Trust-Based Relational Intervention® (TBRI®) for Adopted Children Receiving Therapy in an Outpatient Setting

The goal for every adopted child is to gain parents that will love them unconditionally and make them a permanent family member. However, parents are often unprepared for the challenges of integrating a new child into their home, especially one who may be exhibiting unusual or unexplained behaviors that are unresponsive to typical parenting practices. This can leave adoptive parents feeling overwhelmed and hopeless about their own role as parents and about their chances of successfully incorporating the child into the family. Reports by adoptive parents have shown that adopted children have more difficulty functioning in the home, school, and community when compared to non-adopted peers (Howard, Smith, & Ryan, 2004; Smith & Howard, 1991).There are approximately 136,000 adoptions annually in the United States, with 39% occurring through public child welfare agencies, 14% through foreign countries, and nearly half through other sources such as private agencies and tribes (Child Welfare Information Gateway, 2011). Adoption disruption rates range from 10-25% in the United States, with variations based on population, geographic region, and other factors (Festinger, 2006; George, Howard, Yu, & Radomsky, 1997). Factors associated with disruption can be grouped into several categories. Children's factors include older age at adoption, presence of emotional and behavioral issues, strong attachment to birth mother, and pre-adoptive sexual abuse. Adoptive family factors include families beginning a new relationship with the child (as opposed to first fostering the child), lack of a social support system, unrealistic expectations, and interestingly, adoptive mothers with more education. Agency factors include having insufficient information about the child and his/her history; inadequate parental preparation, training, and support; non-continuity and changes in staff who prepare the child; having more caseworkers involved in the case; and providing insufficient services (see Child Welfare Information Gateway, 2012). However, research has shown that when foster and adoptive parents know the challenges they may face and are prepared for these challenges, they are much more satisfied than those without preparation, even when the challenges are greater (Barth & Berry, 1988).Histories of TraumaApproximately 68% of Americans have experienced some type of childhood trauma (Copeland, Keeler, Angold, & Costello, 2007), and a significant number of children entering the child welfare system have a history of multiple, chronic, and interpersonal traumas (complex trauma), causing them to exhibit more traumatic stress and mental health symptoms, risky behaviors, day-to-day functioning difficulties, developmental delays, and fewer strengths compared to other children (Becker-Weidman, 2009; Kisiel, Fehrenbach, Small, & Lyons, 2009). In a study of children in the child welfare system in one state, Fusco and Cahalane (2013) found that more than a quarter of these children exhibited trauma symptomology. The type of trauma most commonly experienced by children is complex trauma, which includes physical, sexual, and emotional abuse; neglect; and/or witnessing domestic violence, and is perpetrated on children by their caregivers (Greeson et al., 2011). These children often maintain a state of hyperarousal and hypervigilance (constantly prepared for fight, flight, or freeze; hypersensitive with a tendency to overreact or misinterpret actions of others or certain elements in their environment) (Perry, Pollard, Blakley, Baker, & Vigilante, 1995). Children with histories of complex trauma most often exhibit disorders related to attachment systems, affect regulation, physiology, dissociation, behavioral control, cognition, and self-concept (Cook, Blaustein, Spinazolla, & van der Kolk, 2003).Other studies have found that adopted children may exhibit behavioral problems such as conduct disorders, attachment disorders, or other emotional and psychological issues that can cause significant hurdles to placement stability when adoptive parents are unprepared to cope with such challenges (e. …