Clinical Issues in Adoption for Mental Health ProfessionalsAspecte clinice ale adoptiei pentru profesionistii din sanatatea mentala

Zoe Breen Wood, PhDAssistant Professor

Director of Educational Outcome Assessment

Types of Problems Reported by Familiestipuri 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 ServicesCele 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)

Loss/ pierdere

Grief/suferinta

Loyalty/ loialitate

Control/ control

Rejection/Abandonment/ Respingere/abandon

Shame/Guilt/ jena/ vinovatia

Self-esteem increderea de sine

Trust/Increderea

Core Adoption Issues for Triad Members/ problemele centrale pentru membrii triadei in adoptie

Identity/ Identitatea

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 ne-sensibilizati 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’?

A move / mutat

Divorce/ divort

Transition from one school level to another/ trecerea de la un nivel scolar la altul

Triggers/ factori declansatori:Birthdays / zile de nastere

Anniversaries of Separations/ Aniversari ale separarilor

Mother’s Day / ziua mamei

Holidays/ concedii

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

Arousal/ excitare

Need Met/ nevoi satisfacute

Trust/ Attachment/

incredere/atasament

Relaxation/ relaxare

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

Secure/securizant

Anxious / Ambivalent/ anxios/ambivalent

Disorganized/ dezorganizat

Avoidant/ evitant

Both/ ambele

Neither/ nici unul

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 pierdere- suferinta

• 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/ sumarChild 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, non-blaming 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