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Needs assessments, which many states performed recently or were in the process of conducting, are designed to describe the kinds of services most needed among the families surveyed, generally families receiving adoption subsidies. Without the persistent follow-up efforts needed to achieve high survey response, however, these assessments may not adequately represent the population of adoptive families.
Available data on the needs of adoptive families were not adequate to guide current PAS programs, nor to plan for future needs. |
High-quality data on families’ needs would support a strong planning process. Needs assessments do not allow estimates of the number of adoptive families needing services, because it is not known how families responding to the survey differ from those who do not respond. Nor does this approach establish when, in terms of children’s ages or elapsed time since adoption, the various services are most likely to be needed. This information will be all the more valuable as the population of adopted children (and young adults) continues to expand, so that states can plan for adequate service availability. A national probability-based sample of adoptive families that are receiving subsidies would help to provide a picture of underlying needs among those families that have, and have not, obtained PAS from state sources.
The needs assessment process is ongoing. The needs of adoptive families are likely to evolve as PAS programs influence service delivery systems, as families mature, and as the characteristics of children being adopted change. As PAS programs increase their visibility within states and communities, they are becoming better situated to monitor these needs by compiling information on client characteristics and services needed. These data can become a valuable tool for ongoing planning and program adaptation.
The adoptive parents participating in the focus groups were vocal self-advocates. Although the single focus group held in each case-study state does not support generalizations about adoptive families in those sites, several themes about needed services emerged consistently across sites. These themes tended to converge with those identified in previous reviews of programs and related literature, although the emphasis on respite care was particularly keen in this study. This may reflect a change in the needs of adoptive families or a finding unique to the states or parents selected.
PAS programs offered valuable services to adoptive families, but unmet needs remained. |
The parents who participated in focus groups in the case-study sites confirmed the usefulness of services offered by the PAS programs, especially information and referral, respite, advocacy, crisis intervention, and counseling. They also identified additional needs, including more usable information about their children, better information about supports available to them, and improved access to service providers of their choice. Although these needs might lie outside the boundaries of typical PAS programs, state adoption program offices could potentially address them.
Parents stated that having better information about their child’s pre-adoption history and, consequently, a better understanding of the child’s strengths and limitations, could have considerably lessened the difficulties the families had experienced. Two issues are involved in this assertion. First is the well-documented desire among adoptive parents to be provided with as much information on their child as is available at the child welfare agency. Although states have increased their commitment to preadoptive disclosure in recent years, parents in the focus groups might not have benefited from this change. It also is possible that parents eager to move forward with adoption listen selectively to what is disclosed. “They need to hear it about three times,” according to one adoption worker. In either case, parents indicated that they thought they would have benefited from the opportunity to review their child’s history with an adoption worker as needed over the course of the adoption.
Parents needed assistance in understanding their children’s history and needs. |
Information on the child’s history is of limited value without interpretation of its implications for educational, perceptual, emotional, and behavioral functioning and future needs. Thus adoptive parents expressed a need for help in understanding and interpreting the information given them. They wanted access to cognitive, social, behavioral, and educational assessments for their child. They reported that this information would have helped them access needed services but that comprehensive assessments were expensive and difficult to obtain. As with needs assessment, review of this information must be an ongoing process, rather than a single prelegalization event, that can be revisited as the child matures.
Adoptive families needed information about available services before they were in crisis. |
Parents also wanted better information about the services and supports available to them. Recruited for the focus groups by the PAS programs, these parents might have been expected to be highly aware of available resources. However, many were confused about what could be supported through adoption subsidies and how subsidies were adjusted. Only one state described a proactive effort to provide this information to adoptive families on a regular basis. Parents also maintained that they lacked information about supportive and preventive services and were directed to resources only after their needs had reached crisis proportions. Although all states made efforts to publicize the existence of their PAS program, it does not appear that information reached families with mild to moderate needs.
Access to professionals who understand adoption issues was particularly needed. |
Finally, parents stressed the need for easier access to adoption-competent service providers. Some PAS programs were addressing this issue by offering training in adoption issues to mental health practitioners and other professionals. However, families’ access to these providers, or to those who already had the desired expertise and attitudes, may have been limited. Many providers, especially those with specialized expertise, did not participate in state Medicaid program or Medicaid managed care plans. Therefore, they were not available to parents who were unable to pay for their services out of pocket. States’ efforts to train professionals will not benefit adoptive families without efforts to allow families to access services outside their managed care provider or to reimburse services through subsidies.
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Federal funding was essential in encouraging PAS programs in states that were motivated to develop them. |
The federal government has long invested in adoption subsidies and, since the late 1990s, has invested in PAS. Assessing the extent to which the federal funding support has encouraged development of PAS programs is challenging, but there is no doubt that the growth in PAS has been encouraged by the availability of adoption bonuses and Promoting Safe and Stable Families Program funding under Title IV-B, Subpart 2. Although four of the five case-study states used Title IV-B, Subpart 2 funds for their PAS programs, the availability of this support did not seem to have been critical in these states’ decision to develop PAS programs. Instead, adoption program managers described the importance of advocacy by adoptive parents and champions within state agencies or legislatures. The experience for this limited set of states suggests that while federal funding may be necessary for PAS program development, these resources did not in themselves lead to program development. Of course, these states were selected because they are considered well developed in the area of PAS. States with weak or nonexistent PAS programs might be more readily influenced in initiating services as a result of federal initiatives.
Adoptive families may face substantial disparities according to their state of residence. |
The field of PAS has not yet produced a conclusive research base, but strong evidence suggests that some adoptive families need specialized supports for part or all of their child’s development and that PAS programs are providing these supports effectively. Some of these needs could also be supported through adoption subsidies; however, the RTI team’s review of data on subsidy policies does not suggest that any states are increasing subsidy support to compensate for a lack of PAS. To the extent that PAS programs and subsidies do meet the needs of adoptive families, disparities in their availability will mean that children’s long-term outcomes will vary by their state and county of residence/adoption. This research, in the context of work reported in an earlier literature review, suggests that it is timely for the federal government to take stronger measures to encourage all states to make more extensive post-adoption supports available.
Program developers make several decisions in the design process, based on their assessment of how best to balance needs and available resources. Two fundamental choices are the specification of program goals and which families will be eligible. Although based on pragmatic considerations, these decisions have potentially far-reaching policy implications.
The PAS programs studied shared a goal of preserving adoptive families, but varied in the strategies chosen to reach this goal. |
All of the programs studied shared a common goal of keeping adoptive families intact, although the services they delivered in working toward this goal varied across states. More variation was seen in the extent to which programs worked to influence the service delivery environment. Only one program identified an explicit goal of changing service delivery systems through the efforts of its PAS providers to develop service networks. However, four of five programs offered training for mental health, education, and legal professionals likely to serve adoptive families. Considering systems change from a different perspective, Oregon chose not to offer counseling through its PAS program to maintain pressure on the county mental health system to provide the level of services needed by adoptive and other families. Although providing adoptive families with the services they currently need is a logical priority for PAS programs, systems change efforts also are necessary to increase the extent to which other service delivery systems can meet the needs of adoptive families.
Restrictions on the type of adoptive families served limited the potential impact of PAS programs. |
Three of the five states in this study restricted eligibility for at least some of their services to families that had adopted from their state’s child welfare system. Although adoption program managers defended this as a means of conserving scarce program resources, it raises two concerns. First, the effort to increase the rate of adoptions from foster care will be hampered if families that subsequently move across state lines have limited access to PAS. Second, if PAS programs are believed to reduce the likelihood of out-of-home placements or adoption dissolutions, restricting access for families that have adopted privately or from other states might increase the eventual risk of needing high-cost services for these families. PAS programs might be more effective in both preserving adoptive families and encouraging adoptions from foster care if they are able to serve all adoptive families.
Each of the states in the case study contracted out its PAS program to providers who delivered services either statewide or regionally. Data from the ILSU survey suggest that most other states providing PAS contracted out some or all of the services. State adoption program managers identified several advantages to this model, including better protection against fluctuations in state agency budgets, the ability to standardize services throughout the state (especially in states where services are administered at the county level), and the avoidance of the stigma many adoptive parents feel in approaching the child welfare agency for PAS.
States developed a variety of structures by which they offered consumer-driven services and statewide coverage, but serving rural areas remained challenging. |
Several of the case-study states consciously worked to make their PAS program consumer-driven, providing families with an array of services from which to choose. Adoptive parents did not specifically mention these consumer-driven efforts, but it was clear that they had taken advantage of the flexibility. Parents in focus groups cited using varying types of PAS.
Although PAS programs shared the goal of making services available statewide, each coordinator reported frustration in the program’s ability to make services truly accessible in rural areas. Barriers included the scarcity of mental health services (adoption-competent or not), difficulty in gathering adequate participation for a training or support group, and increased travel time for program staff. Because online support groups appear to be effective with social workers (Meier, in press), PAS programs might want to consider new communication technologies for parent support and perhaps for training. The reported success of the online support group in Virginia lends credence to the potential effectiveness of using new technologies to support adoptive families. At least one state has attempted an online approach to training, although with limited success.
Support for adoptive families must be communicated by the child welfare system as well as PAS providers. |
Although many states choose to contract out PAS services, focus groups with adoptive parents suggest that some level of post-adoption support should be maintained within public child welfare agencies. Most states expect adoption workers to be accessible to adoptive families for at least a limited time, and because of their association with the child, adoption workers are likely to be the ones that families in need of PAS will turn to as the “first responders.” However, families participating in focus groups reported that adoption workers often lacked interest in their ongoing welfare. Worse, the families reported encountering surprisingly negative attitudes from some adoption workers and intake workers when seeking residential care or other services. Some PAS programs in the case-study states were addressing this issue by offering training in adoption issues to public agency workers. If families are to feel confident about support from the system, system support must be consistently communicated to them at any point of entry to PAS, even if the content of the interaction consists only of a referral to the PAS program.
The case-study states were fairly consistent in offering a core set of services (information and referral, education and training, support groups, respite, and counseling). Within this core, the variety with which states addressed these core services reflects considerable creativity in program design and commitment to adapting service delivery to local conditions. It also suggests the potential usefulness of systematic program evaluation in shedding light on which service delivery approaches work best under various circumstances.
Respite care was highly valued by families but difficult to provide. |
Respite care appears to be a particularly challenging need to address. Families consistently reported it as a need: in the literature, in state needs assessments, and in these focus groups; and states have tried a variety of approaches in providing respite. Two states offered respite in congregate settings, through camps and weekend outings. In addition to offering parents a break, this model provided beneficial opportunities for adopted children to interact with one another. However, adoptive parents noted that this model did not meet the needs of very young children, those with attachment issues, and those with the most severe behavioral difficulties—in other words, the children whose parents were most in need of respite. In-home respite models might help to provide younger children with a more familiar setting, which would be less likely to raise concerns about being placed again. Such models have been tried successfully with adoptive families (Owens and Barth, 1999). Other models might be needed for families with adolescents.
The two states that assisted parents in finding and paying for family-specific respite care struggled with the challenges of finding or training providers acceptable to parents and funding agencies. Restrictions on using family members as respite providers, even though these may have been most acceptable to the child and parents, suggest a concern with the appearance of misuse of funds or providing “babysitting” rather than professional services. For the most part, limitations on funding meant that only a very limited level of relief was available for parents who were dealing with extremely challenging children.
Both PAS providers and focus group participants reported that PAS is more often used during times of crisis than as a preventive measure. Moreover, while state and provider interviewees mentioned sending information on PAS to families receiving adoption subsidies, they also noted a lack of coordination between adoption workers and PAS providers. A better understanding of the type of need and extent of need for both preventive and crisis services could improve service planning and provide impetus for better coordination and referral systems between adoption workers and PAS providers.
Expanding eligibility to all adoptive and pre-adoptive families could substantially extend the impact of PAS programs. |
None of the case-study states offered eligibility to families in which children had been placed from the state child welfare system but whose adoptions were not yet finalized. Outreach to these families by PAS providers was limited to discussing PAS at adoptive parent classes. However, providers in several of the states expressed a strong interest in providing some of their core PAS to these families, whom they felt were facing some of the same challenges as families with finalized adoptions. Because many PAS providers also were child-placing agencies, they might have been already serving these pre-finalization families. As just described, adoptive parents also felt that greater pre-finalization assistance beyond required adoption classes and home visits were warranted. States using Title IV-B, Subpart 2 funds were not precluded from using the funds to serve these families; however, there did not appear to be any state-initiated movement in that direction.
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In this study and many others, states assessed the nature of service needs using surveys of adoptive families, most often those receiving federal Adoption Assistance Program subsidies. The variation in service offerings and program structure among the five states described here is evidence that states tailor their programs to family needs and existing service delivery systems. However, other than acknowledging that not all desired services could be funded, state adoption program managers provided little explicit information as to how they had made these choices.
Comprehensive planning that encompasses subsidies and existing service resources, as well as PAS programs, could increase support for adoptive families. |
Adoptive families’ needs could be addressed in several ways other than delivery through a PAS program: (1) by making services available through existing health, mental health, or social service systems; (2) providing resources directly to adoptive families so that they can purchase services; or (3) modifying existing service systems to reduce the need for the service among adoptive families. Although these three strategies are not interchangeable, alternative routes may exist for at least some services. States that are constrained in their ability to offer increased subsidies (because basic subsidies are capped at the state’s foster care rate) may be able to facilitate access to other services through Medicaid programs. Services such as case advocacy within schools might be addressed in the long run through systems changes that improve understanding of adoption issues among guidance counselors. Although case advocacy is necessary to respond to families’ immediate needs, changing school systems could improve school interactions for all adoptive families.
Adoptive parents often face a patchwork of services and supports, from which essential pieces may be missing. A comprehensive approach to serving adoptive families would encompass subsidies and existing service delivery systems, as well as PAS programs. Such a network would be challenging to develop, requiring coordination among agencies involved in health, mental health, education, and child welfare. However, comprehensive planning eventually could offer states more efficient use of their resources while improving the delivery of services to adoptive families.
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Evaluation activities in the five case-study sites varied considerably in their focus and degree of sophistication. States conducted formative research to guide program design, developed systems for monitoring client characteristics and services delivered, and identified outcome measures. However, the usefulness of evaluations in some states was limited by inconsistent implementation, insufficient resources to achieve adequate response rates, and limited data analysis. Considering that these five are among the country’s most highly regarded programs, the relatively limited emphasis on evaluation is noteworthy.(1)
Evaluations of PAS implementation and outcomes are needed to support program development and document the value of continued funding. |
None of these programs is more than 10 years old, and the field of post-adoption services is not much older than that. The newness of PAS as a service delivery model is itself a barrier to evaluation. In a new arena, program models, service offerings, and service delivery strategies are subject to ongoing adaptation based on experience; tailoring the program takes precedence over maintaining consistent implementation. Under these circumstances, programs rely on immediate field experience rather than waiting for evaluation findings.
As the field matures, however, the potential usefulness of evaluation increases. The variety of approaches with which states have implemented core services like information and referral suggests the need for evaluation to assess which strategies work best under various conditions. Data from strong evaluations could enable the experience of these five states to provide needed guidance to other jurisdictions currently considering or developing PAS programs. If existing programs are to continue improving and to inform the development of others, their evaluation components will need to be strengthened. This strengthening would include design enhancement in the form of outcome indicators and robust evaluation designs, as well as strategies to minimize respondent burden and engage program staff in the process. Substantially more resources than are currently being dedicated to evaluation will be needed.
The impetus for what evaluation is being done comes from state adoption program managers and PAS program coordinators, in varying combinations. Notably absent is any evidence of pressure from the larger funding agency or calls for accountability from legislators involved in budget negotiations. This absence might reflect the considerable persuasiveness of adoptive parents advocating these programs or a sense of urgency attached to increasing the rate of foster care adoptions. Because these influences might be inadequate to sustain program resources in the face of state budget crises and competing needs, evaluations that can document program implementation and effectiveness must become a priority among leaders in PAS programs. The continued acceleration in the rate of adoptions and the number of adoptive families underscores the need for a scientifically robust base of evaluation research to guide program development.
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The field of PAS is young and evolving rapidly as states implement creative responses to the perceived needs of adoptive families. Although adoption program managers have recognized the importance of these services for years, recent access to federal resources has greatly expanded availability. The five programs described in this report (as well as many in other states) have developed services that did not exist previously and have provided adoptive families with services that most had never had access to before.
Evaluation and comprehensive planning could extend the effectiveness of PAS programs. |
As the value of PAS gains recognition, the need for stronger evaluation and more comprehensive planning becomes more pressing. States need better data with which to estimate the number and characteristics of families needing services and how this population is likely to change in coming years. Adoption program managers are called on both to meet the current needs of adoptive families and to work for system changes that increase the responsiveness of service delivery systems. To respond to these sometimes conflicting priorities, they will need to plan their PAS programs in the context of other service systems and other supports available to adoptive families.
Evaluation of PAS programs is hampered by the ongoing evolution of the field and the premium placed on tailoring services to family needs. As the field matures, however, evaluation information is increasingly essential. Careful analysis of families’ use of and satisfaction with existing PAS programs can help states tailor their programs to changing populations of adoptive families. Finally, it is particularly incumbent on the well-established PAS programs to invest in outcome evaluations. Findings from these evaluations will be essential in documenting the value of PAS programs, improving accountability among providers and public agencies, and expanding the knowledge base about best practices.
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(1) Among the PAS programs considered for the case study, Maine had begun and Illinois had completed extensive evaluations (they appear to be unusual in this way).
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