Abstract
This research arose from concern about the prevalence of UK adoptions of children with significant levels of emotional, behavioural and/or therapeutic needs, and the fact that these are being made in a context where research into the outcomes of such placements is sparse. It focuses on adopters of children pre-identified as having high therapeutic needs and looks specifically at the factors that affect adopters’ ongoing commitment. The methodology was qualitative with findings drawn from six in-depth, semi-structured interviews with adopters, followed by focus groups comprising adopters and social workers. Levels of commitment were assessed using the conceptualisation and measures outlined in previous research involving the ‘This is My Baby Interview’ (Bates and Dozier, 1998). Contrary to initial hypotheses, levels of adopter commitment did not correlate with the severity of need or challenging behaviours in their adopted children per se. Instead, it was found to be associated with their feelings of ‘hope’ about the future, feelings that were closely linked to the level, accessibility and quality of the therapeutic and professional resources available.
Introduction
The UK adoption reforms of recent years, bolstered by substantial government funding, have raised the profile of adoption and initially led to an increase in adoption rates. Yet while the profile of adoption remains high, the reality following the Re B and Re B-S judgements 1 is that rates for placement orders and adoptive placements are falling, and the Government’s continuing promotion of this option has led to public disagreement over the issues (Elvin, 2015). The Government’s position remains unchanged: research shows significantly lower disruption rates for adoptive placements than for special guardianship or residence orders (Selwyn and Masson, 2014) and offers something incalculable to many children in local authority care in terms of outcomes: that much sought-out factor of ‘forever’ commitment.
Yet, the policy agenda to increase adoption often equates to a push on local authorities to promote this for children with significant levels of additional need. In the UK, children are primarily adopted from care after having been removed from their birth families due to proven risk of ‘significant harm’. The harm experienced is generally associated with one or more risk factors, such as severe neglect, maltreatment, exposure to drug or alcohol misuse (including in utero), domestic abuse and parental mental health difficulties, many of which are inter-related. The impact of these on the child can be further compounded by his or her removal, and time spent in temporary care.
Thus, the histories that accompany adopted children with high therapeutic needs have long-term implications for their future emotional, behavioural and cognitive development. Those who are older (a frequently cited characteristic of ‘harder to place’ children) have also often suffered more early years trauma and may present with increasingly complex and severe emotional and behavioural difficulties as they grow up.
In terms of providing permanency, this multiplicity is problematic. Research over many years has repeatedly emphasised that certain background characteristics bring with them a significantly increased chance of placement disruption. Among those identified are: age at removal into care and at point of placement; number of previous moves while in care; and the extent of emotional and behavioural difficulties (Biehal, et al., 2010; Selwyn, Wijedasa and Meakings, 2014). For these children, adoption could almost appear a contradiction in terms if it were not for the powerful subtext of adopter commitment. The expectation, supported by Selwyn and Masson’s (2014) research, is that adopters will be able to provide permanence even for these children when other options are less likely to offer a long-term commitment.
Policy and literature context
The perception that commitment is the central factor that defines adoption is reflected in child care law. It remains the only legal order that involves a permanent, post-18 commitment by the carer to the child, severing all links between the child and birth family from the moment the order is granted. No other legal order can do this. Furthermore, this legal requirement is likely to correspond to a greater personal involvement from carers in terms of emotive and psychological commitment than is the case in other care arrangements, such as long-term fostering (Biehal, et al., 2010: 235).
This was noted in Selwyn and colleagues’ research where, in situations of extreme difficulty, ‘the commitment and tenacity of adoptive parents was remarkable’ (Selwyn, Wijedasa and Meakings, 2014).
Yet, while the policy to increase adoptions is based on a belief in the invaluable benefits of potentially greater carer commitment, this has occurred without much clear public acknowledgement that not all adoptions are the same. The adopters of older children or those who have suffered severe maltreatment, or been harmed in utero, may well be ‘severely tested by developmental and behavioural problems, including aggression, destructiveness and over-activity’ (Rushton, 2003: 26), factors which often lead to placement disruption (Coakley and Berrick, 2006).
The implications of this situation for current adoption policy are significant. Biehal and colleagues noted that regardless of whether or not a placement is called adoptive, it is the likelihood of disruption in either care plan which makes the difference for children. They found that it was those who had experienced placement breakdowns and a lack of permanent carers who were consistently found to have significantly worse outcomes than those who had been adopted or placed in long-term foster homes (Biehal, et al., 2010). Although we know that it is not the case that disruption always directly equates to a lack of carer commitment (Selwyn, Wijedasa and Meakings, 2014), for the child concerned it may be experienced as such.
These findings echo those from US studies of carer commitment to foster children, which found an association between a child’s behaviour and their carers’ levels of commitment. Therefore, while research tells us that carers’ commitment can be affected by their child’s behaviour over time, it equally suggests that a child’s behaviour may be their response to a carer’s lack of commitment. As Dozier and Lindheim (2006: 339) conclude, ‘having an uncommitted caregiver may be experienced as devastating’.
It appears from this that a carer’s continuing level of commitment to their child is as important for placement progress and outcomes as the child’s background characteristics. Moreover, there appears to be some interplay between these two variables, so that in combination they have a significant impact on the subsequent history of the placement.
It is in the light of this policy and research context that this study focuses on the factors affecting adopters’ commitment to the care of children with high therapeutic needs, given the implications of this for these children’s placement outcomes.
Research design and methodology
This research design began by seeking the perspectives of adopters rather than the range of other people involved in the adoption process. This was to ensure that adopters’ experiences and perspectives were fundamental to the analysis. As the study was small, the sampling of interviewees was purposive. Participating adopters were all already parenting children pre-identified with high therapeutic needs. They were all in receipt of post-adoption support from the local authority’s specialist Child and Adolescent Mental Health Services (CAMHS) service for children who either are or have been ‘looked after’.
The research posed four main questions:
What level of commitment did the adopters demonstrate to their adopted children? Did the added factor of adopting a child with high therapeutic needs make (or could it make) any difference to this commitment? What other factors, if any, did adopters see as contributing to their levels of commitment? Were these factors internal or pre-existing to the adoption, or were they external or post-adoption?
As this was a piece of independent practitioner research, it was necessary to gain the consent of the local authority and the specialist CAMHS team as well as the families and children involved. Ethical approval also had to be obtained from the External Ethical Panel at the sponsoring London University.
The bulk of research comprised semi-structured, in-depth interviews with six adopters. Participation was voluntary and adopters were informed of the purpose and design of the research beforehand. Interviews lasted between 45 and 75 minutes and, with permission, were recorded and transcribed. They were initially analysed thematically with the specific information on commitment and support explored later.
An early problem was that no complete, pre-designed way of assessing commitment was available. Other studies have used the ‘This is My Baby Interview’ (TIMB) to assess carer commitment (Dozier and Lindheim, 2006; 2007), but although the questions and final commitment ratings are available (Dozier and Lindheim, 2006), the rating guidelines are inaccessible. Additionally, the interviews were designed for foster carers rather than adopters.
Despite the above limitations, there remained a high level of ‘relatability’ between the TIMB assessment and other measures of adopters’ commitment. Thus, the TIMB definition of a highly committed carer was accepted as useful (Barnard and Dozier, 2011: 260): The caregiver provides evidence of a strong emotional investment in the child and in parenting the child; multiple indices of high levels of commitment are present throughout the interview; descriptions of the child and the caregiver–child affective bond; evidence of the caregiver committing resources to promote the child’s growth; indices of psychological adoption of the child; the child is fully integrated into the family; the caregiver considers the child as hers.
Initial interview questions were designed to elicit the sharing of adopter experiences in these areas. The subsequent interview analysis then looked at how positive or otherwise adopters were in these responses. When placed into each adoptive context, this gave what was deemed to be a fairly reliable indicator of general feelings of commitment felt by the adopter at the time of the interview. The second half of the interview contextualised the adopter’s experiences through consideration of their internal and external supporting factors.
Once the findings from the interviews had been analysed, they were presented to two focus groups, one comprising adopters and the other social workers in the local adoption team. Separate meetings were also held with the managers of relevant services. This ‘validation’ process was particularly valuable given that it had not been possible to incorporate triangulation (the cross-verification of data from two or more sources) into the research design.
Factors affecting adopter commitment: findings
In the light of wider research, the six adopters taking part were all circumstantially at increased risk of experiencing disruption to their placements. All their children had experienced previous adversity and five of them were displaying extremely challenging behaviour. In four cases, the children were older when placed and all their carers said that the difficulties were worse than expected, with two noting that they were having to deal with behaviours that had not been anticipated. Another adopter had adopted a child she had been fostering, so she was familiar with her behaviour, albeit still noting that it was very challenging. Only one adopter said her parenting experience was easier than expected. Perhaps notably, her child was the youngest in the study, aged under three when placed, and had been living in the adoptive home for the shortest length of time.
The challenges faced by parents covered a range of attachment and emotional coping problems, significant practical and self-care needs and a cluster of aggressive and harmful behaviours. One adopter also reported significant sexualised behaviour.
Levels of commitment
The hypothesis informing this research was that adopters would find it harder to remain committed to their children after they had been placed and had begun to show highly challenging behaviours. However, this was not found to be the case.
It was certainly true that five of the six respondents found the experience of parenting their children extremely difficult, describing how they had developed serious health problems, of being unable to go anywhere or do anything due to the overwhelming and constant needs of their child, of putting their children to bed and then going away ‘to cry … because it’s horrible’. They spoke of losing friends, of being physically hurt, of permanent damage to their property and of being unable to spend quality time with their spouse or birth children. The one adopter who had not had this experience still reported difficulties but on a significantly lower level.
Yet despite these pressures, all six participants showed strong and consistent commitment to their children. Surprisingly, it was the adopter who reported facing fewer problems than she expected who displayed the lowest commitment scores from her interview, whereas the respondent with the highest commitment scores reported one of the most challenging and wide-ranging set of behavioural difficulties identified in the study.
Obviously this finding does not indicate that commitment is increased by challenging behaviours per se as this relationship remains complex and multifaceted. However, it is sufficient to undermine the initial hypothesis that adopters would find it harder to remain committed to children who showed more difficult and challenging behaviours.
In the context of TIMB’s rating of what it means to be ‘committed’, all the adopters scored highly on every criterion, although in each case these positive indices were formulated within a framework of difficulties and challenges. Thus, while remaining hopeful, the adopters uniformly expressed serious uncertainties about their child’s future.
These uncertainties included issues such as knowing their child was ‘preloaded’ for future mental health difficulties, awareness that their child would never completely overcome their traumatic history, worry about the possibility of the difficult behaviours escalating in adolescence and wondering if their child would ever be able to live independently in the community as an adult. Hopes and fears were sometimes mentioned alongside one another: I know that the match we have will last; it’s a lifelong, good match. But at its worst I have feared [my child] will kill me … because I might not admit it, but yeah I worry … I do worry that [my child] might cause devastation in our whole family …
What contributed to levels of commitment within this context?
The issue that appeared to be most salient across all the interviews was not the child’s level of need but the adopters’ ability to be positive about their chance of making future progress – what one interviewee called ‘hope’: You’ve just got to kind of learn not to panic when something happens and think, ‘This will be it forever’ … ’ … more recently I thought it might break down … again it was [the CAMHS professional], talking to her … it gave me more hope again, yeah I lost hope and to get that back again … It’s not easy, but having said that … we have seen [our children] grow … because if it was all, you know, that level, we wouldn’t be able to continue with it … With these kids … it isn’t straightforward … we are the primary carers, we are not abdicating our caring, but we needed the support … support for children in helping them start to understand themselves; support for adopters in understanding their children’s needs and behaviour; support from professional agencies and friends and family that includes a genuine understanding of what it means to care for a challenging child.
Support for children in helping them start to understand themselves
Here, adopters highlighted two areas that had made most difference to the care of their children: the quality of preparation given to their children before adoption and the availability of specialist CAMHS/therapeutic interventions after their child had been placed.
Preparing the children for adoption was described in terms of good quality life story work and skilful preparation for moving into their new homes. Inevitably, views varied with some feedback unreservedly positive: I was very lucky [my children] had an amazing social worker … really that has made a huge difference because there’s understanding … it’s helped them make sense of what’s happening to them and feel safe … The specific thing was [my child] not understanding that he couldn’t have stayed forever where he was … almost daily … ‘Why have I been moved?’, um, and therefore I think anger directed at us, which hasn’t helped things … it’s a real issue, he needs to trust us … um, we haven’t, kind of, come in to steal you.
This was closely linked to their own ability to hope that things would turn out well: It will take quite a while … but with the help of the play therapy … I think there is a light at the end of the tunnel … I can already see in [my children] … the fruits of going through it [CAMHS], in terms of our understanding of them and their understanding of themselves … they are becoming emotional beings, which they weren’t before.
Supporting adopters to understand their children’s needs and behaviour
All six adopters spoke of the difficulties of not understanding their child and not knowing how to interpret his or her behaviour: He shifts mood; you don’t understand why … you don’t know what to do. … it was more challenging in the beginning because it was inexplicable; the challenging behaviour goes on, but it is explicable now, I know now.
It is important to note that all the participants were receiving a specialist post-adoption CAMHS service offered within the hosting local authority. In referring to this, they had in mind a skilled, well-resourced and long-term service and not the more typical generic community CAMHS provision. This is significant because generic CAMHS teams have been criticised as sometimes lacking the resources and skills to respond adequately to high-need, complex adoption situations (Selwyn, Wijedasa and Meakings, 2014).
Support from professional agencies, families and friends
Five of the six adopters also had very positive things to say about the help they had received from the local authority after placement and from the professionals involved, noting that they had appreciated having ‘a really good social worker’ and ‘good preparation’ of their child, and contact with schools that were understanding.
Support at the pre-adoption stage
Views on pre-adoption services were noticeably mixed. Three respondents said that the care their child had received before being placed had not reflected an understanding of his or her needs. One family related that prior to the adoption, their children’s additional needs seemed to have been overlooked and no plans had been made for post-adoption support; they had to request this and fight to get the help they needed. They recalled that the description of their children they were given pre-placement had been far ‘too black and white’, the behavioural methods they were advised to use ‘didn’t help the situation’ and the understanding of the children’s needs appeared limited: Nothing really happened [while they were in foster care] … I’m not trying to diss the foster carer, she had a lot on her plate … [but] I think what they needed was some serious attention …
There were, in contrast, one or two exceptions to this view. One adopter said that her child had several years of skilled therapeutic intervention before being placed and that the previous foster carer was ‘outstanding … absolutely brilliant’. These differences in practice appear to reflect variations in the levels of skill among the different social workers and foster carers involved.
Support at the post-adoption stage
Once the placements had been made, the provision of continuation of understanding and emotional support was again highlighted as vital: ‘just being understood actually makes you feel better …’
Five respondents stressed the importance of having not been ‘left on their own’ to manage: What we want, really, is the assistance, which we have had help with … I do believe, it’s almost like a village that does bring up a child, I really do see it now. … the mere fact of knowing that [agencies] are there makes a difference. … having a variety of people I can call on, social workers and [CAMHS workers], is really important because … it is luck whether you have an understanding social worker, whether they understand and if they are not available then you need someone else you can be able to call upon, who understands; that’s the main thing I think, someone who understands … understands that you are totally exhausted and … what the kids are going through … The local authority is useless … it all goes back to having somebody … to realise how difficult it is, because they talk about it all before, we had to go to a big meeting – ‘Do you understand the implications of this? How do you feel?’ We had to go through all that before we could adopt [our child], so they know all that information, and then when the placement is signed and sealed, it’s almost like, ‘See you later,’ and they have forgotten about all of that. [Our child] is priority for everything when [they’re] a foster child and then when you adopt, you get nothing. It stops. But their issues don’t stop, their anxieties don’t stop, they still need the same things. Just because I have signed a piece of paper to say we adopt [our child] and we will keep [them] forever, it’s not a miracle cure. She behaves so much better when we’ve had time, our relationship is so much better. We have had some good friends who have found it quite hard to remain, wanting to come and see us, because [our children] are quite challenging and they see how the challenge goes for [us] … and I think that’s what they find hard …
Focus groups: feedback and recommendations
Both adopters and social workers in their respective focus groups were asked to see if they felt that the findings reflected their experiences. Everyone agreed that they did and made suggestions for constructively taking things forward into agency practice.
Recommendations were made for structural changes that might affect organisational cultures. For instance, there was a suggestion for universal, earlier and fuller therapeutic assessments of children’s needs with problems identified at the start of family-finding rather than later on, as this was seen as essential in constructing effective post-adoption support packages. More multi-agency working between post-adoption services and children’s and adopters’ social workers was also highlighted, again to be facilitated by structural changes that enable the learning of workers across different departments to be shared and enhanced.
Finally, at the practice level, the adopters felt that a major cultural shift was needed among some social workers who seemed to believe that a ‘good’ adopter was one who did not request any long-term support from the local authority, noting instead that in light of their children’s special needs, the opposite should be the case.
These observations suggest that adoptive placements of the type discussed in this article require attention as a specific group within a generic adoption service. This would promote a better appreciation that the long-term commitment of adopters who care for challenging children is more complex than in other situations, and is closely linked to the quality of the support available.
Limitations of this research
This research has many limitations. The sample was both purposive and small, meaning findings can only suggest areas for further work. In addition, the personal characteristics of adopters were not fully considered and the CAMHS support service that was so valued was highly specialised and not available in most local authorities.
Discussion and conclusions
While acknowledging the above limitations, the study does contribute to an area of research that has been sparsely covered and to a rapidly developing area of social care policy and practice. Historically, all adopted children’s difficulties were expected to resolve themselves after a few years in the new home and post-placement support tended to be limited to the first few months or years. But recent research suggests that such approaches can, for some adopted children, be naïve: ‘the consequences of child maltreatment can be long-lasting … [and] the negative impact of earlier abusive experiences does not simply disappear with adoption’ (Selwyn, Wijedasa and Meakings, 2014: 275). This article offers possible avenues to support adopters ‘over the long haul’ and into the future.
The study reinforces the idea that adopters’ levels of commitment, even to challenging children, can be very high. Given this can contribute to placement stability, a policy of adoption for many children with high therapeutic needs may be justified. However, any assumptions that adopter commitment will remain unaffected by the challenges of caring for these children appear deeply unrealistic.
In discussing this, these adopters stressed that their levels of commitment were greatly influenced by circumstantial factors, and that long-term support was essential owing to the exceptional and challenging needs of their children. Hence, in adoptive placements such as these, the types of services offered is an issue that needs more consideration when placement decisions and support plans are made.
Furthermore, it is significant that the participants (who were all, bar one, still in the first few years of initial placement) linked both their levels of commitment and received support with their corresponding feelings of optimism and ‘hope’ for the future. One must ask, therefore, what happens to adoptive homes when this support is withdrawn?
Selwyn and colleagues’ study provides a worrying answer to this question (Selwyn, Wijedasa and Meakings, 2014: 221–222): Parents talked about having had low mood, difficulty sleeping, panic attacks, needing medication and counselling … Some adoptive parents … were from their own descriptions showing signs of secondary trauma.