Tuesday, June 26, 2012

Questions to Ask...Risk

Continuing with the questions adoptive families should be asking themselves...

What level of risk are you okay with?  Adoption is a risk no matter what; you cannot eliminate risk completely.

Being matched
There is risk involved in being matched with a child.  In domestic in almost every situation (foster placement or infant), someone else is choosing your family to parent the child.  With infant adoptions, its the birth parent.  With foster to adopt situations, it's a social worker.  There is a risk that it could take a very long time (years) to be matched.  Are you okay with an indefinite wait because you cannot control the matching process?  Also within domestic adoption is the risk of a birth family deciding to parent after initially choosing an adoptive family.  While I cannot imagine the pain of that, it is important that birth families have the ability to change their minds.  Making an adoption plan has life long implications for all parties not just the adpotive families and if the roles were reversed and we were facing a crisis pregnancy, I am certain we would want the leeway to do the same.

Within international adoption, the risk of an indefinite wait to be matched is lower.  It depends upon the situation, but many times there are waiting children so even if someone else (an agency or orphanage worker) is responsible for the match, once you are signed up with that program, you will probably be matched quickly.  (Or quite possibly, you will make the match yourself if you find a child off of a list of waiting children.)  That said, there are of course exceptions to both instances.  I know people who have done domestic infant adoptions and were matched within days and I know people who chose to do international adoptions and have waited years for a referral.  In the international situations, most often times, the time to referral is outlined by the agency so you have a pretty good idea of how long you will be waiting.  The wait to referral is pretty consistent.  However, there are instances where the "rules" change midstream.  China is a great example of this as that country has experienced a dramatic slow down in its ability to refer healthy, infants.  Many people signed up for that program believing the wait would be x months long and that has now stretched into years.

There is financial risk.  There are two ways to go about processing an adoption:  independently or agency based.  Most international adoptions are agency based which means the adoption agency is the middle man who oversees the processing of the adoption in the country it is occurring in.  There are a few countries which still allow independent adoptions including Haiti and Ghana.  Independent international adoptions mean that the adoptive family completes all paperwork on their own and works directly with an orphanage throughout the process.  Usually, the orphanage hires its own processors to work on the paperwork.  

Domestic infant adoptions can be either with independent adoptions occurring when someone uses a consultant or a lawyer to help them be matched with a birth mom and then uses a lawyer of their choosing to finalize the adoption.  Regardless of what country, agency based adoptions are probably considered less risky financially because there is an agency in the middle who should be looking to protect the interest of its clients.  The agency should be looking for red flags that would indicate that the adoption might never be finalized.  Also, if something does go awry, many agencies have more than one adoption program which means adoptive families can switch to another program if needed.  The family may not be able to recoup all of their monies but switching to another program should prevent them from losing all of their money.    If a family does an independent adoption, there is no agency to act as a safety net.  While the family may have signed a contract with an orphanage, consultant, or lawyer, most often these contracts heavily favor the orphanage, consultant or lawyer.  Often, monies spent are lost.  Within a domestic adoption, money spent on a failed adoption attempt are eligible for a tax write off.

Behavioral Challenges
There is also behavioral risk.  All adoption is a result of a loss.  It is just that simple.  For my child to join my family, he has to lose his first family.  And that loss is a part of his heart forever.  That doesn't mean the loss has to be so invasive that it cuts into everything the child does.  But for some kids, it does just that.  Even kids who were adopted as infants.

Domestic infant adoption carries the least risk emotionally.  An adoptive family is able to be there immediately to nurture and care for the child within a family unit.  There are no questions about if the child was left hungry or if he spent long hours crying in a crib.  But most domestic adoptions arise from stressful, unplanned pregnancies which can impact the fetus.  And there is always a risk of prenatal drug and alcohol use which can affect a child's emotional state.  

Foster to adopt situations are riskier than domestic adoptions in that most children are in state custody for a reason that involves neglect or abuse.  The kids are coming from hard places most of us have not been.  However, a good social worker should be able to give a family a pretty good idea of what needs the child has before a family says yes to adoption.  (There are instances where families have felt like the true needs were not revealed but I hope this is not reflective of the system in general.)

International adoption is more risky yet.  You have no control over what has happened in the child's first years of life and often you will have no back story to tell you about those years.  There is a possibility the child was neglected or abused by birth parents.  A child who suffers from chronic malnutrition in a birth family can suffer brain damage.  Within orphanage care, abuse and neglect can continue.  Even in the best orphanages, a child is left in survival mode where they develop certain behaviors because they feel the need to protect themselves.  There is always a risk of a child struggling to form attachments to a parent because he has not had the opportunity to learn to trust an adult to meet his needs.  In each of the scenarios, attachment is a concern.  You cannot eradicate the risk of emotional issues out of adoption by choosing to adopt as young as child as possible.  Yes, you can reduce the risk.  But you cannot remove it.  For older children, the risk is greater but it is not a certainty.

Karyn Purvis, a well known attachment specialist, breaks the stats up into thirds:  1/3 of kids from hard place will have minor bumps in their lives, 1/3 will have moderate needs, 1/3 will have some major struggles.  Recently, I tried to apply this principal to adoptive families who I personally know, only those families who I know their stories well enough to have a good idea of what the situations are that they are dealing with, specifically in families who adopted children internationally or through foster care.  As I tallied through the stories I know of, here's what I found:  I could think of 27 kids, some adopted domestically as infants, some internationally.  Out of those kids 4 had severe behavior issues and out of those 4, 3 were disrupted into new families.  17 had moderate behavioral needs including things like sensory disorders, sleep issues, and attachment concerns.  7 kids did not have any behavioral issues that were more than minor needs.  There are many many more families who I know of who I do not know well enough to say for certain that all is well.  However, those families appear to be functioning and thriving so my opinion is that those children probably have needs that are at the moderate to minor level.

Medical unknowns
There is a medical risk.  People often assume that international adoption is the riskiest in terms of medical unknowns.  In some ways, this is correct.  Many countries do not have access to proper medical care so you may think a child has one condition but it needs further testing in the U.S. to confirm this.  There is also no comprehensive family medical history for the child so you have no way of knowing what genetics may hold.  But the major things that people are looking for like HIV and Hepetitis are all screened for and these tests are essentially reliable.  (People seem to want to know about communicable diseases; however, if you have not researched them, I would encourage you to do so.  They might not be as scary as you think.)  I think the biggest fear people have is that their child will come home and have a major medical condition that was not revealed to them beforehand.  Honestly, I think the biggest problems occur if this happens and a child was thought to be healthy beforehand because the family now has to adjust to their expectations.  The situations I do know of where this has happened were all with families who knew their child had medical needs but the needs ended up being different than what they expected.  (For example, I know of two people who adopted kids who were always sick.  The families knew something was amiss but they did not know what as the children had not tested positive for any diseases.  In the end, one child had HIV and one child had Sickle Cell Anemia.  There were inaccurate tests in both instance but the families also knew that the child had heath issues.  Still a "loss" and a diagnosis but perhaps different than adopting a supposedly healthy child.)  That said, I think people forget that infant adoption does come with some medical risks too.  Yes, there is testing available prenatally which can help you be aware of any medical needs.  But many times the needs are not known until after a child is born or for many months after birth.  Major conditions like Down's Syndrome or a major heart defect may be apparent and known ahead of time.  But things like cerebral palsy or autism are undetectable until later on.  Thinking back to situations I personally know well, I know of 7 children who were adopted domestically as infants.  4 have moderate medical needs.  (I'm defining severe as situations requiring total care or situations that are life threatening.)  One has a genetic syndrome that has resulted in multiple surgeries and academic delays, two have concerns connected to their digestive systems including major food allergies, and one has vision issues and hip displasia.  Of those 4, only 1 child's needs were known before the family committed to the child.

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