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

128.2Existing vs new service providers

Strengthen the quality and reach of existing post-adoption providers.

vs

Establish new service providers.

Enhancing existing services is likely to be more sustainable, given the funding is time-limited.

However, diversity is needed. A diverse range of support services is confirmed in the literature as a key area of need. The range of support services could include telephone support, specialist face-to-face counselling, and emotional and therapeutic support before, during and after connection, as well assistance when accessing records. For example, the Northern Territory has no other service in relation to past adoptions outside of the government department responsible for facilitating access to adoption information.

The acceptability of some agencies is an issue. (Some mothers say they will never access services from agencies they see as “compromised” because of the philosophical model these agencies adopt, their inclusion of adoptive parents in their services, or their involvement in supporting current adoptions.) The literature supports the view that a supply of impartial services is needed to address the issue of “compromised” agencies or professionals.

Although creating a new national, system-wide provider would have a number of benefits, the costs (in time, funds and stakeholder management) are prohibitive. A better solution is to improve the visibility and coordination of entry points.

128.3Information vs therapy

Balance between funding to expand information support (i.e., self-help guides and assistance with records tracing, family searching and connecting with family).

vs

Therapeutic services to address recognised mental (and physical) health consequences of the “disenfranchised”—grief, loss, trauma and attachment disruption.

The Scoping Study confirmed what the AIFS National Study and the Senate Inquiry has demonstrated: both are needed.

They can be seen as part of a service continuum.

The AIFS National Study (2012) identified that ongoing support was needed to assist people affected by forced adoption throughout their entire search and contact journey, and afterwards, due to the highly personal, sensitive and potentially re-traumatising information and experiences that they are likely to be dealing with. The literature on the mental health problems that a number of people affected are experiencing, including grief and loss, identity and attachment issues, anxiety, depression, PTSD and complex PTSD, suggests that long-term, intensive interventions are needed, particularly because the symptoms have been ongoing for many years and the untreated effects have developed into long-term effects, and because their conditions are likely to be further complicated by co-occurring disorders.

128.4General vs specialist

Funding specialist, qualified therapeutic/clinical services to provide longer-term therapy for grief, loss, trauma and attachment disruption.

vs

Funding more general (but still adoption-specific) assistance with searching and counselling to support clients with information, search and contact.

Both are needed.

Using additional funds could risk duplicating other funding options, such as the funding already allocated to ATAPS, or existing Medicare-funded psychology or psychiatric services.

The biggest issue raised was the skill set and expertise of generalist (mainstream) services, the capacity of existing specialist services (limited by resources, but also variable in terms of standards, accountability, etc.), and facilitating referrals to appropriate service providers (need a database of preferred providers who have undergone training, and/or have interest and skills, and positive feedback from clients about their experiences).

128.5Professional expertise vs personal experience

Fostering home-grown, diverse models, including self-help and peer-support.

vs

Evidence-based, interventions by trained, recognised professionals.

A strong theme throughout this study is the value of self-help models, and the importance of peer support. The literature identifies that peer support has a valuable role for supporting people affected by forced adoption. In terms of peer-support groups, they provide a safe place, validate the experiences of those affected and normalise their symptoms, reduce stigma and isolation, and provide an opportunity for members to share stories and experiences; however, the literature recommends against peer support when it is not run or facilitated by a qualified and experienced facilitator.

Equally, a number of stakeholders identified the potential for peer support to be re-traumatising, and for affected persons to be alienated, silenced, etc. This is consistent with the literature on peer support for trauma survivors, which discusses some of the dangers associated with peer support when traumatised individuals come together without the presence of a trained facilitator.

There are evidence-based models for responding to grief, loss, trauma and attachment disruption in related fields (e.g., EMDR, mindfulness-based therapies, trauma-focused cognitive behavioural therapies, hypnosis, group therapy, narrative exposure therapy, Circle of Security, etc.) See NHMRC guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder

To what extent does funding need to be contingent on agencies providing services that are consistent with the evidence base on responding to trauma?

Many stakeholders (particularly professionals) saw trauma skills as generic and readily transferrable after some initial factual information about the history of forced removal policies and practices that led to adoption and/or institutional care, and issues faced by affected individuals.

Others (particularly mothers from advocacy groups) saw forced adoptions as a very separate issue to other types of trauma, and one into which affected individuals have a unique insight.