Transcript Key Issues in Adoption:

Clinical Issues in Adoption for
Mental Health Professionals
Aspecte clinice ale adoptiei pentru
profesionistii din sanatatea mentala
Zoe Breen Wood, PhD
Assistant Professor
Director of Educational Outcome
Assessment
Types of Problems Reported by Families
tipuri de probleme raportate de catre familii
•
•
•
•
•
Behavior problems/ probleme de comportament 60%
School related issues/ probleme scolare
47%
Adoption issues/ probleme legate de adoptie
38%
Attachment issues/ probleme de atasament
27%
Social adjustment problems/ probleme de adaptare
sociala
8%
• Diagnosed conditions/ conditii diagnosticate
54%
Source: Atkinson & Gonet (2007)
Most Helpful Services
Cele mai utile servicii
• Support /Sprijin
• Adoption-competent counseling /consiliere
competenta specifica adoptiei
• Education / preparation/ educatie/pregatire
• Respite/ odihna
• Help with school related issues/ ajutor pentru problemele
scolare
Sources: Smith (2004); Atkinson & Gonet (2007)
Core Adoption Issues for Triad Members/ problemele
centrale pentru membrii triadei in adoptie
Identity/
Identitatea
Grief/suferinta
Loyalty/
loialitate
Trust/Increderea
Loss/
pierdere
Self-esteem
increderea de sine
Shame/Guilt/ jena/
vinovatia
Control/ control
Rejection/
Abandonment/
Respingere/abandon
For each core issue / pt fiecare problema
centrala:
• WHY is it a potential problem?/ de ce reprezinta o problema
potentiala?
• WHEN and HOW might it be manifested/ cand si cum s-ar putea
manifesta?
• How might this issue be associated with a typical developmental
transition/ cum poate fi asociata problema cu momentele tipice de
tranzitie in dezvoltare?
• WHAT alternative explanations for these behaviors might be offered
by a “non adoption sensitive” practitioner?/ ce explicatii alternative
pot fi date acestor comportamente de catre practicienii nesensibilizati cu adoptiile?
• WHAT treatment approaches might be used if these behaviors are
viewed through an “adoption sensitive” lens / ce abordare
terapeutica poate fi utilizata pt aceste comportamente vazute prin
‘lentile sensibile la adoptie’?
Triggers/ factori declansatori:
Birthdays / zile de nastere
Anniversaries of Separations/ Aniversari ale
separarilor
Mother’s Day / ziua mamei
Holidays/ concedii
A move / mutat
Divorce/ divort
 Transition from one school level to another/
trecerea de la un nivel scolar la altul
Triggers/ factori declansatori:
Medical crises (of child or parent)/ crize declansate
de boli (ale copiilor sau parintilor);
Addition of new child to the family/ aparitia unui alt
copil in familie;
Adolescence/High school graduation/ adolescenta, momentul
bacalaureatului;
Engagement or Marriage/ logodna, casatoria;
Pregnancy/ Birth of a Child/ sarcina/ nasterea unui copil;
Mid-life crisis/ criza existentiala tipica la jumatatea vietii;
Death of Adoptive Parents/ moartea parintilor adoptivi.
Unique Challenges of Building a Family by Adoption/
provocari unice in construirea familiei adoptive
• Infertility - the stealer of dreams/ infertilitatea-hotul de
vise;
• No role model to follow/ absenta unui model al rolului de
urmat;
• Our business is not our own/ treburile noastre nu mai
sunt doar ale noastre;
• No timetable to follow/ absenta unui orar de urmat;
• Are we the “real” parents – validation/ intrebarea daca
suntem parinti ‘reali’ – validarea;
ISSUES IN FAMILY FORMATION/ aspecte ce apar in
construirea familiei
• Adoptive family life is different than life as a biological
family./ viata familiei adoptive difera de a familiei
biologice;
• Different doesn’t mean deficit./ diferenta nu inseamna
deficit!
• Families deal with differences in one of three ways:
(diferentele se manifesta in unul din modurile d emai
jos):
– families reject/deny the differences/ familiile neaga
diferentele
– families insist on differences/ familiile insista pe
diferente;
– families acknowledge the difference/ familiile
recunosc diferentele;
Issues in Family Formation/ aspecte ce
apar in construirea familiei
• Consequences in ways families deal with differences / consecinte
ale modului in care fac fata diferentelor
– create a less open and less reality based environment/ creaza
un mediu mai putin deschis si mai putin bazat pe realitate;
– ascribe blame for difficulties to genetics or preadoptive history
(i.e., "the bad seed" or “the damaged goods”)/ pt dificultatile de
acum sunt invinuite genele copilului sau istoricul de viata anterior
adoptiei (samanta proasta sau bunul stricat);
– openly, sharing concerns and feelings about their adoptive
status/ in mod deschis isi impartasesc ingrijorarile si trairile cu
privire la statutul lor ‘adoptiv’;
Characteristics of Successful Adoptive
Families / Caracteristici ale familiilor adoptive
de succes
• Realistic expectations / asteptari realiste
• Thorough parental preparation/ pregatire atenta pentru
parentalitate
• Positive parenting style/ stil de parentalitate pozitiva
• Communicative openness/ deschidere spre comunicare
• Capacity to cope with stress & challenges/ capacitate de
a face fata stresului si provocarilor
Characteristics of Successful Adoptive
Families/ carcaterictici ale familiilor adoptive
de succes
• Humor/ umor
• self-care/ grija de sine
• adequate formal and informal social
support/ sprijin social formal si informal
adecvat
Healthy Adoptive Families Understand the Developmental Stages
of Adoption/ Familiile adoptive sanatoase inteleg stadiile de
dezvoltare ale adoptiei
• I gained a family - 3 to 6 years/ am
castigat o familie- 3-6 ani
• I lost a family - 7 to 9 years/ am pierdut
o familie -7-9 ani
• I was given away - 9 -12 years/ am fost
parasit- 9-12 ani
• I was rejected - 13 to 17 years/ am fost
respins- 13-17 ani
Risks / Vulnerabilities/
riscuri/vulnerabilitati
• Parent Related/ in
raport cu parintele
• Child Related/ in
raport cu copilul
• Family Related/ in
raport cu familia
Parent Related Risks/ riscuri
legate de parinte
• Unmet Parental Needs &
Expectations/ asteptari si nevoi
parentale nesatisfacute
• Marital Problems/ probleme
maritale
• Incomplete Resolution of Loss/
rezolvare incompleta a
pierderii
• Culture/ cultura
• Lack of Parent Preparation/
lipsa pregatirii pt parentalitate
Child Related Risks/ Riscuri
legate de copil
• Unresolved feelings about prior separation and loss –
Grief/ trairi emotionale nerezolvate legate de separaea si
pierderea anterioara- suferinta
• Attachment/ atasament
• Older child adoptions/ adoptia copiilor cu varste mai mari
• Children with history of abuse or neglect/ copii cu abuz si
neglijare in istoricul vietii lor
• Institutionalized children/ copii institutionalizati
• Lack of background information/ lipsa de informatii
despre trecut
Attachment /Atasament
Biologically based/ baza biologica
Learned behaviors/ comportament invatat
Balance between proximity seeking and exploration / independence/
echilibru intre cautarea apropierii si explorare independenta
Reciprocal & interactive/ reciprocitate &interactiune
Cannot be directly measured – must be inferred from observations /
language / nu poate fi direct masurat/ trebuie dedus din observatii/
limbaj
Early attachment experiences form basis for later expectations of
relationships – “mental map”/ experientele timpurii de atasament
formeaza baza pentru asteptarile din relatiile ulterioare –’harta mentala’
The Mental Map/ harta mentala
• Secure/ securizat
• Avoidant/ evitant
• Anxious/ Ambivalent/
anxios/ambivalent
• Disorganized/
dezorganizat
• Unattached/ neatasat
Arousal/ Relaxation Cycle/ Ciclul
excitare/relaxare
Dr.Vera Fahlberg, Separation and Attachment, 1979
Need
Expressed/
nevoi
exprimate
Relaxation/
relaxare
Trust/
Attachment/
incredere/atasa
ment
Need Met/ nevoi
satisfacute
Arousal/
excitare
Bowlby’s dimensions for problematic attachment/
dimensiunile lui Bowlby in cazul atasamentului problematic
– Avoidant / evitant
• affective cues: shy or timid, withdrawn, and doesn't get
involved with others/ indicatori afectivi: jena sau timiditate,
respingere, nu se implica cu altii
• cognitive cues: cruelty, bullying or meanness to others,
physically attacks people, and threatens people/ indicatori
cognitivi: cruzime, se ia de ceilalti este rautacios cu ceilalti,
ataca fizic persoanele, ameninta oamenii din jur.
• behavioral cues: fears certain animals, situations, or places,
other then school, self-conscious or easily embarrassed /
indicatori comportamentali: se teme de anumite animale,
situatii, locuri, altele decat scoala, constiinta de sine sau prea
repede jenat
Bowlby’s dimensions for problematic attachment/
dimensiunile atasamentului problematic dupa
Bowlby
– Anxious / ambivalent / Anxios/ ambivalent
• affective cues: cries a lot and whining/ semne
afective: tipa mult si scanceste
• cognitive cues: can't sit still, restless, or
hyperactive, clings to adults or too dependent, and
easily jealous/ semne cognitive: nu poate sta
linistit, este nelinistit sau hiperactive, se agata de
adulti sau e prea dependent, devine imediat gelos
• behavioral cues: complains of loneliness, and feels
or complains that no one loves him/her/ semne
comportamentale: se plange de singuratate si
simte sau se plange ca nimeni nu-l iubeste
Indicators of Disorganized Attachment/
semne ale atasamentului dezorganizat
• Behavioral/ comportamental
• Emotional/ emotional
• Cognitive Functioning/ functionare
cognitiva
• Social/social
• Physical & Developmental/ fizic
&developmental
Both/
ambele
c
u
n
o
a
s
t
e
r
e
C
o
g
n
i
t
i
o
n
Secure/securizant
Avoidant
/ evitant
Anxious / Ambivalent/
anxios/ambivalent
Disorganized/
dezorganizat
Neither/ nici unul
A
f
f
e
c
t
a
f
e
c
t
e
Building Attachment/ construirea
atasamentului
• Means Changing the
Mental Map /
inseamna schimbarea
hartii mentale
How/ CUM
• Purposeful use of arousal
relaxation cycle/ utilizand cu
intentie ciclul excitare-relaxare
• Positive interaction cycle/ ciclul
interactiunii pozitive
• Claiming behaviors/
comportamente reclamate
• Eye contact/ contactul cu ochii
• Appropriate touch/ atingeri
adecvate
• Talk/ vorbire
When/ Cand
• Fear/ Teama
• Fatigue/ Oboseala
• Illness/ boala
Sharon ….
•
•
•
What is Sharon’s “mental map”?
Care este ‘harta mentala’ a lui
Sharon?
Identify specific strategies that
you could suggest to the family for
building attachment/ identificati
strategii specifice pe care ati
putea sa le sugerati familiilor pt a
sprijini construirea atasamentului
copilului
Make sure to identify at least three
different types of strategies/
asigurati-va ca ati identificat cel
putin 3 tipuri diferite de strategii
Child Related Risks / Riscuri legate de
copil
• Unresolved feelings about prior separation and loss –
Grief/ trairi nerezolvate cu privire la separare si pierderesuferinta
• Attachment/ atasament
• Older child adoptions/ adoptia copiilor de varste mai mari
• Children with history of abuse or neglect/ copii cu istoric
de abuz si neglijare
• Institutionalized children/ copii institutionalizati
• Lack of background information/ lipsa informatiilor legate
de trecutul copilului
Age At Placement/ Varsta la plasament
• A significant risk factor for disruption./
factor de risc important pentru intreruperea
adoptiei
• Tied to extent and complexity of
maltreatment. Reusita limitata si
complexitatea maltratarii.
Summary/ sumar
Child Related Adoption Issues/ aspecte ale
adoptiei legate de copil
• Important to Assess / Important de evaluat
– The degree to which these issues are
present/ masura in care aceste aspcete sun
prezente
– Their potential impact on presenting
problems/ impactul lor potential in generarea
de probleme
Family Related Issues/ Aspecte legate de familie
• Siblings/ fratriile
• Transcultural / Transracial Placement/
plasament transcultural/ transrasial
• Kinship adoptions/ adoptii intre rudenii
• Openness (will be discussed in session 2)/
deschiderea (va fi discutata in sesiunea a
doua)
Post Adoption Support/ Sprijin post-adoptie
• Families face enormous challenges and strains in adopting a
special-needs child. / familiile se confrunta cu provocari imense care
limiteaza adoptia unor copii cu nevoi speciale.
• Adoption is not a time-limited process, and adoption-related issues
surface throughout the lives of the individuals involved in adoption/
adoptia nu e un proces desfasurat intr-un timp limitat, iar aspectele
legate de adoptie sunt prezente in intreaga viata a indivizilor
implicati
• Involvement with therapy, mental health resources and other
supports should be considered a normative part of an adoptive
family's experience/ recurgerea la terapie, resurse de sanatate
mentala si alte forme de sprijin trebuie vazute ca o parte normala a
experientelor de viata ale familiilor adoptive
Increasing Resources & Supports to Adoptive
Families/ Resurse sporite & sprijin pentru familiile
adoptive
– Post-legal services (also referred to as post adoptive services) should be
available; they include: servicii post-adoptie legala (prezentate ca servicii de
adoptie) trebuie sa fie disponibile; ele includ:
• psycho-therapeutic services to families/ servicii psiho-terapeutice pt familii
• crisis intervention/ interventii de criza
• case management/ management de caz
• Financial assistance/ asistenta financiara
• adoption-related training for parents, mental health professionals and school
personnel/ traininguri pt parinti legate de adoptie, profesionisti din sanatatea
mentala si personalul scolar
• adoptive parent support groups/ grupuri de sprijin pt parinti adoptivi
• groups for adopted teens/ grupuri pt adolescenti adoptati
• "concrete" supportive services to families such as subsidy, respite, buddy
families, transportation, and medical services/ servicii ‘concrete’ de sprijin
pentru familii, cum ar fi subventii, odihna, familii ‘inmugurite’ (cu experiente
pozitive), trasport si servicii medicale
Guiding Principles & Goals of Post Adoption Services/
principii si scopuri ale serviciilor post-adoptie
• Active engagement: empathic listening & accepting, nonblaming approach. Angajare activa: ascultare empatica
&acceptare. Abordare lipsita de critica.
• Flexible, responsive service delivery focused on client
needs/ flexibilitate, livrarea unor servicii responsive
centrate pe nevoile clientului
• Joining with and supporting parents: increasing parental
entitlement/ alaturarea la alti parinti dispusi sa sprijine:
cresterea sentimentului de legitimitate parentala;
• Helping parents understand children in light of their
histories. Sprijinirea parintilor ca sa-I inteleaga pe copiiin
lumina propriilor istorii personale.
Adoption/ Adoptia
• A personal act/ un act
personal
• A legal process/ un
proces legal
• A social service/ un
serviciu social
• An ongoing process – not
an event/ este un proces
continuu nu doar un
eveniment
• An intervention/ o
interventie