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

55.1Implications for addressing current needs

Addressing the needs of people affected by forced adoption presents many challenges. In addition to the shortage of accurate data on the number of Australians who have been affected, the wide-ranging impacts of those affected have the potential to “ripple” through to family members, partners, siblings and other children, and some impacts can even be intergenerational (Higgins, 2011). Furthermore, the individual needs of those directly affected—mothers, fathers and adoptees—are diverse in terms of the severity of symptoms and extent of service needs.

Another challenge in addressing the needs of people affected by forced adoption is providing accessible service options to a specific population who are located across a large geographical area, including regional and rural areas. Providing information and support services through telephone and online models are options for providing some level of support for people restricted by physical and geographical restrictions. However, not all people are comfortable with receiving treatment in this way, and some face-to-face treatment may be necessary. Furthermore, many survivors of interpersonal abuse, such as those affected by forced adoption practices, do not conceptualise their experiences as trauma, legitimise their experience, or name it as trauma, and therefore prevent themselves from seeking professional help (Sanderson, 2010). As identified by the Senate Inquiry (2012), recognition and acknowledgement of forced adoption practices plays a significant role in validating the experiences of those affected. Therefore, greater awareness in the general population and greater access to and awareness of counselling, and support and health services for those affected by forced adoption could encourage more people to seek help and advice, particularly if they know that their experiences and subsequent effects will not be dismissed.

This literature review has identified evidence-based practices and emerging trends for the treatment of PTSD and trauma-related symptoms. Some of these interventions may prove to be effective treatment options for treating the short- and long-term effects of those who experienced forced adoption. Which interventions are suitable and the pace at which treatment occurs will depend on the individual needs of each client. It is important to note that not all people affected by forced adoption have trauma-related issues or require trauma-related support; however, there is a population that require it, and therefore a range of trauma support needs to be available.

The Senate Inquiry report (2012) concluded that any service delivery model of support must include high levels of support for parties to adoptions seeking to connect with their families, easier methods for amending birth certificates and other documentation, and a single national access point to facilitate access to births, deaths and marriage registers across jurisdictions. The AIFS National Study findings supported these conclusions (Kenny et al., 2012). Both the AIFS National Study and the Senate Inquiry report identified that it is fundamental that the services provided to those affected by forced adoption are delivered by highly skilled professionals who understand the complexity of the trauma and lifelong symptoms that can result from practices such as forced adoption, and who have received specialist training to address (or at least be aware of) the needs of people affected by forced adoption.

Synthesising the evidence from these two sources as well as the broader publications examined in this review, potential service delivery models that can respond to the diverse needs of people affected by forced adoptions, need to include a range of services that:

are attuned to the complex symptoms, needs and responses of all those directly affected;

can provide services across a range of health domains—including mental and physical health, and relationship, social and economic wellbeing;

can provide intensive and ongoing psychological and psychiatric counselling; and

can provide flexible and individually focused care.

Support services need to be trauma-informed, aware of grief and loss and attuned to attachment disruption so that they can:

complete a thorough assessment and screening process of each client to establish an appropriate treatment plan, which will depend on the individual needs and circumstances of each person;

be aware of and refer clients to trauma-specific services—for example, trauma-focused psychotherapy interventions;

provide a service that is understanding and non-judgemental of the needs and necessary coping behaviours that were required by the trauma survivor to function in everyday life; and

reduce the risk of re-traumatisation among clients.

56Good practice principles

The following good practice principles apply to service organisations, agencies and groups involved in the provision of forced adoption support services, including information services (including those with identifying information and access to personal records), search and contact services, post-adoption support services, therapeutic services and peer services. The principles are drawn from the literature examined in this review and their application is consistent with the views of those directly affected by forced adoptions as being essential to the delivery of high quality services.

Accountability

Transparency about an organisation’s past or current involvement with adoption on the website, in brochures and in the first sessions (professional groups—including social workers, doctors, and other welfare workers—that may be perceived as “compromised” by potential service users need to address this mistrust and rectify past errors so that they can deliver the most effective service possible).

Formalised complaints processes in place that are known and readily available to service users.

Organisation overseen by an independent governing body (board/committee).

Independent mediator facilitating information searches and information exchange.

Administrative data recorded—including referrals and service uptake.

Accessibility (including affordability)

Identifiable staff to be point of contact.

Flexible hours of operation.

Services to remote locations or those unable to physically access the service on site.

Low cost or free services. Meeting the ongoing needs of those affected by forced adoption should not be contingent on their capacity to pay for services. Obtaining information, making and/or maintaining contact with lost family members is a significant aspect of healing and recovery for some. Costs associated with these activities should be considered within the same context as any mental and physical support needs.

Timely responses to requests.

Ability to provide counselling and support in ongoing or longer term, flexible manner.

Efficacy and quality of service interventions

Well-informed staff who understand the issues associated with adoption.

Sensitivity to the needs of those seeking services (in terms of confidentiality, discretion, language used, etc.).

Staff across all service types and settings appropriately trained regarding adoption issues.

Ongoing training/professional development opportunities available to staff.

Clearly articulated conceptual underpinning of the agency/service’s model of service delivery.

External clinical supervision available to staff.

Ability to address issues associated with grief and loss, trauma, identity, shame, guilt, rejection, emotions of anger/hurt, difficulties in maintaining friendships or close relationships with family (attachment issues), anxiety, and self-confidence problems.

Services tailored to relevant “stage of the journey” of individuals.

Management of clients’ expectations at commencement of support relationship, particularly in relation to search and contact.

Support and follow-up from the agency involved provided on an ongoing basis.

Diversity

Services include telephone support, specialist face-to-face counselling, intermediary services to assist individuals approaching lost relatives, assistance in accessing adoption records, and access to trauma-specific specialists.

Options for both professional and peer supports.

Range of options for participation (i.e., mixed, mother/adoptee-specific, etc.).

Range of support levels (e.g., access to support person—on site and follow-up).

Support, education and information for the other family members is readily available.

A supply of agencies that are independent from any past adoption practices so that clients are not negatively affected in their recovery journey or by experiences with the service system.

Continuity of care

Service has formalised links or arrangements with other relevant services for referral or shared care arrangements where own service can’t meet the full range of presenting needs of service users.

Adoption-related supports are incorporated into existing services and referral networks (such as Family Support Program-funded services, or Medicare-funded psychological services).

Regular networking activities organised both within and external to adoption-specific agencies.

Awareness-raising of the impacts and history of past adoptions is prioritised.