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


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

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

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

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)

Core Adoption Issues for Triad Members/
problemele centrale pentru membrii triadei in
Identity/ Identitatea
Loyalty/ loialitate
Loss/ pierdere
Self-esteem increderea de sine
Control/ control
Rejection/ Abandonment/ Respingere/abandon
Shame/Guilt/ jena/ vinovatia
For each core issue / pt fiecare problema
  • 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
  • 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?

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

  • 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
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

Unique Challenges of Building a Family by
Adoption/ provocari unice in construirea familiei
  • 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
  • Are we the real parents validation/
    intrebarea daca suntem parinti reali

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

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
  • openly, sharing concerns and feelings about their
    adoptive status/ in mod deschis isi impartasesc
    ingrijorarile si trairile cu privire la statutul
    lor adoptiv

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
  • Communicative openness/ deschidere spre
  • Capacity to cope with stress challenges/
    capacitate de a face fata stresului si

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

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

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

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

Child Related Risks/ Riscuri legate de copil
  • Unresolved feelings about prior separation and
    loss Grief/ trairi emotionale nerezolvate
    legate de separaea si pierderea anterioara-
  • 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
  • Lack of background information/ lipsa de
    informatii despre trecut

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
  • 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

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

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

Bowlbys dimensions for problematic attachment/
dimensiunile lui Bowlby in cazul atasamentului
  • 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

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

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

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

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

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

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

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
  • Lack of background information/ lipsa
    informatiilor legate de trecutul copilului

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.

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

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)

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
  • 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

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
  • adoptive parent support groups/ grupuri de
    sprijin pt parinti adoptivi
  • groups for adopted teens/ grupuri pt adolescenti
  • "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

Guiding Principles Goals of Post Adoption
Services/ principii si scopuri ale serviciilor
  • 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
  • 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

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