Experiences, Concerns, and Service Needs of Families Adopting Children with Prenatal Substance Exposure: Summary and Recommendations
McCarty, Carolyn, Waterman, Jill, Burge, Dorli, Edelstein, Susan B., Child Welfare
Parents who adopted children from out-of-home care with prenatal substance exposure were interviewed four months after the child's placement in the home, and again after the first year regarding their experience with adoption and their concerns about their child's development, attachment, and behavior; aspects of parenting and the adoption process; effects of prenatal substance exposure; and availability and helpfulness of resources. Adoptive parents found parenting children with prenatal substance exposure to be both more rewarding and more difficult than they had imagined.
Parental substance abuse, especially when it involves the prenatal exposure of children to drugs or alcohol, has been called "the biggest threat to the well-being of children entering care today and in the next century" [Barbell & Wright 1999: 13]. Escalating parental use of drugs and alcohol has resulted in an increasing number of children born with prenatal drug exposure and an increase in the number of such children in need of out-of-home care [Barth 1991; Goerge & Wulczyn 1999]. These atrisk children require safe, nurturing, permanent families to help ensure their well-being and overcome their difficult beginnings. For many, adoption will be the permanency plan of choice. It follows, then, that factors that optimize the adoption of these children must be identified and quality services provided to support their adoptive families.
Significant obstacles exist to the adoption of children exposed prenatally to alcohol and/or other drugs. Many prospective adoptive parents and professionals are frightened by the uncertainties regarding the long-term outcomes of substance-exposed children. Their fears are fueled by sensational headlines and television soundbites. They may fear the children will be unmanageable or develop abnormally, or that the guidance, services, professionals, and resources needed to meet the children's needs will not be available [Groze et al. 1994; Edelstein et al. 1995; Edelstein et al. in press]. When children with histories of prenatal substance exposure are placed with adoptive families, even minor incidents of acting-out by the child during the transition can generate anxiety and cause adoptive parents to attribute the problems to prenatal substance exposure. These fears, and the challenges presented by children with a history of prenatal substance exposure, highlight the need for postadoption services.
The TIES (Training, Intervention, Education, and Services) for Adoption program attempts to reduce obstacles to adopting children in out-of-home care who have a history of prenatal substance exposure and to ensure the success of such adoptions.* One TIES component is a program of support and services for families during the child's transition from out-of-home care to placement with the adoptive family, and during the first year after placement.
Parents who participate in TIES for Adoption initially receive nine hours of education and preparation focused specifically on exploring issues pertinent to the adoption of children with prenatal substance exposure. Once a potential match has been made between parent and child, the program offers a continuum of services, including interdisciplinary reviews of the child's records and preplacement consultation with the prospective parents regarding the child's strengths, vulnerabilities, and needed services; mental health services, including parent counseling, child therapy, and inclusion in a support group; and pediatric, psychiatric, and educational consultation (for a detailed description see Edelstein et al. [in press]).
This article examines the experiences of adoptive parents at the time of the placement of a child affected by prenatal substance exposure, including their concerns and their perceptions of service needs. It also describes how adoptive parents' needs, experiences, and perceptions changed in the first year after placement, and implications for future service with these families. …