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Clinical Issues in Adoption for Mental Health Professionals Aspecte clinice ale adoptiei pentru profesionistii din sanatatea mentala

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Clinical Issues in Adoption for Mental Health Professionals Aspecte clinice ale adoptiei pentru profesionistii din sanatatea mentala Zoe Breen Wood, PhD – PowerPoint PPT presentation

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Title: Clinical Issues in Adoption for Mental Health Professionals Aspecte clinice ale adoptiei pentru profesionistii din sanatatea mentala


1
Clinical Issues in Adoption for Mental Health
ProfessionalsAspecte clinice ale adoptiei pentru
profesionistii din sanatatea mentala
  • Zoe Breen Wood, PhD
  • Assistant Professor
  • Director of Educational Outcome Assessment

2
Types of Problems Reported by Familiestipuri de
probleme raportate de catre familii
  • Behavior problems/ probleme de comportament 60
  • School related issues/ probleme scolare
    47
  • Adoption issues/ probleme legate de adoptie
    38
  • Attachment issues/ probleme de atasament
    27
  • Social adjustment problems/ probleme de adaptare
    sociala
    8
  • Diagnosed conditions/ conditii diagnosticate
    54
  • Source Atkinson Gonet (2007)

3
Most Helpful ServicesCele mai utile servicii
  • Support /Sprijin
  • Adoption-competent counseling /consiliere
    competenta specifica adoptiei
  • Education / preparation/ educatie/pregatire
  • Respite/ odihna
  • Help with school related issues/ ajutor pentru
    problemele scolare
  • Sources Smith (2004) Atkinson Gonet (2007)

4
Core Adoption Issues for Triad Members/
problemele centrale pentru membrii triadei in
adoptie
Identity/ Identitatea
Grief/suferinta
Loyalty/ loialitate
Trust/Increderea
Loss/ pierdere
Self-esteem increderea de sine
Control/ control
Rejection/ Abandonment/ Respingere/abandon
Shame/Guilt/ jena/ vinovatia
5
For each core issue / pt fiecare problema
centrala
  • WHY is it a potential problem?/ de ce reprezinta
    o problema potentiala?
  • WHEN and HOW might it be manifested/ cand si cum
    s-ar putea manifesta?
  • How might this issue be associated with a typical
    developmental transition/ cum poate fi asociata
    problema cu momentele tipice de tranzitie in
    dezvoltare?
  • WHAT alternative explanations for these behaviors
    might be offered by a non adoption sensitive
    practitioner?/ ce explicatii alternative pot fi
    date acestor comportamente de catre practicienii
    ne-sensibilizati cu adoptiile?
  • WHAT treatment approaches might be used if these
    behaviors are viewed through an adoption
    sensitive lens / ce abordare terapeutica poate
    fi utilizata pt aceste comportamente vazute prin
    lentile sensibile la adoptie?

6
Triggers/ factori declansatori
  • Birthdays / zile de nastere
  • Anniversaries of Separations/ Aniversari ale
    separarilor

  • Mothers Day / ziua mamei
  • Holidays/ concedii
  • A move / mutat
  • Divorce/ divort
  • Transition from one school level to another/
    trecerea de la un nivel scolar la altul

OH 2 Triggers
7
Triggers/ factori declansatori
  • Medical crises (of child or parent)/ crize
    declansate de boli (ale copiilor sau parintilor)
  • Addition of new child to the family/ aparitia
    unui alt copil in familie

  • Adolescence/High school graduation/ adolescenta,
    momentul bacalaureatului
  • Engagement or Marriage/ logodna, casatoria
  • Pregnancy/ Birth of a Child/ sarcina/ nasterea
    unui copil
  • Mid-life crisis/ criza existentiala tipica la
    jumatatea vietii
  • Death of Adoptive Parents/ moartea parintilor
    adoptivi.

8
Unique Challenges of Building a Family by
Adoption/ provocari unice in construirea familiei
adoptive
  • Infertility - the stealer of dreams/
    infertilitatea-hotul de vise
  • No role model to follow/ absenta unui model al
    rolului de urmat
  • Our business is not our own/ treburile noastre nu
    mai sunt doar ale noastre
  • No timetable to follow/ absenta unui orar de
    urmat
  • Are we the real parents validation/
    intrebarea daca suntem parinti reali
    validarea

9
ISSUES IN FAMILY FORMATION/ aspecte ce apar in
construirea familiei
  • Adoptive family life is different than life as a
    biological family./ viata familiei adoptive
    difera de a familiei biologice
  • Different doesnt mean deficit./ diferenta nu
    inseamna deficit!
  • Families deal with differences in one of three
    ways (diferentele se manifesta in unul din
    modurile d emai jos)
  • families reject/deny the differences/ familiile
    neaga diferentele
  • families insist on differences/ familiile insista
    pe diferente
  • families acknowledge the difference/ familiile
    recunosc diferentele

10
Issues in Family Formation/ aspecte ce apar in
construirea familiei
  • Consequences in ways families deal with
    differences / consecinte ale modului in care fac
    fata diferentelor
  • create a less open and less reality based
    environment/ creaza un mediu mai putin deschis si
    mai putin bazat pe realitate
  • ascribe blame for difficulties to genetics or
    preadoptive history (i.e., "the bad seed" or the
    damaged goods)/ pt dificultatile de acum sunt
    invinuite genele copilului sau istoricul de viata
    anterior adoptiei (samanta proasta sau bunul
    stricat)
  • openly, sharing concerns and feelings about their
    adoptive status/ in mod deschis isi impartasesc
    ingrijorarile si trairile cu privire la statutul
    lor adoptiv

11
Characteristics of Successful Adoptive Families /
Caracteristici ale familiilor adoptive de succes
  • Realistic expectations / asteptari realiste
  • Thorough parental preparation/ pregatire atenta
    pentru parentalitate
  • Positive parenting style/ stil de parentalitate
    pozitiva
  • Communicative openness/ deschidere spre
    comunicare
  • Capacity to cope with stress challenges/
    capacitate de a face fata stresului si
    provocarilor

12
Characteristics of Successful Adoptive Families/
carcaterictici ale familiilor adoptive de succes
  • Humor/ umor
  • self-care/ grija de sine
  • adequate formal and informal social support/
    sprijin social formal si informal adecvat

13
Healthy Adoptive Families Understand the
Developmental Stages of Adoption/ Familiile
adoptive sanatoase inteleg stadiile de dezvoltare
ale adoptiei
  • I gained a family - 3 to 6 years/ am castigat o
    familie- 3-6 ani
  • I lost a family - 7 to 9 years/ am pierdut o
    familie -7-9 ani
  • I was given away - 9 -12 years/ am fost parasit-
    9-12 ani
  • I was rejected - 13 to 17 years/ am fost respins-
    13-17 ani

14
Risks / Vulnerabilities/ riscuri/vulnerabilitati
  • Parent Related/ in raport cu parintele
  • Child Related/ in raport cu copilul
  • Family Related/ in raport cu familia

15
Parent Related Risks/ riscuri legate de parinte
  • Unmet Parental Needs Expectations/ asteptari si
    nevoi parentale nesatisfacute
  • Marital Problems/ probleme maritale
  • Incomplete Resolution of Loss/ rezolvare
    incompleta a pierderii
  • Culture/ cultura
  • Lack of Parent Preparation/ lipsa pregatirii pt
    parentalitate

16
Child Related Risks/ Riscuri legate de copil
  • Unresolved feelings about prior separation and
    loss Grief/ trairi emotionale nerezolvate
    legate de separaea si pierderea anterioara-
    suferinta
  • Attachment/ atasament
  • Older child adoptions/ adoptia copiilor cu varste
    mai mari
  • Children with history of abuse or neglect/ copii
    cu abuz si neglijare in istoricul vietii lor
  • Institutionalized children/ copii
    institutionalizati
  • Lack of background information/ lipsa de
    informatii despre trecut

17
Attachment /Atasament
  • Biologically based/ baza biologica
  • Learned behaviors/ comportament invatat
  • Balance between proximity seeking and exploration
    / independence/ echilibru intre cautarea
    apropierii si explorare independenta
  • Reciprocal interactive/ reciprocitate
    interactiune
  • Cannot be directly measured must be inferred
    from observations / language / nu poate fi direct
    masurat/ trebuie dedus din observatii/ limbaj
  • Early attachment experiences form basis for later
    expectations of relationships mental map/
    experientele timpurii de atasament formeaza baza
    pentru asteptarile din relatiile ulterioare
    harta mentala

18
The Mental Map/ harta mentala
  • Secure/ securizat
  • Avoidant/ evitant
  • Anxious/ Ambivalent/ anxios/ambivalent
  • Disorganized/ dezorganizat
  • Unattached/ neatasat

19
Arousal/ Relaxation Cycle/ Ciclul
excitare/relaxareDr.Vera Fahlberg, Separation
and Attachment, 1979
Need Expressed/ nevoi exprimate
Relaxation/ relaxare
Trust/ Attachment/ incredere/atasament
Arousal/ excitare
Need Met/ nevoi satisfacute

20
Bowlbys dimensions for problematic attachment/
dimensiunile lui Bowlby in cazul atasamentului
problematic
  • Avoidant / evitant
  • affective cues shy or timid, withdrawn, and
    doesn't get involved with others/ indicatori
    afectivi jena sau timiditate, respingere, nu se
    implica cu altii
  • cognitive cues cruelty, bullying or meanness to
    others, physically attacks people, and threatens
    people/ indicatori cognitivi cruzime, se ia de
    ceilalti este rautacios cu ceilalti, ataca fizic
    persoanele, ameninta oamenii din jur.
  • behavioral cues fears certain animals,
    situations, or places, other then school,
    self-conscious or easily embarrassed / indicatori
    comportamentali se teme de anumite animale,
    situatii, locuri, altele decat scoala, constiinta
    de sine sau prea repede jenat

21
Bowlbys dimensions for problematic attachment/
dimensiunile atasamentului problematic dupa Bowlby
  • Anxious / ambivalent / Anxios/ ambivalent
  • affective cues cries a lot and whining/ semne
    afective tipa mult si scanceste
  • cognitive cues can't sit still, restless, or
    hyperactive, clings to adults or too dependent,
    and easily jealous/ semne cognitive nu poate sta
    linistit, este nelinistit sau hiperactive, se
    agata de adulti sau e prea dependent, devine
    imediat gelos
  • behavioral cues complains of loneliness, and
    feels or complains that no one loves him/her/
    semne comportamentale se plange de singuratate
    si simte sau se plange ca nimeni nu-l iubeste

22
Indicators of Disorganized Attachment/ semne ale
atasamentului dezorganizat
  • Behavioral/ comportamental
  • Emotional/ emotional
  • Cognitive Functioning/ functionare cognitiva
  • Social/social
  • Physical Developmental/ fizic developmental

23
Both/ ambele
cunoastereCognition
Affectafecte
Secure/securizant
Anxious / Ambivalent/ anxios/ambivalent
Avoidant/ evitant
Disorganized/ dezorganizat
Neither/ nici unul
24
Building Attachment/ construirea atasamentului
  • Means Changing the Mental Map / inseamna
    schimbarea hartii mentale

25
How/ CUM
  • Purposeful use of arousal relaxation cycle/
    utilizand cu intentie ciclul excitare-relaxare
  • Positive interaction cycle/ ciclul interactiunii
    pozitive
  • Claiming behaviors/ comportamente reclamate
  • Eye contact/ contactul cu ochii
  • Appropriate touch/ atingeri adecvate
  • Talk/ vorbire

26
When/ Cand
  • Fear/ Teama
  • Fatigue/ Oboseala
  • Illness/ boala

27
Sharon .
  • What is Sharons mental map? Care este harta
    mentala a lui Sharon?
  • Identify specific strategies that you could
    suggest to the family for building attachment/
    identificati strategii specifice pe care ati
    putea sa le sugerati familiilor pt a sprijini
    construirea atasamentului copilului
  • Make sure to identify at least three different
    types of strategies/ asigurati-va ca ati
    identificat cel putin 3 tipuri diferite de
    strategii

28
Child Related Risks / Riscuri legate de copil
  • Unresolved feelings about prior separation and
    loss Grief/ trairi nerezolvate cu privire la
    separare si pierdere- suferinta
  • Attachment/ atasament
  • Older child adoptions/ adoptia copiilor de varste
    mai mari
  • Children with history of abuse or neglect/ copii
    cu istoric de abuz si neglijare
  • Institutionalized children/ copii
    institutionalizati
  • Lack of background information/ lipsa
    informatiilor legate de trecutul copilului

29
Age At Placement/ Varsta la plasament
  • A significant risk factor for disruption./ factor
    de risc important pentru intreruperea adoptiei
  • Tied to extent and complexity of maltreatment.
    Reusita limitata si complexitatea maltratarii.

30
Summary/ sumarChild Related Adoption Issues/
aspecte ale adoptiei legate de copil
  • Important to Assess / Important de evaluat
  • The degree to which these issues are present/
    masura in care aceste aspcete sun prezente
  • Their potential impact on presenting problems/
    impactul lor potential in generarea de probleme

31
Family Related Issues/ Aspecte legate de familie
  • Siblings/ fratriile
  • Transcultural / Transracial Placement/ plasament
    transcultural/ transrasial
  • Kinship adoptions/ adoptii intre rudenii
  • Openness (will be discussed in session 2)/
    deschiderea (va fi discutata in sesiunea a doua)

32
Post Adoption Support/ Sprijin post-adoptie
  • Families face enormous challenges and strains in
    adopting a special-needs child. / familiile se
    confrunta cu provocari imense care limiteaza
    adoptia unor copii cu nevoi speciale.
  • Adoption is not a time-limited process, and
    adoption-related issues surface throughout the
    lives of the individuals involved in adoption/
    adoptia nu e un proces desfasurat intr-un timp
    limitat, iar aspectele legate de adoptie sunt
    prezente in intreaga viata a indivizilor
    implicati
  • Involvement with therapy, mental health resources
    and other supports should be considered a
    normative part of an adoptive family's
    experience/ recurgerea la terapie, resurse de
    sanatate mentala si alte forme de sprijin trebuie
    vazute ca o parte normala a experientelor de
    viata ale familiilor adoptive

33
Increasing Resources Supports to Adoptive
Families/ Resurse sporite sprijin pentru
familiile adoptive
  • Post-legal services (also referred to as post
    adoptive services) should be available they
    include servicii post-adoptie legala (prezentate
    ca servicii de adoptie) trebuie sa fie
    disponibile ele includ
  • psycho-therapeutic services to families/ servicii
    psiho-terapeutice pt familii
  • crisis intervention/ interventii de criza
  • case management/ management de caz
  • Financial assistance/ asistenta financiara
  • adoption-related training for parents, mental
    health professionals and school personnel/
    traininguri pt parinti legate de adoptie,
    profesionisti din sanatatea mentala si personalul
    scolar
  • adoptive parent support groups/ grupuri de
    sprijin pt parinti adoptivi
  • groups for adopted teens/ grupuri pt adolescenti
    adoptati
  • "concrete" supportive services to families such
    as subsidy, respite, buddy families,
    transportation, and medical services/ servicii
    concrete de sprijin pentru familii, cum ar fi
    subventii, odihna, familii inmugurite (cu
    experiente pozitive), trasport si servicii
    medicale

34
Guiding Principles Goals of Post Adoption
Services/ principii si scopuri ale serviciilor
post-adoptie
  • Active engagement empathic listening
    accepting, non-blaming approach. Angajare activa
    ascultare empatica acceptare. Abordare lipsita
    de critica.
  • Flexible, responsive service delivery focused on
    client needs/ flexibilitate, livrarea unor
    servicii responsive centrate pe nevoile
    clientului
  • Joining with and supporting parents increasing
    parental entitlement/ alaturarea la alti parinti
    dispusi sa sprijine cresterea sentimentului de
    legitimitate parentala
  • Helping parents understand children in light of
    their histories. Sprijinirea parintilor ca sa-I
    inteleaga pe copiiin lumina propriilor istorii
    personale.

35
Adoption/ Adoptia
  • A personal act/ un act personal
  • A legal process/ un proces legal
  • A social service/ un serviciu social
  • An ongoing process not an event/ este un proces
    continuu nu doar un eveniment
  • An intervention/ o interventie
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