Adopted children require significant therapeutic input to recover from past trauma – providing families support throughout the adoption process is vital

29 September 2017

When prospective parents look into the option of adopting a child, they are often not as aware as they could be of the possible difficulties a child may have. The post-adoption experience presents most families with a huge, unrecognised reservoir of serious complex emotional needs that come from children carrying significant trauma from their experiences of violence and maltreatment.

We welcome that this issue has been brought to light in this week’s survey conducted by BBC Radio 4’s File on Four programme and Adoption UK. The reality of adoption from my professional, clinical perspective is that 95% of adoptions should be regarded as therapeutic for the child— that is, children who enter adopted families require significant therapeutic input to help recover from past trauma.

Recently in the Social Work field there has been a focus on child-to-parent violence, as was discussed in the survey. Whilst not all children are violent, and violence is not the only difficulty adoptive parents may face, for many adopted children violence is a coping strategy and a way to protect themselves against those who are trying to get close to them.

The general public and clinicians alike can find it difficult to imagine that that a five year old child could pose a threat to a mature adult—but unless a parent has the knowledge of how to safely restrain and de-escalate a child having an aggressive outburst, the child can inflict serious physical harm to adults that include bites, scratches and bruises. This does not take into account the enormous emotional impact for a parent of having to deal with a violent child, and that the cumulative experience of a parent having to deal with this situation repeatedly can lead to trauma for the parent and eventual adoptive placement breakdown. This can have an enormous impact not just on the parents but on the whole family, including siblings.

Here at the Tavistock and Portman NHS Foundation Trust we regularly see families who are struggling to cope with adjusting to an adoption placement. Our main method of intervention involves careful therapeutic attention to the experiences of the child, the parents and any siblings, in order to help the family grow the new emotional and relationship resources they need to deal with the pressures that could lead to placement breakdown. Many adoptive children with traumatic histories go on to thrive in later life, but most also need to traverse a period of powerful testing of their family environment – can those caring for them stand to know what it was like for them in their earlier life?

Letterbox-shaped image of father holding child in front of NHS sign

Providing families with the support they need throughout the adoption process, and ideally before a placement is made, is vital to ensuring families are equipped with the knowledge and skills they need to be able to de-escalate violent situations, strategically plan for difficult behaviours and support each other through times of need. This can be achieved through providing parents with training on such courses as Nonviolent Resistance Training. This can help families enormously to deal with the kind of aggressive behaviours that provoke child-to-parent violence.

Currently adoptive families are eligible to access the Adoption Support Fund (ASF), which gives families access up to £5,000 per child to support the child’s therapeutic needs. Whilst the ASF is of immense value, the capped financial support is often not enough. £5,000 can pay for one child’s once weekly psychotherapy for around a year. This is a welcome and important resource but it has come under increasing pressure, and families often need help beyond what the fund can provide.

It would be beneficial for the government to focus on enabling stronger regulation of what therapeutic interventions are both available and funded. Currently there is a marketplace of support packages available to adoptive parents and some are of questionable therapeutic value.

The most effective form of support that could be offered to adoptive families can come through Child and Adolescent Mental Health Services (CAMHS), which are delivered by the NHS and Local Authorities. The work required to support adoptive families is complex, and CAMHS teams are multidisciplinary, comprising experienced clinicians who are based in the local community. Leaving the provision of therapeutic interventions to a private sector market is not helpful.

It is also vital to examine the practices and policies that exist around the delivery of services, to ensure that at the top level we are focusing on delivering long-term sustainable interventions throughout the adoption process, and not just providing support at crisis point.

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This post is by Andrew Cooper, Professor of Social Work and a Psychoanalytic Psychotherapist here at the Tavistock and Portman NHS Foundation Trust.

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