Foster Care to Adoption — Preparing Youths and Families for the Transition
By Deborah H. Siegel, PhD, LICSW, DCSW, ACSW
Social Work Today
Vol. 18 No. 6 P. 10

Permanency is a sensitive process, not simply a legal event. The movement from foster care to adoption is a passage that requires careful and thoughtful preparation.

"Getting adopted is like finally being able to sit down after standing up for a painfully long time." — Sam, age 9, in foster care

"I thought our love and skilled parenting would slowly heal his wounds. But our child came to us traumatized; he can't love us back—not yet." — Adoptive parent

The day foster children's adoptions are legally finalized brings joy. Great sorrow accompanies those days, too, for the children have lost their original families and endured trauma, abuse, neglect, and dislocation. Adoption does not obliterate the wounds of the past; it does present new challenges as well as delights. The child and parent need careful preparation for the transition.

Preparing the Child
Severe psychosocial stressors such as family violence, parental substance use, disability, and mental health issues precipitate a child's entrance into the foster care system. Losing one's original parents in and of itself is traumatic, even when those parents have been unable to keep their child safe. Sadly, too often children are also unsafe in the foster homes, shelters, and residential programs. Typically, a child in state custody experiences multiple placements. Thus, the child's traumas accumulate, affecting the child's sense of permanence, trust, attachment, neurocognitive development, learning, and behavior.

To prepare children for adoption, professionals must help them review their life stories, exploring their understanding of and feelings about events that have happened. Misunderstandings must be clarified. The child's feelings of inadequacy, unlovability, rejection, and abandonment must be carefully acknowledged. Children need to grieve their losses and learn that those losses are not their faults and not reflections of their worth as people—no matter what sorts of behaviors the child has exhibited.

To process this material, children need truth about the original parents' and previous foster parents' challenges that rendered them unable to take adequate care of a child. These facts must be delivered in clear, simple words that convey empathy and compassion for the parents' struggles, so children don't conclude that they are "bad seeds" who come from "damaged goods" or that they are responsible for or deserve the maltreatment, losses, and disrupted placements they have endured.

Children who have been abused or neglected often love and long for their parents despite the pain experienced in their care. Coming to terms with the fact that the parents they love and yearn for cannot keep them safe is a complex cognitive and emotional task that takes a long time to manage.

Well-intentioned child welfare workers might say unhelpful things to the child, such as, "Your behaviors are too much for this family. If you continue to act this way, they won't adopt you, and if they do, it won't last."

This puts the burden on youngsters, who may be doing their best to manage trauma-reactive behaviors; their highly activated amygdala, not yet linked via neural pathways with their prefrontal cortex, make them unable under stress to engage in rational problem solving or anticipate consequences.

Instead, the worker could say, "This foster family wants to keep you safe, and they're concerned that they don't know how. They know you need and deserve a family who can do that." This places the responsibility for permanence where it belongs: on the adults.

Children transitioning from foster care to adoption need a sense of identity and help redefining relationships while maintaining connections with important people from their past, including, when safe, the original parents and siblings, other biological relatives, neighbors, playmates, clergy, teachers, and other professionals. For instance, the child may have formed a special connection with a foster parent who is no longer able to maintain that role but who is willing to be a "visiting resource" who stays connected to the child in other ways.

The adoptive family needs preadoption education and support that enables them to understand and embrace the responsibility of helping the child maintain important relationships from the past. Doing so takes the adoptive parent's commitment, emotional stamina, time, and resources.

Successful adoptive families evolve over time as they adapt to the challenging realities of family life with a child who may not be ready to attach and whose behaviors can be hard to manage. Thus, permanency is a process, not simply a legal event.

"Relational permanency" is paramount. It is misguided to assume that legal permanency and relational permanency are the same. Relational permanency develops at the child's pace when adoptive parents are able to hang in there, remaining committed over time, even when the child's behaviors are consistently defiant, angry, rejecting, and distancing.

Parents need to be prepared emotionally for this possibility and supported along the way as they realize that the child may not meet the parents' needs for obedience, affection, appreciation, love, and pleasant companionship on fun family outings and holidays. The ability to tolerate sustained family distress and absence of gratification can be key to successful adoptive parenting of children who have difficult histories or special needs.

The legal processes involved in removing a child from the original parents, moving the child from one placement to another, terminating parental rights, and approving foster and preadoptive placements can be laborious, invasive, and confusing. Even adults can have a hard time navigating the child welfare and legal systems, so youths in particular need support in grasping what's happening and why, and where things stand legally. Clarifying for the child the legal and emotional differences between foster care and adoption is crucial.

The child's explicit agreement to be adopted matters. Children in foster care typically have no say in when, where, or with whom they are placed. Just as the preadoptive family must decide whether, and whom, to adopt, it's important for children to decide that they want to be adopted by a particular family. Children should be invited to state what kind of adoptive family they'd like to have; the worker should take these preferences seriously in finding them a family.

This facilitates the process of "claiming," whereby both child and family explicitly state that they want one another and belong together. The child needs explicit permission to simultaneously remain emotionally connected to the birth family and love the adoptive family, too. Both child and parent need help understanding that being adopted means neither forsaking one's personal history and genetic heritage nor diluting one's commitment to the adoptive family.

Children who declare, "I don't want to be adopted," may fear that agreeing to be adopted means they're disloyal to their original parents, they'll never see their biological siblings again, they'll have to move far away from the world they know, or that changing their last name will obliterate their identity. They may feel worthless, scared that yet another family will disrupt.

These feelings must be processed and reprocessed as they emerge in different ways over time, both before and after the adoption. It's important to tell children clearly that they deserve a "forever family." The worker's dependability and consistency in making and keeping appointments is important to convey that adults can be counted upon.

Helpful Tools
While there is not yet a definitive research-based protocol to prepare children for adoption, there are many widely used tools. A "life book" is a scrapbook the child creates with a social worker or parent that tells the child's life story using photographs, drawings, magazine clippings, court documents, and a written narrative. It can help the child understand what has happened and express feelings about those events, hopes for the future, and consolidate a sense of identity. A time line of significant events, collage, eco-map, and family photo album can be included.

Saying good-bye to the original parents, each prior foster family, and other significant relationships matters. The good-byes should be in person and accompanied by a simple ceremony or ritual. For example, the foster parent and child can make each other a decorated box into which each person places items representing activities they've experienced together, such as foods they've cooked, photographs of places visited, friends they've shared. They can read aloud to each other letters summarizing what they have learned from one another, and good wishes they'd like the other to carry forward into the next chapters of their lives. Skilled clinical work with the original parents may enable them, when saying good-bye, to give the child their blessing to love the adoptive parents too.

It's also important to write a plan detailing the nature and frequency of postplacement contacts with previous birth and foster family members. Even if relationships have been strained, people can agree to stay in touch at least minimally, via greeting cards. It's wise to keep the door ajar for future contact rather than slam the door shut or swing it wide open without well-defined parameters about who will have what kind of contact with whom, how often, and when.

Shutting the door can cause frustration, alienation, and cut off the possibility of further healing together down the road. Keeping the door wide open with insufficient structure can set up false hopes of contact that may not occur, blur boundaries, and exacerbate pain.

Preparing the Adoptive Family
An emphasis on therapy for the child, without including the family receiving the child, is misguided, as both parties need psychoeducation and therapeutic opportunities to explore their fantasies, hopes, anxieties, past losses, and vulnerabilities. Trauma-informed treatment for the child should include all of the systems and actors in the child's eco-space, so caring adults are coordinated in their efforts to support them. Nurturing supports should be cultivated and toxic relationships ameliorated.

Trauma systems therapy involves all of the people and systems in the child's life, including current and past extended family members, child welfare and court personnel, medical providers, and current and former therapists. All these players need guidance so they give the child consistent, truthful messages that convey nonjudgmental compassion for the child and the original family members. Adults can all be taught, for instance, to tell the child, "What happened to you is not your fault. You're just a child. Adults are the ones who made the choices that made this happen. Your behavior alone couldn't have been good enough to prevent it, or bad enough to cause it."

Parents will benefit from coaching in how to talk with the child about adoption, manage difficult behaviors, deal with school personnel, and respond to others' unhelpful comments (e.g., "Why do you put up with his mouth? He needs a good kick in the butt!"). Given the omnipresence of social media, they also need to plan how to handle the likelihood that the child and former original and foster family members may at some point have unsupervised contact.

Help the preadoptive family write down, with the child, household routines and expectations. Every family has different norms and rules of behavior, any of which can overwhelm and confuse a youngster who has had to adjust to many different homes. For instance, "In our family we put everyone's silenced cell phones into this basket at bedtime, and the basket sleeps in the parent's bedroom."

The child should be encouraged to have input in the list of rules, consequences for keeping and breaking rules, and procedures for changing them.

Just as a "good-bye ritual" can demarcate a child's exit from foster care, a "hello ritual" to welcome the child into the new family can be a useful way to facilitate transition. The preadoptive parent is well advised to acknowledge explicitly that since loss and sorrow are what made adoption possible, the child's mixed feelings are acceptable and they are welcome to express them without fear of wounding their adoptive parents.

During and after transition, adoptive parents can provide unstructured time together with their child, as well as structured time for games and family meetings to talk about how things are going.

Effective adoption preparation is only a first step. Easy access to long-term postadoption support is crucial for helping adoptive families thrive. Research shows that adoption disruption (which occurs before legal finalization) and dissolution (after finalization) occur when needed services to sustain the family have been delivered late, insufficiently, or not at all.

Families who transition from foster care to adoption may experience a predictable process. There's the joy of the adoption day, followed by a honeymoon phase. Ultimately, intense distress emerges, often in the form of a troubling child behavior. This leads to mutual disillusionment, then despair as difficulties persist or escalate. Fear of adoption disruption begins.

The parent's commitment to the child, and access to needed postadoption support services, can help. Sometimes, the commitment includes the child spending time in another out-of-home placement so all parties get respite and therapeutic care. Even while the child is placed out of home, it is important to empower adoptive parents, having them visit the child and participate in decision-making about the child's care.

Preparing the Social Worker
Adoption is a beginning that requires access to social workers' ongoing emotional and practical support, including crisis intervention; psychoeducation; trauma-informed, adoption-competent, family-focused, attachment-oriented psychotherapy; special education; after-school and respite care; and other resources as needed. Often, services are unavailable, making it important to create, fund, and sustain a full range of postadoption supports.

Upon finalizing an adoption, it is unwise for social workers to terminate services in the hope that the family will reach out for help down the road if needed. Closing services is a disservice. Often, an adoptive family's embarrassment, shame, and demoralization over the fact that they are struggling prevent them from asking for help until it's too late. By that point, the family is emotionally and financially exhausted, so rife with mutual frustration and despair they're beyond the breaking point. This misery can be avoided when, throughout their journey, families have access to a sustained relationship with a trusted adoption competent clinician.

Even when a foster family with whom the child has lived successfully for years adopts the child, the transition to adoption can be fraught. It is prudent to prepare for the possibility that the emotional intensity and unspoken expectations that accompany becoming a forever family can trigger trauma-reactive behaviors, challenging the newly adoptive family as it seeks to reestablish its equilibrium.

Too often, social workers, fearing adoption dissolution or disruption, avoid inviting parents and children to express their anger or ambivalence about the adoption. The worker may encourage parents to stretch themselves beyond their comfort zone, pressuring them to persist when they can no longer do so. It is more helpful for the worker to invite parents to express the anger, exhaustion, and feelings of incompetence that come from feeling constantly overwrought. Pushing this under the rug, hoping it will go away, exacerbates it.

Planning and preparation for the transition from foster care to adoption nurtures the family, helping children and parents thrive.

— Deborah H. Siegel, PhD, LICSW, DCSW, ACSW, is a professor at the School of Social Work at Rhode Island College in Providence.

Resources
Child Welfare Information Gateway. (2012). Helping your foster child transition to your adopted child. Washington, D.C.: U.S. Department of Health and Human Services, Children's Bureau.

Child Welfare Information Gateway. (2013). Preparing children and youth for adoption or other family permanence. Washington, D.C.: U.S. Department of Health and Human Services, Children's Bureau.