Creating a Family: Talk about Adoption & Foster Care

Finding an Adoption​ and Foster​ Competent Therapist​

September 28, 2022 Creating a Family Season 16 Episode 39
Creating a Family: Talk about Adoption & Foster Care
Finding an Adoption​ and Foster​ Competent Therapist​
Show Notes Transcript

Do you think your child or your family would benefit from counseling? How do you find the right therapist and how can you tell in advance if they will be a good fit for your family? We talk with Debbie Riley, a Licensed Clinical Marriage and Family Therapist and CEO of the Center for Adoption Support and Education.

In this episode, we cover:

  • What type of professional can provide therapy to an adopted or foster child or family?
  • What’s the difference between being adoption competent and adoption informed?
  • Why is competency in adoption or foster issues important?
  • What do we mean be an “adoption competent therapist”? What makes a therapist adoption competent?
  • Is adoption/foster competence the same as trauma competence?
  • How can you tell if a therapist is competent to handle adoption or foster issues? Are there specific trainings that provide adoption competency?
  • Creating a Family provides a list of ways to find an adoption competent therapist on our Adoption Therapy section.
  • Is one type of therapeutic model of treatment more effective for adoptive children and families? Theraplay, Dyadic Developmental Psychotherapy, Trust-Based Relational Intervention (TBRI), Narrative therapy, EMDR (Eye Movement Desensitization and Reprocessing), etc.
  • Should therapy with adopted kids on adoption issues involve just the child, or the child and the parent?
  • What is home-based therapy and are there advantages to this type of therapy for adoptive and foster families.
  • How can you find a therapist that will provide therapy within the home? (One source is
  • Is therapy via tele-health or via teleconferencing as effective for adopted children? For families? How to know if it will work for your family? Ways to make it more effective.
  • How can a parent determine if the therapist is a good fit for the child and family? What questions should they ask?
  • How many sessions to try?
  • When to seek a therapist?
  • How to find a therapist with lived experience of being adopted?


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Please pardon the errors, this is an automatic transcription.
Welcome, everyone to Creating a Family talk about adoption and foster care. I'm Dawn Davenport. I'm both the host of this show, as well as the director of a nonprofit creating a Today, we're going to be talking about finding and adoption and foster competent therapist. And we'll be talking with Debbie Riley. She is a Licensed Clinical Marriage and Family Therapist, as well as the CEO of the Center for Adoption, Support and Education, also known as CASE. Welcome, Debbie, I'm so glad to be talking to you about this this topic, you are very well qualified to talk about adoption competency and foster competency. Because that's certainly an area that case has been extremely involved in and has really done some revolutionary things in the field of of providing adoption competency training for therapists. Let's start however, with a more general question, and what type of professionals can provide therapy to an adopted or a foster child or their family?

Well, first, I want to thank you for having me today to talk about this important topic of any mental health professional, licensed mental health professional, who's qualified to provide clinical services certainly can support foster and adoptive families, what you know, I've come to believe in is that there is an extra layer of training that we all need to have in order to be successful in meeting the unique needs of this population of children. And that's what, you know, cases sort of leading that movement nationally around concept of adoption competency.

So what's the difference when we say adoption, competent adoption informed? Because I see both of those terms used? Is there a difference?

I think there's a difference. I mean, you know, informed I'm not sure what, what goes along with that definition. I mean, you know, what does that mean to be informed? And you're probably thinking in the audience, what does it mean to be adoption competent. And what we've done since 2009, to sort of ground that, conceptually, is that we, you know, pulled together a National Advisory Board many, many years ago, as I said, in 2009, those with lived experience, researchers in the field practitioners, and some of the best thinkers in adoption and foster care, and began to think about what would be the core competencies, what would be the core knowledge base that a trained therapist like myself would need to have in order to meet what we see as these very unique needs of this population. And so we defined those competencies. And then we developed a curriculum that aligned with knowledge, values and skills, it's I mean, it's a very detailed process when you're building competencies, and then built a curriculum around those competencies. And that's what we're we're vetting as adoption competent that a clinician would need to finish a certain level of training in order to what we feel have the foundational knowledge that they need to do this work.

And do you perceive a difference? You're speaking of adoption competent? What about families with children in foster care who are aiming for reunification? Is that does adoption competency overlap with competency in treating foster children and foster families?

Certainly, so yeah, I mean, that's a great question. When when we first came into this, that was the terminology we used, and it's so grounded now and research and practice. But underpinnings of the training is that it aligns with the needs of foster kinship and adoptive families.

Because the children have experienced similar things, similar issues, similar losses. And so I think that the the knowledge base, certainly would transfer to all of these kids and all these families as well.

Well, yeah, I mean, the training is specifically geared toward treating the mental health needs of the children. I mean, when I say families, because we don't see the work individually here at case, nor is the competency built upon that premise. It's really family systems perspective. So we believe firmly that you have to include the family in the treatment with the child. We're going to talk

about that in a minute. Yeah. And that is that is so that is such a message we need to get out. And I'm gonna tell you, it's not out there with all therapists. But anyway, before we get to that, let's also ground ourselves with some of the background here. Why do you think competency and adoption or foster care issues is important for a therapist, and for therapists working with these children and families?

Yeah, well, you know, as I said, I started did this work, I'm a licensed marriage and family therapists. I've been doing this work for 35 years, I thought I had great knowledge coming into this specialization of adoption. And, you know, I learned through the children and families that we treated, that there are there are nuances to the support that's needed and the kind of training around where it's well seated in attachment. Well, it's well steeped in the areas of loss and grief, where it's well steeped in the issues of race and identity and ethnicity and culture, where it's, you know, seeped in the underpinnings of adoption through a developmental framework where you're talking about issues in relationships with birth, family members, and searching reunion. I mean, all of these constructs are not taught to us in graduate school. In fact, there has been research that showed that very little of this is ever touched upon in graduate school. And the research showed that in postdoc professor said that maybe they spent about seven and a half minutes total, seven and a half minutes talking about these issues. So that's why I came into wanting to pursue this this workforce development area, because we were seeing here at cases family started to come for support, that they had had many other treatment, interventions and episodes with therapists, but the outcomes were not great. And if you look at the research, you know, for particularly children from foster care, 80% of kids in care, have significant mental health issues. But yet, when you look at the outcomes, it's very concerning. And it's concerning, because we don't have, you know, when I'm saying is a workforce that has those skills to treat this population. And we have to own that, as therapists, you know, that we have to, there's a lot of things that we don't know, and if we choose to specialize in something that might be maybe a child that you're seeing has an eating disorder. I mean, the question is, how skilled Am I to be able to treat this this clinical presentation? And if I'm not I refer out? Or is this something I want to get more training in?

Another thing that I see utilized? Is it when when therapists are advertising? Is trauma competent? or trauma informed? How does that relate to adoption or foster competence?

So we embed sort of the trauma, you know, training and the foundational elements of what trauma is and the impact upon the child and the family throughout our adoption, copsey training. So it's a piece of it, I think that trauma informed is, I mean, critical training that that anyone really working with children today should have. But when I'm when I'm trying to articulate is, the issues are so broad, when we're thinking about the foster guardianship, kinship, adoption constellation, that it's just not one protocol that one needs to be trained in. It's a body of knowledge that really you have to embrace, and to be able to call upon, as you're assessing the unique needs of each child and their family. Because not no two families and children are the same.

And that perhaps the underpinning it, we need to have a knowledge of trauma and how it impacts these kids. But there are many other things in addition to trauma, because that also needs to be considered. Am I understanding you correctly?

Yeah, I mean, so I can I can give an example of why that's important. So as I said, we've been leading to two initiatives here, across the country. One is the training for adoption competency, which is TAC, which is an evidence based curriculum that case developed in 2009. And it's now rated by the California evidence base clearing house, and it's also the only accredited adoption comp see training program in the country. And then in 2014, we were given the award by the Children's Bureau, there was a five year cooperative agreement to create to state of the art web based training programs to infuse adoption competency into all child welfare agencies, tribes and tort territories, and community based mental health. And so we piloted we develop this very rigorous training, it's 20 hours for child welfare professionals and 25 for mental health providers. And we pilot tested in eight child welfare systems across the country and one tribe. And what was really exciting was that we ended up with over 6000 providers in child welfare and mental health that took the took the training And we learned an awful lot about what what these two professional populations knew or didn't know, in relationship to being able to support our children from a mental health perspective. And sadly, what was, you know, what surfaced out of rigorous evaluation that we conducted was there were eight modules, and a lot of those modules had the same competencies that we've been talking about. But one in particular was the module on loss and grief. And in the child welfare population, these are child welfare workers and their supervisors, again, several 1000 that took this training with a 73% completion rate. In the pretest, they could only answer four questions correct, like four out of 100. Prior to taking NTI. Afterwards, they were almost at 100%. And what was so concerning was that if you think about loss and grief as being sort of the hub of the experience of our children, you know, being removed from their biological families, all the losses that that occurs in the impact that it has on mental health. And you think about who's holding them in child welfare is the child welfare worker. But the child welfare workers didn't have the skills to begin to talk about the issues of loss and grief with the children. Then when we looked at the data on the mental health side, and these were mental health practitioners that had over 12 years of experience, these were not newly trained therapists, the modules that they struggled with, and they scored even lower was attachment. So you have child welfare workers that can't talk about loss and grief, and then you have mental health providers that are being referred to children who don't know anything about attachment. That's pretty concerning. And then we wonder why our children are struggling with depression and anxiety and parents are struggling and adoptions are being compromised. So it just really validates the work that we're doing. And it's not intentional. But you know, in some ways, you know, we focus so much on trauma, that we forgot a lot of these other pieces, and even on the trauma modules, they were not scoring as high as they would have, you would think they would have given all the trauma training that's out there.

And there is quite a bit, is there one type of therapeutic model of treatment that is more effective for adoptive children and families, and there are so many out there, and I would assume that all of these could become adoption or foster competent or adoption, competent being the term that is most often used. I mean, there's theraplay, there's didactic developmental psychotherapy, trust based, relational intervention, tbri, narrative therapy, EMDR, eye movement, desensitization and reprocessing. Is there one type of model? And is there any research out there are a map?

There's not one type of model? And I don't think there will ever be just one because, again, the the needs are very diverse. I don't believe just one is the answer. So there isn't one that we can speak of all of those treatment protocols are embedded in our curriculum where we're educating the therapists about each one with its application. And you raise a really good question. None of these protocols have been studied, effectively, efficiently or in any depth with this population of children. There just hasn't been enough funding in the research realm, you know, to really look at studies of efficacy on this population of children. I hope one day the field will focus on that, and there will be funding for that. But there hasn't been.

But any of these therapies, if I'm hearing you correctly, have can be can be successful. Absolutely. At any of these, any of these therapists who practice one of these therapeutic models can be adoption or foster competent.

Yes, any of those. And again, like when you go to your physician, you have an ailment, there's an assessment, and then there's a protocol. So I mean, it's the same thing in mental health is that that's our job is to conduct a very thorough assessment, to develop a treatment plan and think about what is the most effective tools, interventions that we can use to help address what we're seeing, and all of the things that you have spoken of are effective with certain mental health diagnoses and disorders and clinical presentations, but you have to know which one and you have to be skilled in delivering that one in which a lot of folks our folks are specially trained in EMDR PCIT or play therapy, and that's a good thing. Yeah,

yeah. Yeah, exactly. Different families, different children respond to different things. Yeah. Hey, guys, did you know that we have a monthly newsletter through creating a family It is absolutely terrific. If you are not a subscriber yet to this newsletter, please go to the following link to subscribe now. And that link is Bitly slash C A F guide, I'll spell that out bi T dot L y slash C, A fgu IDE, you will get our free downloadable guide parenting a child exposed to trauma when you do. And then of course, even better than that you will get our great content delivered right to your inbox monthly as well. So you mentioned this earlier about therapy with adopted or foster kids on adoption issues or foster issues involving not just the child? Let's talk some about that. Because I, as I mentioned before, I don't think we hear from we have a huge online support group and the number of times we hear from families, where not only is are the parents not being involved, the parents are not included in as to what's going on. So let's talk some about the importance of why do you use the Family Systems Approach? And why do you believe that is the better approach when working with adoptive and foster kids?

Well, my lens I'm I'm trained as a marriage and family therapist. So that's my my core of who I am as a therapist. So I can't imagine that you would treat particularly a child, particularly children, in our space, independent of a family when most of our work is helping children transition, whether it's it's reunification, whether it's guardianship, or whether it's permanency through adoption, you're working within a systems framework, and to leave the parent out of that process is counterintuitive to me, I also believe is that parents are really the experts on their children, you know, we as therapists might spend 50 minutes a week with a child, and to discount what the parent knows the interactions, the interplay, the interpersonal reciprocity of those relationships is I just, you know, I couldn't I couldn't work in that framework, and we don't hear a case and in our training, in fact, that's one area in our tech training, we look at change of practice, from the clinician and acquisition of knowledge. And the greatest change in practice is moving from individual to family. Interesting, that they have learned through this training the value, I mean, it's harder, I mean, think about it, you know, you're not in a room with one person, you might be in a room with five people. I mean, it does take a very different skill set. And it does take different training, and a lot of therapists are not either trained or comfortable with that modality. But for the parents listening today, I do have a strong bias. And my bias is that you shouldn't be involved in the treatment, you should request to be involved in the treatment. And if there's the therapist that's not willing to work within a family perspective, then I don't think that's right for your family.

We're seeing and hearing a lot more about home based therapy, it addresses the issue that you had spoken about, you know, a therapist may be with your family for 50 minutes, and they also don't see the the nuances that are in the home. And sometimes quite frankly, the chaos or, you know, the fact that you know, grandma comes in and out and the fact that you know, there's a baby constantly with colic, crying or whatever. Just the so what are your thoughts on home based therapy?

Yeah, I think home based therapy can be extremely valuable. Particularly if you're working with a very taxed system, you know, where typically home based services are very intensively focused, right, where things have gotten fairly out of control at home where the family is feeling overwhelmed, feeling depleted, feeling at their wit's end. And I think coming in and having that kind of support, and as you mentioned, Don, the value of, of seeing it in, in, sort of, like in utero, like in and happening is, is often really valuable. There's could be so many dynamics that we don't see. It's sort of like doing telehealth now versus having, you know, families and face to face, you know, that that, that creates some distancing. So, I think that it can be really productive for families and something that, you know, we support with a lot of the families that we're working with and collaborating with those entities that provide home based services and you have, you have to help the families feel comfortable because often they feel like they're under a microscope and I don't want somebody You know, when somebody's coming into my home,

and they feel self conscious about the fact that, you know, the, there's still laundry sitting on the couch, or in our case, the dining room table, the, which, of course, is really a folding table for laundry. So I think there is self consciousness, but the it seems one of the most powerful things is the ability to put into practice. Okay, this is happening right here. We've talked about this, and this type of what could be what could be some of the underlying things? And what are some techniques? So it's the ability to put into practice, that seems to be particularly strong. You mentioned telehealth, what are your it is this is a fast changing time. And it's an interesting, I can't tell you the number of personal friends I have that are therapists that don't ever want to go back to. They love telehealth. And this is and don't ever want to go back to seeing having office hours and seeing people in their office. How does that impact however, two questions One, children and youth? And the second question is, is when you're working with the family system does telehealth lend itself to that?

You know, I think telehealth can lend to a lot of populations and a lot of situations, I think for some kids and some families, being in the office is really imperative. And you know, that's what we're trying to navigate. Now as you're right most most therapists and most families now have gotten very comfortable with, you know, the zoom through, you know, telehealth through zoom. But we're beginning to see here at case other families that are saying that we really want to come back in, we really feel like it's not as effective, particularly with kids with a lot of attentional issues, or, you know, very, I would say complex mental health presentations, and also families that might be struggling as the ones we were saying earlier, where we can be more effective in office,

I suppose we have to individualize we have to be open to the it sounds like to both options.

Yeah, just like our physicians are today, you know, you can either have a telehealth with your physician or go into the office. So I think it's provided an opportunity for families that are living in rural areas, or, you know, who can't manage to get into the office a real opportunity. So it's it's broken a lot of barriers, which is wonderful. It's allowed us to reach further, but at times doesn't take the place of in office care or in home care.

Yeah, I guess with so many things. We are all individuals and our families are all in the family's adoptive families, foster families are all individuals, and we can't there's not a one size fit all. Which speaking of fit, how can a parent determine if a therapist is a good fit for their child and their family? And what are some questions? They should be asking to make it that just to make a determination? Well, first

of all, I think it's important to find out about the therapists background. So you ask about what questions like I'd want to know, what type of clients do they work best with? You know, do they treat young children? Do they only treat adolescents? Have they worked with children who have joined their family through adoption? What does that look like? Is that most of their practice? Is that maybe a few families? How do they view adoption? What do they think are some of the issues that might present itself? For family a child who is adopted? Have they what experience have they had working with reunification with birth family members? What experience have they had in working with children who've had, you know, time in foster care? So I would want to drill down deeper to not just check a box because often you can read our profiles, and we check all these boxes and it says adoption, check the box. But to be able to ask more specific questions about what they're seeing in regards to, you know, adoptive families and children.

And from a very practical standpoint, how does this work? Do you schedule an appointment to you have a telephone call where you're interviewing them? And and should you view it as an interview? So just from a practical standpoint, how does this work? Well,

it depends on the therapist themselves. You know what, sometimes there isn't the opportunity for an interview or you know, you might have a 20 minute consultation and just be able to ask some more questions after review the profile, possibly set up a consult with a therapist and come in before you bring the child in to get to meet the therapist and have some questions about, you know, how do they work? Do they include the family? What does that look like to maybe negotiating and say, Well, you know, we'll try. Oftentimes, we'll say let's try three or six sessions and see how discos, is it the right fit, and also to listen to your children, I know that some kids are treatment resistant, don't want to go no matter who it is. But sometimes they'll be very clear and say, you know, I just I couldn't connect with that lady or that guy or God, they felt weird, or, you know, I mean, kids, kids, you know, can also give you some feedback about what it was like, or I, you know, I really liked it, I'm, I would like to go back. So don't discount what your children have to say also about the experience.

And also not just what they say, but how they're acting in the sense that they have seen wear, a team will have our child to be resistant. But yet, even though they're, they still complain, and you also notice that they're quickly getting to the car, and they're not putting up as many barriers, even though they're still complaining loudly, you could tell that the barriers are coming down. And some of this is just protesting for the sake of protesting or to, you know, keep their honor. How many sessions? Is it? Should you expect to try in order? Before you make that decision, I liked what you said about setting up at the beginning, saying, let's try three sessions, or let's try six sessions, because it gives you a specific time, then that you can reassess. But is that common? And I think people worry that if we end up at six sessions, and we don't want to continue, are we hurting our therapists feeling?

Well, you know, we all have to accept that. Clients may not continue with us. And that's, that's part of our world. And we may choose that this, that we're not the right fit. I mean, it can work both ways where I think sometimes as therapists, you might feel like I don't, I'm not sure I'm the right therapist for you, and maybe make a referral to someone else within your practice or outside of your practice. I like the three to six sessions, particularly for I mean, my area of expertise is the adolescents and you're right, you know, they're not going to come skipping down the hallway, into the office rarely. And for those that are a little bit more resistant, or like you said, want to say face, I said, you know, it's okay, let's just meet three to six times and then, and then We'll reevaluate. And by the time we get to the sixth session, they're, you know, embedded into the process, they want to continue coming. And sometimes, maybe not, maybe after six sessions, mate, maybe right now is not the right time for treatment, you know, I mean, that's something else that we have to be aware of, and try to make that assessment. Sometimes we have to push it harder when children are, you know, what I say in danger and really need of being in treatment. And other times, maybe it's okay to take a pause and say, You know what, let's, let's get back in a couple of months and see where we are. But that's around the safety issues in the middle, you know, sort of the stability, where if kids are making that assessment.

Let me stop here and tell you about a free educational resource that we're offering. Thanks to the Jackie being Family Foundation, we have 12, free online courses available right now for our listeners, you can find them at Bitly slash JB F support. And you can see all the titles there, there are 12 of them. The link again, is Bitly, bi T dot L, Y, slash, j, b, f support, check them out. And be sure to tell a friend about him as well. I wanted to circle back with the talking about therapy within the home home based therapy. How do parents find someone if they are? They feel like that model might work well for them? And they could use that? How do they find such a place? One place is the Family Center treatment foundation. That's one place to go to find this information. But are there others? Are there other ways to find home base therapist?

I would say that what the best way to approach this and often it's the child welfare agencies that have contracts with or relationships with home based, it's usually organizations versus the therapists themselves. And it's usually an entity that specializes in home based services in their wraparound services, they're much more intensive. And so I think you're you'd have to reach out into your community. And as I said, one place might be the child welfare agency themselves, knowing what organizations exist out there that provide the service because they're high end services.

And they're not inexpensive and that is the other thing that one has to make certain that your insurance covers it or that it you're referred, there are some referral criteria that might that might kick in that you need to be cognizant of, from a financial standpoint. Correct. Yeah. And, and also circling back to telehealth. You have certainly a case as well as is really I think the entire mental health profession has had a lot more experience. It's in the last several years with teletherapy. What are some? How can we make that more effective? Let's say that for you believe that that's going to work best for your family? What are some ways to make that more effective for your family, for your for your child as well as the family unit?

Well, it certainly would want to back to the questions I've been asked the therapists have they had some specialized training in the delivery of telehealth, like all of our therapists here at case are certified to deliver telehealth? I mean, you know, really to go through a training, there are certain things that I think that we need to put into practice to ensure the confidentiality to ensure that we're delivering the service in the most effective ways to working with families and setting some boundaries about what that looks like, like, we're not going to do it as you're doing your laundry, are there 20 People walking in and out of the room that is there a quiet space, a specific time, you know, obviously, that we're setting up the session, who was supposed to be in this session, at what point in time, you know, not being distracted? You know, sometimes you'll see kids where they've got incredible systems in their room, and they're looking at screens, and you know, they're looking at not the screen that you're looking at, but another screen, or they're playing video games, or they've got their phones, and they're texting, so you have to set boundaries around, you know, what this relationship is going to look like. And a structure if you're providing telehealth services.

How do you handle the issue of multitasking as a therapist? Because I, and how should parents try to help handle that, assuming they're not the ones quite frankly, they may be the ones who are multitasking. And by I use that word multitasking, loosely, checking social media checking, Tiktok, checking in or playing a game, all of those counters multitasking?

Yeah, well, we'll talk with the parents about it. So if it's a younger child, we might have the technology, you know, put on the kitchen counter, where they're not coming into the room where the computer set up for the session. I mean, again, setting some ground rules, creating a very safe, quiet space, letting the other family members know, depending upon who's involved in the session that day, you know, that this is going on in this room from this period of time. And often we'll call kids out on it, you know, we have to say, we need to pause here, I need you to focus on on our work together here. So let's look at what's distracting you right now, and find a way to lessen that distraction. Or we may have to end the session for today. Because you have to set some boundaries around it, or all the sudden you get on Zoom and they're in the car. And we're not going to do therapy in the car. I mean, no, that's, that has led us to people in walking in parks and walking their dog in all kinds of places now. And we really have to set that that boundary around what's appropriate and what isn't appropriate, you know, lying in your bed with in your pajamas and all kinds of things.

Wow. Yeah, those are all things that you would need to think through. And that's one way of being able to determine if the therapist has much experience, because if they're not setting these boundaries upfront, that gives you an idea that perhaps they haven't had a lot of experience working with, in particular working. I think it's different if you're working with one adult versus the family unit involving a child.

Yeah, yeah. And then, you know, how are you? I mean, I'm really proud of the, you know, the work that we've done here over the years during COVID, because you have to find ways to transfer some of the clinical tools that you're using in office, know, like, think about theraplay or think about sort of the more the expressive therapies, how do you begin to integrate that through a telehealth modality. So we were sending children home, you know, art packets of materials to use in their therapy that typically we use here, so that we can continue some of that work.

Interesting. What are some resources for? Well, for therapists, because there'll be a number of therapists listening to this as well? What are some resources on how to improve? Because there are some sounds like there are some very creative ideas that have been learned, and especially in the last several years about how to do telehealth, well, what are some resources that that we can send parents or therapists to for, for upping their their telehealth game?

Yeah, I mean, you could just Google Now, you know, therapeutic, you know, tools to be used, you know, through telehealth and millions of things will pop up and a lot of the different modalities that people have been trained upon now have some adaptive tools that you can use it in a telehealth. And then for some, I mean, you know, I know our clinicians worked, you know, as teams to really think about things that they could create that worked well through a telehealth modality.

And how to determine whether the This particular person you're working with is responding well, to telehealth or when you need to, especially now that we have the option when you need to say no, this is really, this is not working. Right, right. Yeah, exactly. I want to send a special thanks out to one of our longest partner agencies, they are children's connection. I don't know when they became our partner and started supporting this show. But it was been a long time. Children's connection is an adoption agency providing services for domestic infant adoption, and embryo donation and adoption throughout the US. They also provide home studies and post adoption support services to families in Texas. Thanks, children's connection for your support. So when should families seek therapy? I realize it's a very general question. But it's a question that, you know, obviously, if a family is in crisis, where the parents are at their wit's end, and really don't know whether that nobody is happy. Okay, so that is that's one extreme. But oftentimes, we have families that are that are not at that extreme. And they're wondering, do they need a tune up? Is their kid doing relatively well? Are they making a problem there? Where there isn't one, if they're suggesting therapy? So how do we know if we're not at the extreme? Obviously, if, if the child is in danger, or the family is in danger, as far as of disconnect, dissolving the adoption, or disrupting the placement? That's we know, then that therapy, actually therapy? Might that point be too late? But how do we know for some of the lesser cases, when to suggest therapy?

I think again, goes back to the the parent being very intuitive. If you're asking yourself that question all the questions that you just mentioned, then I think that's where you reach out. And let a professional help you assess that. If you think if you're thinking does my son or daughter need therapy or extra support, because I'm worried about this, or I'm seeing this or there, they might be acting a little differently than they normally do, then I would seek that support, you know, I wouldn't make that assessment by myself. But rather, again, go find a therapist that you feel is competent to address your family and get an opinion about it, and then make some decisions around that.

Does it make sense to have what we used to call a tune up? You know, that my know, my, let's say, My child was adopted at a young age seems to be doing well. I don't really see any issues, but they're approaching adolescence, or they're in the midst of adolescence? And I'm not sure you know, should they? Should they have somebody? Do we need to address these adoption issues, when my child doesn't seem to have that need?

So I think it's really important that we as adoptive parents of which I am really tried to promote what we call communicative openness, that we're always sort of rolling some conversation about adoption throughout the journey from developmentally different times talking about it. Maybe there was a movie that you saw that had an adoption theme, maybe it's around your adoption day, how do you celebrate that maybe it's around a birthday, I mean, wherever it presents itself, you want to help children feel that it's okay to talk about these things. You know, if the family is not talking about it, often the children won't. And I think, again, if you're thinking and seeing something that you're concerned about, and you raise an interesting point about adolescence, because in any time in an adoptees life, that they're likely to enter therapy, it's during adolescence. I mean, I've spent my whole career focusing exclusively on this complexity of adoption in adolescence and wrote a book about it. So it's a population of children that we see more of here at case than any other ages during adolescence, because it's a time where you know, your brains evolving to a point where it can think more abstractly and you're really re thinking about how adoption came into your life, what does it mean to be adopted? And then how does that impact who I am as a person and those complexities of integrating, you know, the birth family and the adoptive family and that sense of self. It's also a time for children who've had early histories of trauma, to really begin to revisit all of those early traumas. So I think parents know when things are off kilter. I really believe that dawn, I think sometimes what keeps them from reaching out is they don't know who to reach out to. And that's why I think what you do is so important, and hopefully this dialogue today will be important to affirm that to them that you know, there are professionals out there you should ask the question again, what kind of specialized training that they have in a day option foster care. But maybe, you know, you might have to push your kids a little bit and have them see someone to talk about some of these issues.

And let me mention, I will link to this the book, the book, and it's, it's excellent. And we have actually, Debbie, you. And I've talked about the book before. But we recommend this book all the time, beneath the mask understanding adopted teens excellent book for all parents and parents of not just teens, but those who are approaching teens, we recommend that as well, so that you can be thinking about it.

Yep. And I want to share that we have another companion book now that we actually is for teens, written by teens. So it's really kind of a cool, it's a workbook and happy to you know, it's beneath the mask for teens. And we had a lot of young people who receive services here at case decide to share their stories and parents were reaching out to saying, you know, we don't have anything from other kids to speak to our kids. So it's really a beautifully well written book. And it's actually written as a workbook so the kids can interact with it and, you know, begin to think about issues around identity and issues around adoption in general and loss and grief. So I would encourage parents who are listening to look at the book and maybe give it as a resource to their kids.

Absolutely. I highly recommend that. And the last question is, I think there is value with, especially from young people, as well as adopted adults, to finding a therapist who's had the lived experience of having been adopted or having been a in the foster care system. How do we find a therapist with this lived experience?

Well, what we tend to see like we're keeping data on our TAC, train therapists, and also ones that are using the federal web based training there, there's always an over representation, I think, of those with lived experience in this field that attracts us to this work. Some therapists are very open about sharing the fact that they're part of the adoption constellation. And some may be a little reticent, maybe that comes out later on. But again, that would be another question that I might ask as a parents interviewing is, do you have a personal connection to adoption? And they may say, Well, I'm adoptive parent, I'm a birth parent and adoptee or I have a family member that's adopted. So certainly, really important to ask that question, and oftentimes can be extremely valuable to have that relationship with someone that has lived experience.

And I will say that creating a family has a list of, of ways to find adoption competent therapist. But as we have a, we list, a directory that has been created for therapists with this lived experience so that you can utilize that directory and it's broken out by the type of adoption, as well as, of course, the state that the therapist is in. Well, thank you so much. I want to allow you to now have the opportunity to tell us anything more you want to tell us about the the TAC or the NTI training and, and data. You guys have been doing it for a while now. What have you learned, and you've shared some of the beginning that you learned, but anything, anything in addition that you want to share?

Well, I think what we learned is that this knowledge base is desired by therapist and child welfare workers. And so if we have therapists listening, please visit cases website. And you can find out how to engage in either one of the trainings that the NTI training is free, it's web based their CPE credits attached to it. And for TAC, it's much more longer commitment. It's 72 hours of a training. It's an assessment based accreditation program. So I encourage you, if you want to specialize in this work, please feel free to visit and look into it. What we're seeing is that there is value, Don to this specialization, I think the field has begun to see, as I said earlier, the concern about the poor outcomes from treatment and that there is now a need for specialization, I think we've documented the need and we've also documented the outcomes of having therapist train. We had a small study that we completed about a year and a half ago that was funded by the Annie Casey Foundation to start looking at the impact of adoption competency and training upon families. So we studied families in Virginia that had received services through an adoption competent trained therapists through TAC, and families that didn't. And the outcomes were really affirming that families felt more connected. They felt their outcomes were better. They felt that the therapist understood what it meant to be an adoptive family. that they had positive adoption language, and that they really were much more effective in working on relational issues working with families and attachment based therapy. So we're now showing the efficacy not only in therapists acquisition of knowledge and changes in practice, but now the impact on families.

Excellence great work. I am so glad you're doing it. i i there's such a need and I'm so glad somebody's out there doing it. Thank you so much, Debbie Riley for being with us today to talk about finding an adoption and foster competent therapist.

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