MON July 9, 2018 MON July 9, 2018
2:00 pm 2:00 pm
International I International I

Jill Waterman

Jill Waterman

Symposium: Supporting Adopted Children and their Families: Pre-placement Education and Post-placement Intervention

Preparing Families to Understand and Support the Needs of Children Adopted from Foster Care

This presentation includes an evaluation of the effectiveness of the TIES Pre-placement Education and Preparation curriculum (TIES PREP) for prospective foster/adoptive parents in improving knowledge of potential strengths and challenges of raising children adopted from foster care, attitudes toward children with prenatal substance exposure and their substance-using birth parent(s), and increasing willingness to adopt these children. Participants included 1,836 prospective parents seeking adoption through foster care who received 9 hours of TIES PREP training. TIES PREP sessions include information to help families understand addiction, build empathy for birth parents, practice how to answer children’s difficult questions about being in care in honest and developmentally appropriate ways, common medical/pediatric issues for children involved in foster care, demystifying prenatal substance exposure, understand individual temperament and attachment-based strategies in caring for children with trauma histories and other risk factors, family strategies for positive, child welfare competent parenting and strategies to help prevent substance abuse in adolescents. Additionally, families hear from an experienced parent who has adopted through foster care about their experiences. Prospective parents completed questionnaires assessing their knowledge about important issues involved in adopting a child from foster care, attitudes, and willingness to adopt children with potential risk factors common to the histories of youth involved in child welfare such as prenatal substance exposure, behavioral issues, family histories of mental illness and substance abuse, ADHD, etc. Changes from pre- to post-TIES PREP training were examined. Results indicated significant increases in self-reported knowledge; significantly more positive attitudes toward substance abusing parents and children with prenatal substance exposure; and significantly increased willingness to adopt children with a variety of potential difficulties, including children with prenatal substance exposure, serious behavior problems, ADHD, and children with a biological history of mental illness. Findings suggest that prospective adoptive parents who attended the TIES PREP sessions felt better prepared by the end of training with regard to issues related to adoption of high-risk foster children with potential special needs, particularly those with prenatal substance exposure.

Adoption-specific Therapy: Description of a Manualized Intervention for Adopted Children and their Families

This presentation will describe Adoption-specific Therapy (called ADAPT), an intervention designed to improve child behavior and family attachment for families adopting children past infancy from the United States foster care system or internationally. Older children adopted from foster care often have histories of prenatal substance exposure, abuse, neglect, and multiple placements, while internationally adopted children may have experienced neglect, orphanage care that did not foster attachment, and abandonment — all these factors predict behavior problems over time. However, standard evidence-based psychosocial interventions are not tailored to the unique clinical needs of adopted children and their families. Adoption-specific clinical services are also needed to address the emotional underpinnings of the child’s adoption experience. Adoption-specific Therapy developed over a period of 10 years, based on work with many families adopting from foster care at UCLA TIES for Families on the West Coast and Center for Adoption Support and Education (C.A.S.E.) on the East Coast.

ADAPT is a resilience-focused, trauma-informed manualized intervention that integrates evidence-based components such as positive parenting strategies and cognitive behavioral coping strategies for children, with best practices in adoption for core issues such as grief and loss, attachment, developing an adoption narrative, managing divided loyalties, identity formation, transracial adoption/diverse families, trauma treatment, and adoption-specific behavioral strategies. Families learn to view difficult child behavior through the lens of the child’s past history, and develop parenting strategies that take this understanding into account. We will describe the modules of ADAPT: 1) Trust, positive coping, and behavior management, 2) Developmental understanding of adoption experience, 3) Loss and grief issues in adoption, 4) Attachment/joining with adoptive family; 5) Search for identity/self-esteem/transracial adoption, 6) Adoption and the outside world, and 7) Trauma treatment. Each module involves several parent and child sessions, followed by a joint family session (approximately 24 sessions total). All children’s sessions are activity-based, and there are 60 handouts total to utilize with both parents and children. ADAPT materials and clinical case examples will be presented. A book for therapists detailing the intervention, Adoption-specific Therapy: A Guide for Helping Adopted Children and their Families Thrive, will be published in Summer 2018 by American Psychological Association Press.

Parent and Child Outcomes for a Pilot Trial of Adoption-specific Therapy

In the last presentation, we will discuss results of a pilot trial of Adoption-specific Therapy, examining outcomes of the modularized, manualized ADAPT curriculum with 40 children and their families. Data were collected at 3 sites in the Los Angeles area, as well as at an additional site in the Washington, D.C. area. Measures of child behavior problems, parenting stress, adoption dynamics and satisfaction, as well as measures of 3 individualized problems that parents wanted to change were examined prior to treatment, at treatment completion and at 3 month follow-up. Preliminary data analysis with the first 15 cases indicated a significant decrease in parenting stress (p<.02) following treatment, and significant decreases in parent’s weekly reports of three individualized problem behaviors (p=.02, .03 and .02) selected at the beginning of treatment as targets of intervention. Additionally, on the Child Behavior Checklist, both Externalizing Problems and Internalizing Problems decreased significantly (p<.03 and .01 respectively). At baseline, 46% of the children scored in the borderline or clinical range while only 15% scored in the borderline or clinical range post-treatment. In addition to updated data on the whole sample on the above measures and at 3 month follow-up, we will also present information about adoption dynamics obtained from children at the different time points. Qualitative data collected will also be presented; preliminary examination shows that both parents and children felt more comfortable discussing issues related to the adoption and their birth family, and felt family closeness and attachment was increased. This is one of the first trials of post-adoption intervention aimed at families adopting older children from foster care. The results are encouraging in both decreasing child problem behaviors, and improving parental stress and family bonding. Clinical implications and future research directions will also be discussed.