CASE’s clinical treatment approach and services

CASE’s clinical model was influenced by the guiding principles established by the National Consortium for Post Legal Adoption Services: Adoption Support and Education

(Ameaud et al., 1996). The CASE approach emphasizes the need for family-focused treatment and incorporates an array of services ranging from advocacy to psychosocial services. CASE’s framework integrates several theoretical models around attachment, grief and mourning, and trauma-informed treatment. It incorporates knowledge of children's thoughts and feelings about adoption from a developmental lens, the impact of compromised beginnings, and the importance of birth family connections. CASE’s model includes a thorough assessment involving the individual child, adolescent, or adult and their family that focuses on emotional, social, behavioral, and academic functioning; marital and family relationships; attitudes, communication about, and relationship with birth family; and the family’s access to social supports.

As CASE continues its adoption competent practice development, it has incorporated best practice approaches, strategies, interventions, and evidence-informed/evidenced-based treatment modalities from an adoption lens. CASE utilizes psychoeducation for parents about the impact of compromised beginnings, including trauma, breaks in attachment, loss and grief, and neurobiology. Psychoeducation includes helping both parents and professionals understand the importance of birth family to adoptees. Assessment and treatment with transracial adoptive families focuses on the family’s promotion of positive identity development and the need for racial socialization. The clinical team utilizes a range of evidence-based models. (See adoptionsupport.org/member-types/therapists.)

The CASE model includes referrals to other adoption competent professionals who provide adjunct therapies including those who specialize in occupational and speech therapy. To assist families with their children’s academic, social, emotional, and behavioral needs in school, CASE therapists advocate for families in school, consulting with counselors and teachers, and attend Individual Education Program meetings. When indicated, CASE clinicians collaborate with hospitals and psychiatrists. CASE has an in-house psychiatrist who provides consultation and medication management. CASE clients also have access to non-clinical services, including bibliotherapy, adoption-related materials, webinars, workshops, and publications. CASE has created a support group curriculum for children, teens, and adoptive parents. The WISE Up! Program teaches parents and children how to respond to questions and comments about adoption. All CASE therapists have received the Training in Adoption Competency (TAC) outlined next.

Defining adoption competency and developing TAC

As CASE continued its adoption competent practice, it recognized the direct correlation between the positive outcomes it achieved and its adoption-specific clinical model. In 2008, that recognition led to CASE’s implementation of a multi-year initiative. Training and National Certification for Adoption Competent Mental Health Practitioners. Funded by multiple national private foundations, the initiative’s long-term goals were greater access for prospective adoptive parents, adopted individuals, adoptive families, and kinship families to adoption competent mental health professionals; provision of mental health services to adoptive families to promote their stability and health; reduction of the rates of adoption disruption and dissolution; and strengthening the post-adoption services offered by mental health and child welfare systems nationwide.

CASE convened a National Advisory Group of nationally recognized child welfare and adoption experts, including those with personal adoption experiences. The Advisory Group focused on defining “adoption competency” for mental health professionals and developing a strong statement of need for adoption competency training. The work of the group was informed by an online survey of 485 adoptive parents and other members of the adoption kinship network conducted in 2011 and early 2012 (Atkinson, Gonet, Freundlich, & Riley, 2013). Respondents provided accounts of seeing multiple incompetent therapists over the years, and nearly one-quarter found that therapists lacked knowledge about attachment, trauma, or loss, and that many did not have a basic understanding of adoption.

CASE's experience in working with families who had previous unhelpful therapeutic experiences added to the understanding of the critical need to develop and expand the availability of adoption competent mental health professionals. Families reported therapeutic interventions that had been completely ineffective, had escalated the difficulties, or were directly harmful. In therapy at CASE, one parent reported,

We were referred to a therapist who was trained in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). When my seven-year-old son began smearing feces all over his room after visits with his birthmother, the therapist said that we needed to finish the treatment sessions first before we could address what was happening with the visits. This rigid adherence to a model of treatment without the flexibility to talk about our son’s and our distress from these visits left us feeling completely helpless.

(Edna, adoptive mother, age 32; CASE, 2018)

Many parents shared that they often were not given much time with the therapist, spending most of the time in the waiting room. Consequently, parents lacked guidance even when they reported that they could not manage their child’s behavior or felt no real attachment between the child and themselves. Many families reported that the subject of adoption was either not addressed, only superficially addressed, or dismissed as unimportant. One teen told her therapist that being adopted meant “suffering the greatest loss of my life” (Center for Adoption Support and Education, 2018). The therapist responded by saying that “birth parents are only a sperm and an egg.”

Other reports focused on the harm done to the adopted child or teen. One family credits CASE with saving their daughter and their family from serious destruction. The parents’ six-year-old daughter, adopted from the Philippines at the age of two, was exhibiting out of control behavior. The treating psychiatrist’s recommendation included removal of the child's toys and stuffed animals until she calmed down; shaving the child’s head when the child engaged in hair pulling; and taking their daughter to the Emergency Room for hospitalization. Instead, the family brought their daughter to CASE, where the family found the needed healing support.

In response to these needs expressed by families and professionals, again in 2008, the National Advisory Group, under CASE's leadership, undertook the development and implementation of the TAC program, an advanced adoption competency clinical training program for licensed mental health professionals. The group produced two expert consensus foundational products: the current definition of an adoption competent mental health professional and a set of specifically defined knowledge, values, and skills — core competencies in 18 domains essential for adoption competent mental health professionals. The TAC competency-based curriculum and evaluation design were guided by expert advisers and informed by research and practice literature reviews of adoption and mental health-related best practice, adult competency-based learning, and assessment of clinical competencies. The current definition of an adoption competent mental health professional is in Table 32.1.

Table 32.1 Definition: an adoption competent mental health professional