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Say "adoption" and many Americans think "babies." The U.S. system was largely organized around placing infants, both from this country and abroad. It turns out that, by far, the largest number of adoptions in the U.S. is through the foster care system. That means toddlers, young children, even teens.
Yet many in the field say the system does little to help families cope with the special issues a number of these children will face, even years after adoption.
Foster adoptions have nearly doubled since 1997, when a policy change gave states financial incentive to place children with permanent families. The federal government has also waged an aggressive and charming ad campaign, with TV spots reassuring people that they "don't have to be perfect to be a perfect parent."
Today, more than 50,000 foster children are adopted each year by people like Carlton Hadden and Ronnie Roebuck. The Maryland couple met their son, Phillip, when he was 9, the median age of those adopted from foster care. Since he was a toddler, Phillip had cycled through some 10 different foster placements, twice being abandoned by people who'd planned to adopt him. Roebuck says that early on the boy told them, "I have major issues."
"And I said, 'Phillip, we all do, trust me,' " says Roebuck. "But during that time, I clearly remember thinking that I wanted to have a therapist in place, for all of us, because it's an adjustment."
Phillip not only has individual therapy sessions, but he's also had several group sessions with Roebuck and Hadden, who say it's made all the difference. Phillip, now 13, has stopped acting out and is excited about school. The family is even considering adopting another child.
Roebuck is blunt about what would have happened without all that counseling. "It would have never worked," he says. "We would have been totally lost, and we would have done what thousands do — they take them back."
In fact, Debbie Riley, head of the Center for Adoption Support and Education in Maryland, says she is seeing an increasing number of "disruptions."
"Families are calling and saying, 'I can't do this,' and [they're] putting children back into [foster] care," she says.
Riley, whose group provided Phillip's therapist, has been at the forefront of helping adoptive families for more than a decade. She says too many families are left to fend on their own, and are not prepared to help a child cope with the ongoing effects of neglect, abuse and abandonment.
"It may make them have difficulty connecting with others," she says. "It could result in childhood depression. Their spirits can be broken, and then you put them into what looks like a healthy family, and all of a sudden things look pretty crazy."
And when parents do look for help, Riley says many mental health professionals have no experience with adoption issues. She trains therapists across the country to promote what she calls "adoption competency."
Adam Pertman, of the Adoption Institute, says there's a big need for other kinds of support, as well. "That family needs respite," he says, and "probably needs support to get the kids to their therapist. And we're not doing that very well."
Some state foster care systems do offer such services, along with phone counseling, parent coaching, mediation and group therapy for teens. There can be subsidies for lower-income families. But tight budgets are always a challenge, and Pertman says a number of programs have been cut back.
Mostly, he'd like to see a change in attitude.
"We have to stop thinking about adoption solely as child placement," Pertman says, "and understand it as a process that requires supports and services to facilitate family success."
Matching a child to a family, he says, is really just the beginning.
Last week, the D.C. Council voted to designate e-cigarettes and "similar vapor products containing nicotine" as tobacco products. That means that their sales tax will jump from the regular 5.75% sales tax to the 70% tax that's tacked onto sales of products like cigarettes and cigars. We explore what this means for the evolving public health debate surrounding e-cigarettes.