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Independent evidence review of post-adoption support interventions

Research report

This report presents the main findings from a review of available evidence relating to 15 adoption support therapeutic interventions between August and November 2015. The interventions were selected as those that are most frequently funded through the Adoption Support Fund (ASF) or judged to be most high profile in the field of adoption support. This review was an initial step in a longer-term process led by DfE to improve the evidence base in post-adoption therapeutic support. Its overall aims were to better understand key post-adoption therapeutic interventions for children and families; to examine the extent of the existing evidence on their effectiveness in achieving successful outcomes for adopted children and their families; and to identify gaps and make recommendations on what future research is needed.

Many adopted children have experienced painful, fragmented, unstable and chaotic beginnings to their lives, and evidence suggests that a high proportion – as many as 72% – have experienced abuse or neglect (Selwyn et al., 2014). These children have often suffered from psychological, sexual or physical abuse, neglect and malnutrition, exposure in the family to drugs and alcohol, parental mental health problems and domestic violence (Lewis and Ghate, 2015). This often results in a range of emotional and behavioural challenges, leading to adopted children being more likely to experience physical, emotional, cognitive, educational and social development needs (Richardson and Lelliott, 2003), and being at greater risk of poor mental health throughout their life span (McCann et al., 1996; Saunders and Broad, 1997). Due to the disturbances of their attachment patterns and experiences of early life trauma, the most severe consequences for adopted children and young people are those affecting the quality of their relationships (Stateva and Stock, 2013).

There is a growing drive to improve the therapeutic mental health support for adopted children as highlighted by Pennington (2012), with the aim to address and reverse the emotional, psychological and developmental traumas they may have suffered in their early lives. This concern was embodied in the launch of the national Adoption Support Fund (ASF) in May 2015, which initially provided funds £19.3 million over two years to improve adopted families access to therapeutic support, including growing local markets of therapeutic providers – the ASF was extended in January 2016 to provide support to families over the next 4 years. The fund recognises that adoption can improve outcomes and stability for looked after children (Holloway, 1997), but that many families post-adoption have short- and long-term therapeutic support needs that are currently not being met, in particular help in managing the consequences of early childhood trauma, difficult behaviours and attachment problems (Randall, 2009; Atkinson and Gonet, 2007).

However, despite such an increased focus on improving post-adoption therapeutic support, there is a lack of knowledge of both the content of different interventions being delivered to adopted families through the Adoption Support Fund and their evidence base (Lewis and Ghate, 2015; NICE, 2015).