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Section 18
Family in Crisis: Adoption of Special-Needs Children

Question 18 | Test | Table of Contents

The Adoption and Safe Families Act of 1997 seeks to promote the speedy adoption of children with special needs who are in the public child welfare system, when reunification with their parents is unlikely. In addition, the Adoption 2002 Initiative set the goal of doubling the number of adoptions or other permanent placements of children in out-of-home care between 1998 and 2002 (Duquette, Hardin, & Dean, 1999; Sullivan & Freundlich, 1999). In fiscal year 1999, 46,000 children were adopted from the public foster care system, and an estimated 134,000 children were waiting to be adopted as of March 31,2000 (U.S. Department of Health and Human Services, Children's Bureau, 2001). Children in out-of-home care awaiting adoption typically have a range of special needs (Child Welfare League of America, 2000).

Special-needs adoptions generally are regarded as having favorable outcomes, as based on adoptive parent satisfaction and low rates of disruption (Barth, 2000; Gallant, 2000; Rosenthal, 1993). In their review of studies, Kadushin and Martin (1988) found that about 70% of parents regarded their special-needs adoptions as excellent or good, a percentage comparable to adoptions in general. Rosenthal's (1993) review of studies suggested disruption rates for older special-needs children at about 10% to 15%. Although different studies show some contradictory results, disabilities (physical impairments, developmental problems, and serious medical conditions) do not appear to be major risks for disruptions (Rosenthal, 1993). McRoy (1999) found that adoption disruptions and dissolutions were related to various aspects of the adoption service delivery system, adoptive parents, and child characteristics. For example, the child's emotional and behavioral problems and the parent's unrealistic expectations of the child may be linked to disruptions (Barth & Berry, 1988; Rosenthal, 1993).

The small proportion of adoptions that are regarded with some or much dissatisfaction or those that end in disruption or dissolution may indicate stress in these families. Special-needs adoptions are generally believed to be stressful and challenging for adoptive families and parents (Barth & Berry, 1988; Groze, 1996; Groze & Gruenewald, 1991). Hartmann (1984) stated that accompanying the change in view that every child is adoptable, are two assumptions: ( 1) Families will need help post-placement, and ( 2) because of the new demands and changes to the parents' lifestyle and to the family system, the family may be in crisis after placement of a child who has special needs.

Parenting stress and parent-child interactions are a function of a complex interplay among variables related to the parent, child, and situation (Abidin, 1990a). Literature about parenting stress in nonadoptive families of children with special needs shows that, despite having an inordinate number of Stressors, a significant proportion of parents with children who have disabilities do manage well (Kysela, McDonald, Reddon, & Gobeil-Dwyer, 1988). The severity of disability, the degree of responsiveness of the child to the parent, and the extent of attachment may, however, affect family stress (Kysela et al., 1988). Parents of emotionally impaired and learning disabled children had higher stress scores than parents of children in regular education (Fuller & Rankin, 1994). Mothers of developmentally delayed children had higher stress scores related to child issues but not parent issues (Cameron, Dobson, & Day, 1991). Other studies of nonadoptive families have found correlations between child behavior problems and parenting stress scores related to child characteristics (Cuccaro, Holmes, & Wright, 1993; Eyberg, Boggs, & Rodriguez, 1992).

A theoretical literature is emerging on stress and special-needs adoption (Barth & Berry, 1988; Groze, 1996). Barth and Berry (1988) described a social and cognitive model of adjustment to adoption. The model is based on stress being a function of an individual's (the parent's, the child's, or the family's) resources and appraisal of any situation. Barth and Berry's model identified the following Stressors for adoptive parents: misleading expectations, lack of social support, instant parenthood, new roles, financial costs, establishing the parenting role, and nurturance of marital relationships.

Groze (1996) conceptualized the adoptive family system as including Stressors from the community, the service system, the family, and the child. In a four-year longitudinal study, Groze identified various Stressors in adoptive families of special-needs children. These Stressors included significant behavioral difficulties, challenges from placing siblings together or separating them, attachment difficulties, and negative parent/child relations. The lack of background information on the child, regarded as a stressor for parents by Groze, may also be the strongest service related predictor of disruption (Rosenthal, 1993).

Todis and Singer (1991) interviewed families who had adopted multiple children with severe disabilities and identified four sources of stress: ( 1) medical emergencies and procedures such as surgeries, ( 2) crises from adolescents' behavior problems, (3) dealing with service providers to obtain services (special education, physical therapy, and medical), and (4) concern about the future. Families were helped by receiving social support from other parents of children with disabilities, maintaining a positive focus, appreciating the child's progress, learning about the child's condition and what could be controlled, and having no sense of guilt over the child's condition.

In families who adopted children from Romanian orphanages, parenting stress was significantly correlated with the child's behavior problems, whereas the number of developmental delays, number of medical problems, and number of siblings were not correlated with parenting stress (Mainemer, Gilman, & Ames, 1998).

McCarty, Waterman, Burge, and Edelstein (1999) reported that, within three to five months after placement of a prenatally substance-exposed child, adoptive parents scored relatively higher on the amount of stress generated by child issues than by parent issues on the Parenting Stress Inventory (PSI). The majority of these adoptive parents reported parenting to be more difficult than they had imagined, but also more rewarding (McCarty et al., 1999). In the interviews, parents described more difficulty with attachment and development issues of the child than with the child's behavior. Almost one-half of the parents, however, reported clinically significant distress on subscales of the PSI related to the child's mood, demandingness, inability to adapt, distractibility, or acceptability (meeting parents' expectations). At the follow-up interview, within one year, the total stress scores were lower, but the change was not statistically significant.

Casey Family Programs is a national foundation that serves children, youth, and families. Its primary focus is on children who cannot live safely within their own homes. The agency provides . direct services to children and families in need, funds national child welfare projects, and collaborates with other organizations in the areas of prevention, permanency, and transition. In 1984, the Honolulu Division of Casey Family Programs began providing long-term foster care for children removed from their homes because of abuse and neglect. In response to an increasing need for permanency options in Hawaii, the division began working in 1997 with the Hawaii Department of Human Services to develop an adoption program for these high-risk youth. The goals for the program are to expedite the adoption placement of special-needs children and to support the stability of the placements. The program defines special needs as all children from the child protective/foster care system, because they are exposed to losses, issues of neglect and/or abuse, instability, violence, or substance abuse and, therefore, are more at risk than children from intact, safe homes. Children are referred from the child protective services system after the parents' rights have been terminated. Casey licenses the prospective adoptive parents, who are required to participate in intensive preservice training and are expected to participate in ongoing training. Once a child or children are placed, intensive services are provided to assist the family. Services include assisting families to find community resources, providing legal services, and helping the family in dealing with birth family issues, cultural identification, and with day-to-day management. Reimbursement for room and board, medical coverage, and limited financial assistance for special situations are provided. Social workers assist families in applying for federal adoption assistance. Adoption usually occurs from 6 to 12 months after placement. Families are invited to participate in post adoption services for one year after the adoption. Longer term follow-up services are being developed. Families are invited to contact the agency as needed, and to attend adoptive parent-support groups, as well as agency-sponsored workshops, training, and social events.

Although models of stress and adoptive parenting have been developed, relatively few empirical studies have addressed the stress of adoptive parents in adoptions of children with histories of abuse and/or neglect.
- McGlore, Katalina, Santos, Linda, Kazama, Lynne, Fong, Rowena & Charles Mueller; Psychological stress in adoptive parents of special-needs children; Child Welfare; Mar/Apr 2002; Vol. 81; Issue 2.

Personal Reflection Exercise #4
The preceding section contained information about psychological stressing adoptive parents of special-needs children.  Write three case study examples regarding how you might use the content of this section in your practice.

Update
Mental Health Engagement among Foster
and Adopted Youth: The Transition
from In-Person to Telemental Health Services

- Perez, V., Ruderman, M., Kussman, M., Waterman, J., & Langley, A. (2022). Mental health engagement among foster and adopted youth: the transition from in-person to telemental health services. Social Work in Mental Health, 1-20.

Peer-Reviewed Journal Article References:
Cioffi, C. C., Griffin, A. M., Natsuaki, M. N., Shaw, D. S., Reiss, D., Ganiban, J. M., Neiderhiser, J. M., & Leve, L. D. (2021). The role of negative emotionality in the development of child executive function and language abilities from toddlerhood to first grade: An adoption study. Developmental Psychology, 57(3), 347–360.

Grotevant, H. D., Wrobel, G. M., Fiorenzo, L., Lo, A. Y. H., & McRoy, R. G. (2019). Trajectories of birth family contact in domestic adoptions. Journal of Family Psychology, 33(1), 54–63.

White, E. E., Baden, A. L., Ferguson, A. L., & Smith, L. (2021). The intersection of race and adoption: Experiences of transracial and international adoptees with microaggressions. Journal of Family Psychology. Advance online publication.

QUESTION 18
What are the four sources of stress for families who adopted multiple children with severe disabilities? To select and enter your answer go to Test.

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