Healthcare providers, we can enhance relationship + experience.
Understanding the mentality and feelings of individuals who have experienced adoption or foster care without having a direct connection to either community or the proper insight into the lifelong impacts of adoption/foster care is complicated. The complex nature of these systems can leave healthcare providers feeling as if they are up against a wall not knowing how to best acknowledge and discuss these important issues with their patients or their colleagues. Learning about the degrees of trauma associated with adoption and foster care, using proper terminology, and taking the time to acknowledge and validate the individual’s point of view will enhance the relationship between provider and patient resulting in better quality visits and more effective outcomes.
As an adoptee and a trauma therapist, I have experienced firsthand the inequities that adopted individuals and those who have been in foster care face when it comes to healthcare. I can recollect countless examples throughout my life of entering providers’ offices where my adoption was not acknowledged or discussed or where I was asked invasive questions that seemed to stem more from the provider’s own curiosity rather than for the benefit of my treatment. In other cases, despite providers’ having an awareness of my history, I recall being questioned about my medical history or other family history information that I did not and still do not have access to.
As a mental health provider, I regularly witness providers who are at a complete loss when it comes to treating children and families touched by adoption or foster care. I have sat in countless supervisions and trainings with colleagues who demonstrate major discrepancies related to the quality of care being provided to these individuals; from unknowingly using insensitive adoption/foster care vocabulary, to completely ignoring separation trauma apart from noting it on a demographic form, to perpetuating the societal narrative of adoption and foster care as something for which to be grateful. To say these experiences with providers have caused me a fair share of headaches would be an understatement.
Oftentimes, as a patient, I would sit through an appointment feeling completely anxious or unheard. I would leave a provider’s office feeling uncomfortable, judged, and misunderstood. As a professional myself, I have participated in meetings with coworkers where the discussion focused on how challenging adoption/foster care cases are and how they have no idea where to begin— when to me, it was glaringly obvious. Admittedly, I became frustrated with them for not recognizing what felt natural to me. And while I realize this lack of understanding is not intentional, it quickly became evident to me that things need to change—we need to do better as professionals.
I believe it is important to shed light on these issues and assist providers to better understand that certain forms of questioning (or the lack thereof) or refusing to validate the adoption/foster care experience reduces feelings of safety in patients and can be negatively internalized by individuals who have been adopted or are in foster care. This makes it nearly impossible to form quality provider/patient relationships. Adoption and foster care related trauma is something that impacts clients/patients to their very core and affects every facet of an individual physically, mentally, and emotionally. It is the responsibility of providers to increase adoption/foster care competency as a way to promote and enhance provider relationship and achieve what we all strive for—healing.
MAKING POSITIVE CHANGE FROM WITHIN
Speak From Experience
One huge way in which I feel better care can be provided, is by increasing the number of therapists and other providers who have personal experience with adoption and/or foster care.
Since becoming a trauma therapist, I have worked with many individuals and families impacted by adoption and foster care. When working with these clients, I always disclose my connection to adoption and have found that it makes such a difference when working with these complex cases. When I disclose to my clients and their families that I am adopted and understand how complicated it is, I witness their bodies instantly loosen; the sigh of relief and physical response speaks volumes. Hearing me share that I am there to listen if they want to talk about adoption/foster care related issues or that I understand to a degree what their child is going through because of my own experience results in an immediate increase in safety and trust. The client sees me as someone who they don’t have to explain themselves to. I am not someone they have to educate about the conflicting feelings, the loss, or the other challenges, because even though our stories may not be exactly the same, we have a mutual understanding and respect. There is an inherent message of “I see you, I understand you, and I get it,” a message that I wish I had received from others when I was growing up.
It is unrealistic to expect every therapist to have first-hand experience with foster care/adoption and this is where education comes in for providers. I have been in the position of having to educate my providers, as many of my adopted/foster care clients have had to. This is because too many professionals have no touchpoint or understanding of adoption/foster care, its complexities and its influence on health. This lack of experience unintentionally puts the client/patient in the position of knowing more that the professional, who is supposed to be the expert. This tip in the scale of power sends the underlying message to clients, “I don’t know what I’m doing, I don’t know how to help you, and I don’t even understand you.” This is not the message professionals mean to send or what clients need to hear. It does not facilitate feelings of safety and security that adoptees and individuals in foster care often crave the most—and that sense of safety is necessary to start the healing journey. It is imperative that education and training surrounding these topics are made a priority when first-hand experience does not exist to tip that scale into balance; otherwise, we only do a disservice to our clients/patients who have already faced so much.
The good news is, times have changed. I have noticed steady progress on the front of adoption/foster care education since my experiences as a child and even since I began working in the mental health field. There have been many research studies on the impacts of trauma associated with adoption and foster care, more adoptees/individuals with histories of foster care are in the field of healthcare, and there are evidence-based treatments that can address the deep-rooted feelings and promote healing. That said, there is still much to be done to make sure this often underserved population is receiving quality care.
Adoptive/foster parents and providers can be proactive in helping to make available the best quality care for those touched by adoption and/or foster care.
Enhancing provider relationship as an adoptive or foster parent:
- Advocate for your child. Do not be afraid to voice concerns to providers or provide them with pertinent information about your child’s adoption or foster care placement. This information is always important.
- Search out adoption/foster care competency trainings to help you feel more confident in providing and advocating for your child’s needs.
- Find pediatricians and other medical providers who are aware of the trauma associated with adoption or foster care and how it can cognitively, physically, and emotionally impact your child’s development.
- Seek out mental health providers who specialize in adoption, separation trauma, and attachment.
- Locate therapists in your area who are trained or certified in trauma resolution therapy (e.g., Eye Movement Desensitization and Reprocessing or Progressive Counting).
- Search for providers who are adoptees or have histories involving foster care such as Adoption Perspectives. Having that connection can go such a long way in helping solidify feelings of safety and therapeutic rapport.
Enhancing provider relationship as a provider:
- Educate yourself about adoption and foster care related issues. This will only help you to feel more confident when working with these kids of clients/patients. Attend training(s), read adoption/foster care literature, meet with individuals willing to share their experiences. The more you know, the better you can serve those coming to you for help. More on Adoption Perspectives training seminars.
- If you see the words “adoption” or “foster care” on intake paperwork or a demographic, don’t gloss over it! Don’t just have this be a one liner in a social history write up or a box you check off on a form. Work collaboratively with the adoptive/foster parents (biological parents if they are in the picture), foster care workers, and any other person who can shed light on the individual’s history to provide as complete a picture as possible.
- Do not view early life adoptions or placements as irrelevant. Separation trauma, regardless of the age of the child, is serious and can have lifelong impacts. It is always a factor that should be considered throughout the course of treatment.
- Do not expect the client/patient to explain themselves to you. They have come to you for help and it is up to you to do your research on how best to help them. Avoid putting them in a position where they feel obligated to teach you about the adoption/foster care experience and associated issues.
My hope is that the future will be different for those touched by adoption and foster care when it comes to seeking healthcare services. I believe the best way to enhance the provider relationship is through education and open dialogues that include the voices of those personally impacted by adoption and/or foster care. By bringing these experts and their experiences to the table, we validate those who have dealt with the challenges personally and we empower professional healthcare providers to become more comfortable and effective with promoting healing for this population.