Transcript Slide 1

Dr. Rajesh Sagar
Additional Professor
Department of Psychiatry
AIIMS, New Delhi
Name of the Court
Case
Date of Judgement
Order By
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Supreme Court of India
Civil Appeal No 7475 of 2010
08.09.2010
Hon’ble Justice M. Katju and
Hon’ble Justice T.S. Thakur
Inter – country adoptions should be allowed only after full and
proper satisfaction is recorded by all the agencies including a
committee of experts wherever reference to such a committee is
considered necessary. CARA may have similar expert committees
at state level.
….It would be appropriate if CARA requests the Director, AIIMS to
constitute a committee of experts to be headed by HOD of
Psychiatry, AIIMS.
A child who without medical, physical,
emotional or developmental
intervention will not be able to reach
his full potential - INDIA
Age, ethnic or racial background. Risk of
above disabilities based on family history
Any condition that is making
the adoptive family difficult to
find (broad definition)
Narrower definition often followed .
A ‘special needs’ child is one who, without
medical, physical, emotional or developmental
interventions will not be able to reach his/her
full potential
It has multiple dimensions such as:
 Medical issues
 Behavioural issues
 Developmental issues
 Learning issues
 Mental health issues
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‘Special needs’ children deserve special attention.
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They are often difficult to place with domestic
families.
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Parental preparation, education and support are
crucial for the stability of an adoption & for the
long-term emotional well-being of all family
members
It is hard to place these children in adoption &
should be prepared from day one in the
institution.
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Category of Special Needs children (1) For the
purpose of adoption, ‘special needs’ children may
be categorized as under:a)Children having visible and or serious medical conditionsmental or physical;
b)Older children;
c)Siblings and
d)Extremely low birth-weight children (to be certified by a
Government Medical Officer)
(Source: Guidelines Governing the Adoption of Children-2011 notified by
Govt. of India)
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2.
3.
4.
5.
Special care taken, so that the prospective adoptive family is
aware/ready to provide extra care & attention that the child
needs.
Important to understand that child with special needs requires
more than any other child, the care and love of a family at an
early stage.
Adoption process shall be completed as expeditiously as
possible by the concerned authorities and time lines
PAPs wishing to adopt special needs children shall be given top
priority in the waiting list.
In spite of best efforts, some special needs children do not get
adopted and have to remain in institutions. These children
should be shifted by the Specialized Adoption Agency to
specialized institutions in case such institutions are available in
the State.
(http://adoptioninida.nic.in/guideline-family/Part_1.pdf)
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Of child
Of the interested parent
Of the new environment to meet child’s needs
Matching child requirement and expectation
with that of adoptees.
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Thorough evaluation by professionals for their medical/
social/ emotional/ intellectual capacities, at the time of entry
into the agency
Prepare report based on above information, should be
available with agency and determine the choice of PAP.
Attaching a Certificate in this regard by a qualified
professional with Medical examination Report (MER)
The following personnel in the institution are jointly
responsible for each child having special needs. They are:
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Social Worker/Counselor
Pediatrician
Psychologist
Speech therapist
Occupational therapist
Teacher
Nurse & Care Taker
Volunteer
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Social worker is to learn as much as possible about the child
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Social
worker
should
place
special
emphasis
on
understanding the health conditions of the child, the kind of
special needs, interventions in the past, current interventions
and prognosis of the concerned special needs etc
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Every child at all ages understands rejection, may likely to go
into depression/ mood swings and face emotional turmoil
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Children should be prepared for the placement such as to see
photographs of the family, counseling, language issues etc.
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Parenting requires lot of commitment for life, preparation,
motivation, adequate resources and strong will as it is a full time
job.
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Understand and explore the way they are feeling
Develop new coping strategies
Find ways of managing stress
Learn more about the lifelong effects of adoption
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Adoption professionals must create a collaborative relationship
with adoptive parents
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Agencies should hold regular/group meetings of adoptive
parents
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Agencies/social worker should provide
information about the child to parents
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International adoption may pose some risk with children who
come from institutions
all
the
relevant
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PAP’s capacity to meet the emotional, psychological, physical
and social needs of the child
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Require parents with exceptional patience, stability, flexibility
and parenting skills
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PAP’s health
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Home study Report (HSR) should reflect the motivation and
ability of the PAP(s) to adopt such a child
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Acceptance
to
only
those
PAPs,
who
preference/willingness to adopt such children
have
given
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PAP’s in stable relationship
PAP’s age
Number and ages of the other children in the family
Family should have a support system of family, friends or
other adoptive parents
Family should have adequate resources to take care of the
medical needs of the child
Medically fragile child should be placed with a family who is
familiar with pediatric disorders and has access to medical
facilities
Family deserves to know all known medical information about
the child
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CARA has facilitated online reservation and matching of
children having special need by foreign parents through their
foreign agencies/authorities
CENTRAL ADOPTION RESOURCE AUTHORITY
Database maintained by CARA w.e.f. July’ 2011 to June ’2012
Category of Children
Physical (Speech Delay + Squint Eye
+ Congenital Heart Disease + Older
with TB + HIV Positive turn Negative
+ Born from HIV PAPs +
Psychomotor Delay Older + Hearing
Loss,
Spine Bifida, Limbs Missing, Cleft
Lip, Cleft Palate, Chronic Asthama,
Severe Seizure Dissorder, Blood
Disorders, Deaf, Disfiguring Birth
Marks, Hemophilia, Thalasemia
Major, Epilepsy, etc.)
Category of PAPs
S. No.
Month
Mental
Older
Cerebral
palsy, Down
syndrome,
Microcephaly,
etc.
Siblings
Normal
Foreigner
1
2
3
4
5
6
7
8
9
10
11
12
July, 2011
August, 2011
September, 2011
October, 2011
November, 2011
December, 2011
January, 2012
February, 2012
March, 2012
April, 2012
May, 2012
June, 2012
10
5
9
14
20
17
6
8
8
15
8
16
0
0
1
1
1
2
0
0
0
1
0
0
7
21
8
8
8
9
8
2
10
13
7
8
1
4
3
3
5
3
0
4
0
4
5
2
11
15
14
12
11
7
5
9
9
6
10
6
14
32
24
25
33
27
13
11
16
28
21
25
Total
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136
6
109
34
115
269
OCI
NRI
PIO
9
7
7
9
9
10
4
12
7
9
8
5
5
5
4
4
3
2
2
0
4
2
1
0
1
0
0
0
0
0
0
0
0
0
0
2
96
32
3
Total number of NOCs issued in case of special needs children
Total number of NOCs issued in case of normal children
Note: Number of children in Siblings or Siblings Group
:285
:115
:69
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Recognizing
and accepting the limits of their
emotional attachment to the child and vice versa
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Understanding the mixed feelings of the child
towards birth parents
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Dealing with the complex needs (emotional, physical,
etc.) of the adopted child
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Finding the appropriate support services in the
community
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Dealing with the child's emotions and behaviour,
especially for those parents with no prior experience
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Issues related to separation and adoption
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Issues unrelated to adoption–
◦ Developmental issues
◦ Psychiatric illness
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Sense of Loss and Grief - dealing with the loss of the
birth parents
◦ feeling of rejection,
biological parents
abandonment
and
anger
towards
◦ Sense of loss of culture, country, other dear ones (especially
in cross-cultural adoption)
◦ May result in feeling of inferiority
◦ May also reappear later in life upon loss of dear ones, spouse
◦ Adoptee may feel guilty or find difficulty in expressing above
feelings if adopted family is a good one
 Timely recognition and appropriate outlet for these feelings is
essential
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Identity and Self-Esteem Development
◦ Identity issues start around adolescence
◦ Problems more for older children as it often overlaps with
need to establish one’s own identity among peer group and
family
◦ Questions about the biological family and their need to
place him for adoption, finding traits common with birth
parents and his place in current social class, culture, peer
group, often come up
◦ The above have impact of adoptee’s self-esteem
◦ Low self-confidence, unwelcome or rejected feeling is
common.
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Developmental and mental health issues:
◦ Adopted children are more at risk of physical and
mental health problems
◦ Reasons may be varied –
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Prenatal and post-natal exposure to drugs and alcohol
Abuse or neglect in biological family or at foster care
Lack of structured family and foster care environment
Poor nutrition and reduced stimulation
Children with developmental problems are more likely
to be abandoned by biological parents
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Insecure attachment
caretakers
to
their
primary
adult
Behaviour problems like hiding or hoarding food,
polyphagia, rumination, self-stimulating and
repetitive behaviours (masturbation, rocking or
head banging), sleep disturbance
Depression and anxiety disorders
Externalising problems like conduct
oppositional defiant disorder, ADHD
disorder,
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Match the type of physical and emotional environment
needed by the child with the one that can be provided by
the PAP’s
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Assess and continuously monitor the level of care provided
to special needs children both before and after adoption
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Recommend a children’s special needs, parents’
requirements, and parents’ preference for care setting
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Post-adoption provision of assistance to parents in
childcare and regular follow up
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Assessment and consultation
diagnosed children
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service
for
yet
non-
Need for ‘Special need team’?
THANK YOU