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Executive summary (English) Background In 2018, a new Adoption Act was passed in Norway which, among other things, entailed a new framework for prior approval of applicants for foreign adoption. In this connection, the Norwegian Directorate for Children, Youth and Family Affairs (Bufdir) was tasked with preparing a circular concerning the requirements for the applicants regarding their suitability. During the processing of the Act, The Norwegian Parliament also made a request to identify the needs of adoptive parents and children for assistance and follow-up after adoption. In connection with the preparatory work on the Adoption Act, Bufdir initiated the assignment that forms the basis for the work on this report. In the assignment, Bufdir emphasised the significant need for more knowledge about the field of adoption, in terms of both the knowledge base for the criteria that form the basis for the approval of adoptive parents and for the choice of methods and mapping tools that are used when studying applicants who wish to adopt children from abroad (prior approval). There is also very limited knowledge about the needs of health care in adoptive families after adoption. This is why Bufdir commissioned the Norwegian Institute of Public Health to help ensure that the criteria for assessing adoptive parents are firmly rooted in updated research, that good methods are in place for conducting this assessment, as well as contributing to ensuring that the authorities have a good knowledge base for planning the future follow-up of adoptive families. Method The aim of the project was to arrive at reasoned and quality-assured assessments and guidance based on the following: • A review and systematisation of research literature on the importance of family resources and parenting skills for adoptive children's health and development. The results of this work have been published in the report "What characterises good (adoptive) parents? A literature review"2 . • Mapping and review of assessment criteria and methods for assessing adoptive parents nationally and internationally. • Survey of families who have undergone adoption from 2003 until October 2020. Results The project has responded to the following issues: 1: Are the current assessment criteria based on updated research about which parental characteristics are important for the children’s development? We have noted that there is support in the research literature for the assessment criteria currently being used for assessing adoptive applicants in Norway. We have also found studies suggesting that it is beneficial to apply increased focus on the fundamental 2 https://www.fhi.no/publ/2021/hva-kjennetegner-gode-adoptivforeldre/ 10 personality traits that form the basis of the applicants’ perceptions, motivations and actions and, to a greater extent, assess resilience and stress management in light of the major care tasks associated with many of the children. 2: Do we have sufficient methods for assessing adoptive applicants in Norway? The practice in Norway is similar to the practice in other countries: Unstructured interviews with little or no utilisation of systematic and standardised mapping methods. The method that is used ensures a good overall picture of the family and succeeds in building up the necessary level of trust to create a good and trusting dialogue between the investigator and the applicants. However, the method is susceptible to insufficient clinical and psychological expertise in the investigator and the investigator’s own adaptation of questions or emphasis on different topics. 3: What do applicants feel about the assessment process? The survey results show that parents generally have a positive experience of the process during which they were interviewed, in terms of their suitability as parents. 4: What do parents feel about their first time with the child? Findings from the survey indicate that around half of the parents regarded the first time with the child as being unproblematic. However, a not insignificant proportion of parents felt that the first time was challenging, in terms of both bonding with the child and also adapting procedures and the relationship between the adoptive parents to the new life. 5: How high a percentage of the families reported having children with various difficulties? What kind of difficulties are most prevalent? Although three out of four parents stated that they have children who, during the course of their own childhood, had one or more of the difficulties that we asked about, half of the parents stated that their children currently have no difficulties. However, one in three parents stated that their child currently has tangible or serious difficulties. The most widespread difficulties in adoptive children are behavioural problems, mental health problems, reading and writing difficulties, social difficulties, as well as attachment disorders. Around two out of five families reported having children who had at least one of these difficulties. 6: What characterises the families that have children with the most difficulties? The families that have children with the most extensive difficulties reported poorer family finances and a greater degree of perceived parental stress compared to families that have children with less extensive difficulties. 7: Do parents feel that their family receives the help they need from the support system? Like other similar surveys, the responses from parents indicate that the support system is not designed in such a way as to ensure that children with difficulties receive the help they believe they need. Even though a high proportion of the families have received various kinds of health care, there were many that feel they have not received enough help. This particularly applies to the parents of children with substance abuse problems, developmental disabilities and severe mental disorders. More than half of the parents of children with serious diagnoses in need of treatment feel that they had received much less help than they needed. 8: What characterises the kind of families in which the parents state that they have not received sufficient help? Such families are characterised, for example, by the primary caregiver having a lower level of education, less social support and a greater desire for adoption assistance, compared to primary caregivers who state that they have received adequate help. 9: According to the parents, what are the most widespread help requirements in the families? The need for help is great in adoptive families. Most parents see the need for adoptive websites and parental guidance, which could be described as preventive services. This is followed by the need for help from mental health personnel with competence on adoptive children: Both directly to the child and in terms of receiving parental guidance and help the first period after they adopted the child. Moreover, many parents have needed help with self-help: Help to get in touch with other adoptive parents and to take care of their own mental health. Fewer parents wanted direct guidance online. In the open text responses, the parents stated that the school and the support system lacked the necessary skills to help their children. The results show that the more difficulties a child has, the greater the need for help from someone with special expertise in adoptive children. There is a widespread perception, particularly among the parents of adopted children with major difficulties, that adoptive children have some unique challenges that require special knowledge from the helpers, in both the health service and in the school system. Recommendations Recommendations regarding rating indicators The Norwegian Institute of Public Health recommends that the following indicators are mapped when assessing adoptive applicants. A more detailed description of the nature of the various indicators and how to proceed in assessing applicants on the various indicators is presented in the report. 1: Applicant characteristics: Empathy, self-image, control, attachment style, ability to process life events, resilience and resilience to stress, mental health and quality of life, age, mental illness, addiction problems, serious illness or chronic illness, antisocial personality. 2: Family characteristics and their resources: Family environment, adaptability/flexibility, conflict/conflict management, parental relationship, partner violence/family violence, parental stress, parental characteristics/style of upbringing, finances, education, housing standards, social networks. 3: Adoption-specific assessment criteria: Motivation to adopt, parents’ (realistic) expectations, the importance of openness and communication regarding adoption, when adopting children from ethnic backgrounds other than the applicants’: Cultural and ethnic socialization, attitudes towards other ethnic groups. Recommendations on methods for assessing adoptive applicants: The Norwegian Institute of Public Health recommends that the following methods be used when assessing adoptive parents: 4: The assessment should primarily be based on a personal interview, with supplementary standardised screening tools for assessing mental health and attachment ability. 5: The responsible authority should use a comprehensive standardised tool to assess the parents’ primary characteristics. The Canadian Structured Analysis Family Evaluation (SAFE) assessment tool is a good example of such a holistic standardised tool. SAFE has been developed to investigate adoptive applicants and foster parents and includes interviews, procuring the necessary information from various registers, as well as completing standardised questionnaires. 6: The responsible authority should include interviews with a third party, i.e. a person who knows the applicants well. Recommendations on measures for follow-up of families after adoption: The Norwegian Institute of Public Health recommends the following measures to support and guide families after adoption: 7: Update the contents of the adoption preparation courses so that the course prepares families to a greater extent for potential mental health issues in the children. 8: Establish a website with relevant information about adoption-specific conditions, including an overview of the rights of adoptive families, as well as an overview of the various support services. 9: Establish an adoption competence center comprising employees associated with an already existing research and teaching environment. 10: The competence center will be responsible for organising a service that ensures that all recent adoptive families are offered the opportunity to meet a mental health specialist (with knowledge of adoption) during the first period after adoption. 11: The competence center will be responsible for running a telephone service staffed by mental health professionals with experience with adoptive families and adoptive-related issues and challenges. 12: The health centre will invite the parents and the child for checks and guidance in the first period after adoption, similar to the way in which biological families receive follow-up after birth. 13: There should be a specialist psychologist in each of the four health regions given primary responsibility for receiving adoptive children who are referred.
