International Adoption And Clinical Practice

No matter how positive the intent of prospective parents, international adoption is fraught with emotional, medical, administrative, linguistic, and geopolitical issues. And while a wide range of professionals supports adopted children and their families in adjusting to the inherent changes and disruptions, the pediatrician's tasks--identifying and treating existing health problems and preventing numerous others--are particularly complex. International Adoption and Clinical Practice equips pediatricians with a comprehensive set of tools for establishing a long-term care plan and creating interventions to promote healthy development. This concise guide overviews the intricacies of the international adoption process and how they can affect the pediatrician's job, from potential pitfalls in collecting medical data from a child's birth country to tracking health concerns into adolescence and young adulthood. Developmental and behavioral issues including attachment, language acquisition, identity development, and consequences of abuse and neglect are also examined in this context. Figures, tables, and reference lists complement current information on topics such as: Epidemiology and demographics of international adoption. Pre-adoption evaluation of medical records. Guidelines for diagnostic testing, screening, laboratory evaluations, and immunizations. Common mental health issues faced by adopted children and their families. Long-term and adult outcomes of international adoption. Relevant policy issues and areas for future study. Every child deserves a safe and healthy home, and International Adoption and Clinical Practice gives pediatricians an in-depth framework for helping to make this possible as children make the transition to a new country and the next stage of their lives.

Advances in medical, biomedical and health services research have reduced the level of uncertainty in clinical practice. Clinical practice guidelines (CPGs) complement this progress by establishing standards of care backed by strong scientific evidence. CPGs are statements that include recommendations intended to optimize patient care. These statements are informed by a systematic review of evidence and an assessment of the benefits and costs of alternative care options. Clinical Practice Guidelines We Can Trust examines the current state of clinical practice guidelines and how they can be improved to enhance healthcare quality and patient outcomes. Clinical practice guidelines now are ubiquitous in our healthcare system. The Guidelines International Network (GIN) database currently lists more than 3,700 guidelines from 39 countries. Developing guidelines presents a number of challenges including lack of transparent methodological practices, difficulty reconciling conflicting guidelines, and conflicts of interest. Clinical Practice Guidelines We Can Trust explores questions surrounding the quality of CPG development processes and the establishment of standards. It proposes eight standards for developing trustworthy clinical practice guidelines emphasizing transparency; management of conflict of interest ; systematic review-guideline development intersection; establishing evidence foundations for and rating strength of guideline recommendations; articulation of recommendations; external review; and updating. Clinical Practice Guidelines We Can Trust shows how clinical practice guidelines can enhance clinician and patient decision-making by translating complex scientific research findings into recommendations for clinical practice that are relevant to the individual patient encounter, instead of implementing a one size fits all approach to patient care. This book contains information directly related to the work of the Agency for Healthcare Research and Quality (AHRQ), as well as various Congressional staff and policymakers. It is a vital resource for medical specialty societies, disease advocacy groups, health professionals, private and international organizations that develop or use clinical practice guidelines, consumers, clinicians, and payers.

Adoption has become widely practiced, accepted, and accessible, and has greatly changed the composition of families making it a timely subject for study. The authors of Understanding Adoption undertake exploration of this important terrain of loss and connection, and of the fragility and resilience of human bonds.

Since 1989, more than 165,000 children have been adopted by American parents. Every indication suggests that this number will increase in the years to come. Many of these children arrive with complex medical and behavioural problems. These children require specialized medical attention to help them get well and adjust to their new lives and surroundings. The Handbook of International Adoption Medicine presents an overview of the medical and developmental issues that affect internationally adopted children, offering guidelines for families and physicians before, during, and after adoption. Laurie Miller has comprehensively researched these topics and also draws from over fifteen years of experience in international adoption and orphanages throughout the world. This book shows how to advise families prior to an international adoption, how to perform an effective initial screening assessment of the newly arrived child, how to manage common behaviour problems, and how to recognize and manage developmental and other more long-term problems as they emerge. Sections cover such subjects as the risks of prenatal exposures, problems in growth and development, infectious diseases, and other medical conditions such as inherited disorders, uncertain age, and precocious puberty. This information has never been available in one place, making the book an invaluable resource for families and professionals in the field of international adoption.

Drawing on clinical data obtained through the study of children adopted from overseas orphanages, the author of this cutting-edge text applies the Developmental Trauma Disorder (DTD) conceptual framework to the analysis of psychological, educational and mental health impact of the early childhood trauma on development. A massive scale of international adoption of children, victims of profound neglect and deprivation, combined with the fundamental change in a child's social situation of development after adoption, offers a valuable opportunity to explore the concept of Developmental Trauma Disorder, in particular, developmental delays, emotional vulnerability, "mixed maturity", cumulative cognitive deficit, and post-orphanage behavior patterns, being presented by many adoptees long after the adoption. By focusing on the neurological and psychological nature of childhood trauma, Dr. Gindis offers a unique approach to understanding the ongoing impacts of DTD and the ways in which any subsequent neuropsychological, educational, and mental health issues might be assessed. Offering an evidence-based exploration of DTD, and a critique of "conventional" approaches to rehabilitation and remediation of international adoptees, this book will be of great interest to researchers in the fields of psychology, mental health, education and child development; as well as clinicians involved in trauma treatment and international adoption.

New pathways to parenthood are being traveled by growing numbers of couples and single adults, including many who face medical and social barriers to having children. From a psychological standpoint, families formed by complex adoption and assisted reproductive technology (ART) are first and foremost just that--families. Yet they also face a unique array of issues and challenges that may be clarified and resolved in the therapeutic setting. This much-needed book provides a deeper understanding of the ways that complex adoption and ART shape the life experience of children and parents, identifying important areas and methods for assessment and treatment. Combining developmental and ecological research with in-depth case material, the book establishes an integrative framework for clinical practice. The authors draw upon knowledge and skills gained from working in a variety of new family contexts. In the area of adoption, many new options have evolved that differ from traditional practices of adoption at birth. Thousands of older children in foster and institutional care in the United States and abroad are awaiting permanent placements. Open adoption, kinship adoption, and transracial adoption are also transforming family life, as is the use of ART, which raises significant issues of family identity and family process. The book explores such key themes as the significance of early experience, the capacity to recover from exposure to trauma, the impact of heredity and the difference that environment can make, and the centrality of primary attachment relationships. Also discussed are the impact of bias and other issues affecting families of difference, including lesbian and gay families. Concluding chapters consider promising future directions for training and research. This is an important resource for social workers, family therapists, clinical psychologists, psychiatrists, and other professionals working with children and families, as well as researchers and students in these fields. It will serve as a text in advanced undergraduate and graduate-level courses.

Experts representing practitioners, researchers, advocates, and triad members, explore the similarities and differences between adoptees placed as infants and as older children. The book promotes better integration of theory, practice, policy, and research in working with clients who are members of the adoption triad: adoptees, birth parents, and adoptive families. For the first time, the separate practice areas are bridged, pointing out the significant overlap between the two populations and the similar interventions that can be used when working with adoptees regardless of their age at placement. Developed as a resource text for practitioners, researchers, students, and adoptive triad members, the first chapter provides an overview of the clinical and practice issues. Next the work presents issues surrounding infertility, and explores identity development with a following chapter on search and reunion issues. The fifth chapter discusses adoption support, both historically and with current developments and issues. The work then examines ethics and offers a model for ethical adoption practice. The final chapter explores treatment issues from a family systems perspective.