Assessing the suitability of special needs children

1. Assessing the suitability of special needs children Dr. Rajesh Sagar Additional Professor Department of Psychiatry AIIMS, New Delhi

2. Court Judgment Name of the Court : Supreme Court of India Case : Civil Appeal No 7475 of 2010 Date of Judgement : 08.09.2010 Order By : Hon’ble Justice M. Katju and Hon’ble Justice T.S. Thakur • Inter – country adoptions should be allowed only after full and proper satisfaction is recorded by all the agencies including a committee of experts wherever reference to such a committee is considered necessary. CARA may have similar expert committees at state level. • ….It would be appropriate if CARA requests the Director, AIIMS to constitute a committee of experts to be headed by HOD of Psychiatry, AIIMS.

3. Definition of special need Narrower definition often followed .

4. ‘Special needs’ children A ‘special needs’ child is one who, without medical, physical, emotional or developmental interventions will not be able to reach his/her full potential It has multiple dimensions such as: • Medical issues • Behavioural issues • Developmental issues • Learning issues • Mental health issues

5. ‘Special needs’ children deserve special attention. • They are often difficult to place with domestic families. • Parental preparation, education and support are crucial for the stability of an adoption & for the long-term emotional well-being of all family members • It is hard to place these children in adoption & should be prepared from day one in the institution.

6. Category of Special Needs children (1) For the purpose of adoption, ‘special needs’ children may be categorized as under:- • Children having visible and or serious medical conditions- mental or physical; • Older children; • Siblings and • Extremely low birth-weight children (to be certified by a Government Medical Officer) (Source: Guidelines Governing the Adoption of Children-2011 notified by Govt. of India)

7. Adoption of Child having special needs • Special care taken, so that the prospective adoptive family is aware/ready to provide extra care & attention that the child needs. • Important to understand that child with special needs requires more than any other child, the care and love of a family at an early stage. • Adoption process shall be completed as expeditiously as possible by the concerned authorities and time lines • PAPs wishing to adopt special needs children shall be given top priority in the waiting list. • In spite of best efforts, some special needs children do not get adopted and have to remain in institutions. These children should be shifted by the Specialized Adoption Agency to specialized institutions in case such institutions are available in the State. (http://adoptioninida.nic.in/guideline-family/Part_1.pdf)

8. Assessing suitability: • Of child • Of the interested parent • Of the new environment to meet child’s needs • Matching child requirement and expectation with that of adoptees.

9. Preparing Children • Thorough evaluation by professionals for their medical/ social/ emotional/ intellectual capacities, at the time of entry into the agency • Prepare report based on above information, should be available with agency and determine the choice of PAP. • Attaching a Certificate in this regard by a qualified professional with Medical examination Report (MER) • The following personnel in the institution are jointly responsible for each child having special needs. They are: • Social Worker/Counselor • Pediatrician • Psychologist • Speech therapist • Occupational therapist • Teacher • Nurse & Care Taker • Volunteer

10. Preparing Children..contd… • Social worker is to learn as much as possible about the child • Social worker should place special emphasis on understanding the health conditions of the child, the kind of special needs, interventions in the past, current interventions and prognosis of the concerned special needs etc • Every child at all ages understands rejection, may likely to go into depression/ mood swings and face emotional turmoil • Children should be prepared for the placement such as to see photographs of the family, counseling, language issues etc.

11. Preparing Adoption Parents • Parenting requires lot of commitment for life, preparation, motivation, adequate resources and strong will as it is a full time job. • Understand and explore the way they are feeling • Develop new coping strategies • Find ways of managing stress • Learn more about the lifelong effects of adoption • Adoption professionals must create a collaborative relationship with adoptive parents • Agencies should hold regular/group meetings of adoptive parents • Agencies/social worker should provide all the relevant information about the child to parents • International adoption may pose some risk with children who come from institutions

12. Determining suitability of Parents • PAP’s capacity to meet the emotional, psychological, physical and social needs of the child • Require parents with exceptional patience, stability, flexibility and parenting skills • PAP’s health • Home study Report (HSR) should reflect the motivation and ability of the PAP(s) to adopt such a child • Acceptance to only those PAPs, who have given preference/willingness to adopt such children

13. Suitability of Parents…contd… • PAP’s in stable relationship • PAP’s age • Number and ages of the other children in the family • Family should have a support system of family, friends or other adoptive parents • Family should have adequate resources to take care of the medical needs of the child • Medically fragile child should be placed with a family who is familiar with pediatric disorders and has access to medical facilities • Family deserves to know all known medical information about the child

14. Child Adoption Resource Information & Guidance System (CARINGS) • CARA has facilitated online reservation and matching of children having special need by foreign parents through their foreign agencies/authorities

15. CENTRAL ADOPTION RESOURCE AUTHORITY Database maintained by CARA w.e.f. July’ 2011 to June ’2012 Total number of NOCs issued in case of special needs children :285 Total number of NOCs issued in case of normal children :115 Note: Number of children in Siblings or Siblings Group :69

16. Challenges for adopted parents • Recognizing and accepting the limits of their emotional attachment to the child and vice versa • Understanding the mixed feelings of the child towards birth parents • Dealing with the complex needs (emotional, physical, etc.) of the adopted child • Finding the appropriate support services in the community • Dealing with the child's emotions and behaviour, especially for those parents with no prior experience

17. Mental health issues in adoption • Issues related to separation and adoption • Issues unrelated to adoption– • Developmental issues • Psychiatric illness

18. Issues related to separation and adoption • Sense of Loss and Grief - dealing with the loss of the birth parents • feeling of rejection, abandonment and anger towards biological parents • Sense of loss of culture, country, other dear ones (especially in cross-cultural adoption) • May result in feeling of inferiority • May also reappear later in life upon loss of dear ones, spouse • Adoptee may feel guilty or find difficulty in expressing above feelings if adopted family is a good one • Timely recognition and appropriate outlet for these feelings is essential

19. Issues related to separation and adoption contd… • Identity and Self-Esteem Development • Identity issues start around adolescence • Problems more for older children as it often overlaps with need to establish one’s own identity among peer group and family • Questions about the biological family and their need to place him for adoption, finding traits common with birth parents and his place in current social class, culture, peer group, often come up • The above have impact of adoptee’s self-esteem • Low self-confidence, unwelcome or rejected feeling is common.

20. Issues unrelated to adoption • Developmental and mental health issues: • Adopted children are more at risk of physical and mental health problems • Reasons may be varied – • Prenatal and post-natal exposure to drugs and alcohol • Abuse or neglect in biological family or at foster care • Lack of structured family and foster care environment • Poor nutrition and reduced stimulation • Children with developmental problems are more likely to be abandoned by biological parents

21. Specific mental health issues in foster and adopted children • Insecure attachment to their primary adult caretakers • Behaviour problems like hiding or hoarding food, polyphagia, rumination, self-stimulating and repetitive behaviours (masturbation, rocking or head banging), sleep disturbance • Depression and anxiety disorders • Externalising problems like conduct disorder, oppositional defiant disorder, ADHD

22. Few suggestions……. • Match the type of physical and emotional environment needed by the child with the one that can be provided by the PAP’s • Assess and continuously monitor the level of care provided to special needs children both before and after adoption • Recommend a children’s special needs, parents’ requirements, and parents’ preference for care setting • Post-adoption provision of assistance to parents in childcare and regular follow up • Assessment and consultation service for yet non-diagnosed children • Need for ‘Special need team’?

23. THANK YOU