November/December 2013 Issue

Adoption Competency in Clinical Social Work
By Deborah H. Siegel, PhD, LICSW, DCSW, ACSW
Social Work Today
Vol. 13 No. 6 P. 16

Adoption is not an event but a lifelong process. Working with adopted people and their extended biological and adoptive families requires training and awareness of attitudes, perspectives, beliefs, and values that shape everything social workers do.

Mark and Henry, a gay couple with Irish Protestant roots, sit in their clinical social worker’s office asking for guidance: “We adopted two boys. Our 10-year-old son, Trey, is African American, and we have an open adoption with his birth parents. Our 11-year-old son, Juan, is Puerto Rican, and he’s had no contact with his birth family since he was removed from their care at age 2. Juan is misbehaving, acting angry every time Trey’s birth mom visits us. We’re wondering if these visits are bad for Juan and if we should stop them. Juan never asks any questions about his adoption, and we don’t know if we should be bringing up adoption conversations or just wait for him to do it. How do we know if Juan’s anger is about adoption or something else if he won’t talk about it? Also, Juan was conceived by rape. Do we ever tell him this and, if so, when and how? What’s your advice?”

Fortunately, the clinical social worker has adoption competency, which means she is familiar with the literature addressing Mark and Henry’s specific questions and has received post-master’s education, training, and consultation in how to work with adoptees, birth parents, adoptive parents, extended family formed by adoption, and the complex legal and service systems in which they are embedded.

Unfortunately, most social workers have not been trained in adoption competency; they do the best they can using the knowledge and skills they have, sometimes overlooking or possibly mismanaging key issues, adding to the distress of the clients they want to help.

Most social workers will encounter adoption issues in their work. According to Adam Pertman, executive director of the Evan B. Donaldson Adoption Institute and author of Adoption Nation, an estimated 100 million Americans are touched by adoption. The U.S. Children’s Bureau reports that 1.8 million children under the age of 17 were adopted in 2010. While most people who have been adopted do not seek mental health care, a disproportionate number of adoptees are represented in clinical populations (Harwood, Feng, & Yu, 2013). Adoptive parents in several studies have reported being unable to find mental health providers who understand the adoption-related issues in their families (New York State Citizens’ Coalition for Children, 2010; Riley, 2009; Javier, Baden, Biafora, & Camacho-Gingerich, 2007). They report having to educate their clinicians—a frustrating task—as they try to explain and legitimatize the challenges they face.

Competence is comprised of values, knowledge, and skills. The NASW Code of Ethics states that social workers should provide service in areas only in which they are competent. As adoption competency is not a mandated component of curriculum in accredited schools of social work, most social workers need postgraduate training to work ethically and effectively with people whose lives are touched by adoption.
While there is no universally accepted definition of adoption competency in social work, a review of existing adoption competency training programs for mental health providers (such as the programs at Hunter College in New York, Rutgers University in New Jersey, and the Center for Adoption Support and Education in Maryland) suggests consensus about some components of adoption competency.

Values
Attitudes, perspectives, beliefs, and values shape everything social workers do, including their work with adoptees and their extended biological and adoptive families. Competent social work practice in adoption adheres to the following core values:

• The child’s needs and interests are primary; the purpose of adoption is to provide the child with a family, not to provide prospective parents with a child.

• Every child needs and deserves a safe, nurturing, permanent family.

• Before a child is placed for adoption, assertive family preservation efforts must be made. Generally, a child’s interests are best served within the child’s biological family and country and culture of origin.

• Whenever possible, the child should be included in the adoption decision and in the choice of family.

• Everyone has a right to access all of their personal information. Permanently sealing original birth certificates does not serve the adopted person’s needs.

• All information known about the child should be shared with the adoptive parents (or parent) before the adoption is finalized.

• The child should have access to ongoing medical information that emerges in the birth family over the life span.

• In most cases, the child has a right to some sort of contact with the biological family. This may be as minimal as an infrequent exchange of letters via a post office box or as involved as face-to-face visits, depending on the circumstances.

• Birth parents, including those who have had their parental rights involuntarily terminated because they abused or neglected the child, should be treated with respect.

• Deception, dishonesty, and coercion in adoption are unacceptable. Client autonomy and self-determination should be supported.

• It is best to take a strengths perspective when working with people whose lives are touched by adoption. Being adopted, a birth parent, or an adoptive parent does not mean that someone is trouble or troubled. Clients should be viewed as the experts in their own lives. Crises that emerge can be seen as normative, predictable developmental phases, not necessarily signs of pathology.

• Adoption should build family connections, not sever them. The notion of an adoption triad, comprised of the child, adoptive parent(s), and birth parent(s), should be reconceptualized as a circle composed of all adoptive and birth family members, systems, and stakeholders involved in the adoption. The relational matrix formed by adoption is best understood in a social context.

• Adoption is not an event but a lifelong process. For this reason, members of the extended family of adoption may need access to informed, competent pre- and postadoption services across the life span.

Knowledge and Skills
Adoption competency knowledge and skills can be viewed in three categories: societal context, relational dynamics, and intrapsychic issues. While these categories are not mutually exclusive or exhaustive, they are helpful in thinking about adoption issues.

Societal Context
Pathways to adoption: The first contextual factor that must be considered is a child and family’s pathway to adoption, as the route through which the child enters the family affects the subsequent adoption experience. For instance, while all children who are adopted experience loss of their biological family, children who are adopted at an older age, after multiple foster placements or institutional care, or across national or ethnic lines face issues that other adopted children may not. Private adoptions finalized without adequate preadoption education for all parties, public child welfare adoptions formed as a result of “concurrent planning” (i.e., the state simultaneously pursues the opposite goals of reunification with the biological parent and prepares for adoption), kinship adoptions (when a child is adopted within the biological family, thus shifting family roles), and stepparent adoptions all may present unique postadoption issues. Children conceived by donor egg or sperm or those gestated within a surrogate also may experience some adoption issues.

History and law: Knowledge of how today’s adoption laws and practices evolved over history helps practitioners grasp the importance of and practice in accord with the values underpinning adoption competency. The adoption-competent clinician knows how laws impact the issues each extended family of adoption must face. Each state’s adoption laws differ, and there also are federal laws and international agreements that must be followed.

The June Supreme Court decision in Adoptive Couple v. Baby Girl et al illustrates the need for adequate preadoption legal and clinical services. In that case, an infant, Veronica, was adopted in South Carolina by Matt and Melanie Capobianco. Four months after her placement with them, Veronica’s birth father, who is about 1% Cherokee, invoked the federal Indian Child Welfare Act, claiming that he had terminated his parental rights without full knowledge or understanding of what he was doing. When Veronica was just over 2 years old, the court ruled in the biological father’s favor, returning Veronica to him. Eighteen months later, the Supreme Court ruled that Veronica should be returned to her adoptive parents.

It may have been possible early in this traumatic process for adoption-competent clinicians to help Veronica’s biological and adoptive parents work together to form a cooperative, collaborative extended family united in shared love for this child, thus avoiding an adversarial tug of war in which everyone was hurt. Few would argue that multiple changes of family are in a child’s best interest. (Laws to be aware of include the Multiethnic Placement Act of 1994, as amended by the Interethnic Adoption Provisions of 1996; the Indian Child Welfare Act of 1978; the Adoption and Safe Families Act of 1997; the Safe and Timely Interstate Placement of Foster Children Act of 2006; the Child and Family Services Improvement Act of 2006; the Fostering Connections to Success and Increasing Adoptions Act of 2008; and the Hague Convention on Protection of Children and Cooperation in Respect of Intercountry Adoption of 1993.)

Prevailing beliefs: History and law may reflect and perpetuate biases, myths, and misconceptions that shape the adoption experience. Social workers, as members of the public, often hold views that do not serve the extended family formed by adoption. For example, sealing the child’s original birth certificate and issuing a new one at the time of adoption grew out of the view that the child was “a bastard” who needed to be protected from the shame and stigma of illegitimate birth. Agencies that practice traditional confidential adoptions, planning as if preserving a birth parent’s total anonymity is possible, deny the fact that omnipresent social media and digital technology today make such promises impossible to ensure.

Adoption competency entails careful use of language to describe the adoption experience. For instance, using the term “birth parent” to describe the expectant biological parent who is considering making an adoption plan may exert subtle pressure to go through with the adoption; it is preferable to reserve the term “birth parent” for the person who has terminated parental rights.

Other common terms also convey questionable messages. The phrase “blood is thicker than water” implies that adoptive family connections cannot be as strong as biological connections. The phrases “keep the baby” and “give the baby up for adoption” imply that the biological parent gave away an unwanted child (it is preferable to use more neutral language, such as “the biological parent chose to parent the child” or “decided to make an adoption plan”). Adoption competency entails recognizing and managing social workers’ countertransference stemming from these and other beliefs, assumptions, and misconceptions. Words are among the clinical social worker’s most useful therapeutic tools.

Racism, oppression, and discrimination: Adoption-competent clinicians know that a child adopted out of even the most miserable circumstances into a wonderful adoptive family may not feel lucky to be adopted, as there is no adoption without loss, and loss is painful. Children adopted across national, racial, or ethnic lines may face special challenges that they need their adoptive families to acknowledge and address. Clinicians’ or adoptive parents’ beliefs in “color blindness” and “love conquers all” may be well intended but naïve. Adoptive families need clinical support to anticipate, plan for, and cope with lifelong issues that being a transcultural or transracial family unit may entail.

Programs and services: Adoption competency includes extensive knowledge of the resources that adoptive and birth families may need as they travel the adoption journey over the years. These include how to access and advocate for adoption subsidy payments, special education services, residential programs for youths who have educational and mental health needs that cannot be met through home-based care, support groups, and Internet resources. Members of the adoption circle may need access to an adoption-competent clinician with whom they consult during times of discomfort over the life span.

Adoption ethics: Clinical practice in adoption requires the ability to recognize and manage a complex array of unique ethical challenges, especially related to issues of privacy, confidentiality, boundaries, informed consent, self-determination, autonomy, paternalism, and conflicts of interest. Knowledge of the adoption ethics literature and ethical decision-making frameworks is essential for competent practice.

Relational Dynamics
Phases of the adoption process: Adoption competency involves addressing the specific emotional tasks that the biological parents, child, and adoptive parents must confront and process when considering adoption, planning it, and managing each phase of the family unit’s and individuals’ development across the life span.

Family system dynamics: Predictable themes and issues emerge within the complex relational matrix in the adoption circle. Adoption competence involves acknowledging likely issues without insisting that those issues be present in a particular family. Each family is unique, so the clinician needs advanced skill to simultaneously assess for predictable issues while not stereotyping families by imposing a view of adoption that does not fit the family at hand.

Child and family development: Specific adoption issues likely will emerge as a child’s cognitive capacities grow and as the family undergoes life-cycle transitions such as births, graduations, deaths, divorce, and illness.

Open adoption: Most U.S. adoptions today involve some sort of exchange of identifying information and contact agreements between the child’s biological and adoptive parents. Families may need help managing and renegotiating open adoption relationships as people evolve and their circumstances change (Siegel & Smith, 2012).

Search and reunion: Members of the extended family formed by adoption may need help thinking through whether, when, and how to reconnect and then living with the relationships that search and reunion produce.

Intrapsychic Issues
Core issues: Much has been written about the psychological issues confronting birth parents, adoptive parents, and adopted people (Silverstein & Roszia, 1998). Among these issues are loss and grief, shame, guilt, identity, self-esteem, loyalty, confusion and bewilderment, intimacy, trust, mastery and control, rejection, fear of abandonment, and anger.

Trauma, attachment, and neurobiology: A child who has endured abuse, neglect, or multiple placements has experienced trauma that may affect brain development and attachment. Adoption-competent clinicians can assess for and apply various evidence-based therapeutic interventions to help children and families foster brain plasticity and form enduring, nurturing family connections.

Behavioral health and behavior management: Because of genes or trauma, some children’s brains are not wired to learn from consequences, so parenting methods that are adequate in most families may not work well in others. Adoption-competent clinicians do not assume that a child’s misbehavior indicates a parent’s failure to consistently and accurately use common behavior management strategies (e.g., time out, rewards, punishments) or that a child’s misbehavior is willfully oppositional. Instead, adoptive parents are taught alternate behavior management methods more useful with children who misbehave because they are overwhelmed by and unable to cope with typical expectations and behavior management methods.

Genetics: Adoptive parents believe in the power of love and a nurturing environment. Adoption-competent clinicians support these beliefs while helping families, when necessary, accept the reality of a child’s genetic heritage, which may include learning disabilities, mental health issues, and talents that differ from those of the adoptive family.

Answering Mark and Henry’s Questions
Mark and Henry clearly are conscientious, thoughtful parents who have complex, important questions. For example, they wonder whether they should limit one son’s access to his birth mother because their other son, who doesn’t have that sort of contact, is upset when his brother’s birth mother visits.

An adoption-competent practitioner understands that everyone, including adoptees, needs human connection and has a basic right to access their biological families, except when direct contact is unsafe. Hence, in families where one sibling has safe birth-parent contact while another adopted child in the family does not, the child who has contact should never be denied contact because it troubles the sibling. In such situations, often the involved birth parent is willing to pay attention to both children, and the adoptive parents use the situation as an opportunity to explore both children’s adoption-related feelings. They may say to the child who lacks contact, “What’s it like for you when your brother’s birth mom visits?” or “You kicked the dog when your brother’s birth mom visited. We wonder if you’re feeling sad or mad at those times. Tell us about that.”

An adoption-informed clinician also knows that children who are adopted typically have thoughts and feelings about their adoption whether or not they express them. The child who doesn’t ask questions may need parents to gently mention adoption periodically as a way of communicating that it is OK to talk about adoption. For example, at bedtime, a parent may say, “Time to close your eyes. Sleep tight. You have such beautiful eyes. I bet you got those gorgeous eyes from your birth family.” Watching movies or TV shows with adoption themes also are natural opportunities to bring up adoption.

Similarly, adoption-competent practitioners understand that keeping secrets can be toxic. When the truth comes out, a natural response is, “What other important information have you kept from me? How can I trust you now?” It’s better to tell a child his or her whole story from the start using age-appropriate, nonjudgmental language that over the years will become more detailed and nuanced as the child develops cognitively and emotionally.

In the case of rape, which is how Juan was conceived, Mark and Henry may say, “We know who your birth mother is, but we don’t know who your birth father is.” When Juan is ready, he asks, “How come?” and they may say, “Your birth father never introduced himself to your birth mom.” When Juan is old enough to understand basic facts of human reproduction, he may ask, “How could they have sex without her knowing him?” and his parents may answer, “He didn’t ask her permission before having sex with her. He made a mistake, but that does not make him a bad person, and out of that mistake came something wonderful: you.”

Finally, Mark and Henry want to know how they can tell whether their son’s anger is related to adoption or something else. They may never know for sure. However, they can cultivate openness in their family in which anyone can ask about and discuss any feeling, concern, or question. Active listening, nonverbal attending, genuine empathy, and answering questions directly and honestly even when the topic is painful or uncomfortable are important parenting skills. Adoption-competent counseling can help parents nurture these skills.

— Deborah H. Siegel, PhD, LICSW, DCSW, ACSW, is a professor in the School of Social Work at Rhode Island College, a clinician specializing in adoption issues, an adoption researcher, and an adoptive parent.

References
Harwood, R., Feng, X, & Yu, S. (2013). Preadoption adversities and postadoption mediators of mental health and school outcomes among international, foster and private adoptees in the United States. Journal of Family Psychology, 27:3, 409-420.

NYS Citizens’ Coalition for Children. (2010). Parents and Professionals Identify Post Adoption Service Needs in New York State: Post-Adoption Services Survey. Brooklyn, NY: NYS Citizens’ Coalition for Children.

Riley, D. (2009). Training Mental Health Professionals to be Adoption Competent. Burtonsville, MD: Center for Adoption Support and Education.

Javier, R. A., Baden, A. L., Biafora, F. A., & Camacho-Gingerich, A. (2007). Handbook of Adoption: Implications for Researchers, Practitioners, and Families. Thousand Oaks, CA: Sage.

Siegel, D., & Smith, S. (2012). Openness in Adoption: From Secrecy and Stigma to Knowledge and Connections. New York, NY: Evan B. Donaldson Adoption Institute.

Silverstein, D., & Roszia, S. (1998). Adoptees and the seven core issues of adoption. Adoptive Families Magazine. Retrieved July 15, 2013, from http://www.adoptivefamilies.com/articles.php?aid=489.