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

18Literature review

The aim of this review is to conduct a thorough search, and deliver an informed presentation of the current literature on the impacts, service models and approaches for people affected by forced adoption and removal policies and practices. The review also seeks to determine if there is any existing literature on emerging practices, services and interventions in the treatment of those affected by the impacts of forced adoption.

In particular, the review builds on the work completed by Higgins (2010) and synthesises the existing evidence available from both the AIFS National Study (see Kenny et al., 2012), and the response from the Senate Inquiry (2012) to identify the current support needs of those affected.

To supplement any gaps in the literature, the review also examines the treatment options for people who have experienced other types of traumatic events, such as child sexual abuse or domestic/family violence, recognising the increasing demand for the application of trauma-informed therapies/treatments/supports/services in the context of treatment interventions for those affected by forced adoptions.

18.1Framework of the literature review

There is a considerable amount of primary literature on the long-lasting impacts of adoption in the form of biographies and written submissions to inquiries; however, there is a significant gap in research on the impacts and support service needs of people affected by forced removal policies and practices that resulted in adoption, in both the Australian and international literature. The most comprehensive and most recent study on the impacts of forced adoptions, including forced adoptions, is the Past Adoption Experiences: National Research Study on the Service response to Past Adoption Practices (Kenny et al., 2012) published by AIFS. The AIFS National Study has contributed significantly to the design and framework of this report and its accompanying literature review, as have the findings and recommendations of the Senate Inquiry report.

19About the National Research Study on the Service Response to Past Adoption Practices

On behalf of the Australian Government and endorsed by the Community and Disability Services Ministers’ Conference (CDSMC) on 4 June 2010, the then Australian Government Department of Families, Housing, Community Services and Indigenous Affairs (now DSS) commissioned AIFS to undertake the National Research Study on the Service Response to Past Adoption Practices (AIFS National Study). The aim of the study was to identify the long-term impacts of forced adoption practices and to determine the current support and service needs of affected individuals, including the need for information, counselling and reunion/connection services. In addition, the study aimed to identify the extent to which affected individuals had previously sought support from services and the types of services and support that were sought.

In commissioning the AIFS National Study, the Department intended that the findings be used for developing best-practice models or practice guidelines for the delivery of support services for individuals affected by forced adoption practices. The study included a wide group of those with adoption experiences, including mothers and fathers separated from a child by adoption, adopted persons, adoptive parents, wider family members (to look at “ripple effects”), and those servicing their current needs (counsellors, psychologists and other professionals).

The study incorporated mixed methods (online surveys; a reply-paid survey; in-depth interviews; and focus groups), integrating results from across the different elements of the study. It utilised and built on existing research and evidence about the extent and impact of forced adoption experiences.

More than 1,500 individuals across Australia participated in the study, comprising 505 mothers, 823 adopted persons, 94 adoptive parents, 94 other family members, and 12 fathers. Follow-up individual interviews and focus groups included more than 300 participants, in 19 locations across all states and territories. It also included survey responses from 58 service providers about their views on the current needs and service models for those affected by forced adoption practices.

Consistent views of participants across the range of respondent groups identified the following actions were a priority in order for the service and support needs of those affected by forced adoptions to be adequately addressed:

acknowledgment and recognition of forced adoption practices (including the role of apologies and financial resources to address current service and support needs);

raising community awareness of and education about forced adoption practices and their subsequent effects;

providing specialised workforce training and development for primary health carers, mental health and broader health and welfare professionals to appropriately respond to the needs of those affected;

reviewing the current search and contact service systems, with a commitment to develop improved service models;

improving systems for accessing information currently held separately by different organisations in each state and territory;

reducing the costs and improving accessibility of mental, behavioural and physical health services; and

ensuring that lessons from forced adoption are learned from and translated where appropriate into current child welfare policies, and that adoption-specific services are created or enhanced to respond to current needs of those affected by forced adoption.

20Literature search

The literature search began with a digital literature search using combinations of key search terms across all the databases available through the Australian Institute of Family Studies’ EBSCO subscription, which includes search engines such as Academic Search Premier; Australia/New Zealand Reference Centre; E-Journals; PsycARTICLES; Psychology and Behavioural Sciences Collection; PsycINFO; SocINDEX; Women’s Studies International. Additional searches from external sources (university libraries) were used to identify relevant literature for this review.

To ensure relevance to the current understanding of forced adoption and current service delivery, the literature search was limited to literature that was published between 2000 and 2013. The literature search was approached in three stages:

Stage 1: Existing forced adoption support service models in Australia;

Stage 2: International forced adoption support service models;

Stage 3: Trauma-informed support service models.

Stage 1: Existing forced adoption support service models in Australia

The first stage of the literature search focused on Australian search databases from the EBSCO subscription. Key search terms derived from the findings of the AIFS National Study were used to search the digital database for research, evaluations and reports on existing support services available to those affected by forced adoption. The key search terms used were: adoption and counselling; adoption and motherhood; adoption and quality of services; adoption and secrecy; adoption and social services; biological family and adoption; closed adoption; forced adoption; past adoption; and post-adoption services.

The search generated more than 200 results. Many of the sources were duplicates, and after the duplicates were eliminated, the results were reviewed for relevance. The majority of the sources were related to the history of adoption and the impacts of adoption in Australia, and were therefore of limited applicability. No directly relevant sources on service delivery models to those affected by forced adoption were found. The result of this literature search clearly demonstrates the lack of current research and literature on the support service needs of people affected by forced adoption.

Stage 2: International forced adoption support service models

The next stage of the search was to expand the databases to include international literature on post-adoption services related to closed or forced adoption practices. The key search terms applied in stage one were used again to search the relevant databases available through the AIFS database subscriptions for the time period of 2000 to 2013. The databases used to search for international literature included:

Informit;

SocIndex;

PsychInfo;

Google scholar;

Social Care Online; and

Cochrane library of systematic literature reviews.

The search generated a number of references; however, most of the results were concerned with the history of adoption and current adoption rather than support services for those affected by forced adoption. No relevant international literature that discussed support services and service models was found.

A source identified to be of some relevance was the research conducted by the Adoption Research initiative (ARi) in the United Kingdom; however, as detailed below, its applicability to the Australian context of the current Scoping Study is limited.

The Adoption Research initiative (ARi) has conducted some key research on post-adoption support services for birth relatives in the United Kingdom (Neil, Cossar, Lorgelly, & Young, 2010). However, the emphasis of the study was on birth families’ experiences with support services and the impact of support services for recent adoptions. At the time the study was conducted, the majority of participants had experienced adoption in the past two years, and in many cases the child was adopted 1 to 3 years after their birth. While there are similarities in support needs among birth families who have experienced adoption, the circumstances of people who experienced forced adoption are unique and the resulting impacts are different, particularly in terms of long-term symptoms and the effects of trauma.

A second study conducted by the ARi (Neil, Cossar, Jones, Lorgelly, & Young, 2011) focused on support services for adoptive families and birth families involved in agency-supported post-adoption contact. Again, the focus of the study was on recent contact after adoption. The mean length of time that children had been with their adoptive families was 4.8 years. Therefore, when contact is made the adopted person is still a child. For people who have experienced forced adoption, the adopted persons are now adults, and in some cases they only discovered that they were adopted during their adult life. These cases are likely to have different emotional and therapeutic needs that require support from services because of the amount of time that has passed since the adoption took place.

Stage 3: Trauma-informed support service models

With no relevant results on forced adoption support service models or evaluations, the next stage of the literature search examined the components needed to deliver a support model, in particular trauma-informed services. This direction was informed by the AIFS National Study and the Senate Inquiry report, as there is an increasing awareness of the link between trauma and the experiences of forced adoption (Higgins, 2011; Kenny et al., 2012; Parliament of NSW: Legislative Council Standing Committee on Social Issues, 2000; Rickarby, 1995; Senate Community Affairs References Committee, 2012). In particular, the literature was reviewed for relevance and examined to determine whether it might be transferable when developing a model for people affected by forced adoption (e.g., the applicability and evidence base for online therapy, group therapy).

Three categories of search terms were used in combination:

service-related terms: services, support, treatment, models, group therapy, peer support, counselling, online or web counselling, telephone counselling;

trauma-related terms: interpersonal trauma, post-traumatic stress disorder (PTSD), trauma-informed, complex-trauma, trauma-aware, trauma and depression/grief; and

experience-specific terms: child sexual abuse, rape, domestic violence, and family violence.

This search generated hundreds of results, which were screened for relevance and applicability with consideration to the treatment of trauma-related symptoms such as PTSD. The results of this stage of the literature search are presented in a later section.

Having presented the results of the literature search, the review will now discuss the findings in the published literature, according to the distinct aims of the review:

examining the impact of forced adoptions, including long-term effects;

examining the utilisation of support services by those affected by forced adoption;

examining the current service and therapeutic needs of those affected;

reviewing practice interventions that are appropriate for meeting those needs; and

examining potential modes of delivery for such interventions.