Fetal alcohol spectrum disorder (FASD) is a common neurodevelopmental condition and is especially common in care-experienced children. Individuals with FASD often have the additional complication of a history of early life adversity. Providing appropriate support during childhood can improve outcomes, but this can be difficult for caregivers, especially where FASD-informed service provision is lacking. In this study, 12 adoptive families of children with FASD, based in England, took part in semi-structured interviews to explore their experiences of raising a care-experienced child with FASD. Transcripts were analysed using thematic analysis and without a pre-determined thematic structure. Families described the challenges of parenting children with FASD. Their children were seen as having a range of strengths and difficulties and there were many rewarding aspects of parenting. However, there was a strong feeling that service provision was not adequate, and most professionals did not have appropriate training related to FASD. Professionals tended to use a trauma-informed approach which was sometimes helpful, but which parents felt ought to be used alongside an FASD-informed approach, which was usually missing. The findings of this study suggest that more attention is needed for FASD-informed service provision and support for families in England.
This article explores the stability and impact of birth country and heritage interest among international adoptees from adolescence to adulthood, using data from the English and Romanian Adoptees (ERA) study. While adolescence is often seen as key for ethnic identity development, adulthood may also offer opportunities for reflection and integration. We examined interest in Romania at ages 15 and 23, and its links to earlier neurodevelopmental difficulties, behavioural engagement (e.g., visiting Romania, contact with biological relatives), and adult wellbeing. Four main findings emerged: first, interest in Romania was generally stable – 49% showed persistently low interest, 11% persistently high, 23% increased, and 17% decreased; second, higher interest was linked to visiting Romania and contact with biological relatives, especially mothers and siblings; third, greater interest was associated with fewer childhood attention-deficit/hyperactivity disorder (ADHD) symptoms, but not with other deprivation-related issues or institutional deprivation duration; and fourth, higher interest was associated with fewer emotional problems in adulthood, though not differences in self-esteem or functional outcomes. These findings suggest heritage interest may support mental health in adulthood for some adoptees. Adoption support should encourage heritage engagement and tailor interventions to individual neurodevelopmental profiles, promoting identity exploration across the lifespan.
Adoption is increasingly seen as a lifelong experience, with cascading effects from early life experiences into adulthood. Consequently, support needs can often persist long after adoption. Current post-adoption support has largely been informed by infant studies and developmental theories such as attachment theory, emphasising the importance of early bond forming with adoptive caregivers. Recent evidence and cohort studies as adoptees have grown older suggest that support needs, especially beyond early childhood, are both broad and complex. This systematic review aimed to consolidate research about adoptee support needs as reported by adoptees and/or their families. The review included international, English-language primary studies published between 2002 and 2025 that reported on the lived post-adoption experiences of adoptees and their families, with particular attention to areas of unmet support. Following a review of 120 full texts, 76 were included. Support needs were identified for areas of attachment, identity, neurodevelopmental conditions, mental health and trauma, education, grief/loss, and contact with birth families. Participants reported that neurodevelopmental problems and the role of early adversity and trauma on later mental health outcomes were not well understood among service providers, which created a barrier to diagnoses and interventions received. Practice implications and recommendations for service providers are discussed.
This longitudinal study examines the reciprocal relationships between self-reported personal and contextual resources, mental health (internalising and externalising symptoms) and wellbeing in adolescents in out-of-home care (OOHC) compared to adolescents living with their biological families (BF). Data from two measurement points (T1, T2) were analysed using path models and multivariate analyses of variance. The results show stabilities of mental health over time in both groups, with wellbeing being less stable for adolescents in OOHC. Comparisons of different models with varying cross-lagged paths showed that the best model fit was found for the mental health-directed model, in which higher personal resources at T1 predicted significantly higher wellbeing scores in both groups at T2. In the OOHC group, higher personal resources at T1 were also associated with lower externalising symptoms at T2. Furthermore, the placement type (OOHC vs BF) proved to be a significant moderator. Adolescents in OOHC reported significantly fewer personal resources and more externalising symptoms. The findings emphasise the preventative importance of personal resources and argue for resource-oriented interventions, especially for at-risk adolescents in OOHC. In the long term, stable, validating care environments could promote the development of personal resources and encourage good mental health.
Introduction: Evidence indicates that for some children and young people, levels of mental health difficulties increased over the initial years of the Covid-19 pandemic. Aim: We examined whether levels of carer-reported mental health difficulties and wellbeing were different between 2019 (pre-pandemic) and 2020 and between 2019 and 2021 for children looked after. Method: We conducted a repeated cross-sectional secondary analysis using propensity score matching. Mental health difficulties and wellbeing were measured using the 87-item BERRI assessment tool. Overall, N = 593 young people (7-26 years) were included from 23 settings. Results: Between 2019 and 2020, carers reported lower levels of behavioural (coefficient=-9.85, 95% CI = -15.84, -3.85), emotional (coefficient=-10.27, 95% CI -17.38, -3.16), relationship (coefficient=-12.31, 95% CI = -21.45, -3.17) and overall (coefficient=-46.43, 95% CI = -76.77, -16.09) difficulties for young people. Between 2019 and 2021, carers reported only lower levels of behavioural difficulties for young people (coefficient=-8.25, 95% CI = -14.14, -2.35). Discussion: Although levels of mental health difficulties decreased over the first year of the pandemic, by the second year they had for the most part returned to pre-pandemic levels. Implications for practice: The present research on the mental health and wellbeing of children looked after during the early stages of the Covid-19 pandemic remains relevant to help understand and contextualise the longer-term psychosocial impacts we are seeing today.
Given the links between childhood maltreatment, attachment representations and affect regulation and the research gap in both longitudinal and qualitative designs addressing such topics, this study explores the attachment-related representational and emotional trajectories of three late-adopted women from childhood to early adulthood. A reflexive thematic analysis drew upon data from three different measures (the Story Stem Assessment Profile, Friends and Family Interview and Adult Attachment Interview). Data analysis illustrated the elaborative handling of negative emotions, the conflictual - yet eventually repaired - internal representations of parents, an oscillation between neediness and independence, and the appreciation of childhood bliss. Such findings provide insights on the attachment-related outcomes of late-adopted individuals in adulthood and serve as a theoretical basis for the implementation of related policies in adoption services.
Background Fetal alcohol spectrum disorder (FASD) refers to the constellation of difficulties resulting from impaired physical development and neurodevelopment following alcohol exposure in utero. The UK has the fourth highest rate of prenatal alcohol use worldwide, but the condition remains stigmatised and under-recognised. The parents of children with FASD play a crucial role in informing the development of relevant policy to address these shortfalls.Aims This study sought to examine parents' experiences of caring and advocating for children with FASD in Scotland, taking an exploratory perspective to give voice to the most salient issues for families.Methods and procedures Six adoptive parents were interviewed and interpretative phenomenological analysis was used to analyse the data.Outcomes and results Four superordinate themes were identified: 'The fight for support'; 'A life of inequity'; 'An uncertain future'; and 'A complex psychological journey'. These reflect the complexity of the participants' experiences in navigating a world that is not set up to allow them or their children to thrive.Conclusions and implications Caring for a child with FASD brings significant challenges, often driven by shortcomings in professional knowledge and services. Parents described their futures as highly uncertain, with mental health, social support and financial wellbeing reported as being precarious.
Adoption has a lifelong impact, with events such as parenthood reactivating adoption-related thoughts and feelings. English adoption generally falls into two eras: pre-1980s adoptions, typically secretive infant relinquishment due to societal views on illegitimacy and interracial relationships, and post-1980s adoptions, involving older children often removed due to abuse or neglect. This study explores how adults adopted before 1989, potentially raised with limited biographical and communicative openness as well as less post-adoption support, experience parenthood, a life stage affecting identity, mental health and relationships, areas notably complex for adoptees. Four English adult adoptees (two men and two women, aged 40-50), adopted domestically before 18 months old (three at birth), with two or more children predominantly in their teens and 20s participated in semi-structured interviews covering their parenthood journey. Interpretative phenomenological analysis revealed three themes: 'Parenthood is an awakening'; 'Adoption echoes on'; and 'Moving forwards'. Communicative openness within the adoptive family had lasting effects on adoptees' own parenting communication. Recommendations include training adoptive parents on adoption's lifelong impact and promoting open and supportive communication with adoptees. Targeted psychosocial support for adoptees who become parents is also advised.
Background The present study aimed to explore the attachment and internal representations among looked after children who experience conduct difficulties (CDi). CDi were explored alongside levels of emotional symptoms (ES), as were how young people responded to stories in a narrative-based measure.Methods Children living in care at Five Rivers Child Care aged four to 11 were eligible for the study. In part one, quantitative analyses were conducted on 82 participants, drawing upon the relationship between the children's Story Stem Assessment Profile completions and the carers' Strengths and Difficulties Questionnaire (SDQ) completions. In part two, qualitative analyses focused on a subsample (n = 27) of those who scored high for CDi and within normal parameters for ES, as captured through the emotional difficulties subscale, on the SDQ.Results Quantitative analysis showed no significant findings between levels of CDi and attachment representations of the self and others. In part two, negative representations of parental figures were more commonly portrayed, and there was less coherence in stories that were emotionally arousing.Conclusion This study emphasises the importance of understanding the complexity of CDi. These findings provide preliminary insights for professionals working with looked after children and contribute to developing future regulations, policies and interventions. Consideration of the prevalence of both ES and externalising presentations when exploring CDi remains essential to deepen our understanding of what can be such a unique aetiology.
This study analyses birth mothers' primary motivations for placing their child for adoption, aiming to provide a more comprehensive understanding of the factors influencing these choices. The researchers examined open-ended survey question responses from 768 birth mothers who placed a child for private domestic adoption. Four key themes emerged: (1) lack of resources and support for parenting; (2) respondents' desire for an ideal family environment for their child; (3) present life circumstances; and (4) beliefs and pressures related to adoption. Responses also highlighted the complexity and multifaceted nature of birth mothers' placement decisions, with many offering several factors that contributed to their decision-making. These results can inform future research, impact service delivery and improve public discourse regarding motivations for placement.
The UK's foster care system supports over two thirds of children in care, with the majority being in care due to maltreatment, neglect or family-related adversities. While evidence shows that children in care face greater risks of emotional, behavioural and mental health challenges than the general population, foster care uniquely offers children the opportunity to build attachment relationships that can be protective in the face of adversity and support their overall wellbeing. However, differences in outcomes and operation between independent fostering agencies (IFAs) and in-house local authority (IHLA) foster placements remain largely underexplored. This study investigates the characteristics, psychological needs and stability of children/young people in IFAs and IHLAs using data from the online BERRI assessment. Findings reveal that children in IFAs are typically older and experience greater psychological needs than children in IHLA fostering. Despite these differences, children in both placement types were found to be similarly susceptible to risk, and demonstrated comparable stability and trends in mental health outcomes over an approximate four-month period. These findings suggest that IFAs perform an alternative function to IHLAs, where they appear capable of providing support that better accommodates children with more complex needs, though this distinction requires further investigation.
Background Foster carers (including kinship carers) play an essential part in the lives of children in care, but the role can be challenging, necessitating effective support. However, there is a lack of evidence for which types of support are most effective in supporting carers and improving the wellbeing of the children in care.Design A definitive, superiority, two-armed, parallel, pragmatic, randomised controlled trial, evaluating whether adding the Reflective Fostering Programme to usual support was more effective and cost-effective than usual support alone, for foster carers of children between four and 13 years old.Findings 524 participants joined the study. Over 12 months, the children of those carers attending the Programme did not yield significantly greater improvements in children's psychosocial functioning (the primary outcome) or emotion regulation compared to usual support; however, there was evidence of significantly enhanced carers' reflective capacity, reduced carer burnout and stress levels and improved child-carer relationships. The health economic evaluation demonstrated the Programme had a higher probability of being cost-effective compared to usual support.Conclusions The Reflective Fostering Programme found evidence of greater improvements in a range of carer-related outcomes, carer-identified problems and the carer-child relationship, alongside evidence to suggest it is cost-effective compared to usual support. However, there were no significant differences between groups in terms of the child's emotional and behavioural wellbeing or their capacity for emotion regulation.
A quality improvement project that focused on the health outcomes of a local population of unaccompanied asylum-seeking children (UASC) in Cornwall, with a specific emphasis on immunisation.Aim To increase immunisation uptake among UASC within four months of their entering local authority care or by the time they turn 18.Background Although a successful public health intervention, global immunisation coverage remains a concern. Declining uptake of routine immunisations is associated with increased childhood infections. Poor local UASC vaccination rates reflect the broader immunisation inequalities strategy.Design A small test of change was introduced to a clinic for UASC, led by a trainee Advanced Nurse Practitioner. The clinic offered UASC the three-dose vaccination 'catch-up' schedule within statutory health assessment appointments, extending the already established 'one-shop' model.Methods The Model for Improvement was applied for this quality improvement project. The vaccines administered were quantified, and post-vaccination surveys were conducted to capture the experiences of clinic users.Outcomes UASC vaccination uptake increased significantly during the project, and UASC reported positive experiences at their clinic appointments.Conclusion This project demonstrates that offering vaccinations to UASC within a specialist provision improves vaccine uptake, enabling an equitable and inclusive service. The benefits of applying a child-centred and trauma-informed model were evidenced in the positive feedback and improved immunisation outcomes for UASC.
This study investigated the psychosocial impact of perceived social stigma on adopted adolescents in Peshawar, Pakistan, focusing on emotional regulation difficulties, identity confusion and internalised shame. Grounded in Goffman's stigma theory and Erikson's theory of identity development, the research examined how stigmatising societal attitudes influence adolescents aware of their adoptive status. A total of 709 adolescents aged 12 to 18 years, who had lived with their adoptive families for at least three years and were enrolled in formal education, completed structured questionnaires with newly developed and validated scales measuring stigma, shame, identity confusion and emotional regulation. Using structural equation modelling, findings revealed that perceived social stigma significantly predicted internalised shame, emotional regulation difficulties and identity confusion. Internalised shame acted as a key psychological mechanism in these associations. Adolescents who felt stigmatised were more likely to internalise this negativity as shame, which in turn heightened their struggles with emotional regulation and identity development. These results highlight the psychological toll of stigmatisation on adopted youth and underscore the critical role of shame in shaping their development. The findings provide insights for educators, psychologists and social workers in supporting adopted adolescents and suggest the need for stigma reduction efforts in educational and social settings.
Child rights belong to all children under the age of 18. However, the recognition of infants as rights holders still challenges many practices in child welfare. This article focuses on infants' rights in alternative care and explores them through the views of the practitioners who are involved in developing - and advocating - rights-based alternative care in Finland. Based on 15 interviews with foster carers, social workers and other practitioners, the study analyses motivation, advocacy practices and the present state of infants' rights in care. The findings demonstrate that motivations for advocating for infants' rights in care are driven by the recognition of shortcomings in practice related to the standardisation of legal norms and othering infants in care regarding their needs for development, theoretical and legal learning as well as personal history. Advocacy is embodied, institutional and structural and mainly takes place through role-modelling. The study suggests age-aware expertise and related organisational arrangements to acknowledge infants as rights-holders in mainstream practice.
The experiences of transracially adopted individuals remain diverse, with some narratives revealing ongoing challenges related to racial trauma and identity outcomes. This suggests that cultural considerations within the child welfare system may not always be fully realised. In this study, we apply the concept of 'post-racial phantasmagoria' as a critical lens to explore the extent to which current social work practices are equipped to address and prevent racial trauma in transracial adoption. Existing challenges around identity are caused by visible and invisible systemic barriers, and colour-blindness resulting in unmet identity needs and identity erasure. Through qualitative co-creation focus groups with a total of 55 participants based in England - including social workers, adoptees and adoptive parents - a significant need was identified for early planning and preparation in transracial adoption, along with the importance of good collaboration with birth families to better understand children's identity needs before care proceedings get underway to ensure they are considered throughout the adoption process. Our findings indicate that intentional engagement in transracial adoption practice with all involved parties may help to address some of the risks associated with post-racial phantasmagoria; however, further research and ongoing dialogue are needed to fully understand and respond to these complex challenges.
