[ Main page of Report | Contents of Report ]
For the purposes of this study, state officials and PAS providers were asked primarily about services provided under the auspices of their PAS program. Across the five states, the services most widely considered to be part of the PAS programs included information and referral, counseling, crisis intervention, respite, case management, training for parents and professionals, advocacy, and support groups (Exhibit 6-1). Some variation existed among the states. Texas was the only state to offer residential treatment within the PAS program; Georgia was the only one to offer tutoring; and Oregon was the only state that did not include counseling, crisis intervention, and respite. This section discusses other, more subtle, differences among the programs.
| Core Services | Georgia | Massachusetts | Oregon | Texas | Virginia |
|---|---|---|---|---|---|
| Information and referral | x | x | x | x | x |
| Counseling | x | x | x | x | |
| Crisis intervention | x | x | x | x | |
| Respite | x | x | x | x | |
| Case management | x | x | x | x | x |
| Parent training | x | x | x | x | x |
| Professional training | x | x | x | x | x |
| Advocacy | x | x | x | x | x |
| Support groups | x | x | x | x | x |
| Residential treatment | x | ||||
| Tutoring | x | ||||
| Note: Families that adopted privately or from another state have limited access to some of these services in Georgia, Texas, and Oregon as described in Section 5.4. | |||||
All of the 36 states responding to the ILSU interviews reported providing at least one of the services listed above to adoptive families. However, many of these services were not consistently provided to all adoptive families or were provided outside the context of a formal PAS program.
The five case-study states all had a broader network of supportive services for adoptive families that extended beyond their PAS programs, including adoption subsidies, mentoring, mediation, adoption search and registry, tuition reimbursement, health care (e.g., Medicaid) residential treatment, and day care. The availability of these supports is discussed in Section 7.
[Go to Contents]
Strategies used for information and referral services were diverse: 24-hour phone lines, websites, lending libraries, databases of adoption-competent professionals, printed materials (both about the program and about specific resources for families), and newsletters. Providers in Massachusetts and Oregon operated lending libraries, which were said to be well used. In addition to offering a wide selection of books and videos in English, the Oregon library had a small collection of Spanish-language materials.
| In two of five states, adoptive parent liaisons were matched with families to provide information, referrals, and advocacy. |
Georgia recently awarded a contract to establish a Statewide Adoptive Parent Support Network. The network will provide a statewide information, referral, and access system (e.g., toll-free information and referral phone number), place regional advisors around the state, establish a lending library and website, and initiate a quality assurance program for adoption services.
The Virginia and Massachusetts programs used parent liaisons, who were themselves adoptive parents, to provide information and referrals. In both states parent liaisons talked with the families that had contacted their agencies, identified their needs, and worked to locate needed resources. Both states considered parent liaisons to be part of the response teams, providing nonclinical services such as accompanying families to meetings at school or facilitating support groups.
PAS programs in the five states provided families with referrals to community mental health and other service providers. In Massachusetts, a subcontractor to the lead service agency provided families with free access to its extensive provider database. Across states, providers noted the care with which referrals were made. The Oregon PAS coordinator noted that staff made referrals in an objective manner, not endorsing particular therapists or service providers. To empower families, staff encouraged them to call the service provider themselves. PAS providers in Texas said that they relied on several factors to ensure the quality of the professionals receiving their referrals, including routine reviews of status reports and notes from subcontracted therapists, annual renewal of contracts, and input from families.
[Go to Contents]
All study states except Oregon included counseling and crisis intervention in their array of PAS.(1) Counseling and crisis intervention were available directly from the PAS providers or through referrals to community mental health agencies that were reimbursed by the PAS provider.
| Crisis intervention and counseling were integral components of PAS in four of five states; in two states, teams comprising counselors, parent liaisons, and clinicians worked with families. |
The four states used a variety of approaches in delivering counseling and crisis intervention services, including multidisciplinary teams and in-home services. In Virginia, each region had a regional response team that consisted of a family counselor, a mental health clinician, and a parent liaison. In Georgia, the provider offering crisis intervention used teams consisting of counselors and clinicians located around the state. Providers in Georgia and Massachusetts reported that families received crisis intervention and counseling in their homes and in the provider’s offices. In Texas, the Department of Protective and Regulatory Affairs recently added in-home therapy to its list of allowable services. Counseling often was family-oriented and could have been offered to siblings and parents as well as adopted children. One provider noted that couples counseling also was provided if it was integral to the adopted child’s well-being. Providers did not expressly mention conducting comprehensive clinical assessments and testing, a need mentioned by adoptive parents.
One PAS provider offering crisis intervention services felt strongly that these services were cost-effective by preventing family disruption. “It’s a lot less expensive to provide our services than to maintain a child in residential placement or [incur] the cost of a disrupted adoption.” She noted that the intervention services need not be provided for long but should be available in a crisis, especially early in the adoption. The Georgia state adoption program manager asserted that crisis intervention was one of the most successful aspects of the program.
In Oregon, where the PAS program does not offer counseling or crisis intervention services, the state adoption program manager said that such services were supposed to be available from the county mental health system but acknowledged that the services provided may not have met the specific needs of adoptive families. However, she noted that discussions with the state’s mental health providers about funding adoption-specific therapies had led to increased information sharing about the needs of adoptive families.
[Go to Contents]
In the four states where respite was provided through the PAS program, providers reported that these services came in several forms, including providing reimbursement or vouchers for a caregiver, sending a child to camp or on an outing, holding special events (e.g., annual parties), or offering art therapy. In Virginia, the state created a Client Fund that gave PAS providers the flexibility to fund an array of services identified by clients, including respite. One PAS provider in Virginia reported that she tried to leverage respite funds with support from private sources such as vouchers from hotels and restaurants.
Due to the high demand for caregiver respite, many programs limited the availability of respite funding. In Virginia, providers were allowed to spend up to $500 per adoptive child per year under the Client Fund. (The limit originally was $500 per family.) In Massachusetts, each provider received $12,000 per year to spend on respite services for families in their region. In Texas, each family was allowed to receive $28 per day. In Georgia, families were approved for up to 20 hours per month and could borrow into the next month.
PAS providers in the four states reported that camp stays also had been limited due to high demand and limited funding. In Texas, families were eligible for a one-week stay at any camp. Demand for “camperships” in Massachusetts often exceeded the availability of funds. In Georgia, the state-sponsored camp was limited to 30 slots on a first-come first-served basis. In Virginia, a regional provider was negotiating with a children’s camp to reserve a week specifically for adoptive children, seeking private funds to support the cost of the week at camp.
| Reimbursing family members for providing respite care remained a contentious issue for PAS providers and adoptive parents. |
Finding respite providers that were acceptable both to families and the state often was challenging. In several states, adoptive families could not receive payments for respite provided by other family members. However, providers in Georgia reported that they allowed adoptive families to use other family members to provide respite. A regional provider in Virginia had developed “respite circles,” connecting families with similar children and parenting styles who could provide respite for each other.
Virginia funded an effort to increase respite resources for adoptive families through the Virginia Institute for Developmental Disabilities (VIDD), an organization affiliated with Virginia Commonwealth University. VIDD had a separate state contract to work with regional PAS providers to develop respite resources in their region. The VIDD coordinator visited each region to discuss resource development and developed a resource guide for adoptive parents based on her experiences with respite for families with developmentally delayed children.
[Go to Contents]
providers in the five states engaged in varying levels of case management in conjunction with providing crisis intervention, counseling services, and/or information and referral. One provider described the broad role of the case manager by saying, “families need a relationship with someone who knows a lot about adoption, a lot about the issues of loss and separation, some basic counseling and social worker skills, who can make appropriate referrals.”
All of the states used client-tracking systems to assist staff in case management activities. Events that were tracked included incoming referrals, case openings, service use, and case status.
Case management was most formal in Texas, where PAS providers billed the state for reimbursement. Case managers were required to develop service plans that the families and state liaison approved. Providers stipulated what services were needed in the plan and then submitted an authorization form to the state, which served as a basis for reimbursement of those services. Every six months (sooner if residential treatment was provided) a state liaison reviewed the service plan.
| The sophistication of care management systems varied widely, from spreadsheets to a Web-based system. |
In the other four states, program staff documented their activities in spreadsheet or Web-based programs. In Massachusetts, a Web-based case management system was developed that all service providers could access.
PAS providers in four of the five case-study states admitted having had difficulties adjusting to more formal case management requirements, particularly in the early stages of implementation. However, they said that they had come to appreciate the ability to monitor cases and produce service statistics.
[Go to Contents]
State adoption program managers and PAS coordinators/providers in all five states felt that training for parents on adoption issues was an integral part of the program. They provided training not only on adoption-specific issues (e.g., grief and loss) but also on child development issues relevant to adoptive families (e.g., fetal alcohol syndrome). Other examples of trainings offered included managing difficult behaviors for traumatized children, preparing for the teen years, post-traumatic stress disorder, and parenting sexually troubled children. Although many of the trainings were one-session events, providers also reported offering workshops and a series of sessions on a particular topic. Providers also sent families to adoption conferences.
In Oregon, PAS program staff noted that training logistics, including when the trainings were scheduled and whether child care and/or transportation were provided, greatly influenced attendance. The program had experimented with training schedules to find the best day and time to maximize attendance. The PAS program director reported having experimented with the statewide teleconference system for training but discontinued its use after initial trainings had poor attendance. Outside experts originally had been hired to conduct training, but now PAS program staff had enough expertise and experience to conduct training themselves. Georgia provided training around the state through a provider, which offered trainings on a variety of adoption-related topics. Sessions were scheduled for parents and professionals on successive days.
As discussed in Section 5, providers in several states raised awareness about their PAS program by attending pre-adoption parent trainings. One PAS provider in Virginia said the agency planned to better integrate the PAS program with its placement program to address parental concerns during the placement period. A PAS provider in Texas also reported trying to reach out beyond presenting at training sessions to make personal contacts with families before adoptions are finalized. His agency was applying for a grant to contact adoptive families at finalization to discuss the PAS program.
[Go to Contents]
| PAS providers continued to explore training methods and topics for adoptive parents and professionals. |
Providing training to professionals on adoption issues is a basic component of all PAS programs studied. PAS providers in all five states reported offering professional training, on adoption-specific issues and child development issues. Training audiences included child welfare workers, mental health professionals, teachers and other school staff, court system staff, and medical practitioners. Topics offered to professionals included cross-cultural competency, transracial adoption, attachment in adoption, respite care for adoptive families, education law and advocacy, and openness in adoption.
Training mental health professionals to be aware of the specific needs of adopted children and families was a concern among PAS coordinators/providers and adoptive parents. Georgia was sponsoring a training program on attachment therapy for mental health providers. Oregon was considering a model that was being piloted in Washington, in which the state collaborates with a local university to offer a certificate program in adoption issues to mental health practitioners.
In several case-study states, the PAS providers themselves also received training. For example, one regional PAS provider in Virginia with extensive experience in training around adoption issues provided training on a regular basis to the other PAS providers. Georgia’s crisis intervention services provider offered ongoing training in adoption issues for other team members.
[Go to Contents]
PAS providers reported that advocacy came in many forms in dealing with adoptive families. Staff described accompanying client families to meetings and conferences with schools and community service providers. Staff in one Texas region attended community review board meetings for cases where the child’s needs extended to several state agencies. As discussed earlier, many adoptive families reported a particular need for advocacy with respect to education because they felt school professionals did not understand the potential special needs of adopted children.
| Educational advocacy was particularly important to adoptive parents. |
Several PAS providers across the five states noted that, although they were advocates for families, they also wanted families to feel ownership of the effort so that they could maintain balance in their families. One provider asserted that her agency upheld a strong emphasis on “parent self-determination and family responsibility” and a focus on empowering families rather than serving as a “rescuer.”
Parent liaisons provided advocacy for families in Virginia. In Georgia, under the Statewide Adoptive Parent Support Network that will be established in 2002, regional network advisors will be responsible for one-on-one assistance and advocacy on behalf of adoptive families. The state adoption program manager noted that experienced adoptive parents would be preferred for these positions. These advisors will be expected to be an advocate for and coordinate services to adoptive families and to be aware of adoption resources.
[Go to Contents]
PAS providers in all five case-study states operated support groups either by leading them or through more limited assistance (e.g., offering a location, providing refreshments, mailing flyers). In addition to PAS staff, counselors, parent liaisons, and graduate students helped facilitate the support groups. Most often, providers formed support groups according to age and level of need (e.g., therapeutic support group). A regional PAS provider in Virginia started an online support group that had approximately 250 active members and over 6,000 postings as of November 2001.
PAS providers and adoptive parents in several of the states reported a growing interest in serving the needs of older adopted children through adolescent support groups. Several providers reported plans to establish support groups for preteens and older adolescents.
| PAS providers were expanding from traditional parent support groups, adding child and adolescent support groups. |
Although providers considered support groups an essential component of PAS, recruiting and retaining families had been a continuing challenge, especially in more rural areas. Providers tried several adjustments to increase and sustain attendance, including holding child and parent groups simultaneously, offering child care for parent support groups, and providing transportation. In Virginia, parent liaisons telephoned parents to remind them about the support group meetings. As discussed earlier, adoptive parents in the focus groups expressed satisfaction with their support groups and took great comfort from participating in them.
(1) Although Oregon’s PAS program did not include counseling, one of the state’s service areas used state funding to support a Post-Adoption Family Therapy (PAFT) unit whose staff provided counseling and crisis intervention to families that adopted from the state and live in the Portland area.
Main Page of Report | Contents of Report
Home Pages:
Human Services Policy (HSP)
Assistant Secretary for Planning and Evaluation
(ASPE)
U.S. Department of Health and Human Services
(HHS)