The Impact of Mental Health and Substance Abuse Challenges of Former Foster Youth on Adoption Breakdown and Parent Perceptions after Adoption

Background/Purpose: Up to 20% or more of youth adopted out of the child welfare system face significant challenges, including mental health (MH) and substance abuse (SA) difficulties, and adverse long-term outcomes such as adoption breakdown (i.e., foster care reentry or informal placement changes). More research is needed to understand the post-adoption experiences of former foster youth and their parents. Thus, the purpose of this study was to investigate how youth MH/SA difficulties, which signify high-youth needs, were associated with adoption breakdown and parent perceptions of adoption.

Methods: A sample of 288 parents who adopted a youth out of foster care were surveyed as part of the NSCAW Adoption Study. Adoptive parents were asked about demographics, placement changes, parenting, and family relationships. Bivariable chi-square and correlational analyses examined youth MH/SA challenges after adoption, pre-adoption preparation (i.e., whether parents were “very well” prepared or not), adoption breakdown, and parent perceptions of adoption. Parent perceptions were measured using three Likert questions about the overall impact of adoption on the family, level of difficulty in parenting, and whether the parent would adopt again. Logistic regression models estimated the impact of youth MH/SA challenges on breakdown and parent perceptions of adoption, holding youth gender, age, and race, and parent pre-adoption preparation constant.

Results: Bivariable analyses supported that MH/SA challenges in youth were associated with adoption breakdown and negative parent perceptions of adoption. For example, youth with a history of MH difficulties had an adoption breakdown rate of about 37% as compared to 14% for those youth without MH difficulties (Х2(1) = 15.09, p<.000). Multivariable models showed that youth MH challenges were associated with more adoption breakdown (OR = 3.00, p = .003), worse impact of adoption (OR = 0.27, p = .010), more parenting difficulty (OR = 0.09, p < .000), and less favorable parent views on adopting again (OR = 0.23, p = .011). Also, youth who were adopted at age 5 or younger had lower adoption breakdown (OR = 0.55, p = .042) and more positive overall impact of adoption (OR = 3.04, p = .003). Finally, parents who reported being better prepared for adoption reported a more positive impact on the family (OR = 9.90, p < .000), less difficulty parenting (OR = 4.99, p < .000), and a more favorable attitude towards adopting again (OR = 10.65, p < .000).

Conclusion/Implications: This study is consistent with previous literature in that MH/SA challenges among high-needs foster youth strained post-adoptive family relationships. Youth with MH/SA difficulties were more likely to experience breakdown, and their parents reported worse perceptions of adoption. Younger youth ages at adoption and more parent pre-adoption preparation were associated with fewer breakdowns and more positive parent perceptions. These findings emphasize the importance of in-depth adoptive parent training (e.g., trauma-informed training about behavioral management) and preventative MH interventions for older foster youth (e.g., in-home services). Further, child welfare agencies should assess risk and offer services to adopted youth into adolescence and young adulthood.