Riley, Debbie

Waterman, Jill

English

ScholarWorks@UMass Amherst

 Jill Waterman, Ph.D. UCLA Dept . Of Psychology & TIES for Families Debbie Riley, M.S. Center for Adoption Support and Education (C.A.S.E.)  April 8, 2011 Thanks to our Team  • Jeanne Miranda, Ph.D., Department of Psychiatry and Biobehavioral Sciences, UCLA  • Audra Langley, Ph.D., Department of Psychiatry and Biobehavioral Sciences, UCLA  • Susan Edelstein, LCSW, TIES for Adoption • Kevin Haggerty, MSW, University of Washington   •Adoption initiatives during the Clinton administration • Rise from 26,000 to 53,000 children adopted from foster care annually • More kids in post-adoption than in foster care • Average age at adoption is 6 years  Average time in foster care 3.5 years  •Children adopted from foster care have elevated mental health problems • 30% have severe mental health problems • At high risk for substance abuse •Age at adoption consistently risk factor for problems •Other problems include  • Poor school achievement, substance use, poor self-esteem, physical health, fighting, lying  Need for Adoption-Specific Psychotherapy  Some standard techniques are useful, but may need an “adoption lens”  Positive parenting  Older kids can enter families with many behaviors seen as unacceptable by families  Older kids may respond particularly poorly to discipline  Behavioral techniques may need to be modified to take into account past history and trauma  Parent-child issues  Parents want to protect kids from painful stories  Kids want to protect adoptive parents from their feelings about birth parents  •Adopted children think frequently about birth families and their adoption experience •May be issues of unresolved grief and loss •Unrealistic parental expectations •Standard psychotherapy often ineffective •Children adopted later bring many complexities       Our Approach to Developing  New Therapy • Brought together experts:  TIES & C.A.S.E. • Held a national conference – Annie E. Casey Foundation sponsored -  May 2008 • Brought together  Adoption/foster care researchers  Child psychotherapy researchers  Adoption policy specialists  Cost-effectiveness experts   Our Approach to Developing  New Therapy • Developed a manual and toolkit • Evidence based child and parent techniques • Best practices in adoption treatment • Pilot test manual • Revise manual • Seek funding for randomized control trial to develop evidence base • Training and dissemination   Proposed Research Plan Randomized control pilot  2 sites – Los Angeles & Washington DC metro area  5-12 y.o. children being adopted from foster care Children placed after age 5  In pre-adoptive or adoptive home less than 3 years   40 families in each group •Uses core components of evidence-based care,  with an adoption lens • Behavioral interventions • Trauma, loss and attachment interventions • Focus on positive parenting •Teaches important child coping skills • Emotion regulation • Problem-solving •Developmental framework of adoption  Goals of Adoption-specific Psychotherapy - Child  Promote appropriate behaviors/bonding through positive parenting  Facilitate developmentally appropriate understanding of adoption process  Develop coping strategies  Working through loss/grief  Strengthen sense of identity, self-esteem  Honor birth family – loyalty issues  Talking with others about adoption  Cope with trauma  Goals of Adoption-specific Psychotherapy - Parent  Promote positive parenting/attachment  Teach parents to talk with child about adoption  Understand child’s need to grieve losses  Teach parents to support positive coping  Help parents understand complexity of identity development in adoptees  Help parents understand loyalty to birth family  Help parents use adoption-specific lens in parenting child •8 modules plus Trauma Treatment if needed •Each has several parent and child sessions, then joint family sessions •Separate parent and child therapists •Activity-based with discussion •May not use all modules, depending on family’s circumstances •May involve consultation of other disciplines •20-24 weeks total •Baseline, post-treatment, 3 mo. follow-up •Child-focused measures  • General, symptom-focused, coping & emotion regulation, trauma, attachment, adoption dynamics •Parent/family-focused measures • Parenting stress, family functioning, discipline •Therapeutic alliance scales  •Parent Daily Report (MTFC) given weekly by independent evaluator •Fidelity checklists •Purpose – Parent and Child:   • Form therapeutic alliance; discuss basic premises of adoption; focus on children’s strengths (e.g., “What I Like About You) and engender positive interactions (reflective listening, child-led play); help parents develop appropriate behavior management plans (e.g., pre-teaching, reward charts); aid child in developing coping strategies (affect regulation, feeling identification, problem-solving strategies).    •Purpose :  Parents:   • Assess parents’ understanding of adoption experience for them & child; help parents tell child’s adoption story & develop comfort & skill in talking to child about difficult history  •Purpose: Child:  • Assess children’s understanding of their adoption; help child tell their story at appropriate developmental level; create list of unanswered questions; validate adoption as a valued family form   •Purpose:  Parents:  •Increase parents’ understanding prenatal substance exposure ( if appropriate); help parents talk with child about birth parent substance abuse; reduce family risks and strengthen protective factors; reinforce child refusal skills.    •Purpose:  Child: • Help children discuss birth parents’ substance use; discuss child’s increased risk for substance abuse and substance abuse prevention strategies; improve discussion of substance use with parents; teach child refusal skills; practice resisting peer pressure to try drugs/alcohol. •  •   •Purpose:  Parents:   • Facilitate parents in understanding child’s losses; assisting children in grieving; coping with own adoption-related losses; dealing with rejection; talking with child about divided loyalties     •Purpose:  Child:  • Help child acknowledge previous losses; understand the “whys”; explore related feelings; grieve the losses; coping with divided loyalties  •Purpose:  Parents:   • Assist parents in understanding attachment & how to facilitate it; “claiming” the child; developing family rituals •Purpose:  Child:   • Help child talk re: feelings about safety & security (or lack thereof); increase attachment to parents   •Purpose:  Parents:   • Help parents understand identity development for adopted children; explore special identity issues with transracial adoption.  •   •Purpose: Child:   • Assist children with identity development & integration of heritage of birth and adoptive families; explore the particular issues for transracially adopted children. •Purpose:  Parents:   • Help deal with questions about child’s background and adoption from other children, parents and strangers; decide who to tell about child’s difficult past history.    •Purpose:  Child:   • Empower children to handle questions others ask about adoption.    •Purpose:  Parents:   • Help parents understand that later placed children likely to have experienced traumatic events; accept children’s trauma disclosures; provide a safe place  for child to talk, draw or play about what happened to them.    •Purpose: Child:   • Help child process memory of traumatic event(s) with trusted therapist by creating trauma narrative, reframing maladaptive beliefs of child about event or their role.    •Purpose: • Parents and children focus on positive gains and and what they learned • Meet separately with own therapists for ½ session • Deal with own goodbyes and possibly past goodbyes • Come together for celebration          •Secure funding for randomized pilot •Do larger trial •Work on sustainable funding for intervention •Expand to international/domestic adoption •Disseminate and train for replication • East and West Coast training centers 

Adoption-Specific Psychotherapy

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Adoption-Specific Psychotherapy

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