child welfare services and means of support.That continuum is illustrated in the flow chart below.

The International Social Service InternationalResource Centre for the Protection of Children inAdoption presents a similar continuum:

One can envisage a desirable hierarchy oflife environments that can be offered a child:

• Family solutions (prevention of abandonment

1

Background

The Pew Commission on Children in FosterCare presented this concept of a continuum ofservices as it relates to children in the arena ofpermanency planning.1 The Commission workedfrom the premise that “All children need safe,

permanent families that love, nurture, protect, andguide them” (p. 9). To achieve this goal for everychild, the Commission maintains that the childwelfare system must implement a full array of

1 The Pew Commission on Children in Foster Care. (2004). Fostering the future: Safety, permanence and well-being for children infoster care. Washington, DC: The Pew Commission on Children in Foster Care. Available athttp://pewfostercare.org/research/docs/FinalReport.pdf

National Council For Adoption225 N. Washington Street • Alexandria, VA 22314 • (703) 299-6633 • www.adoptioncouncil.org

CONTINUUM OF CHILD WELFARE SERVICES TO PROMOTE PERMANENCE FOR CHILDREN

by Elisa Rosman, Ph.D.with Chuck Johnson

This article presents NCFA’s philosophy concerning the continuum of child welfare and supportservices as provided to children and families in need of social services, either domestically or interna-tionally. NCFA is a vocal and enthusiastic proponent of domestic and intercountry adoption as a viableoption for children without families to care for them, and we believe this continuum should be non-hier-archical; the continuum is not “one size fits all,” as different options may prove better for different children and families. This article provides a framework for government officials, policymakers, andchild welfare practitioners to use as a reference as they work to implement policies and practices thathave an impact on the child welfare continuum.

FamilyPreservationServices

Community-BasedFamily Support

FamilyReunificationServices

Adoption Promotion and Support

AdoptionAdvocate

A PUBLICATION OF THE NATIONAL COUNCIL FOR ADOPTIONNO. 23 • APRIL 2010

NICOLE FICERE CALLAHAN, EDITOR CHUCK JOHNSON, EDITOR

2

Adoption Advocateand keeping the child in his/her family,returning the child to his/her family of origin, foster care, internal or intercountryadoption) must take precedence over long-term institutionalisation.

• Permanent solutions (keeping or reintegrat-ing the child in his/her family of origin,adoption) must take precedence over tempo-rary solutions that perpetuate themselves.

• Temporary solutions (foster care, placementin an institution) must give priority to thereintegration of the child in his/her family oforigin, or else to the search for a permanentsolution.

• National solutions (family reintegration,internal adoption) must take precedence over international solutions (inter-countryadoption).

Nonetheless, the important thing is not toapply this range of measures mechanically orrigidly. Every child is different; his/her historyand his/her personal and family situation are special (p. 4).2

While this ISS statement represents a morehierarchical approach than NCFA embraces, weinclude it here in our good faith opinion that theISS supports timely decision-making in the bestinterest of each child in question, and that they doin fact consider international adoption a viableoption and treat it as such.

Within the adoption community, the Familiesfor Orphans Coalition (on whose ExecutiveCommittee NCFA serves) has also presented itsown version of this continuum of services as itrelates to permanency planning:

1. In-home family preservation services tosupport families and prevent institutional-ization and re-institutionalization. Thisincludes the development of community-basedsocial services, such as short-term, time-limitedrespite care, or interim foster care placementfor families in crisis; day care and protectiveday care; home health or nursing visitors; child

development services; and/or targeted incomesupport for families in financial crisis and atrisk of dissolution.

2. Reunification. A primary objective of thechild welfare system is to identify and prepareprimary and/or extended family members toprovide safe, permanent family care for indi-vidual children or sibling groups currently ininstitutional care in a timely manner.

3. Adoption – domestic and international.For children for whom family preservationand/or reunification is not a timely possibility,families should be provided either throughdomestic (in-country) adoption or intercountryadoption before the decision is made to leave achild in long-term institutional or foster care.

4. Guardianship, mentoring, and independ-ent living for older children and youth,either with family members or in a safe,permanent legal setting with members oftheir community, can be an option once it hasbeen determined that domestic or intercountryadoption are not practical, realistic possibilities.

5. Foster care services. Foster care shouldgenerally not be considered a permanent alter-native to institutional care.

6. Community responses to child abuse andneglect. It is imperative that communitiesdevelop and improve community-based childwelfare services, including the following:reporting systems that identify children beingabused or neglected; investigation and legalintervention when indicated; risk and safetyassessment; in-home interventions to protectchildren in their own families; and removal andplacement to ensure child safety when childrencannot be protected at home.

7. Strengthening public policy so that allnations can better sustain family care programs for children over the long term.

2 International Social Service. (1999). The rights of the child in internal and intercountry adoption. Retrieved from:http://www.crin.org/docs/ISS_ICA_ENG.pdf

3

Adoption Advocate

3 Save the Children. (2010). International Adoption Policy Brief. Retrieved fromhttp://www.crin.org/docs/International%20Adoption%20FEBB%20edit%2018_01_10.pdf 4 In concurrent planning, alternate permanencies goals are pursued at the same time. For further information, see: Child WelfareInformation Gateway. (2005). Concurrent planning: What the evidence shows. Retrieved from:http://www.childwelfare.gov/pubs/issue_briefs/concurrent_evidence/5 SOS Children’s Villages International & International Social Services. (2009). Guidelines for the alternative care of children: AUnited Nations framework. Retrieved from http://www.sos-childrensvillages.org/focus-areas/children-and-family/family-based-child-care/pages/guidelines-for-the-alternative-care-of-children.aspx

NCFA’s Statement

NCFA fully supports the idea of a child wel-fare continuum, and believes that it represents ourcore beliefs as an organization. Our continuum,presented below, ensures that adoption, bothdomestic and intercountry, remains a viableoption for children after family preservation or

reunification is ruled out as a timely and appro-priate option—and before a child is placed inlong-term institutional or foster care. (Weacknowledge that interim foster care may be anecessary part of the process for some children.)Drawing from resources outlined above, we present the child welfare continuum chart above.

While the list is presented as a step-by-stepflow chart, the specific needs of children andfamilies within each country may require devia-tion from this step-by-step formula. The implicithierarchy presented in this chart is often referredto as the ”Principle of Subsidiarity,” with the firstchoice being the preservation of the birth family,followed by a permanent family-based option inthe birth country, followed by intercountry adop-tion.3 We want to stress that, in NCFA’s view, theappropriate action must always be taken in the

best interest of the child, and the best action isone that shall result in a permanent, legal familyfor a child in every situation possible; the correctoption for one child and family will not necessari-ly be best for another. Also, when options are lessthan clear, agencies can and should engage inconcurrent planning to appropriately prepare fortimely and effective decision-making for the ben-

efit of the child.4 The importance of consideringthe needs of each individual child and family isalso emphasized in the United Nations’Guidelines for the Alternative Care of Children(2009): “All decisions…should be made on acase-by-case basis, with a view notably to ensur-ing the child’s safety and security, and must begrounded in the best interests and rights of thechild concerned” (p. 6-7).5

The concept of the child welfare continuumis clearly demonstrated in the advocacy work ofthe adoption community following the Haitiearthquake in January, 2010. Advocates are argu-ing for the child welfare system to be “built backbetter,” so that out of this tragedy a stronger childwelfare system can emerge. As KathleenStrottman, Executive Director of theCongressional Coalition on Adoption Institute(CCAI) argues:

Family Preservation/Reunification

Domestic Adoption

Intercountry Adoption

Foster Care = Interim Option

Institutionalization or Long-Term Foster Care = Last Resort

4

Adoption AdvocateWe can go about making plans to provideprotection to orphan children in temporaryshelters until they can be returned to theirorphanages, or worse the streets, or we cantake the recent outpouring of internationalsupport and use it to begin anew. Workingtogether, we can help the people of Haiti todevelop a child welfare system in whichHaitian children are being raised in safe, loving and permanent families, not by insti-tutions. Such a system could be built uponinternational best practices in preservingfamilies, providing foster care, as well aspromoting domestic and international adoption.6

We now present each stage of the continuum,followed by a review of research concerning childand family outcomes for each stage. While webelieve that the continuum has internationalapplicability, we specifically draw from theUnited States’ child welfare system for most ofthe information and examples presented below.

Family Preservation/Reunification

Description/Statistics

Ideally, all families would have the personaland financial resources they need to stay together,and there would be no need for foster care oradoption services. Even for children in fostercare, typically the “first choice” outcome is fami-ly reunification, when this is a realistic and viableoption that can be accomplished in a timely man-ner. For fiscal year 2008 (the most recent year forwhich data is available), of the 463,000 childrenin foster care in the United States, 226,867 (49%)

had reunification with parents or primary caretak-ers as their case goal. Furthermore, 148,340 chil-dren (52% of those who exited foster care in2008) were reunified with parents or primarycaretakers.7

The United Nation’s Guidelines for theAlternative Care of Children similarly maintainsthe importance of family preservation and reunifi-cation: “States should develop and implementconsistent and mutually reinforcing family-orient-ed policies designed to promote and strengthenparents’ ability to care for their children (p. 11).”8

Research clearly indicates how to keep fami-lies together and reunify families successfully. Inthe area of family preservation, the Guidelinescited above mention specific support services thatcan help enable families to care for and protecttheir children, including parenting courses, thepromotion of positive parent-child relationships,conflict resolution training, opportunities foremployment, and other social services.

An issue brief from the Child WelfareInformation Gateway also highlights key compo-nents of successful reunification.9 These include:

• Family engagement — This includes involv-ing the birth family in decision-making,encouraging foster parents to support birth-parents, and ensuring that the birthparentscan visit their children while they are in fos-ter care.

• Assessment and case planning — It is crucialto not only assess the particular needs andstrengths of children and families, but to thenmake plans that specifically build on theirstrengths and address their needs.

• Service delivery — Services targeted to the

6 Strottman, K. (2010, February 23). Orphan children of Haiti deserve a future [Web log post]. Retrieved fromhttp://ccainstitute.wordpress.com/?blogsub=confirming#subscribe-blog7 U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth andFamilies, Children’s Bureau. (2009). The AFCARS Report. Retrieved fromhttp://www.acf.hhs.gov/programs/cb/stats_research/afcars/tar/report16.htm8 SOS Children’s Villages International & International Social Services. (2009). Guidelines for the alternative care of children: AUnited Nations framework. Retrieved from http://www.sos-childrensvillages.org/focus-areas/children-and-family/family-based-child-care/pages/guidelines-for-the-alternative-care-of-children.aspx9 Child Welfare Information Gateway. (2006). Family reunification: What the evidence shows. Retrieved from http://www.childwel-fare.gov/pubs/issue_briefs/family_reunification/family_reunification.pdf

Adoption Advocate

5

10 Wulczyn, F. (2004). Children, families, and foster care. The Future of Children, 14, 95-113.11 Parks, Y. (2009). Children and families first: A chronicle of the Alameda County Social Services Agency Foster Care System.Retrieved from http://www.casey.org/Resources/Publications/pdf/Alameda_ChildrenFamiliesFirst_FIN_LO.pdf 12 Placek, P. (2007). National adoption data. In T.C. Atwood, L.A. Allen, and V.C. Ravenel (Eds.), Adoption Factbook IV, (pp. 3-69).Washington, D.C.: National Council for Adoption.

specific needs of children and families mustbe provided.

There are also ways to promote family reuni-fication system-wide. These include:

• Funding to support reunification efforts• Court-related reforms, such as increased col-

laboration with child welfare agencies• Improvements for child welfare staff (lower

caseloads, lower turnover, etc.)

Outcomes

How can the success of family preservationand reunification be measured? For family reuni-fication, the most obvious measure is whether ornot the family is able to remain together in thelong term. The available data for family reunifi-cation is not overwhelmingly positive. In a reviewof family reunification for The Future ofChildren, Wulczyn finds that nearly 30% of chil-dren who were reunified with their families in1990 had reentered foster care within ten years.He provides an overview of programs and prac-tices that show promise in promoting and sup-porting successful reunification. These includeprograms that are comprehensive, theory-based(i.e., based on empirically proven theories andintervention strategies), culturally competent (i.e.,acknowledge cultural differences and norms),build on families’ inherent strengths, address chil-dren’s developmental needs, and provide ongoingaftercare.10

Another measure of family preservation iswhether fewer children are entering foster care inthe first place. One example of a community thathas successfully embraced family preservationand reunification is Alameda County inCalifornia. In that county, the number of youthentering the child welfare system decreased by40% from 2000 to 2007. According to Carol

Collins, Assistant Agency Director at theDepartment of Children and Family Services,“One of our themes became ‘Let’s focus ourefforts on early intervention, prevention, andkeeping children safely at home’” (p. 19). Thecounty accordingly implemented the AnotherRoad to Safety (ARS) Initiative to target threecommunities and provide services via socialworkers. The social workers helped link familieswith support services such as medical care, devel-opmental assessments, job training, and basic lifenecessities. There was also a team to provideongoing support, which included psychologistsand developmental specialists. In 2003, AlamedaCounty implemented the Annie E. Casey Familyto Family Initiative, which focused on developingpartnerships within the community and stressingfamily involvement in decision-making. In addi-tion, the county applied for a Title IV-E waiver inorder to use funds to help keep children fromentering foster care in the first place.11

Domestic Adoption

Description/Statistics

Domestic adoption typically occurs via pri-vate adoption (primarily infant adoption) or fromthe foster care system. The most recent and com-prehensive data regarding the number of domesticadoptions in the United States, dating from 2002,can be found in NCFA’s Adoption Factbook IV.In that year, there were 76,013 unrelated domes-tic adoptions. Of those, 22,291 were infant adop-tions, 56.5% were by public agencies, 22.4%were by private agencies, and 21.1% were by pri-vate individuals.12

6

Adoption AdvocateOutcomes

From a research and policy perspective, it isimportant to investigate outcomes for adoptedchildren: Do they fare better or worse than theirnon-adopted peers? Of course, it is difficult togeneralize about such a diverse group of children,but recent data sheds some light on this issue.The National Survey of Adoptive Parents (NSAP)was conducted between April 2007 and June 2008as an add-on to the National Survey of Children’sHealth, specifically for families with adoptedchildren, and a Chartbook was recently publishedpresenting data from the NSAP.13 It is the firstsurvey to provide nationally representative infor-mation about adopted children and their families, and it includes interviews withfamilies of 2,089 children, representing the nearly1.8 million adopted children in this country.

NSAP data provides a generally positive pic-ture of outcomes for domestically adopted chil-dren. Overall, their physical health is very good.81% of parents who adopted children from fostercare and 84% of parents who adopted via private

domestic adoption report that their child’s healthis “excellent” or “very good.” As the table aboveshows, the authors did find that, while overallthey are doing quite well, children adopted from

foster care are more likely than children adoptedprivately to demonstrate certain problems in theareas of social and emotional well-being. Thismay result from the fact that children are typical-ly adopted from foster care at an older age thanchildren adopted domestically; additionally, thesechildren may have suffered abuse and neglect andmay have been in several temporary placementsprior to being placed in a permanent adoptivehome. As the Chartbook authors explain: “As agroup, the pre-adoptive experiences of childrenadopted from foster care—many of whom areadopted at older ages than children adopted fromother domestic sources or internationally—arelikely to make them more vulnerable than otheradopted children” (p. 6). This points to the impor-tance of timely decision making for childreninvolved in the child welfare system.

Academically, children adopted domesticallyalso seem to be doing well. For children adoptedfrom foster care, 50% of parents rated their read-ing and language arts skills as “excellent” or“very good,” and 41% were rated “excellent” or

“very good” in math. For children adopted pri-vately, those percentages are 64% and 58%,respectively. As for being engaged in school, 61%of parents whose 6-to-17-year-old children were

13 Vandivere, S., Malm, K., & Radel, L. (2009). Adoption USA: A Chartbook based on the 2007 National Survey of Adoptive Parents.Washington, D.C.: The U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning andEvaluation.

Children Adopted from Foster Care

Ever Diagnosed with Attachment Disorder

Ever Diagnosed with ADD/ADHD (age 6+)

Ever Diagnosed with Behavior Conduct Problems

Problems with Social Behaviors

Exhibits Positive Social Behaviors (age 6+)

21% 6%

38% 19%

25% 11%

18% 10%

83% 91%

Children Adopted Privately

Adoption Advocate

7

adopted from foster care report they are usuallyor always engaged in school. That figure is 74%for children adopted privately.

For these families, the parent/child relation-ship is generally strong as well. Seventy-five per-cent of parents with children adopted from fostercare and 85% of parents with children adoptedprivately describe the parent/child relationship as“very warm and close.” Eighty-one percent ofparents of children adopted from foster care and93% of parents of children adopted privatelyreport they would make the decision to adoptagain.

Intercountry Adoption

Description/Statistics

UNICEF officially recognizes the importanceof intercountry adoption. As stated in their posi-tion on intercountry adoption: “For children who

cannot be raised by their own families, an appro-priate alternative family environment should besought in preference to institutional care whichshould be used only as a last resort and as a tem-porary measure. Inter-country adoption is one of a

14 UNICEF. (nd). Statement: UNICEF’s position on Inter-country adoption. Retrieved fromhttp://www.unicef.org/media/media_41118.html15 United States Department of State. (nd). Total adoptions to the United States. Retrieved fromhttp://www.adoption.state.gov/news/total_chart.html

NCFA believes that intercountry adoptionshould remain a viable option as long as there arechildren in other countries who need families andparents in this country who are interested inadopting internationally. Dr. Elizabeth Bartholetof Harvard University recently addressed this

issue before the Inter-American Commission onHuman Rights at the Organization of AmericanStates.

In November 2009 the commission held ahearing on the human rights of unparented chil-

25,000

20,000

15,000

10,000

5,000

0

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

15,719

18,85719,647

21,378 21,65422,990 22,734

20,68019,609

17,475

12,753

Adoptions to the United States

range of care options which may be open to chil-dren, and for individual children who cannot beplaced in a permanent family setting in theircountries of origin, it may indeed be the bestsolution. In each case, the best interests of theindividual child must be the guiding principle inmaking a decision regarding adoption.”14

Despite this international validation, howev-er, intercountry adoption among American fami-lies is decreasing. According to the Department ofState, 12,753 children were adopted in 2009.15

As the graph below illustrates, adoptions havesteadily decreased every year since their peak of22,884 in 2004.

(Source: http://www.adoption.state.gov/news/total_chart.html)

Adoption Advocate

8

dren. In her testimony, Dr. Bartholet argued that,in the area of intercountry adoption, human rightsarguments have focused too heavily on the humanrights of parents and the sovereignty rights ofstates. She argues that the human rights ofunparented children must be considered as well:

We assert that children’s most fundamentalhuman rights are to live and to grow up in anurturing family so they can fulfill theirhuman potential. These rights have beenlargely ignored in the debate surroundingunparented children and related InternationalAdoption policies. We argue that unparentedchildren have a right to be placed in families,either their original families, or if that is notfeasible, then in the first available permanentnurturing families. This includes the right tobe placed in international adoption if that iswhere families are available. We argue thatchildren have a related right to be liberatedfrom the conditions characterizing orphan-ages and most foster care.16

Of course, one of the primary argumentsagainst intercountry adoption is the false percep-tion that it is rife with fraud and exploitation. Dr.Bartholet acknowledges these concerns, as doesNCFA, which is why our organization consistent-ly calls for the enforcement of existing laws thatidentify and punish those involved in adoptionfraud and other illegal activities. However, alongwith NCFA, Dr. Bartholet also argues againstother policies, such as moratoria on intercountryadoptions, which “simply punish unparented chil-dren by denying them adoptive homes.” NCFAalso strongly supports international rules and reg-ulations (such as the Hague Convention onIntercountry Adoption) that promote ethical inter-country adoption. We firmly believe that an ethical

intercountry adoption process is attainable inmost countries, and, certainly more often thannot, is already the reality in many countries. Forthe vast majority of internationally adopted chil-dren, adoption provides loving permanent homesfor children who have no family to care for them.“To shut down intercountry adoption, as some ofits more radical critics suggest, would harm farmore children than it would help and is thereforenot an appropriate response to the problems fac-ing the institution.”17

The United States government also supportsintercountry adoption as an option for childrenand families. In a statement celebrating NationalAdoption Month in November 2009, MicheleBond, Deputy Assistant Secretary for OverseasCitizens Services in the Bureau of ConsularAffairs, affirmed America’s commitment to inter-country adoption: “Here at the State Department,we continue to work with other countries todevelop and implement standards and proceduresto help ensure that as many children as possiblecan find permanent, loving homes. We believethat inter-country adoption can be an importantoption for children in need, and that every childdeserves a loving home.”18

Outcomes

As in the case of children adopted domesti-cally, it is difficult to generalize about outcomesfor a group as large and diverse as internationallyadopted children. Research is clear that multiplefactors have an impact on outcomes for adoptedchildren, including their country of origin, age atadoption, and length of time spent in an institu-tion prior to adoption. However, the NSAP studymentioned above19 does provide some data specificto intercountry adoption as well.

16 Bartholet, E. (2009). Inter-American Commission on Human Rights, Organization of American States, Hearing on Human Rightsof Unparented Children and Related International Adoption Policies, 137th Ordinary Period of Sessions. Retrieved fromhttp://www.law.harvard.edu/programs/about/cap/ia/testimonyfullnov09.pdf17 Zappala, M & Johnson, C. (2009). A case for ethnical intercountry adoption. Adoption Advocate, 11, p. 1. 18 Office of the Spokesman, U.S. Department of State. (2009, November 20). Briefing by Deputy Assistant Secretary of State forConsular Affairs Michele Bond on National Adoption Day [Press briefing]. Retrieved fromhttp://www.state.gov/r/pa/prs/ps/2009/nov/132215.htm19 Vandivere, S., Malm, K., & Radel, L. (2009). Adoption USA: A Chartbook based on the 2007 National Survey of Adoptive Parents.Washington, D.C.: The U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning andEvaluation.

Adoption Advocate

9

NSAP data suggests that, as a whole, inter-nationally adopted children are faring quite well.In the area of physical health, 93% of childrenadopted internationally have parents who reportedtheir health as being “excellent” or “very good”.Children adopted internationally are also doingwell academically. Parents report that 73% ofchildren ages 6 to 17 are usually or alwaysengaged in school. Sixty-three percent of parentsof children ages 5 to 17 report that their child’sschool performance is “excellent” or “very good”in language arts; 65% for math. These childrenare also very engaged with their families andcommunities: 64% eat meals with their familiessix or seven days a week, and 93% have partici-pated in an organized activity.

Internationally adopted children and theirfamilies also enjoy quality family relationships.Forty-six percent of parents report that the par-ent/child relationship is “better than ever expect-ed,” and 62% say that having their children intheir lives is “better than they ever expected.”Eighty-five percent of parents report that theirrelationship with their child is “very warm andclose” and 91% report being not aggravated asparents. Overall, the research is clear that inter-country adoption benefits both children and parents.

Controversy Surrounding Intercountry Adoption

There are those who argue that intercountryadoption is too heavily favored and widely prac-ticed, as well as those who argue that it isn’tfavored enough. Those who argue that it is tooheavily favored are, in essence, opposed to inter-country adoption in any form. They believe thatan individual’s birth culture and nation shouldtake precedence over a child’s right to a perma-nent family. As Jeneen Interlandi explained in arecent Newsweek article, opponents of intercoun-try adoption argue that “that taking orphanedchildren from their birth countries and raisingthem elsewhere robs those nations of their most

valuable resource and leaves the adoptees with ahopelessly fractured ethnic identity, only to satis-fy the capricious whims of wealthy Westerners.(The contentious term cultural genocide is some-times employed.)”20

This is an untenable argument. Interlandi(who was herself adopted internationally) alsoargues that race and ethnicity should not be thedeciding factors in any adoption. She claims thatmany white parents—her own included—are per-fectly capable of successfully raising childrenfrom other races and cultures. She concludes: “Inthe end, what matters most is not where a child isfrom, but whether or not that child is well lovedand well cared for by a responsible family—regardless of race or nationality.”

Those who argue that intercountry adoptionisn’t favored enough object to it being consideredonly after family preservation and reunificationefforts have failed. They fear that those whooppose intercountry adoption at every opportunitywill ignore the need for timely action or createsome sub-category of placement that falls short ofreal permanency.

We at NCFA believe that the child welfarecontinuum presented above is the correct order ofsocial services. We by no means consider inter-country adoption a “last resort.” On the contrary,in the continuum presented in this article, inter-country adoption is considered a viable optionand, in fact, a first-level option when otheroptions higher on the continuum have failed todeliver permanency in a timely manner or are notlikely to succeed based on circumstances. In allcases, intercountry adoption must be considered aviable option before a child is relegated to life inan institution or any other nonpermanent place-ment or care. NCFA believes that, by ensuringthat intercountry adoption remains in proper per-spective on the continuum of child welfare serv-ices, we are in fact preserving it as a positiveoption for many children who lack a family tocare for them.

20 Interlandi, J. (2010). The case for international adoption [Online exclusive]. Newsweek. Retrieved fromhttp://www.newsweek.com/id/234343/page/1

Adoption Advocate

10

Avoiding Institutionalization forChildren

All of these options along the child welfarecontinuum are needed in order to keep childrenout of institutional care and in the permanent careof a family. According to UNICEF, there aremore than two million children currently living ininstitutions around the world.21 Save the Childrenbelieves that figure may be as high as 8 million.22

It is nearly undisputed that institutional care isnot good for children. A report from the organiza-tion EveryChild outlines the range of negativeoutcomes associated with institutionalization,including poor health, poor physical growth,hearing and vision problems, delays in the devel-opment of motor skills, reduced cognitive devel-opment, reduced social development, and abuse.Furthermore, EveryChild estimates that institu-tional care is twice as expensive ascommunity/group homes and up to eight times asexpensive as providing vulnerable families withthe support they need to stay together.23

A recent report from Save the Children urgesgovernments to reduce the use of institutionalcare, arguing that it can have a long-term negativeimpact on all children, and that it is particularlydamaging for children under the age of three.24

Karen Bos, in her testimony before the Inter-American Commission on Human Rights,explained the detrimental effects of institutional-ization on child development. According to Bos,children in institutions receive inadequate input(i.e., stimulation), resulting in the “under-devel-opment of some brain circuits and the mis-wiringof others.” She identifies the long-term impact as

follows:Children raised in institutions are known toexperience a range of problems, includingimpairments in physical, cognitive, language,and social-emotional functioning. Specifically,these children often show growth stunting,impaired intellectual development, languagedelays, attachment problems, depression andanxiety, aggressive behavior problems, andinattention/hyperactivity.25

The negative impact of institutionalization iswell-documented by researchers who are part ofthe Bucharest Early Intervention Project (BEIP).For this project, researchers created a foster caresystem in Bucharest, and then randomly assigned136 children to either stay in institutions or moveinto foster care. They also studied a comparisongroup of 72 typically developing children whohad never been institutionalized. The childrenwere assessed at 9 months, 18 months, 30months, 42 months, and 54 months, with plans toassess them through age 8. In one of the mostrecently published studies from BEIP, the authorsexamined attention and emotion expression inboth groups at 30 and 42 months of age. At 42months, the foster care group showed significant-ly higher levels of attention than the institutional-ized group, as well as higher levels of positiveaffect (i.e., positive mood). The authors conclude:“Institutionalized, socially deprived children,when placed into family environments, showedrapid increases in both expressed positive affectand attention in social episodes that weredesigned to be enjoyable for infants and youngchildren.”26

21 UNICEF. (2009). Progress for children: A report card on child protection. Retrieved from:http://www.unicef.org/publications/files/Progress_for_Children-No.8_EN_081309.pdf22 International Save the Children Alliance (2003). A last resort: The growing concern about childrenin residential care. London, Save the Children UK.23 Carter, R. (2005). Family matters: A study of institutional childcare in Central and Easter Europe and the former Soviet Union.Retrieved from http://www.crin.org/docs/Family%20Matters-A%20Study%20of%20Institutional%20Childcare%20in%20Central.pdf24 Csaky, C. (2009). Keeping children out of harmful institutions: Why we should be investing in family-based care. London: Savethe Children.25 Bos, K. (2009). Inter-American Commission on Human Rights , Organization of American States, Hearing on Human Rights ofUnparented Children and Related International Adoption Policies, 137th Ordinary Period of Sessions. Retrieved fromhttp://www.law.harvard.edu/programs/about/cap/ia/testimonyfullnov09.pdf26 Geera, M.M., Marshall, P.J., Fox, N.A., Zeanah, C.H., Nelson, C.A., Smyke, A.T., & Guthrie, D. (2009). The effects of foster careintervention on socially deprived institutionalized children's attention and positive affect: Results from the BEIP Study. Journal ofChild Psychology and Psychiatry, 50(3), 246-253.

Adoption Advocate

11

In a 2007 study that focused on assessingcognitive skills, BEIP researchers measured thechildren’s developmental quotients and IQs at 42and 54 months of age. At both points, the chil-dren in foster care scored significantly higherthan their institutionalized counterparts. Theauthors also find that the children fare better theyounger they are moved from institutionalizationto foster care.27

The research clearly shows that it is not goodfor children to be raised in institutions. And yet,in many countries, in the absence of intercountryadoption, institutionalization is the only option left.

Conclusion and Recommendations

NCFA believes that our continuum of childwelfare services outlined above should serve as aguideline for the child welfare and adoption com-munities. We want to stress the fact that we donot believe this continuum to necessarily be hier-archical; planning and evaluating options for achild can be concurrent, and different optionsmay better serve different children and families indifferent situations. It is essential that a case-by-case determination be made for every child, butthroughout all planning, the issue of timeliness isvery important. What is clear is that institutional-ization is not an acceptable outcome for anychild, and that “every tool in the toolbox” mustbe tried to achieve the permanency that is in thebest interests of all children.

A continuum that does not consider timeli-ness in assessing realistic options or allow for the

possibility of intercountry adoption goes againstall that research has shown to be good for chil-dren. Furthermore, the continuum we presentdoes not require trying one option for a time and,if it fails, continuing down the line until an optionis found that finally works. If family reunificationand/or preservation is not a timely or realisticpossibility for a given child, then no time shouldbe wasted at that point on the continuum. In othercases, when options are less clear, agencies canand should engage in concurrent planning toappropriately prepare for timely and effectivedecision-making for the benefit of the child.

In order for the continuum to function effec-tively, governments, agencies, and child welfareadvocates must commit to working together forwhichever solution is in the best interest of a par-ticular child. As important as homeland and cul-ture are, the notion that preserving only thesethings at the expense of permanency undermineswhat children need in order to be safe and loved– a permanent family. If family preservation orreunification is determined to be in a child’s bestinterest and is a realistic and timely option, thenthat must be worked for wholeheartedly. Ifdomestic or intercountry adoption is found to bein the child’s best interest, then all resources mustbe put towards attaining one of these goals asefficiently as possible. Only in this way caneveryone concerned with the welfare and safetyof children effectively employ a continuum ofservices aimed at creating good outcomes for all children.

27 Nelson, C.A., Zeanah, C.H., Fox, N.A., Marshall, P.J., Smyke, A.T., Guthrie, D. (2007). Cognitive recovery in socially deprivedyoung children: The Bucharest Early Intervention Project. Science, 318, 1937-1940.

HELP US FUND THE ADOPTION ADVOCATE

National Council For Adoption is a non-profit organization supported by charitable donations.

To maintain our outstanding programs, we accept contributions of every size. To make a contribution,

please go to www.adoptioncouncil.org and click on “Contribute” or mail your check to

NCFA, 225 N. Washington Street, Alexandria, VA 22314. Thank you!