Adoption: better choices for our children

Annex C:

Alternatives to Adoption for Looked After Children

Peter Selman
Reader in Social Policy

Kathy Mason
Reader Associate in Social Policy
School of Geography, Politics & Sociology, University of Newcastle upon Tyne

Report to Adoption Law Review Group of Scottish Executive
January 2005
Contacts:

Peter Selman:
Work Phone: + 44 (0) 191 222 7538
E-mail: p.f.selman@ncl.ac.uk

Kathy Mason: Work Phone: + 44 (0) 191 222 8483
E-mail: kathy.mason@ncl.ac.uk

Postal Address:
School of Geography
Politics and Sociology
University of Newcastle
Claremont Bridge Building
Newcastle upon Tyne NE3 1DB
United Kingdom
Fax: +44 (0) 191 222 7497

Contents

1 Introduction

2 Comparative Research and Policy Issues
2.1 A profile of the countries compared
2.1.1 Welfare Regimes
2.1.2 Background data
2.1.3 Increases in adoption from care in England and USA

3 Adoption Debates in Oceania
3.1 New Zealand
3.2 Australia
3.3 Conclusion

4 Care Options in the Nordic Countries
4.1 Sweden
4.2 Norway
4.3 Denmark
4.4 Conclusion

5 Adoption in Other Countries of Mainland Europe
5.1 The Netherlands
5.2 France
5.3 Spain

6 Canada

7 Kinship Care

8 Over-riding Parental rights

9. Outcomes
9.1 Studies of Foster Care and Comparisons with Adoption
9.2 The outcome of special needs adoption
9.3 Factors affecting success

10 Summary and Discussion
10.1 Improving Support for families
10.2 The need for a lifelong home
10.3 Improving provision for looked after children
10.4 A continuum of care options

Bibliography

Appendix 1

Alternatives to Adoption for Looked After Children

Report to Adoption Law Review Group of the Scottish Executive
Peter Selman and Kathy Mason
University of Newcastle

1: Introduction

In this report we are responding to a request from the Adoption Law Review Group to look at policy and practice in relation to "looked-after children" in other countries. The report outlines some of the key issues and policies in other countries, whose policies we consider to be of interest as providing some alternative approaches to those currently pursued in Britain and the United States.

The main body of the report is based on three key sources (Selwyn, J. and Sturgess, W. 2001, Thoburn, J. 2000 and Warman, A. and Roberts, C. 2001; 2003), supplemented by a reading of the New Zealand Law Commission reports and personal communications from colleagues working in some of these countries. Professor Pat Petrie at the Thomas Coram Institute is currently researching foster care in Denmark, Sweden, Germany and France, but no findings are yet published. Her research builds on earlier work on residential care (Petrie 2002).

2: Comparative Research and Policy Issues

Comparative policy analysis can be an important stimulus to new thinking about adoption policy and practice but should be used with caution. Many believe there has been an over-reliance on American research studies - and too great a readiness to follow American law, policy and practice - without adequate recognition of the particular problems of the American public care system and the issues of race associated with this.

European adoption research is largely focused on intercountry adoption and there is a tendency to see it as irrelevant to UK issues but the wider childcare system is worth studying and especially the role of prevention and the greater support available to birth families. There is also emerging research on outcomes for foster children.

Finally a wider context should remind us that the UK and USA have had the worst record on child poverty of all developed countries and that policy on tax credits and child care may be of greater relevance to children's well-being in the long run.

The UK is not alone in reviewing its adoption law and practice and we shall make reference to similar concerns in other countries which may help to focus on key issues. In particular we shall look at proposals from the New Zealand Law Commission which have fundamentally questioned the use of adoption as a major resolution of the needs of looked after children. Scotland has the advantage of being able to examine these ideas and also the debates in England leading to the Adoption and Children Act 2002 and subsequent discussion concerning associated guidance and regulations, although any evaluation of the impact of changes is for the future.

With these issues in mind we have looked at child care and adoption policy in nine other countries:

• New Zealand and Australia (section 3)
• Scandinavia: Norway, Denmark and Sweden (section 4)
• Netherlands, France and Spain (section 5)
• Canada (section 6)

As agreed, we have not reviewed policy in the United States, where there is a similar emphasis on adoption as the preferred solution for children in public care, but we have referred briefly to US experience in the sections on Kinship Care, Overriding Parental Rights and Outcomes (sections 7, 8 and 9)

2.1 A profile of the countries compared

All of the countries reviewed are industrialised societies, but there are some important differences in the overall policy directions and also in some of the social and demographic indicators and these are presented (with the US as a comparator) in the following pages.

2.1.1. Welfare Regimes

In recent years there have been several attempts to classify industrialised states in terms of their overall welfare provision. The most well-known is probably that of Gustav Esping-Andersen (1990) who identified three types of welfare state regime:

Liberal: in which "means-tested assistance, modest transfers or modest social insurance plans predominate" and benefits are directed mainly at low-income, usually working-class dependents and "progressive social reform has been severely circumscribed by traditional work-ethic norms"

Social Democratic: under which "the principles of universalism and decommodification" are extended to the new middle classes and there is a pursuit of equality with "all strata incorporated under one universal insurance scheme, with benefits graduated according to earnings"

Conservative-corporatist: committed to the "preservation of status differentials" and usually relying heavily on social insurance, with private insurance and occupational fringe benefits playing a marginal role

States are categorised as one of these regimes according to their public-private mix and the degree of decommodification - i.e. the extent to which "a service is rendered as a matter of right" and a person can "maintain a livelihood without reliance on the market" (1990; 27-28).

The UK is seen as belonging to the first group, which also includes the US, Canada and Australia. Leibfried (1991) suggested a specific Anglo-Saxon welfare regime, embracing the UK, United States, Australia, New Zealand and Canada. The location of Britain alongside the USA makes sense only if we consider the effects of Thatcherism - earlier models (eg Titmuss 1974 or Furniss & Tilton 1977) would have stressed differences - especially in the Beveridge model of social security and the NHS in postwar Britain. This may in turn need revision after two periods of "New Labour" government, which have seen a commitment to reducing child poverty.

The Social Democratic group comprised Sweden, Denmark and Norway, which were classified as Scandinavian Welfare States by Leibfried, who chose the term "Bismarck" countries to describe France and Germany, which Esping-Andersen classifies as Conservative . Leibfried also suggests that Italy, Spain, Greece and Portugal form a distinct type of regime, which he characterises as " Latin Rim" and we have taken Spain as an example, but the cluster has been criticised as essentially a geographical analysis which wrongly implies a less developed system. There has been difficulty in categorising the Netherlands, which is usually seen as "corporate-conservative" but has recently experienced neo-Liberal reforms. Esping-Andersen has described the Dutch welfare regime as "... Janus-headed because the income transfers are large (as in social democratic types) but social services and the sponsoring of women's careers are low (as in Conservative types of welfare state".

Lewis (1997) has looked in particular at the issue of one-parent families and has developed a typology based on the concept of the dominance of a "male breadwinner model family, in which men are assumed to provide income for women and children and women to provide care" (Lewis 1997 p 3). Britain, Ireland, Germany and the Netherlands are seen as examples of a strong male breadwinner model - although in the latter this has not resulted in a backlash against lone parents and support is generous despite the low number of working mothers (Millar & Rowlingson 2001). In contrast, the Scandinavian countries are seen as examples of a "weak" or "dual" breadwinner model.

2.1.2 Background Data

The tables below gives some background data on the countries reviewed, including any available material on looked after children.

Table 1: Looked After Children in Selected Industrialised Countries.

Country	GN1 per capita (2002) 1	Under 5 Mortality (2002) 1	% of children in poverty 2	children in public care 3 1998/9	% adopted from care 4 1998/9
Australia	$19,740	6	12.6%	30	0.8
New Zealand	$13,710	6	-	30	0.8
Sweden	$24,820	3	2.6%	50	0.2
Norway	$37,850	4	3.9%	30	0.7
Denmark	$30,290	4	5.1%	100	0.5
Netherlands	$23,960	5	7.7%	24	N/A
France	$22,010	6	7.9%	80	1.5
Spain	$14,430	6	12.3%	40	-
Canada	$22,300	7	15.5%	90	N/A
UK	$24,250	7	19.8% 5	47 (55)	4.0
USA	$35,060	8	22.4%	75	6.7

¹ UNICEF (2004) State of the World's Children 2004 Table 1, New York: UNICEF
² UNICEF (2000) A League Table of Child Poverty in Rich Nations, Innocenti Report Card no 1 June 2000; Florence: UNICEF Innocenti Research Centre
³ Figures - per 10,000 aged 0-18: Selwyn, J. & Sturgess, W. International Overview of Adoption: Policy and Practice: University of Bristol, April 2000; Thoburn, J. (2000) A Comparative Study of Adoption, University of East Anglia
⁴ PIU (2000) Prime Minister's Review of Adoption, London: HMSO
⁵ For further comments on UK figures see also Bradshaw (2005)

Table 2: Additional Data on Selected Coutries.

Country	Teen births 1998 1	Child Maltreatment 2	Government Expenditure: % of GDP - 2000 3	Inequalities 2001-2 4
Australia	18.4	0.8	36.0	0.305
New Zealand	29.8	1.3	37.2	-
Sweden	6.5	0.8	57.4	0.230
Norway	-	0.3	43.5	-
Denmark	8.1	0.8	54.8	0.217
Netherlands	6.3	0.6	45.3	0.255
France	9.3	1.4	52.7	0.278
Spain	7.9	0.1	-	-
Canada	20.2	1.0	41.2	0.285
UK	30.8	0.9	37.0	0.324
USA	52.1	2.4	33.6	0.344

SOURCES
¹ UNICEF Innocenti Report Card 3 2001
² UNICEF Innocenti Report Card 5 2003
³ OECD
⁴ The Gini coefficient is a measure of income inequality developed as a number between 0 and 1, where 0 corresponds with perfect equality (where everyone has the same income) and 1 corresponds with perfect inequality (where one person has all the income, and everyone else has zero income). Source = Institute for Fiscal Studies 2001

2.1.3 Increases in adoption from care in England and the United States

The number of children placed for adoption in England has risen from 1,900 in 1997 to 3,500 in 2003 (an increase of over 80%), but the impact has been lessened by a rise in the total number of looked after children, so that the proportion adopted has risen by only 57% from 3.7 to 5.8 (see Table 3 below).

Despite over 16,000 children leaving care to join adopted families between 1999 and 2003 the total number of looked after children has risen by over 5,000. The impact of adoption in terms of securing a permanent future for children is limited without a parallel drive to reduce the numbers entering care.

In the United States adoption has been the preferred alternative for children in public care since the late 1990s and especially following the 1997 Adoption & Safe Families Act , following which President Clinton called for a doubling of the number of children placed for adoption from public care. Table 4 shows the rise in adoptions for fiscal years 1998 to 2002. In contrast to England the number of children in care has started to decline, partly as a result of the rising number of adoptions: new admissions are static at about 300,000 per annum.

3: Adoption Debates in Oceania

New Zealand and Australia both emphasise early intervention and working with families. The number of children adopted in both countries is lower than in Britain and 'kinship care' is viewed as the preferred option. These countries (and Canada which is discussed later) have been classed with the UK and the US as "Anglo-Saxon" welfare states in the typology developed by Liebfried (1991); as "liberal" welfare states by Esping-Andersen (1990). Neither country currently regards adoption as an option for special needs children, but there has been much discussion about possible alternatives which can offer more permanence for looked after children

Table 3: Looked After Children in England 1997 - 2003.

Year	Total in Care	Rate per 10,000 aged 0-18	Number fostered	Number placed for adoption	% of Looked After Children
1997	51,200	47	33,500	1,900	3.7
1998	53,300	49	35,000	2,100	4.0
1999	55,500	50	36,200	2,200	4.0
2000	58,100	52	37,900	2,700	4.7
2001	58,900	53	38,300	3,100	5.3
2002	59,700	54	39,200	3,400	5.7
2003	60,800	55	41,000	3,500	5.8
2004	61,100	55	41,600	3,700	6.1

Source: DfES/ DH Statistics for Children Looked After in England for year ending 31st March

Table 4:US Statistics on Looked After Children

Fiscal Year Ending September	Total in Care	Rate per 100,000 aged 0 - 18	Number placed for adoption	% of Looked After Children
1998	559,000	75	37,000	6.7%
1999	567,000	76	47,000	8.2%
2000	552,000	75	51,000	9.2%
2001	545,000	72	50,000	9.2%
2002	532,000	71	53,000	10%
2003	523,000	70	49,000	9.4%

Source: Adoption and Foster Care Analysis and Reporting System ( AFCARS) statistics

3.1 New Zealand

Legal adoption was introduced in New Zealand in 1881, the first country in the British Empire to do so. Adoptive parents and birth parents has access to each others identity and the adoptee's birth surname was retained and hyphenated to the adoptive surname (Griffith 1998). In 1955 a new Adoption Act changed all this, introducing the "complete break" ideology, alongside more positive reforms which increased State supervision and protection of the welfare of the child. This ideology prevailed until the 1970s when members of the adoption triangle began to speak out against secrecy, citing the changes in England & Wales under the 1975 Children Act. A ten-year campaign culminated in the passing of the 1985 Adult Information Act, which gave substantial rights to both adoptees and birth parents, albeit limited by powers to both parties to impose a veto. Since then open adoption has become normal practice. Recently there has been widespread pressure for a further review to explore issues such as intercountry and transracial adoption; assisted reproductive technologies; and the role of alternatives such as guardianship, which is already "frequently promoted as more appropriate than step-parent or kin adoption in accordance with Maori culture" (Selwyn & Sturgess 2001 p92).

The primary legislation regarding looked after children is the Children, Young Persons & Their Families Act 1989 and the Guardianship Act 1968 . In the late 1990s there were 3,500 children in care and 80% were placed in home-based arrangements. Of the small number of adoptions from care in New Zealand around 80% are of children younger than 2 years old, reflecting that adoption is still primarily a means of supplying babies to childless couples.

Family group conferences were introduced in New Zealand in 1989, initially in relation to young offenders but there is now a much wider and extensive use as they are seen to help to reach decisions earlier and reduce delay in relation to children with problems. Where there have been reports of child abuse, neglect or care problems and an investigation has suggested the child is not safe, he or she will be taken into temporary care (with family members if possible) and the case referred to a Care and Protection Resource Panel which arranges the F amily Group Conference, which seeks an agreed plan with consent of all. If agreement is not reached or it is felt that a Court Order is needed the matter will then be referred to the family Court. The model has subsequently been followed in many other countries including Britain and Sweden. The use of family group conferences in Scotland has been discussed by Gill et al (2003).

Two recent publication papers on reforming adoption law have considered the position of looked after children and considered alternatives to adoption.

Adoption: Options for Reform: A discussion paper (New Zealand Law Commission, October 1999)

The Law Commission was asked to review the legal framework of adoption taking into consideration the changing nature of society since the 1955 Adoption Act and the 1985 Adult Adoption Information Act. A wide range of issues were considered including the competing interests of all parties to adoption; openness and contact; who may adopt including single and same-sex parents; access to birth records; the need or not for birth parents to consent to the adoption and cultural sensitivity to Maori traditions. This review was not looking for answers but raising questions to stimulate discussion and opinion. Also, they were not looking at alternatives to adoption but rather, a wide range of current issues relating to adoption.

Adoption and Its Alternatives: A Different Approach and a New Framework (New Zealand Law Commission, September 2000)

This later work from the Law Commission was looking at alternatives to adoption.

When asked whether adoption should be retained, or whether a more flexible approach should be introduced 38 of the 80 submissions said adoption should be abolished; 42 of the supporters of adoption were concerned that alternative would not provide sufficient permanency for the children.

The main recommendation was for the introduction of 'A Care of Children Act', which would include a range of care options, from temporary care arrangements to adoption. It was argued that a major benefit of such a system was that a range of options could be considered and there could be 'an ease of movement between the options' (p42). The majority of submissions to the review felt that adoption was in need of change and one of the first would be to change the 'legal fiction' that the adopted child had been born to the adopting parents. The review proposed adoption be replaced by a transfer of 'legal parenthood' to adopters as a means of giving full parental responsibility.

There was also a recommendation for the introduction of Enduring Guardianship to be used in situations where responsibility for a child had been partially or totally taken by a step-parent or family member (p52). Parental responsibility would pass to a new set of parents without removing the birth parents from the child's life. Parental responsibility would thus be shared and this might be a more appropriate way of meeting the need for permanency in such situations. Unlike current Guardianship, which expires when the child reaches the age of 20 years, an Enduring Guardianship would continue for a lifetime.

In November 2004 New Zealand passed a new Care of Children Act , which will take effect from July 2005, but this was in fact a replacement act for the Guardianship Act rather than the comprehensive statute recommended by the Commission. The proposals on adoption and a continuum of care, including enduring guardianship, are likely to be introduced in a later bill, which would replace the present Adoption Act, but not until 2006 after the next election (Gurney 2004). The new legislation is seen as urgently needed as open adoption has been practised in New Zealand for 20 years without clear legislative backing.

3.2. Australia

There is no national child welfare legislation in Australia, child protection being the responsibility of the community services department of each State or Territory. The role of adoption as an option has declined in recent years with only 543 adoptions in 1998/9 of which 244 were intercountry adoptions, 127 were traditional 'stranger adoptions, 48 carer adoptions and 124 step-parent adoptions. By 2002-03 the number of adoptions had fallen to 472, of which 278 (59%) were intercountry adoptions and 116 (25%) were 'known' (step-parent; carer or other relatives) adoptions. In Australia, in 1999 there were 14,667 children in out-of-home care (30 per 10,000 children under the age of 18) of whom 87% were in home-based arrangements. Almost half of the small number of adoptions from care were infants aged under 1.

Emphasis is placed on identity and openness. Many agencies will not approve adopters who are unwilling to facilitate continuing birth family contact after adoption. Forms of guardianship are available where parental consent is not given. There are special provisions to ensure that whenever possible children of indigenous ethnic origin remain within their kinship groups. Australia has a range of child-care options for children and young people, including out-of-home care, but such options are not seen as culturally appropriate for Aboriginal or Torres Strait Islander families in New South Wales.

In 1992 the Australian state of Victoria introduced a 'Permanent Care Order' under which the new permanent parents have both custody and guardianship of the children and are given caregiver payments until the child reaches the age of eighteen years. It is an option for children only when their parents are unable to fulfil their parenting role and the courts have determined that family reunification is not a desired outcome. The main objective for granting a Permanent Care Order is to provide the child with the opportunity to develop a stable caring relationship with their caregivers without severing ties with the birth family. The order does not affect the child's name, birth certificate or inheritance rights and in most cases contact with birth parents continues. In 2000/2001 91 permanent placement orders were made in Victoria, an increase of 15 over the previous year.

Thoburn (2000) suggests that the numbers of children adopted or in permanent care are low in Australia because formalised kinship care is the preferred option for their children in need of out-of-home placements. However, new legislation in New South Wales in 2001 may lead to a greater emphasis on permanency planning and an increase in the adoption of looked after children (Barber and Delfabbro 2004).

3.3. Conclusion

There has been widespread interest in the idea of a continuum of care options as suggested by the New Zealand Law Commission and the proposals for enduring guardianship were influential on the development of special guardianship in England. Family Group Conferences have already been taken up in many countries including Scotland (Gill et al 2003).

4: Care Options in the Nordic Countries

In her analysis of welfare regimes around Europe, Pringle (1998) found that there was reluctance in Nordic countries to remove children from their families of origin. In each of the countries family preservation was the key via a strengthening of families and via preventative measures. However, open adoption is now being considered by some of the countries as a possible way to meet the need of children away from home but allowing the maintenance of links with the birth family. There is an underlying principle in each of the countries that the State and the family each have equal responsibility for raising children (Selwyn and Sturgess 2001).

In all Nordic countries child poverty is far less prevalent than in the US or UK and preventive and support services more advanced. Welfare policy concentrates on strengthening families and on preventative services and this is reflected in child care practice. Consequently the rate of children entering care is lower in some countries.

In Sweden, Finland and Denmark adoption is not currently viewed as an option in child welfare policy. However, open adoption is now being considered by some countries as a possible way to meet the needs of children within the welfare system and at the same time maintain some links with the birth family. We have looked in detail at the situation in Sweden, but have also included brief comments on Norway, where the number of looked after children is particularly low but there has been a growing interest in a role for adoption, and Denmark where there has been resistance to the trend towards kinship care found in other Nordic countries.

4.1 Sweden

"The Swedish child welfare system has no permanency planning as we know it from, for example, the United States and Great Britain" (Andersson 1999)

The 1980 Social Services Act allows for children to be placed away from home with parental consent, but children can also be removed from parents under the Care of Young Person Act. However the Swedish Board of Social Welfare has stated that "as far as possible, (placements) should be for limited periods of time and focused on treatment, with reunion as the objective" (SoS report 1990). There is no legislation to terminate parental rights so that adoption against the wishes of parents is not possible and there is no provision for a permanent care order or guardianship without consent.

In 2001 there were around 18,500 children and young people in care at some time during the year - around 3000 returned home. The proportion in care is similar to the UK, reflecting the higher level of state intervention in Sweden compared to Norway and Denmark. Statistics show that only 30 children were adopted in 2001 with fourteen of these children being under the age of three. The majority of adoptions in Sweden are overseas adoptions (1,019 in 2003). Adoption is not an option for the majority of children in care because there is no legislation for the termination of parental rights.

Some children are cared for in small residential units that are run by the private sector, but foster care is the preferred option for the child, especially those in long-term care: more than 80% of children in care are placed in foster care with the ultimate aim of family reunion. Placement with kin is usually explored first. Foster parents are generously remunerated - receiving between £500 and £1,000 per month, in large part tax-free and there has been much criticism of recent increases in the number of children removed against parental wishes. There is nothing stated in law about what should happen to children if it is not possible for them to return home and there are no time limits or guidelines about permanency. This can mean that some children "remain in foster homes for the whole of their childhood, on terms similar to adoption" (Andersson 1999, p 175) and concerns have been raised about the outcomes for the children in this type of placement.

The problems surrounding children in long-term foster care have been highlighted in a number of recent studies. Sallnas et al (2004) have reviewed nearly 1000 placements made during 1991 and found that between 30 and 37% were prematurely terminated. The lowest rates of breakdown were found in kinship care and secure units; the highest in non-kin foster homes, where teenagers displaying anti-social behaviour were particularly at risk. Such failure rates are not out of line with other countries, but indicated a particular need for older children. However, the most striking indictment of the failure of foster care in Sweden comes in a study by Hjern et al (2004) of "avoidable mortality in young adults," which showed a much increased risk of suicide in intercountry adoptees and child welfare recipients. The latter - and especially a sub-group defined as in long-term foster care - were found to be also at risk of other "avoidable deaths" (e.g. homicide; deaths related to substance and alcohol misuse). One factor is likely to be the foster children's background - 41% had parents who had been admitted to hospital for alcohol or substance misuse or psychiatric disorder. However, a key aspect of the findings was that such deaths were most likely to occur over the age of 18 (when the international adoptees showed no increased risk) "highlighting the difference of being a permanent and transitory members of a substitute family" ( ibid 415 ). American studies have also identified deaths in "looked after" children as restricted to time after care (Barth 1998; Thomson 1995).

This has raised again the absence of "permanence" as a concept in Swedish child care policy. In 1995 there was discussion about parental responsibility being passed to foster parents with children in long term placements but the Swedish Government turned this down (Andersson 1999) and the possibility of adoption from care remains remote. Since 1995 Family Group Conferences have been introduced in Sweden and other Nordic countries - following the model introduced in New Zealand - and the results have been seen as very promising.

4.2 Norway

In Norway 30 per 10,000 of all 0-18 year olds are in care, one of the lowest rates in Europe. Despite increasing interest in adoption as a permanency option for children who cannot be returned to their family there is no legal provision for open adoption, nor are there any post-adoption services for children adopted from care (Selwyn and Sturgess 2001, p45). Children tend to stay in foster care longer in Norway than in either Denmark or Sweden but this could be because every other avenue has been explored and the care system is the very last option for the most difficult cases (Blacke-Hansen 1992). As in Sweden, most adoptions are inter-country and a majority of the domestic placements are with step-parents. Only 80-100 children are adopted from care each year, most of these being infants born to "drug-abusing" mothers.

4.3. Denmark

The nuclear family is seen as the most important and therefore the extended family is not considered as alternative carers. Care plans have to be drawn up and reviewed on a regular basis - the first time after only 2 months and then every six months. Most children entering the care system are older (teenagers). Special needs children are placed with specially trained foster carers, for whom this is typically a professional full time job undertaken by psychologists or psychiatrists. Continuing contact with birth families is encouraged and there is concern over the poor outcomes for children without families in all types of foster care.

Research by Christoffensen (1996) into the long-term outcomes of children who had been looked after by the care system, found that a quarter had experienced five of more changes of school with many not completing compulsory schooling. Additionally many were found, at the time of the study, to be unemployed and suffering from low esteem and a lack of confidence. There is a growing use of small residential homes, staffed by social educators and psychologists, and this is a reminder of the value of good quality residential care as part of the overall provision for looked after children.

Denmark is one of the few countries that is not turning to members of the extended family for support during times of crisis. It is considered important to preserve the concept of the 'integrity of the nuclear family'. As a consequence, family group conferences are not used in Denmark. The state takes on an active role in supporting families, continuing support after the removal of a child and provides an intense service provision for rehabilitation at home.

4.4. Conclusion

The countries reviewed above all rely on foster care as the main provision for looked after children, although there is evidence of a growing interest in adoption in some. None provide a model which is clearly superior to the appropriate use of adoption in providing permanence, but there is much to learn from the successful use of kinship care and specialist fostering and in the stronger commitment to preventive policies compared to Britain and the USA.

5: Adoption in Other Countries of Mainland Europe

Although today adoption in mainland Europe - as in the Nordic states - is primarily about intercountry and step-parent adoption rather than domestic adoption (including special needs), there may be much to learn from their very different context and we have listed below some examples.

5.1 The Netherlands

The Dutch Ministry of Justice has commissioned an evaluation of the Dutch Adoption Law. One part of that, which is also relevant to domestic adoption, is to look into the age issues. Dutch adoptions are mainly intercountry adoptions (1100 a year compared to 40 domestic adoptions a year) - all adoptions take place under the Dutch adoption law that came into effect in 1998 in order to ratify the Hague Convention on Intercountry Adoption which the Dutch government signed in 1993. Dutch Law sets limits on the age of the prospective adopters, the child and the family formation. The maximum age for adoptive parents is 46 and the maximum age difference 40 years. A child can be no older than 6 years when entering the Netherlands and any child that is placed in a family should be no less than 1 year younger than the youngest child in the family. This legislation was influenced by research by Verhulst (2000) and Hoksbergen (1997), which identified age at adoption as a major negative factor in outcomes.

The Netherlands has one of the lowest levels of looked-after children at a rate of 24 per 10,000 of the child population. Dutch local authorities can take children into care and place them away from home but they must have the full consent of their birth parents and the parents retain full parental responsibility during their children's stay in the care system. When children come in to the care of the state rehabilitation is always the main aim and professionals have to work closely with the birth parents. They also actively encourage the parents to be in regular contact with their children - even when the child has been compulsorily removed. As a consequence of the high levels of intervention and support for families, children in care tend to be older than those in other European countries; they are also likely to have more severe emotional and behavioural difficulties.

Adoption is not considered for children with special needs. Even in situations where there has been a compulsory order made and the children are brought in to care against the wishes of their parents the courts are obliged to review the cases each year, to seriously consider whether the child can be safely returned home (Warman and Roberts 2003). There is no provision at present for "open" adoption. At the current time there is a national shortage of foster carers leading to moves to improve payments, training and 'attachment leave'.

There may, however, be lessons to learn from the Dutch policies in respect of children adopted from abroad. Concern over the outcome of these adoptions has led to a determined effort to provide parents with post adoption support and in 1999 the Dutch government introduced a scheme offering new adoptive parents support sessions with a possibility of follow-up when the child begins school or reaches adolescence (Juffer 2001). The problems facing British parents adopting special needs children are similar but may be even greater where the children have experienced abuse or unsettled early lives (Warman & Roberts 2001).

5.2 France

The French child welfare system was decentralised in 1983, giving local authorities the power to make administrative and financial decisions. There were 80 per 10,000 children in care in the late 1990s (Selwyn & Sturgess 2001). The emphasis is on keeping children at home and even when children are taken into care, rehabilitation to their home will usually be planned and cases are reviewed in the courts every year. Multi-disciplinary teams provide a wide range of services to families in difficulties and financial payments can be made as well as other support. In 2000 1.5% of the French population under the age of 20 years received this kind of help, or a short-term placement, while remaining in the care of their parents. Approximately 1000 children are adopted from care each year, the majority of these being young infants for whom the aim is an early placement within a year. Only children who are wards of court ( pupilles de l'etat) can be adopted and there are five different circumstances, by which children become wards of court:

1) if a child/baby has been abandoned or has no known family or is not recognised by their family;

2) if the parents have consented to the adoption at the time of the child's birth;

3) if the courts make an order on the grounds that the birth parents have relinquished their responsibilities for a year or more;

4) if the child is an orphan with no family guardian and

5) if the courts have removed parental rights.

There are many children who do not become wards of the state because they do not meet the above five criteria and are therefore, in need of long-term out-of-home placements. The majority of these are placed with foster families. All foster carers in France have professional status and since 1992 are obliged to undergo professional training, and are paid a wage in addition to childcare expenses. They are also seen as part of the family placement team and have a role to play in rehabilitation plans for the children. Children in long-term care cannot be adopted as long as their birth parents retain parental responsibility (Warman & Roberts 2003).

For children with special needs who are adoptable there is collaboration between departements (administrative regions) to find a family to accept them for adoption, but it is two private associations (one called Enfants en Recherche de Famille and the other called Emanuelle) which take children with severe handicaps. For the children who are not wards of the state, if their parents maintain family obligations/ ties there is no possibility of adoption, although an article of law requires the Aide Sociale a l'Enfance to ask for legal renunciation if the family does not show adequate maintenance of such obligations (Gueant 2004). Young children are often placed in residential homes for assessment to avoid intense bonding which could jeopardise later family placements.

France has 'full' ( pleniere) adoptions which completely severs legal ties with the birth family but also has 'simple' adoptions where the adoptive parents are given parental rights but the child keeps the birth family name and retains heritage rights. There have been major problems over access to birth records due to the practice of allowing birth mothers to remain anonymous. A new law in January 2002 encourages mothers to leave their identity in a sealed envelope and many are now doing so.

5.3 Spain ¹

In 2002 there were 31,368 children in public care (about 40 per 10,000 children under 18). 45 per cent of these were in residential care - a much higher proportion than in the other countries we have been discussing. This is in part a legacy of the Franco years when residential care was the only form of provision - Spain has only been a free democratic State since 1978 (Colton & Heelinckx 1993). The main form of provision in 2002 was kinship foster care ( acogimiento en famila extensa) which accounted for 46.8% of children - with only 7.9% fostered by non-relatives. However, there are difficulties in obtaining a clear picture of Spain, as provision for looked after children lies with the 17 constituent autonomous communities.

Foster care can be arranged by administrative decision - which implies agreement between the administration, birth parents and foster parents and the child if older than 12 or by judicial decision - where the separation of the child from the birth parents was contested and the case taken to court. The former account for nearly twice as many foster placements each year. There are about 1,000 domestic adoptions a year, an increasing proportion being judicial decisions after the birth parents have contested the plans of social workers, but these remain a minority of total adoptions with the majority now being intercountry adoptions, the number of which increased from under 1500 in 1998 to over 5,000 in 2004. Social workers have the power to remove children and adoption is possible without parental consent.

In Spain Kinship care refers to children who have moved to live with relatives (usually grandparents). There are many kinship care instances that are informal and are not part of any statistics. But those in the statistics are cases where (e.g.) the grandparents are the foster carers, usually in what the law calls "permanent foster care", that is to say a foster care situation where reunification is not considered to be feasible. In some cases, the mother of the child might be living in the same household, although the grandparents are the ones with custodial responsibilities, but grandparents cannot adopt a grandchild.

6: Canada

There are few publications about adoption in Canada and for many years there was little discussion about adoption other than press comments on babies from China and long waiting lists for domestic adoption. Adoption was rarely mentioned as part of the solution to 20,000 children growing up in permanent government care where parental rights have been terminated and many are in small institutional placements due to the shortage of foster homes for such children. Selwyn and Sturgess (2001) excluded Canada from their analysis "as the quality and reliability of the data was poor" (p vi).

According to the May 2002 "Report Card on Adoption" by the Adoption Council of Canada, there are over 66,000 Canadian children in foster care (93 per 10,000 aged 0-18). About 22,000 are permanent wards, and less than 1,700 of them are adopted annually across the country - 2.5% less than in UK and US ( Ross, 2000). In 1997 a new programme - Canada's Waiting Children - was announced by the Adoption Council of Canada. ( www.canadaswaitingkids.ca ). On March 19, 2002, the New Brunswick Adoption Foundation was launched. It is the first adoption foundation in Canada. It champions the cause of over 600 children in the care of the N.B. Ministry of Family and Community Services who need permanent families. Since the Foundation's inception, 164 children have been placed in adoptive homes. The Foundation was created to raise funds to support the New Brunswick Adoption Initiative, through education and public awareness. The Foundation is a charitable non-profit organization, independent of government. A conference on building lifelong connections was held in New Brunswick in October 2004. The slogan of New Brunswick's adoption recruitment campaign is "Kids can't wait to have a family" or "Une famille ... le rêve d'un enfant".

Despite the evidence of growing interest in adoption of looked after children in Canada - and the indication of a growing rate of adoption from care (see Table 1) - we must agree with Selwyn & Sturgess (2001) that the limitations of available data make it impossible to use the country as a source for ideas about alternatives or indeed in relation to improving practice.

7. Kinship Care

One alternative to fostering and adoption by approved non-relatives is formalised kinship care . This has been favoured in Australia and New Zealand where particular doubts about "stranger" adoption or fostering of children of indigenous ethnic origin has influenced overall policy for both countries.

Kinship care is rare in the UK where informal arrangements are more likely (Thoburn, 2000), but in the US there has been a major growth in the number of children in state custody who are living with their relatives. In 1997 approximately 150,000 foster care children, about one-third of all children in foster care, were living with relatives and in California a majority of foster children are with relatives.

This shift has been so significant that its importance is fully national in scope. Some attributing factors for these increases are:

• increased reporting of abuse and neglect;
• a change in drug usage related to the spread of crack cocaine addiction and other drugs;
• increased levels of poverty;
• more children are affected by HIV/ AIDS;
• parents struggle with physical and mental health problems;
• family violence and parental incarceration; and
• decline in the availability of traditional foster homes

Kinship care is also used in Sweden, where recent studies indicate less risk of placement breakdown for children fostered by relatives, who are also more likely to stay with family after 18. Kinship care is also common in Norway, but not in Denmark. In Spain this is the main method of foster care and accounts for nearly one half of looked after children (see section 5.3 above). The children in such placements tend to remain longer and are likely to continue with their new families after the age of 18, when risks for "looked after children" have been shown to be particularly acute.

8. Over-riding Parental rights

In England in March 2003 a majority of looked after children (65%) were subject to care orders and a further 1,900 were "freed for adoption" - a higher figure than in most of the other countries we have reviewed, but similar to the situation in the United States, where the Adoption & Safe Families Act 1997 requires termination of parental rights and a move to adoption, if a child has been looked after for more than 15 of the previous 22 months, unless it can be shown that the State has not made reasonable efforts to return the child to its family or the child is being cared for by a relative or there is a "compelling reason" for believing it would not be in the child's best interests. In Canada about a third of all looked after children are "permanent wards".

In Denmark and Sweden only 3% of care orders are made without parental agreement, compared to 30% in the UK (Selwyn & Sturgess 2001 p 43). The biggest difference, however, is the reluctance of the Nordic countries to place children for adoption, which would involve a permanent termination of parental rights. It is this final step that has been a cause of major concern in other countries, especially New Zealand and Australia, leading to much debate about the possibility of a permanent order which does not involve such exclusion of the birth family.

While the concept of "open" adoption has moved adoption away from the traditional "fresh start" and "secrecy", the extent and implications of long-term contact remains uncertain. The use of open adoption and "adoption with contact" has encouraged more interest in the Scandinavian countries in a possible role for adoption in respect of looked after children.

The 2002 Adoption & Children Act makes the child's welfare the paramount consideration in any decision relating to adoption. This will make it easier to place children for adoption against the wishes of their birth parents, even if there is no specific fault, an approach unacceptable to many of the other countries reviewed and which raises concern over the lack of support for birth mothers who lose their children in this way (Mason & Selman 1997).

9. Outcomes:

This review has provided a limited secondary account of provision for looked after children in nine countries and it is unlikely that any of the models will be appropriate for Scotland. However, the fact that most of the countries have not seen adoption as the preferred solution and the reluctance of most to remove children against parental wishes should act as a reminder of the importance of having a wide range of options in offering permanence for looked after children.

Ideally we would be able to point to one or other approach as more successful, but the data presented suggest that other factors must also be considered. Despite a higher proportion of looked after children being placed for adoption in the UK and USA, the number in need of a permanent family remains higher than many other countries because more children are in public care - preventive measures remain the priority alongside attacks on the social inequalities and poverty that lead to children being unable to live with their birth family.

Variations in the proportion of children who are "looked after" also make it difficult to carry out comparative studies of outcomes, as in those countries with low proportions of children in public care the looked after children may have a higher concentration of problems - as in Norway where the children admitted to care tend to stay for longer periods. Likewise comparisons over time are made more difficult by the changing characteristics of looked after children and particularly the suggestion that the population today includes more children with severe problems.

Nevertheless it is important to consider the outcomes of different modes of care: e.g.

• Residential Care
• Long-term Foster Care
• Kinship care
• Adoption by foster parents
• Other non-relative adoptions

This section of the report will look briefly at national studies which have attempted this and also review the more extensive British and American studies on the outcome of special needs adoptions.

9.1 Studies of Foster Care Outcomes and Comparisons with Adoption

Barth & Berry (1987) compared the long-term outcomes for four groups of looked after children: those reunited with their parents; those who were adopted; children in long-term foster-care; and those with a guardianship order. Findings suggested that children placed for adoption had the best outcomes and those reunited with their birth parents the worst, findings similar to those of Tizard (1977) in an earlier British study. They conclude that "long-term foster care is not a preferred option", a belief that remains at the heart of current American policy (Sargent 2003).

More recently, Triseliotis (2002) has looked at the research literature on outcomes of adoption and long-term foster care for children who cannot return to live with their birth families. He notes that studies carried out before 1990 show significantly higher breakdown rates for long-term fostering compared with adoption (2002 p 26) and that, although many later studies show a narrowing gap, the recent study by Sinclair (2000) for the Department of Health concluded that foster care rarely offers permanence and that the chance of long-term placements lasting is "very low". Caution must be taken in drawing conclusions from these studies as an increasing number of very problematic children are now being placed - e.g. adolescents (Rushton 1988; 2000, 2004) and children exposed to parental substance misuse (Phillips 2004). In respect of the former Mulligan S. (2003) has argued that long-term foster care may be more appropriate for older children given the high breakdown rates associated with older age adoption placements.

Triseliotis argues that "the main defining difference between these two forms of substitute parenting appears to be the higher levels of emotional security, sense of belonging and general well-being expressed by those growing up as adopted compared with those fostered long term" and also the different expectations placed on foster carers and adopters, with the latter more likely to persevere "against the odds" (Quinton et al 1998).

However, he suggests four situations where long-term fostering may be the preferred option:

1. Where children do not want to be adopted;

2. When children attached to their current carers so a move would not be appropriate;

3. Where there are high levels of birth family involvement.

4. Where children, especially older ones, and their carers want time to get to know each other before making a final commitment.

This last point raises important issues about progress from foster care to adoption. Research suggests that the most successful type of adoption for older and special needs children is where foster carers decide to adopt. The dilemma is where foster carers are not prepared to adopt but are willing to offer long-term care. There are clear risks in moving a child from a family where (s)he has made attachments to a new family willing to offer an adoptive home, but leaving a child in the foster home can lead to rejection at a later stage when it will be more difficult to find adopters and where any placement has less chance of success - the result is often a succession of temporary placements and the risk of the child eventually growing up without a family (Triseliotis 2002 p31). This suggests a need for more attention to the support offered in long-term foster care, as well as an exploration of factors which encourage foster carers to offer an adoptive home, including the availability of post adoption support and adoption allowances.

What is clear is that "long term fostering has a firm place in planning" for some children and that there is a need for more research into successful placements and whether these can maintain a family relationship for children into early adulthood (see also Schofield, 2003). There is also a need to explore how both foster carers and the children placed can be given a greater sense of security and it is in this context that the proposals for "special guardianship" in the Adoption & Children Act 2002 are important.

In the next section we look at the more extensive research literature on outcomes of special needs adoption.

9.2. The outcome of special needs adoption ²

Most of the evidence on the "success" of adoption for older and special needs adoption has come from studies in the US and Britain, although there is also a growing body of research on the outcomes of intercountry adoptions, most of which are seen as involving "special needs" (Selman 2003; Verhulst 2000). Some of the findings are discussed below. Appendix 1 contains some definitions of special needs and summaries of factors affecting success drawn from the American literature.

The literature on domestic special needs adoption in US is now vast, especially if we include earlier literature on "permanency planning" or the adoption of older children. Much of this has been loosely labelled "outcome" research and it is this that has generated most concern about the risks of placing older children. In studies of "permanency planning" outcomes have often been defined in terms of "disruption" - usually defined as breakdown of placement plans before adoption order - but sometimes equated with or also embracing "dissolution" - breakdown of adoption placement (McRoy 1999).

Older age at adoptive placement has been linked with increased risk of adoption breakdown or later maladjustment in numerous studies and is seen as a powerful factor within various categories of "special needs" leading to calls for more rapid placement when a family situation is seen as irretrievable. The most widely quoted of such studies is probably Barth & Berry (1988), who show the proportion of disruptions rising from 5% for 3-5 year olds to 24% for those aged over 12 years at placement, a finding replicated in many other studies (Boyne et al, 1984; Festinger, 1986; Thoburn, 1990).

Rosenthal & Groze (1992) studied 800 "intact" special-needs families and claim that their survey "provides empirical justification for what many professionals already know - that adoption of older children and children with handicaps is rewarding and satisfying for a substantial majority of families. In a later study Groze (1996) reports on a four-year follow up of 199 families. After one year 51.5 per cent of parents considered that the overall impact of the adoption on the family had been very positive, but this had fallen to 39% after 4 years and the number reporting the impact as "mostly negative" had risen from 3.1 to 13.6 per cent after 4 years. Despite this, 78 per cent of the parents said they never thought of ending the placement and 84 per cent said they would adopt again. However, caution must be exercised about the findings as only 71 of the families (35%) were left in the study after 4 years.

In the UK Rushton et al (1988) report on a small study of 18 placements of older boys (aged 5-9). A total of 31 children were placed - multiple placements being largely sibling groups. The authors conclude that success seemed to reflect the child's sense of security and parental attitude rather than the severity of problems at placement. In a later study Rushton et al (2000) carried out research into 61 children with very negative early experiences who had been adopted from care and found a disruption rate of 20 per cent, with rates rising with age of child at placement. Most recently Rushton & Dance (2004) report findings from a study of 133 late placed children. The continuation rate was 91% after one year and 71% after six, but the authors note that a third of the continuing placements were considered highly problematic.

There are many other studies of special needs adoption. Excellent reviews of studies from the 1970s and 1980s can be found in Rosenthal (1993) and Thoburn (1990) and the Adoption Quarterly has provided reviews of more recent research on a number of relevant groups: adolescent and older-child adoptions (Haugaard et al 1999a); children with developmental disabilities (Haugaard et al 199b); children affected by HIV and AIDS (Haugaard et al 1998); and those exposed to illegal drugs in utero (Haugaard et al 2001). Other useful sources of research into special needs and of practice implications are Anderson (1997), Avery (1997), Glidden (1990). McRoy (1999) and Parker (1999) pay special attention to practice implications of such research. However, there has been very little research on the outcomes for different forms of care so that these studies cannot answer the question of whether there are alternative forms of provision which could achieve similar (or better) outcomes.

The most recent published study on children adopted from care in the United States comes from the Evan B Donaldson Adoption Institute (2004). The study finds that "the vast majority of adoptions from foster care remain intact over time, notwithstanding concerns by many professionals that the failure rate of such adoptions would rise as a result of huge increases in their numbers during the last decade"

9.3. Factors affecting success

There is now a growing consensus about those factors that are predictors of positive outcomes (McRoy 1999; Rosenthal 1993; Rosenthal and Groze 1992) and these are listed in Appendix 1. There is also agreement about some factors which are consistently associated with negative outcomes. Older children are at greater risk but most placements succeed so that we must be careful not to react to the association of age with less satisfactory development by any suggestion that older children should never be placed for adoption. The message should rather be that, once it has been established that a child can no longer live with his/her birth parents, placements should be made as soon as possible. Similar dilemmas arise over the interpretation of research showing poor outcomes for children experiencing multiple moves before placement.

It is, therefore, important to consider the "value added" by adoption - for many older and special needs children this will be great even if many problems remain, as long as they are able to remain in a family with the prospect of a lifetime relationship. We need, therefore to ask questions about outcomes that look at costs and benefits, for both children and parents e.g.

• Do the costs for the minority of children whose placements fail outweigh the benefits for those that succeed? Is there a "necessary risk"? (Festinger 1986)
• Do the costs for some adoptive parents threaten the whole pattern of special needs adoption?
• What can society do to minimise these costs e.g. by post-adoption support and subsidies?

Many of the studies cited also indicate that post-adoption experience (including some characteristics of adoptive parents) is probably more important than pre-adoptive factors, suggesting that more care is needed in assessing and preparing parents and in matching. McRoy (1999) found that in her study 87% of the disrupted adoptions and 76% of the dissolved adoptions were considered to be poor matches between parent and child.

Finally, we must never forget that the search for permanence is not only about adoption, but about finding where adoption can play a crucial role alongside other forms of long-term care and renewed efforts at prevention and rehabilitation. This brings us back to the need for more studies looking at the effectiveness of a wider range of "permanent" solutions (Selman 2003).

10: Summary and Discussion

This report has aimed to provide a brief introduction to policy and practice in respect of looked after children in nine developed countries, based on a review of recent literature. We have relied heavily on three previous reviews (Selwyn, J. and Sturgess, W. 2001, Thoburn, J. 2000 and Warman, A. and Roberts, C. 2001; 2003), the most useful of which has been Selwyn, J. and Sturgess, W. International Overview Of Adoption: Policy and Practice, (University of Bristol 2001). The authors looked at all of the countries we reviewed with the exception of Spain, but excluded Canada from its analysis due to the poor quality of data.

Of the countries discussed in this report only Canada currently promotes adoption strongly, although adoption is emerging as a part of policy for looked after children in France and Norway. In the other countries foster care is the preferred solution with special needs children likely to be looked after by highly paid specialist foster carers and a wider use of kinship care. Parental rights are only removed in extreme cases. There is, however, growing concern over those children without families and their lack of continuity of care as they grow into young adulthood. Institutional care is widely used in cases of foster home breakdown.

British policy is, therefore, in many ways in advance of most of the countries reviewed in respect of seeking permanence for these children and there are no easy alternatives to recommend. The proposals for a "continuum of care" in the New Zealand Law Commission reports are attractive but have not yet been translated into law. In the mean time the Scottish Adoption Law review is rightly addressing those issues of permanence raised in the review of English Law.

Reviewing policies in other countries shows that there are many different approaches to supporting children and their families. Warman and Roberts (2003:1 p46) suggest this wide range of options has a lot to do with 'deep-rooted attitudes and beliefs' but warn that it is difficult to comment whether any system is 'better' than another without a full evaluation of research findings about each method/system. A central concern must be the evidence that looked after children do poorly in later life and that intervention by the State has been shown to be ineffective. A key issue is the vulnerability of such children when they leave care, especially if they lose contact with their temporary carers - whether in a foster or residential home: - hence the importance in the UK and US of the concept of permanence in the original sense of the term, including rehabilitation. Adoption is just one possible route but one that has proved relatively successful. The danger is that the "costs" of adoption - in terms of loss of links to the birth family - have been neglected and adoption pursued at the expense of a parallel emphasis on improved services for prevention and rehabilitation and on strengthening alternatives such as long-term fostering (Schofield 2000; 2003).

10.1. Improving Support for Families

The level of support for families seems to be a major factor in determining whether children come in to - and remain in - care. Some of the countries reviewed have demonstrated a greater capacity to provide such support to families and two areas seem important:

• Universal, affordable childcare that enables parents to work and be economically self-supporting is especially important for single parents and a major influencing factor when they begin to think about future parenting options. The childcare system in Sweden is often cited as an exemplar.
• The degree to which professionals work with birth families when difficulties arise and the emphasis given to keeping children at home or to rehabilitation in cases where children have been removed.

There are also a number of more specific examples of support which have proved successful in other countries and which merit consideration as Scotland moves towards new provisions for adoption and permanence:

a) Payments to families - are more generous in Denmark, Portugal and Greece - but are usually made only if there is proof that the child would otherwise have to be placed outside the family home.

b) Provision of Day Centres - open to children and parents who are encouraged to discuss their problems and look for solutions. These can vary in type including ones that are open after school hours for families with older children.

c) Home-based support - this can be an expensive alternative because the support can be on a daily basis and continue for several weeks. It works by the professionals visiting the family in their own home on a regular basis. The professionals can be social workers with a role of educators visiting on a daily basis or therapists who may only visit once or twice a week. A novel scheme in the Netherlands is where families volunteer to have certain parts of their daily life filmed. The family and professionals then view the video together to discuss issues that have arisen.

d) Networking - gather relative, friend, professionals and anybody else available to support the family. The Netherlands have a neighbourhood youth care network scheme which involves professionals from the community (nurses, teachers, doctors, social workers) working on a daily basis with under-12s and their parents. Denmark has a scheme where the children spend time away from home with relatives every other day or at weekends.

e) Kinship Care - which has been most widely documented in New Zealand where it is linked to the development of family group conferences discussed earlier, but is now seen as a vital resource in the USA, especially in relation to black ethnic minority children who are over-represented in the care system: Black/African American children represent 15% of the population but account for 41% of looked after children.

10.2. The need for a lifelong home

One of the most compelling arguments for making adoption the preferred option for children unable to return on a permanent basis to their birth families is that it is the only form of substitute care which can provide a home for life. A big problem of children being brought up in residential or foster care is that of 'leaving care' (Ruxton 1996). Children are often expected to become independent at an earlier age than the average and the transition to independence is likely to be more abrupt. As a consequence there are higher levels of unemployment, prostitution and begging amongst those brought up by the care system. This is in direct contrast with outcome studies of children who have been adopted. The Swedish study cited above (Hjern et al 2003) suggests that this is a very real problem, manifested in extreme negative outcomes for a minority of children, especially those in non-relative foster placements.

As foster care is likely to continue as an option for many children in the foreseeable future, it is important to consider how we can provide security into early adulthood and beyond for those children who are not -or cannot - placed for adoption. The proposals for "enduring" guardianship have a clear appeal.

10.3. Improving provision for looked after children

Selwyn and Sturgess (2001) point out that even if adoption is to be a preferred option, there is much to be done to improve current practice and a parallel need to address the issue of those children who cannot be considered for adoption. Some of their key points are listed overleaf:

• A need for better data and research on adoption from care enabling "evidence-based practice"
• A need for more understanding in respect of children affected by parental substance misuse, which is a growing problem and often involves irreparable damage
• Urgent action to minimising delays in permanent placement
• Treatment Foster care - for children with major long-term problems
• Specialist teams to recruit suitable adopters - links to Adoption Register
• Post adoption support - from extension of adoption allowances to the wider availability of counselling services.

10.4. A continuum of care options

While a review of the alternatives to adoption has not indicated any model which can be shown to be clearly superior to that currently pursued by Britain, it does suggest the value of seeking a wide range of measures to provide permanence and of the danger of neglecting the equal importance of improving support for families and preventing children coming into care (Warman & Roberts 2001). In many other countries more resources are devoted to long-term fostering and it is important that adoption does not deflect attention from the current crisis in foster care in the UK. There is growing evidence that adoption by foster parents is more successful than adoption by new parents so that any decision to move a child from a long-term foster home simply to ensure an adoptive placement must be questioned. Likewise the role of kinship care seems to be neglected. What is clearly needed is a wider range of options than adoption and traditional long-term fostering which ends at 18. The examples discussed above - enduring guardianship in New Zealand; permanency orders in Australia; special guardianship in England - show that alternative legal routes to permanence are possible, although few of these have been systematically evaluated in comparison with adoption. What is less clear is how we ensure that such options are fully resourced and that research is undertaken which will show which options work best for which children.

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Useful websites:

Australia, New South Wales Office www.nsw.gov.au

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United States Adoption and Foster Care Analysis and Reporting System www.acf.hhs.gov/programs/cb/dis/afcars/publications/afcars.htm

Warman & Roberts (2003) working paper available at www.apsoc.ac.uk/Docs/01_adoption.pdf

APPENDIX 1: Special Needs Adoption

Definitions:

Rosenthal (1993) identified 6 key defining characteristics of "special needs":

• Older than 4 years
• Emotional or behavioural problems
• Disability - including developmental problems
• Serious medical condition - e.g. AIDS, cancer
• Sibling Groups

And often - as prime examples of "hard-to-place" children:

• Black & Minority ethnic children.

The issue of alcohol and drug misuse in parents has been of great concern in the US and more recently also in the UK (Phillips 2004)

Factors Affecting Success

A number of factors emerge from reviews of outcomes of special needs adoption (McRoy 1999; Rosenthal 1993; Rosenthal and Groze 1992) as associated with positive outcomes:

• Younger age of child at placement
• Absence of behavioural problems
• No prior sexual abuse
• Provision of complete background information
• Careful Matching of parents and child
• Parents who are flexible and realistic in their expectations.

Children involved in disrupted and dissolved adoptions were more likely to:

• have been placed at older ages
• have been severely traumatised before placement
• have experienced numerous moves
• exhibit more aggressive and sexual acting-out behaviours.