators described four PAS program structures:
| States have used the contracting process to encourage collaboration among service providers. |
States have used the contracting process to promote collaboration among service providers. Recognizing that several qualified service providers existed across the state, Virginia and Massachusetts required that agencies submitting proposals collaborate with other providers to offer services as teams. The lead service providers in both states approached competitors to ask them to work together. Adoption program managers and PAS coordinators/providers acknowledged that this collaboration led to formalization of relationships among providers who may not have ever worked together. PAS coordinators/providers mentioned that quarterly regional provider meetings fostered links among providers across the state. A PAS provider concluded that Virginia’s effort to make the program statewide and to foster collaboration had been positive and “marked by regular meetings and information sharing.”
Most of the PAS providers selected by the state have extensive experience in providing services to children and families, including adoption services and child placement. Some of the providers in Massachusetts and Texas have been in operation for over 100 years. In addition, Texas PAS providers are required to be child-placing agencies. Providers who are adoption agencies reported that they had been providing PAS informally to their clients before receiving state funding for PAS. However, not all PAS providers had been established entities. In order to establish services in a region that had previously had none, a PAS provider agency in Virginia was newly established as a satellite office of the lead PAS provider agency.
Regional PAS providers were expected to offer the full array of services for their region. However, their experience may be more extensive in some services than others. Interviewees in Virginia and Massachusetts noted that some PAS providers tended to focus on the services with which they have most experience. Georgia’s adoption program manager noted that choosing statewide providers for specific services reduced variations in service delivery across regions and allowed the state to take advantage of providers’ specific areas of expertise. In Texas, regional providers originally had been intended to provide the full range of PAS. When it became apparent that this was not feasible, the state agreed to let PAS providers subcontract the majority of services while retaining case management. Providers in Georgia, as well as regional providers in Virginia and Massachusetts, subcontracted or outsourced services as needed.
Outside formal PAS programs, child welfare staff provided limited information and support to adoptive families. In all five states, adoption program managers noted that state or county adoption specialists focused primarily on pre-adoption activities (e.g., recruitment of families, pre-adoption training, selection of families, home visitation, post-placement support, finalization) rather than PAS. Although adoption workers may have stayed in touch with families after finalization, they were not expected to provide continued support. Adoption subsidy workers also provided information to families in the course of their interactions. Among the states responding to the ILSU interviews, 19 of 30 (excluding case-study states) reported that state or county staff provided post-adoption assistance to families. However, many of these staff were subsidy workers, intake workers, or adoption specialists who typically provided limited information and referral for post-adoption issues.
Funding mechanisms followed the program structure. Oregon funded its statewide PAS provider, and Massachusetts and Virginia funded the PAS coordinator, who in turn subcontracted to regional PAS providers. Georgia contracted directly with statewide PAS providers for each service. In Texas, the regional PAS providers were given an annual budget limit up to which they could bill the state directly for case management services and other allowable services performed by subcontractors.
| PAS providers reported a degree of flexibility in transferring funds among services. |
PAS providers had some flexibility in their management of state funds. In Texas, PAS providers reported being allowed to transfer up to $5,000 across service categories without contract amendment. In Massachusetts, PAS providers noted that they could transfer funds among services, although they could not pull funds out of respite. The Massachusetts adoption program manager said that the flexibility in funding was “intentional.”
PAS providers in all five states reported that in-house services such as information and referral, parent training, and support groups were provided at no cost to families. However, in some cases, funding did not cover the full cost of a service that families sought through other community providers (e.g., respite, camps).
Contract periods for PAS providers varied across states from three to five years. In Massachusetts, the lead PAS provider noted that having a five-year contract provided the opportunity to fully implement the program and conduct an evaluation.
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Adoption program managers across the five case-study states believed that the primary goal of PAS was to keep adoptive families together and prevent dissolution of the adoption. Other objectives included providing core services through a statewide network and creating a consumer-driven program. An added benefit/result of PAS would be to boost recruitment for future adoptions.
PAS coordinators/providers appeared to understand and share the state’s goals and objectives for the program. Adoption program managers and PAS coordinators/providers realistically assessed the challenges and opportunities they faced in meeting these goals and objectives, especially around achieving statewide access to and availability of services.
State adoption program managers shared the belief that the primary purpose of PAS programs was to help adoptive families stay together and to prevent out-of-home placements among adopted children. The Georgia adoption program manager reported that the concept of permanency had been integrated into the goals of the state adoption program. A Texas PAS provider felt that a family was considered to be “together,” even if a child were placed outside the home, if the adoptive parents were still involved in the child’s care.
Adoption program managers noted that PAS programs were part of larger efforts to support and preserve adoptive families. Oregon’s adoption program manager described the PAS program as one side of a “triangle of services for adoptive families,” with the other two sides being adoption subsidies and the state’s “open door” policy designed to extend ongoing support to families who adopted children from the state. In Virginia, the adoption program manager and the PAS coordinator reported that the PAS program was designed to create incentives for system change by (1) developing post-adoption services; (2) increasing community coordination and collaboration in providing these services; and (3) increasing adoption competency and cultural sensitivity among health, mental health, and education providers who serve adoptive families.
| States structured their programs to provide a full array of PAS, to allow consumer direction, and to provide PAS regardless of geographic location. |
Adoption program managers in all five states indicated the importance of offering services to adoptive families throughout the state. As noted in Section 5.2, a variety of program structures were created to achieve the shared goal of statewide access. These structures included a network of regional providers (Massachusetts, Texas, and Virginia), a central provider with staff assigned to regions of the state (Oregon), and separate contracts with providers to offer specific services on a statewide basis (Georgia).
The use of regional PAS providers offered an opportunity to tailor the program to the needs and resources of each area, ensuring it was “flexible enough to respond to regional issues,” according to Virginia’s adoption program manager. However, several program managers and PAS coordinators/providers noted that PAS providers had varying levels of experience in providing the full range of services, leading to unintended variations in service delivery. As mentioned earlier, the adoption program manager in Georgia indicated that contracting with agencies with particular expertise ensured consistent quality of PAS statewide.
Delivering services to rural areas was a particular challenge regardless of program structure, according to adoption program managers. Although having regional PAS providers offered the potential of wider access to services, adoption program managers and PAS coordinators/providers in those states (Massachusetts, Texas, and Virginia) acknowledged that services tended to be clustered around the regional provider’s location (typically the larger community in the service area). Providers in several states reported difficulties in maintaining statewide coverage due to the demands of staff travel.
Several adoption program managers reported that another explicit objective was to allow families to decide their level of involvement with PAS and to identify the types of services they believed they needed. One program manager reported that providing supportive services in a family-centered manner, “all services being consumer driven,” was critical to the success of the program. One PAS provider stated that the best part of the program was its ability to tailor services to the needs of families, that the program did not “put families in a box.” Another PAS provider noted that a strength of the program was that services were not mandated, allowing families to access services on their own accord.
Virginia was the only state in which the state adoption program manager expressly identified the PAS program as a tool for recruiting adoptive families. She reasoned that if families learned about state-supported PAS before adopting, they would be more likely to feel secure enough to adopt and to seek out PAS after adoption. PAS providers in Texas and Massachusetts noted this connection, however, reporting that they often presented their PAS programs at pre-adoption parent training, raising awareness about PAS and helping to encourage potential adoptive parents.
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Across the case-study states, adoption program managers reported that eligibility for PAS was determined largely by adoption type and receipt of subsidy (i.e., presence of special needs). They all reported that their PAS program served families who adopted from the child welfare system in their state. If these families moved out of state, they retained the ability to access information and referral; however, several adoption program managers said that it was not feasible to provide other services due to geographic limitations. In several of the states, eligibility of families who adopted privately (domestic or international) or from another state’s child welfare system is limited. Exhibit 5-1 summarizes the eligibility for each state.
| Georgia | Massachusetts | Oregon | Texas | Virginia | |
|---|---|---|---|---|---|
| Children adopted from state | Yes | Yes | Yes | Yes | Yes |
| Children adopted from other states who now reside in state | Limited access | Yes | Yes | Limited access | Yes |
| Children adopted through private adoptions | Limited access | Yes | Limited access | Limited access | Yes |
Adoption program managers in Virginia and Massachusetts reported that any adoptive family residing in the state was eligible for PAS. In Massachusetts, eligibility is extended to families in legalized guardianship arrangements. In Virginia, the state opened up PAS to all adoptive families as a way to prevent future foster care placements for children whose needs are not met.
| In two of five states, adoptive families, regardless of adoption type, could access the full array of PAS services |
The availability of sufficient funds to serve all adoptive families is a concern in these two states, although neither has needed to ration services according to adoption type. Service providers in Virginia are directed to prioritize services to special-needs children, children adopted from the state, and transracially adopted children. In Massachusetts, the adoption manager reported encountering some initial resistance to the idea of opening the program to all adoptive families. Many of the adoptive parents who had been engaged in the grassroots effort to develop PAS had adopted from the state and worried that resources would be spread too thin if all families were eligible.
Among the states responding to the ILSU interview, the majority reported offering services to all adoptive families. However, these services may be more limited than the PAS programs in the case-study states. Several states also reported limitations for certain services.(3)
Adoption program managers in the three states that did not extend full PAS to all adoptive families were interested in doing so but believed they did not have sufficient funding. Oregon and Georgia offered some services to all adoptive families while restricting provision of their higher cost services to families who had adopted from the state. Texas was more restrictive in limiting its services.
| In states with limited access, families that adopted privately (domestic or international) were able to access information and referral, but not counseling, crisis intervention, or respite services. |
In Oregon, ORPARC staff provided information and referral services to all families and allowed families who adopted privately to access the lending library for a fee and to attend parent training sessions on a space-available basis. Oregon’s adoption program manager indicated that if more funding became available, the first priority would be to expand the range of services offered to families adopting from the state, although it would be preferable to serve all families if possible. Families who adopted from other state systems are fully eligible for ORPARC services.
In Georgia, all adoptive families were able to access information and referral services, parent trainings, camp stays, and crisis intervention. However, respite (other than camp stays), attachment therapy, and tutoring were provided only for children adopted from the state and receiving adoption assistance. The state adoption program manager noted that, in practice, higher cost services such as crisis intervention were provided to any adoptive family if the child was identified by the child welfare system as being at risk of placement in foster care or in a residential treatment facility.
Texas restricted all services (except limited information and referral) to children adopted from its child welfare system. The state adoption program manager said that the priority was to assist children who were placed by the state child protective services system. Funding was insufficient to serve private or international adoptions or adoptions from other states. In addition, the legislation that enabled PAS funding did not extend to these adoptions.
| PAS providers in all five states reported a strong interest in providing services to families before adoptions were finalized. |
Virginia is the only one of the case-study states whose PAS program is open to families prior to adoption finalization, on the theory that these families are equally at risk of reentry into the system. In other states, providers expressed a desire to serve families prior to the finalization of the adoption. “There is a feeling of being somewhat limited in not being able to serve families post-placement, pre-finalization,” noted a PAS coordinator. Regional PAS providers in Massachusetts asserted that they had the expertise and capacity to help at-risk families prior to finalization of their adoptions, noting that these families experienced some of the same problems as adoptive families.
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Two distinct patterns of funding PAS programs were seen among the five states visited, as shown in Exhibit 5-2. In Massachusetts, Adoption Crossroads received state funds set aside by the legislature in the Department of Social Services annual budget. These funds were dedicated to PAS inside the foster care account. The remaining states used Title IV-B, Subpart 2 funds, with additional funding sources that varied by state. Virginia required its lead PAS contractor to contribute a 10% match toward the cost of the program. Adoption program managers in Virginia and Oregon reported that all Title IV-B, Subpart 2 funds available for adoption promotion and support were spent on PAS.
| Sources | Georgia | Massachusetts | Oregon | Texas | Virginia |
|---|---|---|---|---|---|
| Title IV-B, Subpart 2* (including 25% state match) | Yes | No | Yes | Yes | Yes |
| Adoption Incentive Program | No | No | No | No | No |
| State funding (excluding Title IV-B, Subpart 2* match) | Yes | Yes | No | No | No |
| Provider match | No | No | No | No | Yes |
| * Commonly known as Promoting Safe and Stable Families program. | |||||
None of the five states reported using funding from the Adoption 2002 Initiative toward PAS.
The case-study states’ use of funding streams differed from that reported by states responding to the ILSU survey. Excluding the 5 case-study states, the funding source most commonly reported among the remaining 31 states was state funding (23 states) followed by Title IV-B, Subpart 2 (20 states) and Adoption 2002 (15 states). Some of the state funds cited in this survey may represent the 25% state match for federal Title IV-B, Subpart 2 funds.
Annual funding for PAS in 2001 varied widely across states, ranging from $500,000 in Oregon to between $8 million and $9 million in Georgia (Exhibit 5-3). In Texas it grew from $1.3 million in the early 1990s to $3.9 million. Given the variations in population size and program eligibility among the five states, it is difficult to compare funding levels across states; however, funding levels clearly varied with the provision of higher cost services such as crisis intervention (in Georgia) and residential care (in Texas). Adoption program managers across the states reported that PAS funding had been relatively stable in recent years with some midyear fluctuations. Although they believed that more funds were needed for their PAS programs, significant increases were not anticipated, especially in light of state budget crises and slowing economies.
| Georgia | Massachusetts | Oregon | Texas | Virginia | |
|---|---|---|---|---|---|
Annual funding (in millions of dollars) |
8–9 | 1.25 | .5 | 3.9 | 1.1 |
Among services providers, concern was widespread regarding the current levels of funding, and a range of measures had been taken in response to funding concerns. Although no states reported waiting lists for PAS services, some had to restrict availability of higher cost services. In Georgia, a provider of crisis intervention services noted that her agency had reduced the service period from six months to 90 days. Georgia’s adoption program manager also noted that the state was planning to change how respite rates were determined. The state planned to pay caregivers a flat rate ($9.00/hour), instead of deciding on a case-by-case basis.
| States and PAS providers noted fairly stable levels of funding, but providers expressed concern over the high cost of respite services, crisis intervention, counseling, and residential treatment. |
A regional PAS provider in Texas said his agency was developing a strategy for securing private grant funds to supplement state funds for respite because the agency perceived the need for respite as greater than the current state funding level allowed. His counterparts in Massachusetts noted that they had had the same budget for five years while serving an increasing number of clients. The lead PAS provider said that available funds were inadequate to cover families’ respite needs across the state and that low salaries had increased staff turnover in some regions. Massachusetts had not limited service availability, however, but recently eased limitations on the number of counseling appointments.
The Texas program’s budget was particularly vulnerable to the influence of residential care. PAS providers expressed concern that residential treatment costs were limiting their ability to provide other services. One noted that residential treatment drives the budget, often requiring shifting of funds to cover it, and that the flat reimbursement rates reduced flexibility in responding to families’ particular needs. Faced with funding shortages, PAS providers in Texas met in the mid-1990s and mutually agreed to limit the coverage of residential treatment only to the highest level of care and to not cover therapeutic foster care for adoptive children. They also reduced the coverage of camp stays from two weeks per year to one week per year.
Adoption program managers and other officials in several states expressed concern that the dramatic increase in adoption in the past several years will increase future needs for PAS and require additional funds to support it. A budget official in Oregon noted that as adoption assistance under Title IV-E increases, the funding available for PAS through Title IV-B, Subpart 2 will not increase accordingly. The state expanded its Social Services Block Grant (SSBG) plan to include PAS and independent living services so that future SSBG funds can be allocated to supplement Title IV-B, Subpart 2 funds, if necessary. A PAS provider in Texas expressed fear that increases in adoptions will create enormous pressures for service delivery, especially for residential treatment. “With increases in the number of adoptions in the past 5 years and the increasing average age of adoptive children, there will be a crisis in residential care due to the critical mass and flat [reimbursement] rates.”
Midyear fluctuations in funding also can affect providers’ ability to plan and deliver services. Providers in Massachusetts and Virginia reported that midyear increases in respite funding had allowed them to fund additional camp stays for children; however, this led to dissatisfaction among parents in subsequent years when those funds were unavailable. In Texas, one PAS provider reported being concerned that the annual budgets were shrinking over time and that midyear budget cuts occurred. “[We] do not have a guarantee of how much money is available.”
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State adoption managers and providers in the case-study states reported a variety of strategies by which they inform families about the availability of PAS. These included sending letters about the program to families receiving subsidies, disseminating printed materials, meeting with local or state government social services and other community organizations, and presenting the PAS program at pre-adoption parent training classes. In the two states in which the PAS program was open to all adoptive families, outreach was broadly targeted and did not include specific efforts to reach families who had adopted privately or from overseas. None of the adoption program managers expressed concern that increased publicity would lead to waiting lists for services.
Each of the states conducted extensive outreach to families that had adopted, or were in the process of adopting, from the child welfare system. Methods included announcements sent to all families receiving subsidies at the time of program implementation, program descriptions provided to families when they first received a subsidy check, and information inserted into the state’s adoption handbook. In several states, adoptive parents received materials about the PAS program when the adoption agreement was signed. Providers also reported presenting the PAS program in pre-adoption parent classes, either through PAS staff or parents who had used the services. They used these interactions with future adoptive parents to mitigate the sense of failure attached to seeking out help when it is needed. “Hopefully, we’re planting seeds,” said a provider in Texas. In Texas, regional providers disseminated materials about PAS at recruitment events.
| PAS providers reported a broad range of initial outreach to families receiving subsidy and adoption professionals, but did not report sustained outreach initiatives. |
PAS programs in several states produced a variety of printed materials (primarily brochures) to publicize their existence. These materials provided information on providers, types of services available, and how to contact a provider (e.g., through a toll-free telephone number for information and referral). In Texas, brochures were printed in English and Spanish. In several states, PAS providers supplemented state-printed materials with their own (e.g., brochures, flyers, newsletters, direct mailings, bookmarks, magnets). Regional directors in Massachusetts reported sending materials to schools, courts, churches, adoption agencies, and clinics.
Providers also met with community agencies to raise awareness about the PAS programs and to establish links to those agencies. A provider in Massachusetts reported that her agency still did the “road show” because of the high staff turnover at local social services offices. In Virginia, service providers were directed to establish advisory boards to provide input on the delivery of PAS. These boards, which typically met quarterly, included adoptive parents, local county staff, school staff, and other service agencies. In Georgia, outreach efforts varied by provider (each operating statewide); several reported disseminating information to schools, adoption professionals, and state staff.
Each PAS program also maintained statewide and/or regional toll-free numbers that families could call to learn about the program or to access services. PAS providers operating regionally within the state reported that they received calls directly from parents in their service area or via the central hotline. In Oregon, where there was a single central PAS provider, staff took calls from across the state, although staff members were assigned to a specific region for which they developed resources.
In spite of these extensive efforts, adoptive families across the five case-study states reported that they still needed more information about the types of services offered and how to access them. This was true even for parents who had accessed the state’s PAS program. Parents remarked on the lack of communication about available services. “Services may be there, but parents don’t hear about them.” Several parents reported having learned new information about service availability and access during the case-study focus groups.
| PAS providers noted the challenges of getting referrals from adoption workers, and of getting referrals before families were in crisis. |
Many families went to PAS programs through referrals from the child welfare agency or other service providers. However, in several states, PAS coordinators/providers and adoptive families reported that child welfare workers, including intake staff and adoption subsidy workers, did not refer families consistently to the PAS programs. The ORPARC director reported that intake workers were not very familiar with the program, even though it was intended to complement efforts by state staff to help families. The Oregon adoption program manger agreed that state intake staff were probably less familiar with or less open to referring families to ORPARC because these staff were focused on protection against abuse; she hoped that the renewed push for the “open door” policy on helping all families in need would assist with referrals back to ORPARC.
In spite of extensive outreach efforts, providers reported that many adoptive families first came to them time in crisis situations, having been referred to the PAS program by local professionals or child welfare staff. This included families who had adopted children through the PAS provider’s child-placing agency and were already known to the agency. Many service providers expressed the desire that adoptive families would access services preventively rather than in a crisis mode. Adoptive families in the focus groups confirmed that they often had heard about, or been referred to, the PAS program during a crisis situation.
(2) Virginia did contract separately with two providers for PAS in addition to funding a network of providers. One provider offered professional training, and the other was developing respite resources.
(3) In 12 states PAS were limited to children adopted from a public child welfare program; 20 states provided PAS to all adoptive families.
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