NCSL State Legislative Report

Analysis of State Actions on Important Issues

Post-Adoption Services: Issues for Legislators

For children in foster care who cannot safely return to their birth families, adoption is considered by many to be preferable to other permanency options such as legal guardianship or long-term foster care. This preference is reflected in federal and state legislation intended to promote adoption from foster care with financial incentives, maintenance subsidies for adoptive families and procedural mandates to expedite the permanency process. Policymakers, however, have paid less attention to meeting the needs of families that have adopted foster children with challenging behaviors and medical conditions. This report examines trends in adoption of children from foster care, challenges faced by adoptive families, types of post-adoption services, data on the effectiveness of such services and trends in the funding and delivery of services and supports after adoption.

Trends in Adoption from Foster Care

The increase in the number of children adopted from foster care during the past few years is a major child welfare success story, but one that will create new policy and budgetary challenges for state legislators and child welfare administrators. The yearly number of public agency adoptions increased from 25,644 in 1995 to about 51,000 in 2000. Researchers project that the rate of growth in the average monthly number of children under age 18 who have been adopted from foster care will exceed the rate of growth of the foster care population for at least the next two decades.1 The average monthly number of children eligible for adoption assistance funded jointly by the states and the federal government under Title IV-E was approximately 195,000 in 1999 and is projected to reach more than 600,000 by 2010.2 The Congressional Budget Office (CBO) projects that, within the Title IV-E Adoption Assistance Program, the adoption population nationwide will exceed the number of children in foster care by 2003. This shift has already occurred in some states, including Illinois, Michigan, New York and Ohio.3

Some have expressed concern that the increase in the number of adoptions from foster care will result in a corresponding increase in the number of failed adoptions unless adoptive families are provided with adequate support services. Although most states offer some services that are specifically tailored to adoptive families, there is considerable variability from state to state and even within states in terms of the array and accessibility of such services. Many families that adopt children from foster care report feeling abandoned by the child welfare system after finalization. Accordingly, the area of post-adoption services is attracting more attention in the wake of state and federal laws and initiatives that emphasize more and speedier adoptions from foster care.

• Recent federal legislation reauthorizing the Promoting Safe and Stable Families Program earmarked a portion of the funds thereunder for "adoption promotion and support services." In that legislation, Congress expressed the finding that:

"The rapid increases in the annual number of adoptions since the enactment of the Adoption and Safe Families Act of 1997 have created a growing need for post-adoption services and for service providers with the particular knowledge and skills required to address the unique issues adoptive families and children may face."4

• The final reports on states that have undergone federally mandated Child and Family Service Reviews during fiscal year 2001 reflect a consensus on the part of stakeholders in the child welfare system regarding the importance of post-adoption services. Stakeholders interviewed in Delaware and Florida cited post-adoption services as a gap in their states' array of services. In Kansas, the statewide assessment indicated a need for more specialized services to treat problems specific to adoption. Stakeholders in New York and North Carolina expressed concern that adoption disruptions were contributing to the high rate of foster care re-entries and that there was a need for more post-adoption services. Stakeholders in Oregon and Vermont praised their states' child welfare agencies for increasing available post-adoption services.
• Recent state legislative audits of subsidized adoption programs cite the importance of post-adoption services. A March 2002 performance audit conducted by the Colorado State Auditor stated that "Comprehensive post-adoption services and supports can be valuable components for preserving adoptive placements and reducing the risk of dissolutions."5 A performance audit of Utah's adoption assistance program noted that "Post-adoption support is critical to achieving the goal of finding permanent, stable, loving families for children" and recommended that the state's Division of Child and Family Services develop a plan to expand and improve post-adoption services.6
• Researchers are beginning to make a more concerted effort to analyze and evaluate the field of post-adoption services. The Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services, for example, has funded a comprehensive research project on post-adoption services entitled "Assessing the Field of Post-Adoption Services: Family Needs, Program Models and Evaluation Issues." The study, led by Deborah Gibbs of Research Triangle Institute (RTI) and Richard Barth, a leading adoption researcher at the University of North Carolina, includes a literature review, case studies of post-adoption service programs in several states, a review of evaluation issues and an analysis of secondary data. Similarly, the Center for Adoption Studies at Illinois State University is collecting detailed information about states' post-adoption service programs, including service arrays, funding sources and number of families served.
• An increasing number of foundations, advocacy groups and other nonprofit organizations have taken an interest in support for adoptive families. For example, Casey Family Services, the direct service arm of the Annie E. Casey Foundation, sponsored a major conference on post-adoption services in December 2000 and has made post-adoption services the centerpiece of its public policy agenda. The Dave Thomas Foundation for Adoption, which focuses exclusively on moving children from foster care to adoption, has taken a more active role in advocating for and committing resources to post-adoption services.
• In several states, adoptive parents of children with special needs have organized to raise awareness among state legislators and the general public about the needs of adoptive families. Adoptive parents can be powerful and highly effective advocates. Their advocacy efforts have resulted in increased legislative appropriations for post-adoption support in a number of states, including Massachusetts, Oregon, Texas and Utah.

Challenges Faced by Adoptive Families

Adoption advocates and researchers acknowledge that adoptive and birth families are similar in many ways but stress that the challenges of adoptive families, particularly those that have adopted children from foster care, are substantially different than those of most birth families. 7

Researchers have confirmed that adopted children are disproportionately represented in populations of children diagnosed with behavioral disorders and that adoptive parents tend to report higher rates of problem behaviors than do biological parents.8 In the case of children adopted from child welfare agencies, these behaviors are related to a history of maltreatment and prolonged stays in foster care. Other researchers, however, have suggested that adoptive parents are better informed and more vigilant regarding the state of their children's mental health than are birth parents and are therefore more apt to report higher levels of challenging behaviors. In either event, advocates argue that adoptive families often experience higher levels of stress than do other families and may need a variety of support services.9

Adoptive families under stress are at increased risk of adoption failure (referred to as disruption before an adoption is legalized and as dissolution after an adoption has been finalized). Richard Barth has identified several risk factors for adoption disruption. The leading risk factor is the child's age at the time of adoption. Older children adopted from foster care may have been exposed to more maltreatment than younger children, have stronger ties to their birth parents, and have more ingrained learning and behavioral styles, making it more difficult for them to adjust to their new family. Adoptive families of children with serious behavioral and educational problems also are at increased risk for disruption, especially when the children's progress does not meet the parents' hopes and expectations.10

Despite the challenges faced by adoptive families, the legal dissolution of adoptions from foster care appears to be very rare. A 1997 study by the Chapin Hall Center for Children at the University of Chicago found a 6.6 percent dissolution rate for children adopted from foster care in Illinois between 1976 and 1987.11 A recent study of children adopted from foster care in New York City in 1996 found a high degree of stability. Of the 516 children studied, none was involved in a legal dissolution and only 3.3 percent had experienced some form of out-of-home placement since being adopted.12

What Are Post-Adoption Services?

Numerous surveys of adoptive parents have identified a wide range of desired services. The general consensus, however, appears to be that adoption-competent mental health services, respite care, information and referral, and peer support are among the most important post-adoption services.

Many adoption experts feel that treatment to address the behavioral and emotional problems of adopted children is one of the most critical post-adoption services. Most children adopted from foster care are covered by Medicaid, which is required to pay for medically necessary mental health services. The adequacy and accessibility of mental health services under Medicaid, however, vary from state to state. Moreover, adoptive families often complain that many therapists are not sensitive to the unique but predictable problems that arise in adoption, including those related to grief, loss and attachment. Accordingly, many post-adoption service programs include a training component for mental health professionals, schools, child welfare personnel and attorneys.

Although ongoing support of adoptive families is intended to reduce the need for costly residential treatment and most adopted children will never need to be placed outside the home, adoption experts argue that short-term residential treatment should be more widely available to adopted children in crisis. Because residential treatment is costly, it is the service to adoptive families that is most vulnerable to cuts in the current budget climate. In response to a 2000 survey by the Association of Administrators of the Interstate Compact on Adoption and Medical Assistance (AAICAMA), 29 states reported offering residential treatment to adoptive families.13 Some of these states reported funding residential treatment through Medicaid. In a more recent survey, the North American Council on Adoptable Children found that 19 states provide some funding for residential treatment that is not covered by Medicaid.14

In some states, adoptive families are required to relinquish legal custody of their children to the child welfare agency in order to be eligible for publicly funded residential treatment. A report by the Bazelon Center for Mental Health Law attributes this requirement in part to the mistaken assumption that custody transfer is necessary for states to obtain federal foster care matching funds to pay for maintenance costs under Title IV-E of the Social Security Act.15 The report notes that Title IV-E allows for voluntary placement agreements under which transfer of legal custody is not required. About 11 states have enacted laws to prohibit child welfare agencies from requiring custody relinquishment as a condition of providing mental health services.16

Respite-the temporary care of children to provide both parents and children a break from the stresses of family life-is in high demand by adoptive families. Respite can take many forms, including hourly care, in-home respite, summer camp, group outings, family retreats and other special events. Virginia established a Client Fund that provides up to $500 per adoptive child per year to allow families to purchase respite care.17 Texas pays for one-week of summer camp for adopted children.

States have reported a number of challenges in meeting the need for respite care. These challenges include recruitment and training of qualified respite providers, reluctance of some families to use respite, limited funding for respite care, and difficulty in evaluating respite programs.18

Adoptive families often complain that they do not know where to turn for information about available services, the legal and psychological aspects of adoption, and how to connect with other adoptive families. Many states have created post-adoption information resources in the form of Web sites, lending libraries, 24-hour telephone lines, databases, resource guides, videos, newsletters and workshops. Post-adoption service programs also refer families to community mental health and other service providers. Richard Barth emphasizes the importance of giving adoptive families, both before and after finalization, appropriate information about the challenges they are likely to encounter and what they can reasonably expect in terms of improving their child's behavior, social competence and academic performance.

Adoptive parents often report that other adoptive parents are their most important resource. Accordingly, support groups are an important post-adoption service. The primary challenge for states has been recruiting and retaining members, particularly in rural areas. Some programs provide child care, refreshments and transportation in an effort to generate interest among adoptive families. On-line support groups also are gaining in popularity.

Effectiveness of Post-Adoption Services

With the increase in adoptions from foster care and the attendant increase in demand for post-adoption services, policymakers are likely to ask for evidence of the effectiveness of such services. Given the challenges adoptive families face, what outcomes are post-adoption services intended to achieve? The primary desired outcome cited by most experts is keeping the family together and preventing adoption disruption and dissolution. Post-adoption services also may promote achievement of other outcomes. These include meeting the child's educational and mental health needs, alleviating marital and family stress, promoting healthy child and family functioning, increasing the number of adoptions from foster care and preventing costly short-term residential treatment. This section reviews what is known about the effectiveness of post-adoption services.

The available outcome research on post-adoption services is, at best, inconclusive. The literature review conducted by RTI and Richard Barth identified only five post-adoption service programs that have been evaluated for outcomes.19 The review warns that almost all these evaluations are plagued by serious methodological flaws, such as small sample sizes and nonrandom sampling. Thus, one may not be able to generalize the results obtained.

• Illinois' Adoption Preservation Project: Adoption preservation services were instituted in Illinois in 1991 to strengthen adoptive families and reduce disruptions and out-of-home placements. At the time of its evaluation in 1994, the program provided short-term intensive services, longer-term support groups and linkage to community resources.20 Families referred to the program were experiencing significant levels of stress that parents attributed to their adopted children's behavioral or emotional problems. In fact, 88 percent of the adopted children scored in the clinical range on the Achenbach Child Behavior Checklist prior to delivery of services. After service delivery, children demonstrated a significant decline in behavior problems, and 82 percent of the children remained in the home at the end of the service period, which varied from six months to longer than a year.
• Oregon's Post-Adoption Family Therapy Project: This project used a treatment team comprised of an adoption worker and a family therapist to help adoptive parents deal with their children's confused belief systems. Eight percent of the 50 families served by the project disrupted by the end of the service period.
• Washington's Medina Children's Services: This collaboration between Medina Children's Services and HOMEBUILDERST applied an intensive family preservation services approach to 22 children and their families. Each family received 4 weeks of intensive in-home therapy. A year later, nine children remained at home, nine were the subject of petitions for dissolution, and four children were either in an out-of-home placement or were living on their own.
• Iowa's PARTNERS: Iowa's Post-Adoption Resources for Training, Networking and Evaluation Services (PARTNERS) provided a wide range of services to adoptive families, including support groups and counseling. Similar to PAFT, families worked with two therapists who helped parents understand and deal with their children's behavior problems. At the end of the service period, 29 percent of the children who participated were in out-of-home placements, mostly because of sexual offending by the children.
• New England's Casey Family Services: Casey Family Services, a private child welfare agency based in Connecticut, offers a continuum of post-adoption services throughout the New England region, including information and education, counseling, advocacy, workshops and support groups. An analysis of 400 case records found improvements in child behavior, understanding of adoption issues and effective communication, with less improvement in child-family attachment. Services with longer duration and more counseling sessions appear to have yielded greater gains.

Although adoptive families benefit from ongoing support, there is little evidence of the effectiveness of interventions designed to address adopted children's serious emotional and behavioral problems. For example, attachment theory has heavily influenced the adoption field's approach to post-adoption services, yet the effectiveness of attachment-based therapies remains in doubt. Although reactive attachment disorder is a recognized clinical diagnosis caused by childhood neglect, repeated changes of primary caregiver, or both, there is disagreement in the field as to the appropriate treatment for the disorder, particularly for older children. Desperate parents sometimes resort to controversial therapies such as "rebirthing." The death of 10-year-old Candace Newmaker during a rebirthing session prompted Colorado to ban the practice and Congress to adopt a resolution urging other states to prohibit rebirthing.21

Richard Barth thinks the entire emphasis on attachment is misplaced. He contends that no empirical evidence supports the belief that attachment issues typically are at the root of parent and child problems or that suggests that any of the attachment-based therapies are effective in reducing such problems.22 He advocates, instead, for adapting evidence-based interventions, such as multi-systemic therapy or assertive community treatment, to meet the needs of adoptive families.23

Even though outcome research is limited, it is clear that adoptive families strongly favor post-adoption services-particularly support networks, respite care and information-and say that such services help ease the stresses associated with raising a child with special needs. In a follow-up survey of parents who participated in the Illinois Adoption Preservation program, the majority of respondents expressed a high degree of satisfaction with the program. Many parents felt that the services helped them to understand their children, to become better parents, to find needed resources, and to connect with other adoptive families.24 Similarly, the fourth-year evaluation of Massachusetts' post-adoption program, Adoption Crossroads, found a high level of satisfaction on the part of adoptive parents with information and referral, response teams, respite services and family support.25

Post-Adoption Service Funding and Delivery

The exact amount that states spend on post-adoption services is not known, but it is a small percentage of total state and federal spending on child welfare services, which was $20.5 billion in FY 2001.26 In an era of budget shortfalls, states are finding it difficult to meet the growing demand for services caused by the surge in adoptions. Although state funds account for the bulk of spending on post-adoption services, budget problems in most states will likely result in greater reliance on federal funds.

States may draw on a number of federal funding streams to pay for post-adoption services, including Title IV-B, Subpart 1 and Subpart 2 (Promoting Safe and Stable Families Program); the Title IV-E Adoption Assistance Program; the Title IV-E Adoption Incentives Program; the Title IV-E Foster Care program; Temporary Assistance for Needy Families (TANF); the Social Services Block Grant; Medicaid and the Adoption Opportunities Discretionary Grant Program. Some of these funding streams are described below.

• Promoting Safe and Stable Families Program (PSSF): This program provides funds to states for services in four categories: family preservation services, family support services, time-limited family reunification services and adoption promotion and support services. This last service category includes-but is not limited to-post-adoption services.27 The program provides $305 million in mandatory funds per year through 2006 and requires a 25 percent state match. In addition to annual mandatory funding, Congress also may approve up to $200 million per year in discretionary funds. In FY 2002, Congress approved $70 million, bringing the total FY 2002 appropriation to $375 million. States are required to spend no less than 20 percent of their allotments in each service category, unless states can provide a rationale for spending a smaller percentage.

A recent report from James Bell and Associates states that 1 percent of total child welfare spending-$205 million-was spent from both federal and state sources on adoption promotion and support services in FY 2001, not including Title IV-E adoption assistance. States reported spending these funds on adoptive parent recruitment and training, home studies, worker training, information and referral, parent support, mental health services and respite. The report notes two trends in this service category. First, states are decreasing their use of state funds and increasing their use of federal funds for adoption promotion and support. State spending in this category declined from $134 million in FY 2000 to $125 million in FY 2001, while the expenditure of federal funds, excluding Title IV-E adoption assistance funds, increased from $68 million to $79 million during the same period.

The second trend noted in the James Bell report is that states are allocating an increasing percentage of PSSF funds for adoption promotion and support. The percentage of PSSF funds spent by states in this category increased from 15 percent to 18 percent between fiscal years 1999 and 2001.28 By comparison, allocations to family preservation remained stable, and allocations to family support declined from 40 percent in FY 1999 to 34 percent in FY 2001. Interestingly, more states reported spending in the category of adoption promotion and support than in any of the other categories in both FY 2000 and FY 2001.29

States with nationally recognized post-adoption service programs vary in terms of their use of PSSF funds. The programs in Texas, Oregon and Virginia, for example, are funded solely with PSSF funds at $3.9 million, $500,000 and $1.1 million per year, respectively. Georgia's program is funded at between $8 million and $9 million annually with a mix of state and PSSF funds. Massachusetts uses no PSSF funds for post-adoption services and has funded its program with $1.25 million in state funds.30

• Title IV-E Adoption Assistance Program: This program is an open-ended entitlement under which states are reimbursed at the Medicaid matching rate for adoption subsidies to eligible children, 75 percent for certain training expenses, and 50 percent for all other administrative costs allocable to Title IV-E-eligible children. Federal law requires states to negotiate and enter into adoption assistance agreements with adoptive parents of eligible children. Under these agreements, states may pay a subsidy that takes into account the needs of the child and the circumstances of the family, but the subsidy cannot exceed the amount that the child would have received in a family foster home.31 States have considerable flexibility in what they may include in adoption assistance agreements, and many states structure subsidies to allow adoptive parents to purchase some needed services. According to the AAICAMA survey, the Title IV-E Adoption Assistance program was the second most commonly cited source of funds for post-adoption services, after state funds.32

Under the Title IV-E Adoption Assistance program, states also may receive federal reimbursement at the 50 percent matching rate for case management services provided to eligible adoptive families in connection with the implementation of an adoption assistance agreement.33 Case management, which qualifies under federal regulations as an allowable administrative cost, includes such activities as development of service plans, referral to service providers, monitoring of case status and tracking of service use.34

• Title IV-E Adoption Incentive Program: The Adoption and Safe Families Act authorizes the payment of incentives to states that increase the number of children adopted from foster care. The payments equal $4,000 for each foster child adoption and $6,000 for each special needs adoption, above a baseline. In September 2002, HHS awarded $17.5 million in incentive payments to 23 states and Puerto Rico for adoptions in FY 2001. Fiscal year 2002 is the last year for which the program is currently authorized. Incentive funds may be used for any activity authorized under titles IV-B or IV-E. A recent survey found that 16 states are using incentive funds for post-adoption services.35 Michigan, for example, distributed $540,000 in incentive funds to 22 public and private adoption agencies for post-adoption services.36
• Title IV-E Foster Care Program: Under this program, states can obtain funds for post-adoption services in two ways: through an approved demonstration waiver and through the use of foster care administrative funds for case management services.

The U.S. Department of Health and Human Services includes post-adoption services in the list of demonstration topics in which it is particularly interested. To date, only Maine has applied for and obtained a demonstration waiver to use Title IV-E foster care funds for post-adoption support services. The state is implementing an adoption-specific training curriculum for mental health professionals and other service providers. It is also using Title IV-E foster care funds to provide a comprehensive array of services-including case management, information and referral, support groups, respite care, residential treatment, recreational activities, family and individual therapy and advocacy-to adoptive families of children with special needs. The desired outcomes of the demonstration include an increase in the number of special needs adoptions, a decrease in the incidence of adoption disruptions and strengthening of adoptive families.

Under federal child welfare rules, states may claim federal financial participation for foster care administrative costs associated with foster care "candidates," i.e., children who are at serious risk of removal from home as evidenced by the state seeking such removal or making reasonable efforts to prevent such removal.37 In a recent addition to the federal Child Welfare Policy Manual, the Children's Bureau has pointed out that states may claim allowable administrative costs under the Title IV-E foster care program for children in finalized adoptions who are at risk of foster care placement.38 Virginia is one state that is preparing to claim foster care administrative costs for case management services provided to prevent out-of-home placement of eligible adopted children.39

• Social Services Block Grant (SSBG): SSBG funds represent a small but rapidly growing proportion of state spending on adoption services. The James Bell report indicates that the SSBG contribution to total spending on adoption promotion and support grew from 1 percent in FY 1999 to 12 percent in FY 2001.40

In FY 2000, 27 states spent a total of $39,176,000 of SSBG funds on "adoption services," an increase of more than $17.7 million spent in this service category in 1998.41 "Adoption services" is a broad category and not all these states used SSBG for post-adoption services. The James Bell report found that only 12 states used SSBG for this purpose in FY 2001.

States have taken a number of different approaches to delivery of post-adoption services. Most states use a combination of two or more of the following.

• Delivery by adoption workers in public child welfare agencies: In some states, the same workers who oversee pre-adoptive placements also provide or coordinate services after finalization of adoptions. The primary benefit of this approach is continuity of care. The primary drawback is lack of specialization and high caseloads.42
• Delivery by a special post-adoption unit within a public child welfare agency: Some states have funded post-adoption specialists who work with families after finalization. For example, the South Carolina child welfare agency has a number of highly trained adoption preservation specialists. Oregon has workers who specialize in post-adoption family therapy.
• Delivery by private agencies under contract with a public agency: States have taken different approaches to contracting. Oregon contracts with a single provider with staff who deliver services in all regions of the state. Massachusetts and Virginia contract with a single contractor that subcontracts with regional providers. Texas contracts with several regional providers with no central coordinator. Georgia contracts with separate, statewide providers for different services. Adoption specialists say that families are more comfortable with private providers because of the stigma associated with child welfare involvement.43
• Delivery by other service providers in collaboration with the public child welfare agency and with other service networks: Child welfare agencies in a growing number of states are reaching out to existing service providers-such as schools, community mental health centers and child care resource and referral agencies-to provide training in adoption-specific issues and to enlist their aid in improving the community response to adoptive families.

In addition to providing direct services through public or private agencies, 43 states provide some form of special service subsidy to allow adoptive families to purchase services.44 These subsidies typically are used to cover the cost of medical or psychological treatment that is not funded through Medicaid or private insurance. In an era of flat or declining funding and increased demand, many states are spreading subsidies more thinly. In Ohio, for example, the state has stretched its $3.7 million Post-Adoption Special Services Subsidy (PASSS) to cover more families by requiring counties to obtain more stringent medical documentation, eliminating educational services such as tutoring and lowering the maximum yearly subsidy amount from $20,000 to $15,000.45 In Utah, the state overspent its special subsidy in 2000 by $1.4 million, which triggered a major overhaul of post-adoption services at the legislative, agency and community levels.

Planning for Post-Adoption Services

Policymakers who are considering initiating or expanding post-adoption service programs may want to ask the following questions.

• On what outcomes should we focus?
• How are adoptive families and their children currently doing?
• What do adoptive families say they need?
• To what extent can those needs be met through existing services and supports, including the adoption subsidy?
• What can we do to help existing service providers be more responsive to the needs of adoptive families?
• What service gaps need to be filled?
• How can we pay for them? What federal sources are available?
• Who should be eligible for services? All adoptive families or only families that have adopted from foster care?
• What is the most efficient means of delivering post-adoption services?
• Who are the partners that need to be involved?
• What kind of tracking, data collection, evaluation and oversight mechanisms need to be in place?

Utah has been engaged in a comprehensive planning process since budget overruns and service cuts caused an uproar among adoptive families in 2000. The state Division of Child and Family Services (DCFS), in collaboration with the University of Utah and the state Adoption Exchange, arranged for a needs assessment and held a statewide post-adoption summit meeting in 2001 for adoptive parents, service providers, policymakers and others. Adoptive parents identified a need for information, support and educational groups, respite and mental health services. DCFS hired a post-adoption resource consultant, who coordinated 14 regional meetings to identify available resources that could be mobilized for adoptive families and to identify service gaps. The consultant found that existing services providers-such as community mental health centers, schools, family support centers, youth service centers, and child care resource and referral agencies-were very receptive to additional training and collaboration in order to better meet the needs of adoptive families. In fact, the assessment process itself seemed to increase awareness of adoption-specific issues on the part of the providers.46 Accordingly, the state is hopeful that state/local partnerships among DCFS, service providers, adoptive families and others will help make up for limited state funding.

The Role of State Legislators

The role of state legislators in post-adoption services has, for the most part, been limited to funding of state programs. The few state laws that reference post-adoption services are summarized in the appendix. State lawmakers can, however, play a greater role in planning, oversight and evaluation of post-adoption service programs. As in other service areas, they can bring together the various agencies-such as those with responsibility for child welfare, mental health, education, child care, and other social services-that have a role in serving adoptive families,. They can require a statewide planning process to assess needs and available resources. In 2001, for example, the Oklahoma Legislature mandated a comprehensive strategic plan to support "created families," including families that have adopted from foster care. Legislators also can require and fund better data collection to track service utilization and client outcomes.

Conclusion

Many advocates, adoption experts, child welfare professionals and policymakers feel that supporting families that adopt children from foster care is an important public responsibility. Keeping adoptive families together avoids trauma to both children and their families, is less expensive for states than foster care, retains adoptive families as prospective adopters of other children and as recruiters of other adoptive families, and avoids discouraging prospective adoptive families. What is less clear is the extent to which post-adoption services actually encourage adoptions from foster care or prevent the breakup of adoptive families, or both. At this point, the primary empirical support for post-adoption services is the high level of satisfaction with such services expressed by adoptive parents, primarily with respect to information and referral, support groups, and respite care.

Preparation of this report was supported by a grant from the Dave Thomas Foundation for Adoption.

California: Expresses legislative intent that any adoption incentive payments under ASFA be reinvested to provide increased post-adoption services to families who have adopted children from the public foster care system. Cal. Welfare and Institutions Code §16131.

Requires the state to establish a program of specialized training and supportive services to families adopting court dependent children who are either HIV positive or prenatally exposed to alcohol or a controlled substance. Provides that the program shall be available to any county that requests participation and is subject to annual appropriations. Cal. Welfare and Institutions Code §§16135 to 16135.30.

Connecticut: Authorizes the state to provide counseling and referral services after adoption to adoptees and adoptive families for whom the state provided such services before the adoption. Specifies that post-adoption services include mentoring, post-licensure training, support groups, behavioral management counseling, therapeutic respite care, referrals to community providers, a telephone help line, and training for public and private mental health professionals in post-adoption issues. Conn. Gen. Stat. §17a-121a.

Illinois: Requires the state to offer and provide family preservation services to prevent placement of children in substitute care, to reunite children with their families and to maintain an adoptive placement. Ill. Rev. Stat. ch. 20,§505/5(l).

Indiana: Specifies that pre-adoption and post-adoption services may be available as needed to families receiving family preservation services. Ind. Code §12-14-25.5-5.

Minnesota: Requires the commissioner of human services to establish a post-adoption service grant program to be administered by local social service agencies to preserve and strengthen adoptive families. Specifies eligibility criteria and permissible expenses and limits grants to $10,000 per year per child. Minn. Stat. §259.85.

Ohio: Requires an agency arranging an adoption of a foster child by the child's foster caregiver to provide the foster caregiver certain information, including information about the types of behavior that the prospective adoptive parents may anticipate from children who have experienced abuse and neglect; suggested interventions; and the assistance available if the child exhibits those types of behaviors after adoption. Ohio Rev. Code Ann. §3107.013.

Oklahoma: Requires, by Dec. 31, 2001 a comprehensive strategic plan to assist "created families," including families formed through adoption of children from state custody. Requires, within existing resources, the creation of an information database on existing programs. Requires collaborative and interorganizational partnerships to provide assistance to created families. Authorizes the state to provide created families with case management, flexible funds, child care, respite care, transportation, counseling, support groups and other services. Requires the development of an information brochure for guardians, adoptive parents and other created families. Okla. Stat. tit. 10, §22.2.

South Dakota: Requires the state to establish a program of adoption services, including post-adoptive services. S.D. Codified Laws Ann. §26-4-9.1.

Texas: Authorizes the state to provide services after adoption to adoptees and adoptive families for whom the state provided services before the adoption. Allows such services to be provided directly or through contract. Specifies that services may include financial assistance, respite care, placement services, parenting programs, support groups, counseling, crisis intervention and medical aid. Tex. Family Code Ann. §162.306.

Utah: Authorizes the state to provide supplemental adoption assistance for children who have a special need. Defines "supplemental adoption assistance" as financial support for extraordinary, infrequent, or uncommon documented needs not otherwise covered by a monthly subsidy, state medical assistance, or other public benefits for which a child who has a special need is eligible. Requires the state to establish in each region at least one advisory committee to review and make recommendations to the division on individual requests for supplemental assistance. Provides that Medicaid services available to eligible adopted children shall not be limited to the state prepaid health care delivery system. Utah Code Ann. §62A-4a-801 to 62A-4a-806.

District of Columbia: Establishes an Adoption Support Fund for the purpose of providing support incentives for foster parents who adopt children from District of Columbia custody. Requires that money in the fund be used to establish a scholarship fund for adopted children, to create an adoption resource center with post-adoption service capacity, and to enhance recruitment and support of prospective adoptive families. D.C. Code Ann. §4-344a.

Notes

1. See, e.g., Fred Wulczyn and Kristin Brunner, Growth in the Adoption Population, Issue Papers on Foster Care and Adoption, Topic #2 (Chicago: Chapin Hall Center for Children, 2002).

2. Karen Spar and Christine Devere, Child Welfare Financing: Issues and Options (Washington, D.C.: Congressional Research Service, 2001).

3. Ibid.

4. Sec. 430(a)(4), Social Security Act.

5. Office of the Colorado State Auditor, Subsidized Adoption Program: Performance Audit (Denver: Office of State Auditor, 2002), 32.

6. Office of the Legislative Auditor General, A Performance Audit of UTAH's Adoption Assistance Program (Salt Lake City: Office of Legislative Auditor, 2001), 52.

7. Richard Barth and Julie Miller, "Building Effective Post-Adoption Services: What is the Empirical Foundation?," Family Relations 49, no. 4 (2000), 447-455 (hereinafter "Building Post-Adoption Services").

8. Ibid.

9. Ibid.

10. "Building Post-Adoption Services."

11. Robert Goerge, et al., Adoption, Disruption and Displacement in the Child Welfare System, 1976-94 (Chicago: Chapin Hall Center for Children, 1997).

12. Trudy Festinger, "After Adoption: Dissolution or Permanence?," Child Welfare LXXXI, no. 3 (May/June 2002), 515-533.

13. Elizabeth Oppenheim, Shari Gruber and Doyle Evans, Report on Post-Adoption Services in the States (Washington, D.C.: American Public Human Services Association, 2000), 17.

14. Jeanette Wiedemeier Bower and Rita Laws, Forever Families: Support for Families of Children with Special Needs (St. Paul, Minn.: North American Council on Adoptable Children, 2002).

15. Mary Gilberti and Rhoda Schulzinger, Relinquishing Custody: The Tragic Failure to Meet Children's Mental Health Needs (Washington, D.C.: Bazelon Center for Mental Health Law, 2000).

16. The Bazelon report states that the following states prohibit custody relinquishment: Connecticut, Colorado, Idaho, Iowa, Maine, Minnesota, North Dakota, Oregon, Rhode Island, Vermont and Wisconsin.

17. Patricia Gonet, Virginia Department of Social Services, personal communication with author, Oct. 30, 2002.

18. National Adoption Information Clearinghouse, Respite Care Services for Families Who Adopt Children with Special Needs: A Synthesis of Demonstration Program Final Reports (Washington, D.C.: NAIC, 2002).

19. Richard P. Barth, Deborah A. Gibbs and Kristin Siebenaler, Assessing the Field of Post Adoption Service: Family Needs, Program Models and Evaluation Issues. Literature Review (Chapel Hill and Research Triangle Park, N.C.: University of North Carolina School of Social Work and RTI International, 2001).

20. Jeanne A. Howard and Susan L. Smith, Adoption Preservation in Illinois: Results of a Four Year Study (Normal, Ill.: Illinois State University, 1995).

21. Colo. Rev. Stat. §12-43-222(1)(t)(IV); H. Con. Res. 435, passed July 8, 2002.

22. Richard Barth, personal communication with author, Oct. 3, 2002.

23. "Building Post-Adoption Services."

24. Adoption Preservation in Illinois, 101-104.

25. Christopher G. Hudson et. al, Adoption Crossroads: The Fourth Year Evaluation (Salem, Mass.: Salem State College, 2002).

26. James Bell and Associates, Analysis of States' Annual Progress and Services Reports and Child and Family Services Plans (1999-2001) (Arlington, Va.: James Bell and Associates, 2002) (hereinafter Analysis of Progress Reports).

27. Adoption promotion and support services are defined as "services and activities designed to encourage more adoptions out of the foster care system, when adoptions promote the best interests of children, including such activities as pre- and post-adoptive services and activities designed to expedite the adoption process and support adoptive families." 42 U.S.C. §629a(8).

28. Analysis of Progress Reports.

29. Ibid.

30. Richard P. Barth, Deborah A. Gibbs, Kristin Siebenaler and Shelly Harris, Assessing the Field of Post-Adoption Service: Family Needs, Program Models and Evaluation Issues. Case Study Report (Chapel Hill and Research Triangle Park, N.C.: University of North Carolina School of Social Work and RTI International, 2002).

31. 42 U.S.C. §673(a)(1).

32. Oppenheim et al., Report on Post-Adoption Services in the States.

33. Administration for Children and Families, Child Welfare Policy Manual, 8.1A, Question 3.

34. 45 CFR 1356.60.

35. Cornerstone Consulting Group Inc., A Carrot Among the Sticks: The Adoption Incentive Bonus (Houston: Cornerstone Consulting Group, 2001).

36. Mary Sullivan, National Adoption Information Clearinghouse, personal communication with author, Aug. 28, 2002.

37. Administration for Children and Families, Child Welfare Policy Manual, 8.1D.

38. Ibid., 8.1A.

39. Patricia Gonet, Virginia Department of Social Services, personal communication with author, Oct. 30, 2002.

40. Analysis of Progress Reports, 25.

41. Administration for Children and Families, Social Services Block Grant Program Annual Report on Expenditures and Recipients, 2000 (Washington, D.C., DHHS, 2001).

42. Barth, et al., Assessing the Field of Post Adoption Service: Literature Review.

43. Barth, et al., Assessing the Field of Post-Adoption Service: Case Study Report.

44. Wiedemeier Bower and Laws, Forever Families.

45. Crystal Ward Allen, director of the Public Children Services Association of Ohio, personal communication with author.

46. Marty Shannon, Year End Summary Report from the Statewide Post Adoption Resource Assessment 2001-2002, unpublished report.

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