Creating a sub-specialty in adoption clinical practice

TAC is designed to produce clinicians who provide mental health services to birth, kinship, and adoptive families consistent with the definition of an adoption competent mental health professional. Eligible students hold graduate degrees in counseling-related fields, have clinical skills reflective of a professional license, and possess a basic knowledge of mental health issues as they impact children, youth, and families. TAC differs from other existing training programs in its in-depth clinical focus, transfer of learning to practice through multiple learning opportunities, a manualized delivery, and the rigor of its evaluation. TAC is an evidence-informed, 12-session (72 hour) training with a six-month case consultation component to further aid in transferring learning to practice.

The TAC curriculum

The TAC curriculum continues to evolve to respond to emerging research, practice development, and evidence-informed and evidence-based interventions appropriate to work with members of the adoption kinship network. As of December 2018, TAC includes a 12-module curriculum culminating in a final project requiring integration of learning and application to practice; six monthly clinical case consultation sessions designed to reinforce the

Table 32.2 TAC training topics

The principles that form the bases for adoption competent mental health practice

Clinical skills for engaging adoptive families as healing agents

Adoption-related grief, loss, and separation and evidence-informed clinical interventions

The impact of traumatic experiences on children's physical, emotional, cognitive, social, and neurodevelopment and relevant clinical assessment and evidence-based interventions

Attachment formation and disruption and elements of effective treatment including attachmentbased interventions

Adopted adolescents and identity development, including the “six stuck spots” that are key areas of vulnerability in adolescence (Riley & Meeks, 2005) and relevant clinical intervention

Clinical issues in working with birth and adoptive families, including the transition from foster parent to adoptive parent, LGBT adoptive parents, and adoptive parenting through the life cycle and developmental tasks

Clinical work with adoptive families around managing children's behaviors with an understanding of trauma, attachment, and therapeutic parenting

Clinical issues involved in different levels of openness in adoption and clinical approaches to supporting and educating families on openness issues

Race and ethnicity in adoption, including the formation of racial identity and strategies for effective racial socialization and healthy identity development

Participants’ demonstration of their application of knowledge and skills to practice

transfer of learning into clinical practice and facilitated by expert clinicians; and an ongoing multicomponent evaluation examining training delivery, effectiveness, and outcomes. The robust TAC trainer credentialing and support process, featuring selection in accordance with prescribed qualifications, includes a weeklong in-person orientation, debriefing calls after modules that are informed by participant feedback and fidelity observations, and ongoing supportive technical assistance. Table 32.2 provides the major TAC training topics.

TAC is currently being offered in 17 states in the US with 19 training partners. As of December 2018, training has been replicated with 95 cohorts, training a total of 1,448 professionals. Additional cohorts are added throughout the year. Partnerships include a diverse array of organizations including four universities, three state/county child welfare agencies, and ten private non-profit organizations. Given the impact of TAC in the United States, discussions are under way with several countries for the potential of expanding TAC internationally.

TAC participants

The nearly 1,400 participants in the first 95 cohorts report an average of 8.9 years clinical experience and an average 13.7 years professional experience. Almost 12 percent hold doctorates and 82 percent hold master’s degrees. A remarkable 76 percent report a personal connection to adoption, many as adoptive parents but also as adopted persons or having family and/or close friends touched by adoption. Fifty-four percent are social workers, 23 percent are counselors, 13 percent are marriage and family therapists, and 10 percent are psychologists. Work settings of TAC participants include public and private mental health agencies (32 percent) and private practices (15 percent), adoption specialty organizations (26 percent), family services organizations (21 percent), child welfare agencies (13 percent), residential treatment facilities (8 percent), and other settings (8 percent). More than 12 percent of TAC participants reported more than one work setting, the majority reporting a part-time private practice.

Evaluation of TAC

As pointed out by Brodzinsky (2013, p. 43), “translating knowledge into practice is another area that needed empirical attention.” One of the unique aspects of TAC is the inclusion of assessment and research to study how the acquisition of knowledge gained through TAC influences practice change for the individual professional and his or her organization. Fidelity observations and participant and trainer feedback are used to assess the quality and relevance of the training and fidelity of the delivery (Atkinson & Riley, 2017).

TAC has been subject to ongoing, rigorous evaluation by an independent external evaluator, Policy Works, Ltd., since its inception. Findings represent a strong body of evidence that TAC is a sound and effective training model that produces changes in clinical assessment and intervention practices that enable clinicians to apply trauma-informed, attachment-based skills to address core adoption issues such as loss, grief, control, and identity. The evaluation is designed to assess training delivery, outcomes, and effectiveness.

Training outcomes are assessed using pre- and post-training self-assessments of adoption competency and surveys reporting changes in clinical practices at the midpoint and conclusion of training. Interviews are conducted with TAC-trained clinicians six to eight months after training completion to identify and explore the longer-term impact(s) of training on clinical practices. Training effectiveness is assessed using a 34-item pre- and post-test based on curriculum content which is administered to training participants and a control group of comparably qualified clinicians. On TAC pre- and post-tests, TAC participants experienced average gain scores of 51.35 points on a 100-point scale, while those in the control groups experienced a gain of only 4.50 points. TAC participants scored an average 46.45 points higher on TAC post-tests than control group members.

TAC participants are asked at the midpoint and conclusion of training to identify and comment on the aspects of practice influenced by information or insights gained from the training. Findings to date are based on more than 1,900 responses that contain nearly 10,000 separate narrative descriptions of ways their practices have been influenced by the training and most important learning. At the end of training, all TAC participants to date report change in at least two of the six defined aspects of practice. Key findings are that 61.90 percent report change in all five aspects at the individual clinician level; and 50.86 percent report change in procedures, programming and/or services at the organizational level. The six key areas of changed practice that participants report are: information about adoption collected at intake, with the referral, or in initial phase of assessment; methods used to assess the family and the child; clinical approaches used; techniques used in work with children and youth; use of or referral to other (adjunct) resources and/or therapies; and changes at organizational level in procedures, services, and programming.

Case example: Adoption competent mental health practice

Tanya was placed in foster care at the age of two with her older sister, who was 5 years old. Prior to foster care, Tanya had been separated from her sister several times when her mother placed her with her maternal aunt. Tanya experienced repeated physical abuse at the hands of her aunt and has burn scars on her hands. While in foster care, Tanya and her sister remained together but were moved three times. Tanya was 6 years old and her sister was 9 years old when they were adopted. Beginning at placement, Tanya’s adoptive parents had contacted nine different therapists, seeking help for Tanya’s hiding and hoarding food, emotional overeating, stealing, lying, and raging tantrums. Tanya was constantly in conflict with her parents and her sister. At age 14, Tanya was seen by a TAC-trained CASE therapist. Her parents reported feeling overwhelmed and in despair about not being able to find anyone who could help Tanya or their family.

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