Why is this needed?
Due to the early and often traumatic life-events which adopted children have experienced, a range of specialist therapeutic services may be required bespoke to the needs of individual children and families.
AdoptionUK surveyed more than 1,700 adopters in the autumn of 2017 to collect evidence on how the (Adoption Support) fund was working for families. The survey revealed the following:
- Nearly a quarter of adoptive parents didn’t know what the ASF was and a further 11% didn’t know how to access it
- 54% of respondents reported that it took them more than three months to secure an assessment of need for their family
The evaluation of the Adoption Support fund found that parents currently approved for the ASF funded services reported high levels of satisfaction with the different aspects of the assessment. Respondents were especially satisfied with the process (74%), the identification of needs (73%), and the consideration of their view and preferences (72%).
The following services are commonly available via the agencies which were reviewed, mostly procured from specialist third sector providers and funded from the ASF.
- Clinical Psychology Assessment
- Clinical Psychology Therapy Sensory reprocessing
- Creative Therapies
- Therapeutic Camps
- Dyadic Developmental Psychotherapy (DDP), (PACE Parenting)
- Filial Therapy
- Dialectical behaviour therapy (DBT)
- Eye Movement Desensitisation Reprocessing (EMDR)
- Life span Integration Therapy
- Sensory Integration
- Non-Violent Resistance Training (NVR)
- Therapeutic Life Story Work
- Residential Breaks
- Music Therapy
- Drama Therapy
- Cognitive Behavioural Therapy (CBT)
- Neurological Physiological Psychotherapy (NPP) - “a wrap-around, multidisciplinary, brain based, developmental and attachment-focussed intervention for children who have experienced significant trauma in the context of their early life” developed by Family Futures. See Vaughan et al (2016).
Possible future developments
One of the few NICE-validated therapeutic approaches, Video Interaction Guidance (VIG) (or Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline VIPP-SD) does not appear to be widely available within the adoption support services considered here. The Tavistock and Portman NHS Foundation Trust has announced that it is to become the UK training centre for the Dutch version of this approach. OAWY is exploring this possibility.
Given the prevalence of a range of diagnosable conditions amongst adopted children (e.g. FASD, ADHD, ASD, see section 4), it is not clear that the workforce is appropriately trained, or that pathways to the appropriate specialist services have been identified, to enable these children to be identified as early as possible. Equally, it is not clear that even specialists in children’s mental health are able to reliably diagnose these conditions in the adoptive population (Woolgar et al (2018).
The Child Psychiatry role within Adoption Counts appears to be the only of its kind. It is difficult to sustain financially but provides a level of expertise which some adopters have to wait many months to access from mainstream services, and then with mixed results. It is unlikely that this situation will improve until much stronger links are built between CAMHS, Community Paediatricians and adoption support services. In the meantime, adopters greatly value support from various specialised voluntary organisations (e.g. nofas-uk.org).
Adoption Counts has offered the following learning from the specialist services it has commissioned:
- Where a specialist assessment has been undertaken by a third-party provider this has often led to that provider delivering a service (this has been widely echoed by other agencies).
- Externally commissioned assessments are often not clear on the desirable goals of a therapeutic approach and it is therefore difficult to hold providers to account.
- Historically there has often been little scrutiny of the assessment or evaluation of the service provider. Many complex or multi-disciplinary assessments do not meet NICE guidelines.
- There have been a number of examples of a dependence developing between therapist and family. The family feel that the therapist is their only form of support and the therapist recommends continuation of the therapy.
- We have found that providers are often working with multiple family members (i.e. siblings & parents). This can lead to a conflict of interest, confusing children and inhibiting progress.
- Some therapists have adopted the role of advocate to the family in their relationships with the adoption support agency.
- It is easy to see why adopters resist the idea that therapy needs to come to an end for progress to be made, afraid that they will be again be left unsupported.
- There has been a tendency for Social Workers not to look at wider services and support systems once therapy is in place. This again makes the idea of ending therapy a frightening prospect.
- A therapeutic response is not always the most appropriate.
- A co-ordinated multi-agency response may be more appropriate.
- A therapeutic response often needs a wider co-ordinated supportive response to be successful (e.g. work with the school).
- Therapy often implies that there is something wrong with this child rather than with the response they receive or the environment in which they are functioning. Often the most effective therapeutic approach is to change the perspective of the adults involved. “When a flower doesn't bloom you fix the environment in which it grows, not the flower” Alexander Den Heijer.
Adoption Counts is addressing these issues by developing its internal capacity to undertake complex assessments and via a strategic commissioning approach (see section 11).