Assessing the Field of Post-Adoption Services:Family Needs, Program Models, and Evaluation Issues: Analysis of Secondary Data
Most adoptions have positive outcomes for both children and their families. However, many families need supportive services during some part of their child's development. For some, the needs for post-adoption services are quite extensive and may threaten the adoption's survival. In response to these needs, many states have developed post-adoption service (PAS) programs designed to prevent adoption disruptions or dissolutions and to support child and family well-being. As discussed elsewhere (Barth, Gibbs, and Siebenaler, 2001), these services may be provided by public agency adoption workers, by private providers under direct contract with the adoption services program, or by families who receive adoption subsidies and use those to purchase needed services. Services received by adoptive families may be classic "post-adoption services" insofar as they address adoption-related issues, or they may be other educational, vocational, recreational, health, or mental health services that would be little different from those used by other families raising children with special needs.
This report is part of a series that examines these rapidly growing and evolving PAS programs, using a literature review (Barth, Gibbs, and Siebenaler, 2001), case studies of well-regarded programs (Gibbs, Siebenaler, Harris, and Barth, 2002) and, here, the analysis of secondary adoption data. In this report we discuss efforts to learn more about the relationship between adoption subsidies and post-adoption services. We have looked for secondary data for three related purposes: (1) to better understand the use of subsidies for purchase of services; (2) to illuminate post-adoption service use provided by — or funded by — public adoption agencies; and (3) to describe the disruption, dissolution, and displacement of adoptions. In all of these searches we have been stymied by the highly confidential nature of adoption data — that is, states and agencies are often unable or unwilling to share data about adopted children and their families, given the historically high levels of confidentiality afforded to them.
In this exploratory work, we planned to pursue information about subsidies and the dissolution and disruption of adoptions from administrative foster care and adoption data held by California, North Carolina, and New Jersey. The analyses were expected to illustrate some of the possibilities of this work and to identify barriers. Ultimately, we were only able to obtain relevant data from California and North Carolina.
Before presenting findings from those analyses, we briefly review the available information about the role of adoption subsidies in order to identify some assumptions that this effort attempted to test. We then introduce some additional considerations about data related to adoption disruption, dissolution, and displacement. We finish with some observations about these findings and directions for future research.
This project was funded by the Administration on Children and Families of the U.S. Department of Health and Human Services (DHHS), under contract to the Office of the Assistant Secretary for Planning and Evaluation (ASPE). Research was conducted by RTI and the University of North Carolina at Chapel Hill. We appreciate the participation of the North Carolina Department of Social Services and the California Department of Social Services.
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Although subsidies are widely used, we know little about them.
Our understanding of the relationship between adoption subsidies and other post-adoption services is limited. Administrative data and surveys indicate that adoption subsidies are commonly used. Data from the Adoption and Foster Care Analysis and Reporting System (AFCARS) indicate that 88 percent of children adopted in 2000 were receiving subsidies (AFCARS Report, 2001). Preliminary AFCARS data from 2001 suggest that the number of children receiving subsidies is rising in tandem with the number of adoptions (Penelope Maza, personal communication, August 26, 2002).
Available data on adoption subsidy use are limited and somewhat inconsistent. Little is known about pathways on and off subsidies or the reasons for, or timing of, changes in subsidy levels. There is no analysis that we know of that looks at the transitions associated with receipt of adoption subsidies. These have been treated by scholars as fixed — an assumption that is critical to examine given the many children who are now receiving them. For example, Avery (1998) has looked at the security of adoption subsidies and concluded that, "the life long commitment that accompanies adoption finalization does not necessarily come with the security of continued financial support from the state" (p. 52). Yet her policy analysis does not indicate the proportion of subsidies that decline in amount, over time, or the reasons that they decline. Information about changes in these amounts will help us to better understand the importance of the initial subsidy amount decision.
Many families that could get subsidies do not have them. According to Sedlak and Broadhurst (1993), 84 percent of the children who were adopted between 1983 and 1987 had special needs that would have potentially qualified them for an adoption subsidy (assuming that the adopting family did not have the means to meet those needs without compromising their own well-being), yet only 63 percent were receiving a subsidy at that time. (Much has changed since then, and the coverage of children who are eligible for adoptions has almost certainly increased, as indicated by the AFCARS data.)
Secondary data can also be used to understand the ways that subsidies are a part of the package of post-adoption services and support. A key issue in the use of subsidies is the transition from a deferred (or very low) subsidy to a higher subsidy, suggesting that the family has developed the need for additional services.
States and localities are likely to vary in the assumptions that underlie the design of their subsidy programs. Some consider that subsidies should be set at a rate sufficient to provide general support for needed services. Others set subsidy amounts at a level that can only support the basic care for a child, unless there are time-limited requests for subsidy funds to address specific problems. For example, according to a recent report from the North American Council on Adoptable Children, in four states the subsidy rate slightly exceeds the USDA rate needed to raise a child in a low-income family, yet in three states, the typical state subsidy is just half the USDA estimate (Bower and Laws, 2002). At the same time, some states are far more likely than others to grant a one-time payment or an augmented rate to help families purchase services that they need to better care for their children.
States vary in their subsidy policies and in the organization of subsidy data.
States vary in many other ways that affect the use of subsidies for post-adoption services. Among these are eligibility for Medicaid for state-eligible children, one-time or vendor payments for special services, an augmented "difficulty of care" rate for particularly challenging children, payment for respite care, and support of time-limited placement in residential treatment. In some states there must be quite specific documentation of planned or completed subsidy use. Yet in other states these subsidy expenditures need only be justified in more general terms. In some states, these problems have to be specified at the outset; in other states, there is a mechanism to request the addition of funds to address specific problems that arise later. These different practices certainly have a significant impact on families as well as on efforts to understand subsidy use. The more specific the categories for additional services or requirements for justifying the use of those services, the richer are the potential administrative data.
Adoption subsidy data may be maintained at the county level (in states that have state-supervised but county-administered adoption programs) or the state level (for state-administered systems), or both. In some cases, these data are integrated into the financial system used to make foster care payments, and in other cases the adoption subsidy data are maintained in a stand-alone system. In some states, we learned there is good documentation of the reasons for subsidy changes, and in other states these are not well documented.
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Most studies of adoption disruption, dissolution, or displacement have not relied solely on administrative data (cf. Goerge, Howard, and Yu, 1996). These studies have relied on case record reviews and interviews — labor intensive and costly approaches that are difficult to replicate in subsequent years, to determine if rates are varying. Yet the relative success of AFCARS, and the Multi-State Data Archive at Chapin Hall argue that there are substantial efficiencies to be had in the development of data capacity that does allow for the analysis of such events.
Adoptions can end in several ways. Adoptions that disrupt are foster care placements with the intent of ending in adoption that end before parental rights and responsibilities are transferred to the adoptive parents. Dissolutions occur when a legally finalized adoption is legally ended. This may occur either by a vacation of the adoption order by the court, by the adoptive parents relinquishing their rights or consenting to another's adoption of the child, or by the court terminating the adoptive parents' rights and responsibilities. Displacement occurs when a child leaves the parental home, although the parents maintain their legal relationship with, and responsibilities for, the child. Examples of displacements are children who leave home against parental permission, go into residential care, are incarcerated, or enter mental health hospitalization. Conceptually, there are two types of displacements — those that include continued parental involvement with the child and those in which the parents have given up efforts to be involved as parents, even though the adoption still legally exists on paper (J. Magruder, personal communication, August 4, 2002). We did not find data that expressly address disruption, dissolution, or displacement (of either type) of adoption — we have had to infer this from manipulating administrative data.
The single study that has used administrative data to study disruptions and dissolutions (Goerge, Howard, and Yu, 1996) was set in Illinois. In the course of examining multiple spells of children in foster care, the investigators determined that some of the children who were entering foster care had case information that matched — to a great extent, but not perfectly — children who had previously exited foster care to adoption. The authors interpreted these adoptions as having ended, although it is also possible that these replacements into foster care were displacements rather than disruptions or dissolutions. The authors determined which children had previously been adopted and were now experiencing a dissolution (about 4 percent) and which children had been placed for adoption and had reentered foster care without ever having completed the adoption (about 14 percent). Because states may sharply differ in the way that they define an adoptive placement, these figures may or may not be meaningful in cross-state comparisons. Nonetheless, this effort provided a prototype for the work with North Carolina data, described in the following section.<!--
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