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Lifelong Impacts of Foster Care, Kinship Care, and Adoption

Foster care, kinship care, and adoption are significant experiences with lifelong impacts. The American Psychological Association (APA) has identified mental health challenges as one of the greatest unmet needs of children in the foster care system. Foster and adoptive families seek mental health services at a rate of three to five times higher than the general population.^[1]

Harm experienced by children in the context of early adverse experiences will need to be healed in nurturing, caregiving relationships. Research has shown that traditional parenting and discipline techniques are often not successful in achieving this. Working with an adoption-competent therapist can assist parents in developing therapeutic parenting strategies to address emotional and developmental challenges. Additionally, it helps parents understand the reasons behind their children's behavior, enabling the development of realistic expectations and effective support for their children. As parents gain a better understanding of their child’s needs, they will be able to utilize different parenting strategies that reframe discipline as teaching, and support better coping and self-regulation skills.^[2]

Trauma and Attachment

Trauma and attachment are two interconnected concepts that play significant roles in psychological and emotional development. Early attachment experiences can significantly impact how an individual responds to and copes with traumatic events throughout their lifetime. Trauma, including inadequate nurturance and maltreatment, can also impact attachment patterns, disrupt the formation of healthy attachments, and lead to difficulties with trust, emotional regulation, and forming healthy relationships. But trauma is more than inadequate nurture and maltreatment; it includes experiences of discrimination. Whether it is related to race, adoption, or other aspects of one’s identity, ongoing discrimination is a type of trauma that impacts a youth’s mental health.

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Early attachment experiences can significantly impact how an individual responds to and copes with traumatic events throughout their lifetime.

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According to the U.S. Census about one-third of all adopted children are of a different race or ethnicity than their parents.^[3] In many cases, parents parenting children of different races and cultures are not aware of the prejudices and discrimination their children experience. Additionally, LGBTQ youth experience more placement instability, harassment, rejection, and violence than other youth in foster care. Experiencing high levels of family rejection increases their vulnerability to suicide attempts, depression, drug abuse, and high-risk sexual behaviors. To understand the psychological impact of trauma, it is important to understand the meaning of the event to the child. What are the child’s beliefs about why bad things happened? What caused it? How does it affect his or her beliefs about self and others? Considering the concept of traumatic or traumagenic states can help explore the psychological impact and provide a framework to understand the profound psychological effects, unraveling the intricate ways in which these experiences influence the child's mental well-being and emotional resilience.^[4] It’s important to note that some youth may not disclose traumas until years later when they finally feel safe, so it is important to assess for trauma over time.

Attachment can be viewed as an ongoing relational connection between two people that develops over time through interactions that satisfy needs and bring pleasure. Secure attachment is the foundational building block for all healthy development in children and promotes felt safety; self-regulation; brain development; positive sense of self-worth; and physical; cognitive, and language development. Secure attachment is essential to the development of empathy and a conscience.^[5] However, many children and youth experiencing foster care, kinship care, and adoption have experienced trauma in addition to mental health challenges that interfere with the development of healthy attachment, especially in the first three years of life.

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It's important to note that some youth may not disclose traumas until years later when they finally feel safe, so it is important to assess for trauma over time.

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Attachment difficulties can include a range of behaviors including difficulty seeking comfort and reassurance from caregivers when distressed, refusal to accept the authority of caregivers to set limits and rules, controlling behavior, lack of cause-and-effect thinking, poor emotional regulation, indiscriminate affection with strangers, lying and stealing, lack of conscience, and cruelty to animals or people.^[6] Adoption-competent therapists can help address challenges with trauma and attachment.

Guiding Principles of Adoption Competency

Are you still wondering what adoption competency means? Let’s get to it! Adoption competency refers to providing mental health services tailored to the unique needs of children who are experiencing adoption or guardianship by adhering to key principles and competencies. The principles of adoption competency encompass a deep understanding of adoption’s complexities, including its various forms and the lifelong impact on adoptees, birth parents, and adoptive parents.

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The principles of adoption competency encompass a deep understanding of adoption’s complexities, including its various forms and the lifelong impact on adoptees, birth parents, and adoptive parents.

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An adoption-competent approach prioritizes the well-being and emotional needs of the child, acknowledging the unique challenges related to identity, attachment, and loss that adoption or guardianship can bring. More recently, the term adoption competence has been broadened to encompass experiences of foster care and kinship care in addition to adoption.

Therapists who have adoption competency understand that the nuanced needs and challenges experienced by families formed by adoption are different from those experienced by families formed by birth. Adoption-competent practice includes the following five key principles identified in The National Adoption Competency Mental Health Training Initiative:^[7]

1. Secure attachment: Attachment challenges often arise for children and youth who have experienced foster care, kinship care, or adoption, resulting in a variety of attachment styles. The good news is that attachments are flexible and can be built and rebuilt. Integrating healthy attachments to birth families, adoptive families, and other supportive individuals is essential, with a particular emphasis on sibling relationships to mitigate the impact of separation.

Adoption-competent practices involve assessing a child's attachment history and developing treatment plans to address attachment-related needs. Attachment-based therapy interventions can help children and youth explore their past attachment experiences and build new, secure attachments through trusting relationships. Effective parenting strategies should support attachment to birth and foster families, address behaviors within the context of attachment history, and promote secure attachments while respecting cultural identities.

2. Supporting grief and loss: Acknowledging that loss is at the heart of every adoption, foster care, and kinship care experience is fundamental to adoption competency. Often, the focus is on the gains, without acknowledging and honoring the inherent losses for children and parents. Ambiguous loss and disenfranchised grief are prevalent in adoption and kinship care situations. These types of grief and loss make the process of resolution more challenging, as the individuals lost are often alive, making it hard to accept the finality of the loss. An adoption-competent therapist plays a vital role in validating and supporting the child’s grief, ensuring that it is acknowledged and addressed.

Furthermore, the therapist’s role extends to working with adoptive parents and guardians, helping them comprehend their motivations, assess any unresolved grief, and recognize that their own emotions can be triggered by a child’s behavior, even if they believe they have resolved their grief. It’s essential for caregivers to undergo their own healing process to provide a nurturing environment for their children.

Additionally, the therapist can facilitate understanding and empathy between birth parents and adoptive parents, acknowledging the grief, loss, and feelings of defeat that birth parents may experience. Encouraging respectful and sensitive interactions between these two parties is crucial in supporting the overall well-being of the child and families involved.

3. Understanding the impact of trauma on brain development and behavior: The impact of trauma and early adverse experiences on brain development and behavior is profound, disrupting healthy neurodevelopment and leading to various emotional and behavioral responses in children. Effective interventions for children with trauma histories must be developmentally appropriate, considering both historic trauma and intergenerational trauma. Therapeutic parenting strategies, along with daily routines, are fundamental to building trust and promoting healing. It's essential to view behaviors through a trauma lens and emphasize "what happened to a child?" rather than "what's wrong with the child?"

Caregivers are key agents in the healing process, and their understanding of attachment, trauma, and loss histories is vital when parenting a child with trauma experiences. Adoption-competent therapeutic strategies focus on building coping and regulatory skills in children and providing support for caregivers, including structure, routines, age-appropriate behavior management, nurturing activities, and emotional support.

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It's essential to view behaviors through a trauma lens and emphasize "what happened to a child?" rather than "what's wrong with the child?"

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4. Promoting positive identity development: Identity development among youth in adoptive, foster care, and kinship care families is a complex process, particularly during adolescence, and is further complicated by factors such as complex trauma, ambiguous losses, and unresolved grief. Adolescents often grapple with questions about their origins and sense of self, which can be challenging when they lack a complete understanding of their own story. The degree of openness in adoption or guardianship significantly influences identity formation, with greater openness typically contributing to a more positive self-identity.

Adoption-competent interventions are valuable in helping youth explore their identity dimensions, integrate their histories from birth and adoptive families, manage divided loyalties and difficult emotions, and navigate the search and reunion process when desired. It is crucial to educate parents about the complexities of adoption's impact on identity formation and how to provide support throughout this journey into adulthood.

5. Evaluating the impact of race, culture, and diversity: Race, ethnicity, culture, class, and sexual orientation, gender identity, and expression (SOGIE), all play unique and crucial roles in adoption and guardianship practices and in the identity development of children and youth. Adoption competency involves developing an awareness of how these factors influence assessments and treatment goals. The ability to address discrimination, historical trauma, self-esteem, and identity development—in the context of adoption or guardianship—relies on being adoption-competent.

Adoption-competent therapists must be willing to engage in difficult conversations and encourage caregivers to do the same. When children have a different racial or ethnic background, culture, or SOGIE than their parents, it is essential for parents to respect and honor these aspects of their child’s identity and provide socialization experiences that promote their overall well-being.

The guiding principles of adoption competency help create a supportive and informed environment for all individuals touched by adoption and guardianship, ensuring the child's best interests are paramount while addressing the unique aspects of adoption.^{[8] [9] [10]}

Qualities of an Adoption-Competent Therapist

The challenges of adoptive and guardianship families seeking mental health services are often embedded in a multilayered context, with involvement of multiple systems. In addition to having the knowledge, expertise, and skills relating to trauma, attachment, identity, and loss, the therapist needs to collaborate and advocate with the family and multiple helping professionals, such as child welfare workers, crisis intervention workers, psychiatrists, school social workers, or psychologists. Communication and collaboration among them are essential.^[11]

An adoption-competent therapist will value the participation of adoptive parents. Traditional family therapists who are unfamiliar with adoption-related or trauma-based issues may view the child's problems as a manifestation of overall family dysfunction. They may not consider the child's historical trauma or experiences in other care settings and may view adoptive parents more as a part of the problem than the solution.

An adoption-competent therapist will value the participation of adoptive parents.

Adoption-competent therapists believe that children can heal within the context of new family relationships and with parents who have the skills to support children who come from traumatic beginnings. The therapist you choose must recognize the importance of including parents (and possibly other family members or supports) in the treatment process. If you seek treatment from a therapist who attempts to exclude you as a parent, you may want to reconsider whether that therapist is appropriate for you and your family. Finding the right therapist and managing the right therapy for your child takes effort and commitment. For therapy to be successful, open communication between you, your child, and your therapist is a must.

“Try before you buy” – Interviewing Therapists Before Making a Commitment

Finding the right therapist means searching for one who has adoption-related experience and has been trained in adoption competency. Take time to interview therapists by phone or in-person to find the one with whom you feel most comfortable and who is the best qualified to help your child and family with issues related to adoption trauma, identity development, and more. Here’s some information to gather and questions to discuss during your initial interview/meeting in addition to the general questions about their years of experience, licenses, and certifications:^[12], ^[13], ^[14]

1. What is your experience with adoption and adoption challenges?
2. How many adoptive families have you worked with? (Be specific about the adoption challenges that affect your family, such as open adoption, transracial adoption, LGBTQ adoption, searching for birth relatives, children who have experienced abuse or institutionalization, or children with attachment difficulties.)
3. Do you include parents and other family members in the therapeutic process?
4. Do you include natural supports, such as teachers, coaches, clergy, and other community members in the youth’s life in the therapeutic process?
5. Have you taken any courses/trainings in adoption competency (i.e., The National Adoption Competency Mental Health Training Initiative (NTI) or Training for Adoption Competency (TAC)? (See information about NTI and TAC )
6. What approach to therapy do you use?
7. In your work with transracial and transcultural families, what are some of the challenges they have presented with?

Consider requesting a progress update with the therapist six to eight weeks after treatment begins and regular updates thereafter. These will help all parties assess the progress of treatment. If you feel that the therapist is not meeting your child’s or family’s needs, take action. You may need to find a new therapist, even though that may seem like a daunting task. Too many families have shared stories of ineffective therapists and psychiatrists who have done more harm than good. It is ok to make a change when needed.

Helpful Help Is Obtainable

An adoption-competent therapist approaches their work with a family-centered, strengths-based, attachment-focused, and evidence-informed perspective, considering the historical context and evolving best practices in adoption and guardianship. They are well-versed in the mental health challenges arising from neglect, abuse, trauma, and loss, with an understanding of how early adverse experiences impact later development. Their skill set includes proficiency in evidence-based mental health interventions.

They highly value their role in fostering healing relationships, addressing loss and grief, and facilitating connections among diverse families while respecting cultural and racial identities. They excel at collaborating within interdisciplinary teams and support adoptive and guardianship families in establishing robust support networks. Additionally, they assist parents in implementing therapeutic parenting strategies, promote connection and communication between adoptive/kinship families and birth family members, and ensure caregiver involvement in the treatment process. Their holistic approach encompasses support before and after achieving permanency.