Adopting a better approach

05 October 2018

Adoption is only the start of a new journey that can be both rewarding and challenging. How can you help support adoptive families? Journalist Rima Evans reports.

Overwhelmingly, parents who adopt say it’s a decision they are glad they took.

A survey from last year, which gave us a brief glimpse into the experience of modern-day adoption, revealed that 88% of adoptive parents felt positive about their choice (BBC/Adoption UK Survey, 2017).

The survey of around 3000 adopters also showed more than a quarter found the experience ‘fulfilling and stable’ and 44% ‘challenging but stable’.

So adoption seems to be a transforming and positive experience. It’s an opportunity to offer a stable, loving home – and currently 1115 children in England are waiting to be offered one (Adoption Match, 2018).

However, the survey also brought to our attention a more difficult truth – a fifth of adopters admitted it posed serious challenges that affected the wider family, with some families’ lives being disrupted as a result (Adoption Match, 2018).  


Special needs

The charity Adoption UK highlights that the vast majority of the 5000-plus children adopted in the UK every year are now adopted from care, and as such many have experienced trauma within their birth families that will have a long-term impact and make them highly vulnerable (Adoption UK, 2017a).

This is having a profound effect on the realities of adoption both from the child’s and the parent’s perspective. For example, at least 50% of adopted children have a diagnosable mental health problem, as a result of trauma, neglect or abuse experienced in early life, according to Adoption UK (2017b).

A guide for schools published last year outlines that adopted children can suffer a range of issues, including attachment problems, behavioural problems such as aggression, developmental gaps, and feelings of loss and instability (PAC-UK, 2017). This can lead to learning delays, difficulties with social interaction, speech and language, managing change and more.

Ellie Johnson, health adviser at CoramBAAF, a membership organisation for professionals, adopters and foster carers, says: ‘Statistically, children who have experienced adversity, neglect, trauma and abuse are more likely to have child developmental issues. In terms of emotional health and wellbeing and behaviour, there may be increased long-term risks and needs.’

But it’s also important to consider their experiences in the womb, Ellie, a former health visitor, advises.

‘We know there are much higher incidences of fetal alcohol spectrum disorders in children who have experienced neglect and trauma and therefore in the population of children that have been adopted.’

All this serves to highlight the wide range of health needs adopted children may have and the degree of support required from professionals including health visitors and other community practitioners.


Know-how required

But a key barrier is a lack of understanding, awareness and training for health visitors around the experiences of adopted children and the stresses adoptive parents face. In some areas, this is severely compromising the support families are being given.

Sabrina Purse, a community nursery nurse at Dorset HealthCare University NHS Foundation Trust, adopted her son five years ago. She admits she felt let down by her health-visiting service, mainly because of a lack of understanding of the issues she faced. ‘The support required is crucial in the early days of placement when the child goes to live with their new parent/s permanently. These children are suffering the effects of early adverse childhood experiences, something the adoptive parent/s is/are constantly aware of. Parents need someone there who can help them understand and meet their health needs.’

Sabrina is presenting her research paper on the subject at this year’s Unite-CPHVA annual professional conference. The study involves 150 adopters from the South West and shines a light on gaps in the health-visiting service – and suggestions for improvement.

For example, Sabrina explains that most of the families in her study said they had expected much more than they had received from health visitors: ‘With adoption, there’s a massive amount of disruption very early on both for the child and parents. My study showed that the support parents receive in the first three to six months is crucial to the success of a placement. So health visitors have a key role to play. Yet there are gaps in the service.’

A major obstacle, Sabrina adds, is that a child is automatically placed on the Universal Plus or Universal Partnership Plus pathway while in care but then switched over to the Universal pathway once adopted, even though they remain the same vulnerable child. ‘This isn’t meeting families’ needs,’ says Sabrina. ‘They may need more intensive contact so they can raise concerns. Families can of course ask for help, but not everyone will reach out. If they haven’t already formed a relationship with their health visitor they may feel reticent about approaching someone new or unfamiliar.’

The stresses of the adoptive process itself can put up a barrier for asking for help. ‘Adoptive parents have to undergo checks and approvals and feel a massive sense of responsibility for their vulnerable child. It’s very hard to then admit to someone they may not be coping,’ Sabrina explains.

In practical terms then, how can health visitors provide greater support for both children and adoptive parents? As with any new parent, being the bridge to accessing or signposting to other services is a core requirement.

Sabrina says her study highlighted that, in fact, families were positive about this service from health visitors of referring on to other services such as speech and language, or audiology.This link to services is crucial not just for health visitors but for school nurses, too (see Adjusting to education, right).  


Ask, observe, advise and monitor

First, health visitors need to engage with adoptive parents, encouraging them to open up and express their concerns, Sabrina advises. Health visitors should be professionally curious, ask the right questions, observe, and call up regularly, she adds. ‘It will encourage families to use health visitors’ expertise in relevant areas such as attachment disorders.’

Sabrina’s research points to other ways to better support families, including awareness of, and openness to, therapeutic parenting. This is unlike traditional parenting techniques and aims to meet the needs of children that have come from neglectful or abusive backgrounds (Adoption UK, 2017c).

‘It’s a parenting style that deals with behaviour differently and is centred around being supportive or looking for the reason behind that behaviour rather than a focus on punishment or reward,’ explains Sabrina. ‘It may be a style unfamiliar to community practitioners, but they should aim to find out more.’

Another issue that can be overlooked or misunderstood is post-adoption depression (PAD) (Adoption UK, 2013). Symptoms are similar to postnatal depression (PND) but there can be unique characteristics: parents can feel a sense of guilt, or 
that they have ‘stolen’ another woman’s child.

The strain of the adoption process can have an effect, says Sabrina, who herself was diagnosed with PAD. ‘It has a big stigma attached to it. Many families struggle with it: my research showed 67% of adopters suffered from PAD at some point. Health visitors should be looking for signs of PAD in the same way they would signs of PND so they can offer appropriate help. The risk is highest in the first month of the child being placed with a parent full-time.’

Essentially, it is training and awareness that is at the heart of improved service provision, Sabrina says.

In response, she is now working on putting in place training locally and speaking at child health promotion days over the next couple of months.

‘I’d also like to draw up a pathway so all health visitors know exactly how to approach an adoptive family and which ensures there is a consistent service across the country,’ she adds. ‘Adoptive families need greater support.’ 


Adjusting to education

School can be a distressing experience for adopted children, making it hard for them to cope or settle, says Helen McConnell, education practice manager at PAC-UK, an independent adoption support agency. It’s an unfamiliar environment, which can make them feel unsafe, she adds. Almost 70% of parents feel their child’s progress in learning is affected by problems with their emotional wellbeing in school (Adoption UK, 2017d).

Training schools and all of their staff about the enduring needs of adopted children and how they can best be supported can ensure children have a more positive education experience and don’t get left behind, Helen says. That training should absolutely include school nurses, she adds.

‘They will have a part to play. Anyone that comes into regular contact with the child should know about the plans and strategies put in place for them. It will help them address their needs better.’

School nurses are increasingly knowledgeable about the effects of early life experiences and issues such as attachment, adds Ellie Johnson of CoramBAAF. For adopted children that reach out for help in secondary schools, school nurses are well placed to play a significant role in meeting their needs.



  • CoramBAAF has books and resources for HVs and SNs at corambaaf.org.uk
  • PAC-UK’s education service offers e-learning courses to help schools and professionals meet the needs of children with difficult starts in life at pac-uk.org/education
  • Read Meeting the needs of adopted and permanently placed children: a guide for school staff by PAC-UK and the Department for Education at bit.ly/for_school_staff
  • Find support, information, training and more with the leading charity for all those parenting or supporting children who cannot live with their birth parents at adoptionuk.org



Adoption Match. (2018). Adoption Register Statistics. See: https://www.adoptionmatch.org.uk/statistics/ (accessed 18 September 2018).

Adoption UK. (2017) Bridging the gap: giving adopted children an equal chance in school. See: https://www.adoptionuk.org/Handlers/Download.ashx?IDMF=e460b99a-4ebb-4348-bd23-64a50d747901 (accessed 18 September 2018).

Adoption UK. (2013) Post-adoption depression. See: https://www.nhs.uk/Livewell/adoption-and-fostering/Documents/Adoption UK Factsheet 14 - Post-adoption depression June 2013.pdf (accessed 18 September 2018).

BBC/Adoption UK Survey. (2017) BBC/ADOPTION UK survey: a snapshot of modern day adoption. See: https://issuu.com/adoptionuk/docs/bbc_adoption_uk_survey_doc (accessed 18 September 2018).

PAC-UK and Department for Education. (2017)Meeting the needs of adopted and permanently placed children: A guide for school staff. See: https://www.pac-uk.org/wp-content/uploads/2017/10/Meeting-the-needs-of-adopted-and-permanently-placed-children-A-guide-for-school-staff.pdf (accessed 18 September 2018).

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