Presentation on theme: "Assessing the suitability of special needs children"— Presentation transcript:
1Assessing the suitability of special needs children Dr. Rajesh SagarAdditional ProfessorDepartment of PsychiatryAIIMS, New Delhi
2Court Judgment Name of the Court : Supreme Court of India Case : Civil Appeal No 7475 of 2010Date of Judgement :Order By : Hon’ble Justice M. Katju and Hon’ble Justice T.S. ThakurInter – 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.
3Definition of special need A child who without medical, physical, emotional or developmental intervention will not be able to reach his full potential - INDIAAge, ethnic or racial background. Risk of above disabilities based on family historyAny condition that is making the adoptive family difficult to find (broad definition)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 potentialIt has multiple dimensions such as:Medical issuesBehavioural issuesDevelopmental issuesLearning issuesMental 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 membersIt is hard to place these children in adoption & should be prepared from day one in the institution.
6Category 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 andExtremely 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)
7Adoption 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 linesPAPs 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)
8Assessing suitability: Of childOf the interested parentOf the new environment to meet child’s needsMatching child requirement and expectation with that of adoptees.
9Preparing ChildrenThorough evaluation by professionals for their medical/ social/ emotional/ intellectual capacities, at the time of entry into the agencyPrepare 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/CounselorPediatricianPsychologistSpeech therapistOccupational therapistTeacherNurse & Care TakerVolunteer
10Preparing Children..contd… Social worker is to learn as much as possible about the childSocial 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 etcEvery child at all ages understands rejection, may likely to go into depression/ mood swings and face emotional turmoilChildren should be prepared for the placement such as to see photographs of the family, counseling, language issues etc.
11Preparing 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 feelingDevelop new coping strategiesFind ways of managing stressLearn more about the lifelong effects of adoptionAdoption professionals must create a collaborative relationship with adoptive parentsAgencies should hold regular/group meetings of adoptive parentsAgencies/social worker should provide all the relevant information about the child to parentsInternational adoption may pose some risk with children who come from institutions
12Determining suitability of Parents PAP’s capacity to meet the emotional, psychological, physical and social needs of the childRequire parents with exceptional patience, stability, flexibility and parenting skillsPAP’s healthHome study Report (HSR) should reflect the motivation and ability of the PAP(s) to adopt such a childAcceptance to only those PAPs, who have given preference/willingness to adopt such children
13Suitability of Parents…contd… PAP’s in stable relationshipPAP’s ageNumber and ages of the other children in the familyFamily should have a support system of family, friends or other adoptive parentsFamily should have adequate resources to take care of the medical needs of the childMedically fragile child should be placed with a family who is familiar with pediatric disorders and has access to medical facilitiesFamily deserves to know all known medical information about the child
14Child 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
15CENTRAL ADOPTION RESOURCE AUTHORITY Database maintained by CARA w.e.f. July’ 2011 to June ’2012Category of ChildrenCategory of PAPsS. No.MonthPhysical (Speech Delay + Squint Eye + Congenital Heart Disease + Older with TB + HIV Positive turn Negative + Born from HIV PAPs + Psychomotor Delay Older + Hearing Loss,Spine Bifida, Limbs Missing, Cleft Lip, Cleft Palate, Chronic Asthama, Severe Seizure Dissorder, Blood Disorders, Deaf, Disfiguring Birth Marks, Hemophilia, Thalasemia Major, Epilepsy, etc.)Mental Cerebral palsy, Down syndrome, Microcephaly, etc.OlderSiblingsNormalForeignerOCINRIPIO1July, 20111071114952August, 201121415323September, 2011824October, 20111225November, 201120336December, 20111727January, 201213February, 2012March, 201216April, 201228May, 2012June, 2012Total-1361093411526996Total number of NOCs issued in case of special needs children :285Total number of NOCs issued in case of normal children :115Note: Number of children in Siblings or Siblings Group :69
16Challenges for adopted parents Recognizing and accepting the limits of their emotional attachment to the child and vice versaUnderstanding the mixed feelings of the child towards birth parentsDealing with the complex needs (emotional, physical, etc.) of the adopted childFinding the appropriate support services in the communityDealing with the child's emotions and behaviour, especially for those parents with no prior experience
17Mental health issues in adoption Issues related to separation and adoptionIssues unrelated to adoption–Developmental issuesPsychiatric illness
18Issues related to separation and adoption Sense of Loss and Grief - dealing with the loss of the birth parentsfeeling of rejection, abandonment and anger towards biological parentsSense of loss of culture, country, other dear ones (especially in cross-cultural adoption)May result in feeling of inferiorityMay also reappear later in life upon loss of dear ones, spouseAdoptee may feel guilty or find difficulty in expressing above feelings if adopted family is a good oneTimely recognition and appropriate outlet for these feelings is essential
19Issues related to separation and adoption contd… Identity and Self-Esteem DevelopmentIdentity issues start around adolescenceProblems more for older children as it often overlaps with need to establish one’s own identity among peer group and familyQuestions 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 upThe above have impact of adoptee’s self-esteemLow self-confidence, unwelcome or rejected feeling is common.
20Issues unrelated to adoption Developmental and mental health issues:Adopted children are more at risk of physical and mental health problemsReasons may be varied –Prenatal and post-natal exposure to drugs and alcoholAbuse or neglect in biological family or at foster careLack of structured family and foster care environmentPoor nutrition and reduced stimulationChildren with developmental problems are more likely to be abandoned by biological parents
21Specific mental health issues in foster and adopted children Insecure attachment to their primary adult caretakersBehaviour problems like hiding or hoarding food, polyphagia, rumination, self-stimulating and repetitive behaviours (masturbation, rocking or head banging), sleep disturbanceDepression and anxiety disordersExternalising problems like conduct disorder, oppositional defiant disorder, ADHD
22Few suggestions……. Need for ‘Special need team’? Match the type of physical and emotional environment needed by the child with the one that can be provided by the PAP’sAssess and continuously monitor the level of care provided to special needs children both before and after adoptionRecommend a children’s special needs, parents’ requirements, and parents’ preference for care settingPost-adoption provision of assistance to parents in childcare and regular follow upAssessment and consultation service for yet non- diagnosed childrenNeed for ‘Special need team’?oth