Children and Families Bill

Memorandum submitted by Ali Redford (CF 101)

Summary

I am an adoptive parent; I have worked most of my life within education, in nursery, primary, secondary school and university settings, as a teacher, governor, marketing officer, learning activities coordinator and teaching assistant. In this submission, I am asking the Children & Families Bill committee to consider the need for legislation to improve post-adoption support so that children adopted from care can achieve their potential. The evidence to support this request comes from 6 years as an adoptive parent of two siblings, and knowledge gained from communications with specialist adoption organisations1, local authority adoption teams2, and other adoptive parents (personal friends and colleagues), at events and on training courses3, through adoption groups4, adoption charities5, website message boards6, adoption blogs7 and other adoption-related literature. I, and they, believe that children adopted through the care system should have the same right and opportunity to access specialist CAMHS (Child & Adolescent Mental Health Service) and other therapeutic expertise as looked-after children currently in the care system. This specialist support is necessary to attracting prospective adopters, retaining adoptive parents and, most importantly, giving children adopted from care the chance to achieve their full personal, academic and professional potential at home, through their education and in the workplace. We also believe that the offer of appropriate, ongoing support is a crucial factor in preventing adopted children from returning to the care system or progressing to youth offending institutions and prison.

1. The children

In spite of persistent myths around adoption, mainly perpetrated through stories of adopted adults who were relinquished as babies, most adopted children nowadays were not ‘left’ by their birth parents, they were removed by local authorities or the police for good reason. These children have come to their adoptive families through the care system and, as such, have often suffered abuse or neglect at the hands of birth parents who could not care properly for them, for a variety of reasons including drug and alcohol abuse, criminal activity and custody, mental health problems and learning disabilities. Once removed, these children become looked-after (LAC), and are further emotionally damaged by the insecure experience of moving into and around the care system. Once adopted, it is hoped (and indeed presumed) that these children will form strong, lasting, ‘happy-ever-after’ attachments with their new adoptive parents.

2. The path to adoptive parenthood

As well as meeting the need to house and care for a growing number of traumatised and other more fortunate children, adoption appears to be the 21st century’s answer to the prayers of a generation of often older (35+) couples who have not been able to conceive their own birth children. Adoptive parents (who do not already have children) have often already had to deal with their own trauma and loss. After years trying to conceive, the monthly grief of failed conception, and sometimes several painful and disorienting attempts at IVF, many such people agree to become adoptive parents to children in care8. When the decision has been made to adopt, for many the process of finding an agency

prepared to take them at that time has also been long and difficult. Once accepted by an agency, adoption preparation courses (approximately 4 days spread over 2-4 weeks2), an enormous amount of form filling and an adoption approval panel pave the way for prospective adopters to take on the most damaged children in the UK. There are sessions within the preparation courses on loss, children in the care system and the potential challenges ahead. Some trainees are advised to read yet more adoption literature and/or to volunteer in a childcare setting before facing a panel of professionals, parents, adopters and community leaders, to be approved as adopters.

3. The optimism of prospective adopters

Following years of waiting, planning, reading adoption literature, meeting professionals, joining adoption groups4, watching childcare videos, training and facing approval to become an adopter and any amount of experience in a childcare setting, approved adopters hope to be matched with a child. After this time, most prospective parents believe they will be able to offer the necessary support to a child who has experienced severe developmental trauma, neglect or abuse. Moreover, it should be acknowledged that, before placement, many prospective parents are so desperate to start a family, and hopeful that this is finally achievable through adoption8, their natural optimism, aforementioned years of planning, education and the often considerable previous childcare experience that have led them to this point, further suggest that they will be able make a considerable positive difference to the life of any child they take on, however damaged. Unfortunately, the experience of adopting from care has proved to hundreds of adopters, and former adoptive parents whose families have disrupted, that this is often not the case6, 13.

4. All is not right

Some families who adopt from care have few or no post-adoption problems, and this would appear to be especially true where there has been little or no record of abuse or neglect in the child’s first 3 years6. But many families who have adopted children from the care system experience a range of worrying and challenging behaviours, either very soon after placement or at some point in the following years13. These behaviours appear to be consistent across a variety of different adoptive parents, from varying backgrounds, living in different areas of the country6. They include persistent lying, stealing (especially food and money), soiling/wetting, self harm, defiance, sexualized behaviour, violence and aggression. Moreover, most of the adopted children who present with these behavioural issues, also demonstrate lack of trust, dissociation and low self esteem14, which even the most positive parenting struggles to counter. Even more worrying, there is often an inability to learn from mistakes, a lack of connection between cause and effect and the ever-present perception of natural consequence as a threat. All these behaviours are consistent with attachment disorders and developmental trauma.

5. The psychological and neurological evidence

According to psychological research, children who have suffered neglect or abuse in the first three years of life are much more likely than the generic (i.e. non looked-after) population to present with the range of behavioural problems

described above9. As their needs were ignored at a time when their brains should have been fast developing (between 0-3 years), the neuro-pathways

necessary for healthy development were not properly forged, so the amygdulla which governs the ‘flight, fight or freeze’ mechanism in the brain does not learn to regulate itself and nor do the stressful hormonal surges of adrenalin and cortisol which accompany them. As a result, these children are sent into a recurring state of ’flight, fight or freeze’ at any hint of threat to their wellbeing, or whenever they perceive that their needs are not being met11.

6. Attachment, developmental trauma and CAMHS

Although reactive attachment disorder is recognized as a psychiatric condition10, developmental trauma is still not widely acknowledged as a diagnosis. In spite of the spate of new neurological research and evidence in the last 10 years11, early abuse and neglect (or ‘developmental trauma’) is not fully validated (by the Diagnostic & Statistic Manual of Mental Disorders of the American Psychiatric Association12) as a psychiatric condition or disorder in itself, for reasons as much to do with American health insurance and legal claims as psychology. As a consequence of this, the dysregulated behaviour of adopted children who have experienced trauma in their early years and who are later referred to generic CAMHS professionals in the UK is not always fully understood by those who should be helping them. Resulting from a combination of developmental trauma and attachment disorders, these behaviours do not fit easily into the psychiatric disorders of the general population, although they may accompany them. Dysregulation is often episodic by nature, triggered by unknown or unspecified actions and events, and can present in very particular situations and environments12. The experience of many parents is that CAMHS generic psychiatry, on the other hand, assesses children by ‘condition’, tracking personality, family ‘traits’, and unusual behaviours, constant across a range of settings. This model does not always fit or suit the combined attachment issues, anxieties and dysregulation of a child adopted from care, particularly when these symptoms are accompanied and often masked by other more easily ‘diagnosable’ conditions such as ADHD, OCD and ASDs6.

7. Post adoption support

Once they are adopted, looked-after children become ‘lost’ to the system that rescued them. While they are ‘looked-after’ (i.e. in care), they have access to almost unlimited amounts of local authority and CAMHS support which is rightly tailored to their looked-after status and its associated behaviours. Once adopted, the current legislation assumes that any dysregulated behaviour or past trauma has miraculously disappeared after 3 years, or, if not, that it should be dealt with by psychiatric professionals who do not acknowledge the condition. Post adoption support is not necessary for all adoptive families, but those who need it, are likely to need it more than once. The allotted ‘3 year’ period of guaranteed support often comes at the wrong time – i.e. the child does not display challenging behaviour in the first three years, either because they are too young to know what is happening or for fear of social workers returning into their lives and moving them on again. It is an accepted fact that once adopted children reach around 7 years old and are becoming more cognitively aware of what has happened to them, their behaviour will change accordingly as they start to

process and understand their origins13. As things stand in the UK, if a child is adopted at 2 or 3, and starts to dysregulate at 7, they are not going to be helped

by post adoption support. If they need any support at or after that time, their parents have to fight for it.

8. Placing authority vs. resident authority

At present, children are entitled to 3 years post-adoption support, usually funded by the adoption team within the child’s placing local authority. After this time,

any behavioural or psychological problems are referred (by school, GP, A&E or safeguarding teams) to the generic, non-LAC specialist, resident authority’s CAMHS. Most adopted children are not resident in the area in which they were taken into care. For example, my own adopted son was born in one city in NW England, taken into care in another, fostered in a rural third and adopted in a London borough. We were prepared as adopters by different London borough. There is nothing necessarily wrong with this multi-practitioner approach, if they are all able to join up and give/take as required. But because no LA wants to take responsibility for funding a child’s therapy, each will readily pass the blame onto the other. In the mean time, a needy child gets no help at all. Our resident borough told us that our son could have accessed a specialist CAMHS looked-after children’s team had he been taken into care in that borough, but he was not. It is not any child’s ‘fault’ that they are adopted (although many adopted children believe it is14); it is certainly not their fault that they are living in a different local authority than the one in which they were taken into care - indeed it is common practice to place adopted children outside their birth family’s authority - and it is almost criminal that they should be penalized by Children’s Services and CAMHS’ bureaucratic buck passing in place of appropriate treatment.

9. Access to specialist support

None of the onerous measures adopters are forced to take to find help for their children after the 3 year ‘guaranteed’ post adoption support has expired might be necessary if they were referred to a looked-after children’s CAMHS in the first instance. Even better, a referral to one of the excellent specialist therapeutic organizations for adopted and foster families, such as Family Futures or the PAC1, could be automatic, if such establishments were funded by CAMHS rather than relying on decreasing local authority referrals and private clients. The hundreds of battling emails, phonecalls, letters, reports and meetings many adopters are required to make because there is no obvious pathway for them to get the help and treatment their children need, puts adoptive families under terrible, and needless, additional strain at a time when they are already extremely stressed by the ongoing, dysregulated, abusive and sometimes suicidal behaviour of their children.

10. The cost of no support

The need to support a dysregulated child adopted from care without access to CAMHS LAC teams gives unnecessary extra work, puts pressure on and uses the resources of a huge (and almost incredible) number of public sector professionals. In my own family’s case, over 50 people, many of whom have dedicated weeks of their life to him alone. These have included the adoption

teams of 3 local authorities, our local initial response / safeguarding team, 2 x generic CAMHS teams, A&E staff, children’s ward staff, agency psychiatric nurses, specialist therapists and psychologists, GPs, consultant paediatrician, consultant psychiatrist, educational psychologist, adoption charities, school staff, as well as the ongoing support of our work colleagues, friends and families. In addition, my partner and I (who both work in the public sector) have had substantial time off work for various appointments as well as unprecedented stress-related absence. The need for tailored and responsive post adoption support is pressing - and becoming more so as LAC children are removed earlier and more prospective parents are encouraged to adopt them.

10. The potential cost

Adopted children’s needs are borne of their traumatic past, including their various moves in and out of care. Although they have moved to the nominal security of a new family, their experience, challenges and issues are those of the looked-after children they once were. The evidence of hundreds of adoptive families posting on the Adoption UK website6 is that they are experiencing similar misunderstandings and misdiagnoses by CAMHS teams. As a result, many adoptive parents feel totally unsupported, or that the CAMHS support they are given is not relevant to their child’s needs. At worst, this lack of support will lead to a decrease in the number of future adopters, more disrupted adoptions and children back in care or prison, their lives further ruined by the system that tried to save them.

11. The potential gains

Of all those who have been looked after. adopted children have the greatest opportunity to make something of their lives. They have parents who are well trained, well-read and often well educated, who understand their needs and are motivated to improve their children’s lot and help them make the most of their potential9. The number of looked-after children achieving A level results or university places could be greatly increased if it included all children who had been looked-after and not just those currently in care. The numbers will be even higher if those adopted children who have experienced trauma are given access to the help they need. Adoptive parents are not likely to seek support unless they need it. Most have had quite enough of social services by the time their Adoption Order comes through6. Logically, there can only be gains from offering tailored support to adoptive families.

12. Conclusion

Adoption is now almost exclusively due to removal rather than relinquishment and support for modern adoptive families should reflect this, to encourage future adopters, retain current adopters and acknowledge the needs of adoptees. Legislation, within the Children & Families Bill 2013, is vital to ensure that adopted children who have suffered trauma have the same opportunities for support, from CAMHS and other specialist therapeutic teams, as looked-after children currently in local authority care, so that both groups are able to make the most of their potential and become healthy, productive and economically-viable members of society.

Annex

References

1 Specialist therapeutic organisations:

Family Futures Consortium, a therapeutic service for children in adoptive and foster families; www.familyfutures.co.uk

PAC – advice, support, counselling and training for all involved in adoption and permanency; http://www.pac.org.uk

Tavistock & Portman NHS Trust – a major regional provider of clinical services for people of all ages dealing with mental health difficulties: http://www.tavistockandportman.nhs.uk

2 Local authority adoption teams:

Greenwich, Stockport and Bexley Adoption Teams:

http://www.royalgreenwich.gov.uk/adoption

http://www.stockport.gov.uk/services/education/cypd/childrenssocialcareandsafeguarding/childrenincare/adopt/

http://www.bexley.gov.uk/index.aspx?articleid=921

3 Events & Training Courses

· Mary Corrigan ‘Helping Your Child Through Play’ (Greenwich Adoption Team) 2012

· Non Violent Resistance (Greenwich Family Solutions Team / NHS Oxleas) Mar 2013 tbc

· Greenwich Adoption Team Family Day, July 2012

· Adoption UK Kent / SE London Family Day, August 2010

· Bexley Preparation for Adoption Course, 2004

4 Adoption Networks/ Groups

· Adoption UK - Kent / SE London Group

· Greenwich Adoption Team Network

5 Adoption charities: general

Adoption UK – a national charity run by and for adopters, providing self-help information, advice, support and training on all aspects of adoption and adoptive parenting. http://www.adoptionuk.org

BAAF – British Association for Adoption & Fostering; www.baaf.org.uk

Barnardos – leading children’s charity http://www.barnardos.org.uk/adoption/adopt-support/adopt-specialist-services.htm

6 Adoption charities: Parent support website / message boards

http://www.adoptionuk.org

7 Adoptive parents’ blogs

http://www.sallydonovan.net

http://www.mumdrah.co.uk

http://www.theboysbehaviour.co.uk

http://www.redblogstick.wordpress.com

8 Adopting after Infertility, Patricia Irwin Johnson; Nov 1994, 978-0944934104

9 Attachment, Trauma and Resilience – Therapeutic Caring for Children, Kate Cairns, 2002 BAAF

What Every Parent Needs to Know – The Incredible Effects of Love, Nurture & Play on your Child’s Development, Margot Sutherland Dorling Kindersley, 2007

Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents. Vandivere, S., Malm, K., and Radel, L. (2009). U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation.

Specificity and heterogeneity in children's responses to profound institutional privation. British Journal of Psychiatry. Michael Rutter et al, 2001

Mechanisms linking early experience and the emergence of emotions, Seth Pollak et al, 2008, Association for Psychological Science, Current Directions in Psychological Science

10 Attachment: Attachment & Loss Triology, Vol 1, John Bowlby, 1997 (revised edition) ISBN-13: 978-07126747131988

Reactive Attachment Disorder, A Review for DSM-V, Charles Zeannah & Margaret Gleason, 2010, American Psychological Association

Principles of attachment focused parenting: Effective strategies to care for children, Daniel Hughes 2009 ISBN-13: 978-0393705553

11 The Boy Who Was Raised As A Dog and other stories from a Child Psychiatrist’s Notebook: What Traumatized Children can Teach Us about Loss, Love and Healing , Bruce Perry, 2008 Basic Books

Limbic Scars: Long-Term Consequences of Childhood Maltreatment Revealed by Functional and Structural Magnetic Resonance Imaging . Dannlowski et al. (2012). Biological Psychiatry

The impact of childhood maltreatment: A review of neurobiological and genetic factors . McCrory, E., De Brito, S. A., & Viding, E.(2011). Frontiers in Psychiatry

12 Developmental trauma disorder: pros and cons of including formal criteria in the psychiatric diagnostic systems; Marc Schmid, Franz Petermann and Joerg M Fegert , BMC Psychiatry, 2013

 

Developmental trauma, complex PTSD, and the current proposal of DSM-5, Vedat Sar 2011, European Journal of Psychotraumatology

 

Developmental Trauma Disorder, Bessel A. van der Kolk

www.traumacenter.org/products/.../preprint_dev_trauma_disorder.pdf

13 Beyond Consequences, Logic and Control, A Love Based Approached to Helping Attachment-Challenged Chidren with Severe Behaviors, Heather T Forbes & Bryan Post, 2006, Beyond Consequences Institute

Next Steps in Parenting the Child Who Hurts , Caroline Archer, 1 999, Jessica Kingsley Publishers

14 The emotional and behavioral adjustment of United States adopted adolescents: Sharma, A. R., McGue, M. K., & Benson, P. L. (1996). Children and Youth Services Review, 18(1/2), 83-100.

Other useful adoption literature, which has informed this submission:

· Real Parents, Real Children – Parenting the Adopted Child, Holly van Gilden & Lisa Bartells-Rabb

· The Primal Wound, Nancy Verrier

· Life Story Work, Tony Ryan

· 20 Things Adopted Kids wish their Adoptive parents knew, Sherrie Eldridge

 

April 2013

Prepared 24th April 2013