Adoption-Sensitive Clinical Care: A Pre-Implementation Needs Assessment across Hospital Staff, Birth Parents, and Adoptive Parents

Background and Purpose:
Adoption-related issues arise across obstetrics, pediatrics, emergency care, and primary care, yet hospital-based providers often receive little preparation in adoption-sensitive communication, non-coercive counseling, or caring for patients with limited family health history. These gaps can contribute to inconsistent, stigmatizing, and insufficiently trauma-informed care for birth parents, adoptees, and adoptive families. Although trauma-informed care is increasingly emphasized in health systems, adoption-specific competencies remain largely absent from workforce preparation. This study examined hospital staff knowledge, comfort, prior training, and perceived training needs related to adoption-sensitive care, while also centering the perspectives of birth parents and adoptive parents. The objective was to identify actionable priorities for a hospital-based training approach that is trauma-informed, adoption-sensitive, and feasible in fast-paced clinical settings.

Methods:
This cross-sectional pre-implementation needs assessment was conducted in June 2024 to inform development of an adoption-sensitive, trauma-informed training initiative. Participants included hospital staff (n = 96), birth parents who had placed a child for adoption (n = 112), and adoptive parents (n = 21). Respondents were recruited electronically through professional, healthcare, and adoption-focused networks connected to the project team and partner organizations. The 51-item survey used display logic to tailor questions by respondent group. Measures assessed demographics and role/experience, baseline adoption knowledge, prior training exposure, comfort discussing adoption, perceived training priorities, preferred training logistics, and parent experiences with hospital staff engagement, information, and support. Quantitative data were analyzed using descriptive statistics, and open-ended responses were analyzed thematically.

Results:
Findings revealed a substantial mismatch between the frequency with which hospital staff encounter adoption-related issues and the preparation they receive to respond effectively. More than half of hospital staff reported no prior adoption training (52%), and 55% described themselves as not or only slightly knowledgeable about the adoption process. Only 19% had received training on counseling pregnant patients considering adoption, and 35% reported being not or not very comfortable discussing adoption with patients. At the same time, 64% indicated that adoption knowledge affects care when family history is unknown, and 77% viewed adoption-related training as valuable. Staff most frequently prioritized training on the adoption process (76%), ethical practice (69%), adoption-competent language (66%), transcultural and racial issues (65%), bias and stigma (58%), and trauma (56%). Among birth parents, 80% reported they were not provided adoption information, 71% said staff did not know how to support them, and 95% believed hospital staff would benefit from training. Among adoptive parents, 62% reported not receiving adoption-related information, 71% believed staff need training, and 95% believed clinicians should be knowledgeable about adoption and foster care.

Conclusions and Implications:
This study identifies a clear and consequential training gap in hospital-based care. Across providers and families, findings converged around the need for adoption-sensitive, trauma-informed practice that addresses the ethical, relational, and informational complexities of adoption. Results also point to a feasible implementation pathway: brief, modular online or hybrid training embedded within existing clinical education and onboarding systems. Implications include strengthening hospital policy, clinical guidance, and professional education to support more ethical, equitable, and family-centered care.