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 Background The Australian Government response to the recommendations of the Senate Inquiry regarding the Commonwealth contribution to former forced adoption policies and practices was announced by the then Prime Minister, the Hon. Julia Gillard, when she apologised on behalf of the Australian Government to people affected by forced adoption or removal policies and practices on 21 March 2013. The Government response stated a scoping study would be conducted to provide guidance in relation to the: • establishment of specialist support and counselling services; • availability of peer support groups; • extension of current family tracing and support services; and • extension of state and territory Find and Connect information services to include adoption service provides. In July 2013, the then Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA) (now the Department of Social Services) commissioned the Australian Institute of Family Studies to undertake the Forced Adoption Support Services Scoping Study. The purpose of the Scoping Study is to develop options for service models that will enhance and complement the existing service system to improve support for people affected by forced adoption and removal policies and practices. The Scoping Study is not about making specific recommendations as to which organisation(s) should be resourced to provide services to those affected by forced adoption. Scoping Study methods The Study has built on the information that was provided in the Institute’s Past Adoption Experiences: National Research Study on the Service Response to Past Adoption Practices (Kenny et al., 2012) as the basis of the scoping work conducted with service providers in the current study—to understand the best models for meeting people’s needs. In addition, the findings within the Senate Community Affairs Reference Committee Final Report have been extensively referenced. The study also extends an earlier review of the Australian research on the impact of past adoption practices published by the Department in April 2010. AIFS undertook the following activities to inform the findings of the Scoping Study: • a literature review to synthesise previous research on forced adoptions and the impact they have had on people, including the long-term impact and their current service and therapeutic needs, as well reviewing best-practice models for meeting those needs; • mapping the services currently available for people affected by forced adoption and analysis of the strengths or promising practices, weaknesses, barriers and gaps; • environmental scan of service delivery in other related welfare/human service areas; • consultations with service providers across all states and territories, both adoption-specific and generalist health and welfare providers; and • development of evidence-based national service model options that will complement and enhance the existing services and fill gaps to better meet the needs and expectations of those affected by forced adoption practices. Key findings of the Scoping Study The impacts of forced adoptions are in many instances, long term. The most common impacts of forced adoption are psychological and emotional, including: • depression; • anxiety related conditions; • complex and/or pathological grief and loss; • post-traumatic stress disorder (including complex PTSD); • identity and attachment disorders; and • personality disorders Counselling and mental health care services can perform a range of functions for those affected by forced adoptions: • a way of providing concrete reparation; • support for general difficulties, often described as “ongoing trauma”; • be experienced or utilised continuously, periodically (in response to external events, or • “triggers”), or it can be “random”; • include clinical diagnoses, such as depression, anxiety, and PTSD; • help clients deal with emotions such as grief, loss, guilt, or loneliness; • support clients who have difficulty forming and maintaining positive relationships with others, including partners and subsequent children, family and relationship breakdown, and parenting difficulties; • support clients construct a positive personal identity; • provide support for clients dealing with feelings of loss, abandonment and grief; • provide support for clients presenting with physical health issues (including disabilities), and substance abuse; and • provide support for clients presenting with mental health problems or trauma “triggered” by contact/reunion processes. Trauma There is increasing recognition of the potential for trauma for those who have been subjected to forced adoption and removal policies and practices, and the value of a “trauma-informed” or “trauma-aware” approach to service delivery. Best practice suggests that services providers should approach all clients as if they might be trauma survivors. It is important that an integrated approach is taken when treating trauma survivors with multiple conditions. A trauma-informed service provides: • a safe and supportive environment that protects against physical harm and re-traumatisation; • an understanding of clients and their symptoms in relation to their overall life background, experiences and culture; • continued collaboration between service provider and client throughout all stages of service delivery and treatment; • an understanding of the symptoms and survival responses required to cope; and • a view of trauma as a fundamental experience that influences an individual’s identity rather than a single discrete event. Restorative justice Findings from the Senate Inquiry and the AIFS National Study identified that rather than direct compensation schemes, restoration activities could focus on providing resources to meet the current needs. Restoration activities could include: • addressing trauma and other mental health consequences through evidence-based therapeutic interventions; • repairing the injuries caused to relationships, especially between sons/daughters and parents; • opportunities for truth-telling, storytelling and acknowledgement; and • overcoming shame and recognising past actions through public activities and community awareness campaigns. Key principles The following good practice principles apply to service organisations, agencies and groups involved in the provision of forced adoption support services, including information services (such as identifying information and access to personal records), search and contact services, post-adoption support services, therapeutic services and peer services. Accountability • Transparency about organisation’s past or current involvement with adoption on the website, in brochures and in the first sessions (professional groups—including social workers, doctors, and other welfare workers—that may be perceived as “compromised” by potential service users need to address this mistrust and rectify past errors so that they can deliver the most effective service possible). • Formalised complaints processes in place that are known and readily available to service users. • Overseen by an independent governing body (board/committee). • Independent mediator facilitates searching for information and exchanging information. • Administrative data are recorded—including referrals and service uptake. Accessibility (including affordability) • Identifiable staff to be point of contact. • Flexible hours of operation. • Servicing remote locations or those unable to physically access the service on site. • Low cost or free: meeting the ongoing needs of those affected by forced adoption is not contingent on their capacity to pay for services. Obtaining information, making and/or maintaining contact with lost family members is a significant aspect of healing and recovery for some. Costs associated with these activities should be considered within the same context as any mental and physical support needs. • Timely responses to requests. • Ability to provide counselling and support in ongoing or longer term, flexible manner. Efficacy and quality of service interventions • Well-informed staff who understand the issues associated with adoption. • Sensitivity to the needs of those seeking it (confidentiality, discretion, language used, etc.). • Staff across all service types and settings are appropriately trained regarding adoption issues. • Ongoing training/professional development opportunities are available to staff. • Clearly articulate conceptual underpinning of the agency/service’s model of service delivery. • External clinical supervision is available to staff. • Address issues associated with grief and loss; trauma; identity; shame; guilt; rejection; emotions of anger/hurt; difficulty in maintaining friendships or close relationships with family (attachment issues); anxiety; and self-confidence problems. • Services are tailored to relevant “stage of the journey” of individuals. • Clients’ expectations at commencement of support relationship are managed, particularly in relation to search and contact. • Support and follow-up from the agency involved is provided on an on-going basis. Diversity • Services include telephone support, specialist face-to-face counselling, intermediary services to assist individuals approaching lost relatives, and assistance in accessing adoption records, and access to trauma-specific specialists. • Options for both professional and peer supports. • Range of options for participation (i.e., mixed, mother/adoptee-specific etc.). • Range of support levels (e.g., access to support person—onsite and follow-up). • Support, education and information for the other family members is readily available. • There is a supply of agencies that are independent from any past adoption practices so that clients are not affected in their recovery journey or experiences with the service system. Continuity of care • Service has formalised links or arrangements with other relevant services for referral or shared care arrangements where own service can’t meet the full range of presenting needs of service users. • Adoption-related supports are incorporated into existing services and referral networks (such as Family Support Program funded services, or Medicare-funded psychological services). • Regular networking activities both within and external to adoption-specific agencies. • Awareness-raising of the impacts and history of past adoptions is prioritised. Current service system Consideration of any changes to the current service system for meeting the needs of those affected by forced adoption and removal policies and practices need to take into account the current adoption and out-of-home care systems in Australia. Evidence-based decision-making is of paramount importance. Stakeholders felt that there is currently a strong pro-adoption lobby, with the focus often about “ownership” of the child, not what is in children’s best interest. Some of the specific concerns raised by stakeholders included: • the lack of consideration of the available evidence relating to the longer term impacts of adoption in the current adoptions environment; • legislative changes to overseas and local adoptions prior to the implementation of the • Recommendations of the Senate Inquiry; • attempts to increase the number of babies “available for adoption” in some jurisdictions; • the assumption that “open” adoptions solves all the problems for adoptees; • the difficulties in maintaining or enforcing contact with birth families, and the reality that contact diminishes extensively over time; and • the lack of need for adoption where permanent care orders can provide the stability that children/young people need. Service delivery models that can respond to the diverse needs of people affected by forced adoptions need to include a range of services that: • are attuned to the complex symptoms, needs and responses of all those directly affected; • can provide services across a range of health domains—including mental and physical health, and relationship, social and economic wellbeing; • can provide intensive and ongoing psychological and psychiatric counselling; and • can provide flexible and individually focused care. Support services need to be trauma-informed, aware of grief and loss, and attuned to attachment disruption so that they can: • complete a thorough assessment and screening process of each client to establish an appropriate treatment plan, which will depend on the individual needs and circumstances of each person; • be aware of and refer clients to trauma-specific services—for example, trauma-focused psychotherapy interventions; • provide a service that is understanding and non-judgemental of the needs and necessary coping behaviours that were required of the trauma survivor to function in everyday life; and • reduce the risk of re-traumatisation among clients. Options From the findings of a review of the published literature, an environmental scan of service systems and conceptual models for service improvements in related areas, and findings from the stakeholder workshops and individual consultations, we have developed some detailed lists of options for consideration. The options prioritise coordination and connectivity of existing services and capacity building, rather than creating new services. This will increase the likelihood of sustainability into the future and lay a solid foundation for improved referral pathways. A. Enhancing mainstream services Within mainstream health/mental health and social services, the following have been identified by stakeholders as groups of professionals that should be the target of service enhancements: • medical general practitioners (GPs); • psychiatrists; • psychologists in agencies or private practice (including ATAPS providers); • counsellors and other psychotherapists; • mental health nurses; • clinical social workers; • child/family welfare workers in services funded by the Department of Social Services’ Family Support Program and other Australian Government agencies—including psychologists, social workers, family therapists, counsellors, and other welfare workers; • social support and human services funded by the state and territory governments; and • aged care professionals and service provider organisations (as many mothers and fathers are now reaching their 70s and 80s). B. Expand, enhance and build capacity in existing post-adoption support services Within existing post-adoption specific support services, the following have been identified by stakeholders as agencies or service types that should be the target of service enhancements: • state/territory-funded Adoption Information Services; • peer-support groups; • agencies providing supports for people searching for, or making contact with family • (including formal intermediary services); and • the government agencies with whom these other services intersect (e.g., Births Deaths and Marriages registries, Australian Electoral Commission, state child protection departments, Australian Government Department of Human Services (DHS) and Department of Health). C. Developing new—and improving existing—resources for professional development and training For all service providers and agencies covered under A and B above (i.e., mainstream health/mental health and social services, as well as existing post-adoption specific support services), the following resources, training materials and opportunities for professional development were suggested: • specific training of post-adoption workers, and general awareness and sensitivity training for broader service providers; • resources for agencies such as developing Good Practice Guidelines, evaluation resources etc.; • regular conference for post-adoption practitioners, as well as being open to mainstream practitioners who find themselves working with people affected by forced adoptions; • empathy/sensitivity awareness training for officers in information agencies—particularly • BDM; and • brokerage funding, or grants scheme to enhance capacity of existing agencies and support groups. D. Increasing accessibility and coordination through development of a national web portal Options canvassed in workshops and consultations included community-based service hubs, one-stop-shops, case-management, and a national website. The literature recommends case management for clients who are experiencing severe symptoms, particularly when their symptoms inhibit them from functioning in everyday life or attending scheduled appointments. For these clients, case management helps to aid the effective organisation and delivery of services. Service hubs, or one-stop-shops, are an option for addressing the fragmentation problems of the current service system; however, due to costing constraints, they would be difficult to implement. An alternative option may be the “gateway” approach, where specific centres are established to act as “gateways” to appropriate services, providing information, advice and referrals. It facilitates access to the services and information that clients need from a central service centre. The most consistently supported option was a national web portal, which would: • provide integration, enhance referral pathways and reduce duplication in service; • promote evidence-based practice through development and dissemination of resources; • be a “virtual” one-stop-shop; and • centralise resources, databases and points of contact. For such a web portal to be effective (both in terms of developing content, having it “acceptable” to stakeholders, and keeping it maintained), it needs to be housed in a suitable environment and appropriately resourced. Functions such as increasing accessibility and translating research into meaningful information to meet the needs of practitioners are known as “knowledge translation and exchange” (see Section 9.1). E. Community awareness and action One of the major findings of the AIFS National Study, the Senate Inquiry and in the current Scoping Study in relation to the current service and support needs of those affected by forced adoption, includes the certainty that this would never happen again—a guarantee provided in the National Apology. However, the current national discussion regarding the streamlining of processes for inter-country adoptions, and state-based legislative changes to increase the number of children from the OOHC system who are “available for adoption” has featured prominently throughout this study and directly relates to the consideration of how to most effectively meet the support needs of those affected by forced adoption. There are inherent contradictions in what has been committed to as part of the Government’s response to the findings of the Senate Inquiry (including increasing community awareness of forced adoption and removal policies and practices), and current inter-country adoption policies and practices. Further, any such progress in this matter is occurring before the recommendations of the Senate Inquiry have been fully implemented. Specific considerations for the current government that stakeholders in the Scoping Study identified include: • Increasing community and professional awareness of the transferability of practices of the past and their potential long-term impacts, to the current adoptions (local and inter-country) arena in Australia, and that this awareness is transferred into action legislatively. • Ensuring that any legislative changes are informed by evidence, not the motivations of parties with vested interest (e.g., new adoption programs—including privatisation of adoptions). • Reviewing the appropriateness of allocating funding for provision of services to those affected by forced adoptions to organisations who are also involved in current adoptions. • The act of adoption is permanent and life-long, and the implications of altering the identity • of a child through modified Birth Certificates perpetuates the falseness of a child’s biological and social history. Across these five broad areas for enhancing and expanding services, there is a range of different strategies for how to implement these. In the table below, we outline six strategic options that draw together suggestions raised by stakeholders during consultations
Posted on: Sun, 09 Mar 2014 07:46:00 +0000
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