Conclusions

Child or adult psychiatrists will become involved in child placement work because they are asked to provide therapy for an adopted child, young person, or adult who has been placed for adoption or in foster care, or who have lost a child to adoption. Whether or not this is a temporary or permanent placement will make a big difference to the service provided. Temporary foster parents are a crucial part of the therapeutic, support, and decision-making team. If the placement is intended to be permanent, the message from research is the same as the message for a potential adopter—parenting by adoption is a challenging, at times frustrating, often rewarding but essentially different sort of parenting than parenting by birth. The nature of the adoptive or foster family has to be acknowledged and incorporated into the therapeutic processes. It is for this reason that the need for specialist postplacement and postadoption services is now recognized, which adapt the full range of help from support and advice through therapy to residential care or boarding education to the special needs of the adoptive or foster family.

Psychiatrists are often consulted about the advisability of adoption or an alternative placement. The message from research is that adoption and foster care will be better for most children than being left with parents who can not be helped to provide them with 'good-enough' parenting. However, they are not without risks, which have to be carefully weighed for each child and sibling group in context. At first sight, the breakdown rates for the placement of older children (now the majority of those needing placement) may appear discouraging, given their many difficulties; however, it should be welcomed that as many as 50 per cent of 11-year-old children, and more of those below that age, do find permanent substitute families. Nevertheless, these figures should encourage even greater efforts to ensure that children are provided with services so that, if at all possible, they can receive 'good-enough parenting' within their families of origin (breakdown rates for all ages appear to be lower when children are placed permanently with relatives). If permanent out-of-home placement does become necessary, the inherent risks demand the provision of high-quality long-term services.

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