Forced adoption support services scoping study Daryl Higgins, Pauline Kenny, Reem Sweid and Lucy Ockenden Report for the Department of Social Services by the Australian Institute of Family Studies February 2014

72.1Continuity of care

The range of services offered by individual agencies and the use of a trauma-informed approach varies considerably. Sometimes services can be very search focused rather than encompassing the mental, emotional, physical and social impacts of adoption in their service delivery. Post-adoption specific services often refer clients to other therapeutic services because they lack the resources to provide in-house counselling. These counselling services are often over-subscribed, resulting in long wait lists.

There was widespread support for the idea of enhanced referral networks, to enable holistic service provision. Web-based databases or referral networks were seen as most efficient.

73Networking across agencies/sharing clients

Mixed views were presented during the consultations—some agencies felt the current capacity for networking was a strength; however, a much greater proportion felt that this was an obstacle—that they didn’t know who to refer clients to, or didn’t have confidence in the knowledge base and skills of the workers in other agencies. Further, in one workshop, it was noted that government competitive tendering processes often worked against the notion of cooperation and networking between agencies.

In order to achieve a more collaborative approach among service providers, it does mean that peer supports need to have status and be valued by other services. Equally, it is important for peer-support groups to recognise that clients need choice, and that some have had prior negative experiences in seeking support, and will choose a different peer-support group, post-adoption support agency or professional psychological care.

During the consultations, feedback was given on other services that have regular contact with people affected by the impacts of forced adoption such as hospitals and aged-care facilities. Currently there is little awareness among these services of the need to approach the topic of past adoptions in a trauma-informed way.

Service needs identified by stakeholders included:

information and training for staff working in aged care and retirement homes. Mothers in aged-care homes are mentioning to their family members that they had a baby and their family members do not know what they’re talking about. Aged-care services need to be able to refer family members to appropriate services. Family members need support and questions answered to be able to understand what their mother experienced, and mothers need support while in the aged-care facilities;

information and training for staff and practitioners in other facilities or services such as prisons, the alcohol and other drugs sector and rehabilitation services;

an expansion of the mental health, drug and alcohol, and community health services in regional areas; and

after-hours counselling and support services—however, there was recognition that it would be more cost-efficient to support and upskill existing services such as Lifeline, rather than introduce a new service.

74Awareness raising

The need to improve general awareness had two components. The first component was about promoting awareness of services available to people who may need to access them but don’t know where or how to start. The second component was to engage the public to make people more aware about the history of forced adoption practices and their long-term effects:

It still astounds me when people say, “What apology?”. We need more public awareness to link to service entry points.

Suggestions for increasing awareness of services available for affected individuals included:

once a year, conduct a “phone-in”, run by an organisation such as Lifeline that promotes the issues to the general public, to encourage people out in the community, who are silenced, who think its their fault, or who find it difficult to come forward. However, for it to be effective, there needs to be capacity to recommend GPs in the local area that people can access to get a referral to psychological or psychiatric care from appropriately trained professionals;

a highly publicised central website with a 1800 number;

posters and flyers explaining where you can go for help (e.g., Centrelink, community centres, Medicare Locals and other GP clinics);

provide funding for marketing of existing services;

deliver seminars in regional areas to create awareness. Seminars provide an opportunity for family members to hear different perspectives. Venues of seminars need to be neutral—for example, a community centre or library;

improve linkages to and from related websites;

increase capacity when a spike in accessing services is predicted—for example, after an apology or the release of a television show or film with adoption-related themes;

develop a national website that is continually updated and maintained, and is linked to the Find & Connect and Stolen Generations websites. A campaign is needed to support the launch of the website;

engage in awareness raising when the National Archives exhibition is touring. People need fliers and information booklets that they can take home with them, and resources need to be available when the archives exhibition is touring so that the resources are there when people are ready to seek support. The exhibition needs to be more than a historical exhibition;

more public awareness surrounding people’s rights and access to an “adoption law” legal advisor in each legal aid commission; and

run public awareness campaigns that inform those affected where they can go for help—for example, posters that advertise available services.

Suggestions for increasing awareness of the general public’s awareness of the history and long-term impacts of forced adoption included:

run media campaigns that include personal stories, perhaps presented on ABC radio national, ABC television or online;

establish a travelling exhibition;

increase public awareness around the adopted person’s story;

emphasise that not all people affected by adoption are traumatised (but some are);

encourage broader community awareness, acceptance and acknowledgement of the experiences of those affected by forced adoption and the immoral and illegal practices of forced adoption; and

deliver seminars in regional areas to create awareness. Seminars provide an opportunity for family members to hear different perspectives.

75Service system and referral pathway

Participants discussed the difficulty of navigating the system, explaining that the entry point into services for clients varies dramatically. Some people search online for “adoption” and make contact with various adoption-related services through email, telephone or physically turning up at the agency. Depending on whether the client records are obtained will determine where they are referred to next. Some will make contact with a peer-support group first; others will contact the agency or institution that was associated with the adoption, or the statutory child welfare department responsible for managing adoptions. As one workshop participant explained:

Centralised information is really important. But the services need to be integrated. Be creative about engagement.

Many clients present at general welfare services with other problems (e.g., relationship issues, anxiety, depression, alcohol and other drug issues, gambling issues, etc.) and only later on does the history relating to adoption and removal practices emerge. So a key theme that came out of the workshops was the need for referrals within and across agencies.

Some of the points relating to referral pathways raised by stakeholders included the need for:

better access to other services and quality services (in particular therapeutic services);

availability of specific services for the different groups affected—for example, separate programs for adopted persons, mothers and fathers;

availability of a range of independent and impartial services so potential service users can choose where to seek support;

a flexible service system that caters to the unique needs of each individual, and that service use isn’t necessarily “sequential”;

resources to support community education and awareness-raising (there is no point encouraging a person to seek support when the required resources to meet any increase in demand are not yet in place);

improved community pathways to services;

trauma-informed services;

expanded, longer term funding (beyond the 4-year cycle of the current Commonwealth government funding);

targeted information material on post-adoption specific services to aged-care services to provide alternatives to the Internet;

provide material on relevant agencies and services to community centres, such as crochet groups, yoga, computer classes, libraries, senior citizen clubs, community information centres;

have interstate meetings that include state and non-government organisations; and

develop a broader referral network.

A suggestion of good practice from one agency related to the information provided to clients about pathways:

We have a flowchart that clients can see. They can see where they are, and what needs to happen.

Types of service-delivery models canvassed during the consultations included:

individual case management (currently, support is siloed within each agency);

empowering and supporting individuals to undertake the search process on their own;

one-stop shops that are multi-disciplinary and provide “wrap-around” services (most stakeholders acknowledged, however, that the amount of resourcing that would be required to achieve this is probably unrealistic);

point of contact and community-based information and referral (such as existing communtiy hubs, libraries, etc.) where service users can receive some face-to-face contact;

national coordination of service provision (e.g., website or entry hub like Find & Connect);

restorative justice services—finance, information, and coordination of services; and

building capacity within existing mainstream services (i.e., services funded under the Australian Government’s Family Support Program).

Access to Allied Psychological Services (ATAPS)

In response to the National Apology, the Department of Health (formerly the Department of Health and Ageing) provided Medicare Locals with a short-term increase in funding to support the anticipated demand on ATAPS (Access to Allied Psychological Services) immediately following the National Apology. The incremental one-off funding boost was provided to support people in the immediate post-Apology period (to 30 June 2014). This was viewed as an interim step for the provision of support while future services were being decided upon by the now Department of Social Services (formerly FaHCSIA).

Medicare Locals were informed that the focus of the increased services was for people who were forcibly adopted and their mothers and fathers.

The eligibility requirements for individuals to receive services were:

individuals must have a clinically diagnosed mental illness of mild to moderate severity;

individuals must have a Mental Health Treatment Plan in place with referring GP or psychiatrist;

if/when a person identifies as being affected by past forced adoption practices, they should be given priority and not added to a waiting list;

as per ATAPS Tier 1, sessions are to be provided at low or no cost;

as per ATAPS Tier 1, these clients are eligible for 12 individual sessions per calendar year (in exceptional circumstances, another six sessions may be provided); and

in addition to individual sessions, up to 12 separate sessions will be available for group therapy services.

Guidelines were also provided throughout Medicare Local networks regarding sensitive inquiry and appropriate language to use when discussing the subject of forced adoption with patients. Information received by AIFS during the scoping study revealed that the following directive was given to GPs in at least one jurisdiction:

[Name of jurisdiction] Medicare Locals and GPs are advised not to ask all new patients if they have been affected by forcible adoption practices, as this may cause undue distress.

While clearly well-intentioned, stakeholders noted that this goes against the findings of the AIFS National Study and the Senate Inquiry regarding the need for GPs to “ask the question” of their patients.

In addition, there were very consistent reports from stakeholders that they perceived the allocation of funds for ATAPS services to have been poorly advertised, and many stakeholders who participated in the scoping study hold serious concerns regarding the expenditure of the already limited funding, on services that have had poor uptake largely due to the way in which the funding was rolled out; nor were they aware of any training offered to GPs prior to the distribution of funding. This is a significant issue in the context of the scoping study for several reasons:

stakeholders felt there was a lack of consultation regarding the appropriateness of allocating funds to this particular support option;

there is a very limited time in which the additional services are available—lack of awareness by those eligible has resulted in a very poor uptake; and

the funding has been distributed and is not contingent on the level of uptake by individuals (i.e., stakeholders were concerned that there is no proposal for re-distribution of funding if it hasn’t been spent).

However, it should be acknowledged that our understanding is that ATAPS are not required to disclose a history of forced adoption and we are not aware of any service data being collected about this specific group accessing services.