After Adoption : Direct Contact and Relationships

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After Adoption : Direct Contact and Relationships

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  • 製本 Hardcover:ハードカバー版/ページ数 192 p.
  • 言語 ENG
  • 商品コード 9780415282086
  • DDC分類 362.8298

基本説明

Explores through interviews: participants' feelings about adoption and direct contact; their relationships with each other; what hinders and what helps.

Full Description


Few children nowadays are placed for adoption with no form of contact planned with birth relatives and it has become common professional practice to advocate direct rather than indirect contact. Practice has outstripped evidence in this respect and not enough is known about how contact arrangements actually work out, particularly for older children adopted from state care. Such children have often experienced neglect, and sometimes abuse, and have frequently been adopted without parental agreement. Based on research with a large number of adoptive parents, children and birth relatives, After Adoption considers the impact of direct post-adoption contact on all concerned in such cases. It also:* discusses the development of adoption policy and law, particularly with regard to the legal and social consequences * reviews the research evidence on adopted children's contact with their birth families* explores through interviews: participants' feelings about adoption and direct contact; their relationships with each other; what hinders and what helps.After Adoption challenges readers to re-think the relationship between adoption and the possibility of direct post-adoption contact and at the same time provides a comprehensive understanding of adoption issues. It is a timely and valuable addition to the literature on adoption, making a substantial contribution to policy and practice.

Table of Contents

List of illustrations                              ix
Acknowledgements xi
1 Adoption in context: social change and 1 (17)
openness
Adoption: the pace and nature of change 1 (5)
Adoption practice: openness and secrecy in 6 (2)
adoption arrangements
The changing role of adoption: difference, 8 (4)
identity and 'telling'
Identity issues in context 12 (1)
The current debate: openness, contact and 13 (3)
adoption
Conclusion: the debate about contact and 16 (1)
new challenges
Summary 17 (1)
2 Openness in adoption: essential for 18 (18)
children's well-being?
The practice of open adoption and 18 (2)
arrangements for contact
Adoption and identity: the need for 20 (7)
information and contact
Further research: the impact of contact on 27 (3)
birth and adoptive parents
Further research: the impact of contact on 30 (2)
children
Conclusion: how much do we know about the 32 (2)
benefits of continuing contact?
Summary 34 (2)
3 Policy, law and openness in adoption 36 (17)
Policy issues: openness and access to 36 (5)
information
Policy issues: post-adoption contact 41 (3)
Judicial intervention in contact 44 (6)
arrangements
Conclusion: policy development and judicial 50 (2)
restraint
Summary 52 (1)
4 The study: research issues, methods and 53 (16)
sample characteristics
The study in context 53 (1)
Ethical and methodological considerations 54 (5)
Gaining access to adopters, children and 59 (1)
birth relatives after adoption
Research instruments and data collection 60 (1)
Talking to the children 61 (1)
Children's characteristics and placements 62 (2)
Children's legal and 'looked-after' status 64 (1)
Birth parents' attitudes to adoption and 64 (1)
post-adoption contact
Direct contact: variability, frequency and 65 (2)
arrangements
Conclusion: trials, tribulations and rewards 67 (1)
Summary 68 (1)
5 Preparation and planning for direct contact 69 (18)
Agencies, professional practice and contact 69 (1)
Preparation for direct contact 70 (2)
Adoptive parents' attitudes towards contact 72 (3)
Meeting birth relatives involved in direct 75 (1)
contact
Planning for contact 76 (1)
Contact planning was agency led: adopters 77 (2)
agreed with the plan and felt involved
Contact planning was agency led: adopters 79 (1)
agreed with the plan although they were not
involved
Planning was initiated by the adopters 80 (1)
Contact planning was led by the agency or 80 (2)
other professionals: adopters accepted the
plan but remained hostile to its
implementation
Frequency of contact arrangements 82 (1)
Agency involvement in post-adoption contact 83 (1)
arrangements
Conclusion: agencies and planning for 84 (1)
direct contact
Summary 85 (2)
6 Adoptive parents: perspectives on adoption 87 (28)
and direct contact
Adoptive parents and adoption 87 (1)
Opposition to adoption: birth families and 88 (2)
contact
Managing arrangements for contact: a 90 (1)
complicated business
Direct contact: losses and gains 91 (2)
Adoptive parents' perceptions: advantages 93 (5)
of direct contact
Adoptive parents' perceptions: comfort and 98 (7)
satisfaction with direct contact
Ownership, control and direct contact 105(6)
Conclusion 111(2)
Summary 113(2)
7 Birth relatives and direct contact 115(16)
Introduction: birth relatives, adoption and 115(1)
contact
Birth relatives' attitudes to adoption and 116(5)
satisfaction with adoption outcome
Birth relatives' satisfaction with 121(2)
frequency and security of contact
arrangements
Special Guardianship: an alternative to 123(1)
adoption?
Direct contact: personal comfort, role 124(5)
comfort and satisfaction
Conclusion: birth relatives and direct 129(1)
post-adoption contact
Summary 129(2)
8 Children's thoughts and feelings: adoption 131(20)
and post-adoption contact
Introduction: the children 131(2)
Children and adoption 133(4)
Terminating contact: children's wishes and 137(3)
feelings
Direct contact: children's perceptions of 140(3)
comfort and satisfaction
Children's and adoptive parents' 143(1)
perceptions of contact
Contact and saying goodbye 143(2)
Sibling relationships: placement and contact 145(1)
Sibling contact: children's wishes and 146(3)
feelings
Conclusion: listening to Children and young 149(1)
people
Summary 150(1)
9 Views from the triangles 151(25)
Introduction: triangular relationships 151(1)
The sub-sample of adoption triangles 152(3)
Agreement to adoption and the enforcement 155(2)
of contact arrangements
Experiencing direct contact 157(1)
The development of relationships: respect 158(2)
and liking
The development of relationships: sympathy, 160(2)
acceptance and gratitude
Permission to parent 162(2)
The status of parenthood: conflict and 164(2)
competition
Two kinship networks: the failure to 166(3)
develop a working relationship
The frequency of contact and changes over 169(3)
time
Conclusion: prospects for direct 172(2)
post-adoption contact
Summary 174(2)
10 Direct post-adoption contact: benefits, 176(9)
risks and uncertainties
Sixty-one adoptive families and direct 176(2)
contact
Contact: factors relating to comfort, 178(2)
satisfaction and beneficial experiences
Direct contact; risk and uncertainty 180(2)
Conclusion: managing uncertainty in 182(3)
decisions about direct post-adoption contact
References 185(11)
Index 196

041528209.TOC0415282098



List of tables xiv

Preface xvii

Acknowledgments xix

A note on the icons used in this book xx

Part I The Need for this Book 1 (16)

1 General principles of medication management 3 (5)

The scope of the problem 6 (1)

Mental health in the spotlight 6 (2)

2 Myths and truths about mental health 8 (9)

medication

Mental health medication is a placebo 9 (1)

Mental health medication is addictive 9 (1)

Mental health medication will change 10 (1)

personality

Stop mental health medication as soon as 11 (1)

possible

Mental health medication will overcome bad 12 (1)

habits

If side effects occur, the medication must be 12 (1)

working

Taking medication for depression means 13 (1)

weakness

Antidepressants cause suicidal or homicidal 13 (2)

thoughts

All antidepressants are alike 15 (1)

Alcohol is prohibited while taking 15 (1)

psychotropic medication

Mental health medication will treat alcoholism 16 (1)

A person must be substance-free to be 16 (1)

assessed/treated accurately for mental illness

Part II Medication Management Start to Finish 17 (106)

3 The initial prescriptive interview 19 (18)

What to say after "hello" 20 (2)

General issues of history taking 22 (2)

Essentials that must be obtained for 24 (1)

medication prescription

Mental status exam 25 (1)

Useful but optional information 26 (1)

Target symptoms 27 (1)

Historical information from others 27 (1)

The medical work-up 28 (1)

The next decision 28 (1)

Assessment and formulation 29 (2)

Length of an initial prescriptive interview 31 (3)

Sample clinician guidelines 34 (3)

4 Helping a patient decide to try medication 37 (8)

Patient issues 37 (2)

Other resistances to psychotropic medication 39 (1)

The use of levers 40 (1)

Reasons that patients take psychotropic 41 (2)

medication

The use of metaphor 43 (2)

5 Starting medication 45 (17)

Monotherapy 46 (1)

Overlap and "indications" 46 (1)

What is the target of the medication? 47 (1)

Choosing a starting dose 47 (2)

Loading doses 49 (1)

The art of choosing a medication 50 (3)

Selecting medication in the previously 53 (1)

treated patient

The liver-impaired patient 54 (1)

The kidney-impaired patient 55 (1)

How many pills to prescribe? 56 (1)

The five points of education about 57 (1)

psychotropics

Other issues to be discussed 58 (1)

Informed consent 59 (1)

Involuntary medication 60 (1)

Education as treatment 60 (1)

The use of placebo 60 (2)

6 Follow-up appointments and strategies 62 (25)

When do I schedule follow-up? 63 (1)

How long does it take? 64 (1)

Inpatient medication follow-up 64 (1)

Preparing for a follow-up 64 (1)

Goals of a follow-up 65 (5)

What is an adequate trial? 70 (1)

Switching and side effects 71 (1)

When changing, gradual is best 72 (2)

Polypharmacy - from the doghouse to the 74 (3)

penthouse

Feedback from others 77 (1)

Helping a patient stay on medication - the 77 (2)

compliance dilemma

How and when to refer to a mental health 79 (2)

specialist

Missed doses 81 (2)

Parenteral medications 83 (1)

Pill facts 84 (3)

7 Medication and psychotherapy 87 (6)

The first session dilemma 88 (1)

Patient's preference 89 (1)

What can medication do? 90 (1)

Who prescribes psychotropic medication? 90 (3)

8 Stopping medication 93 (12)

When to stop 94 (2)

Tapering medications 96 (1)

"When I stopped, I got worse" 97 (2)

Management of discontinuation syndromes 99 (1)

Relapse vs discontinuation syndrome 100 (1)

When to stop medication more quickly 101 (1)

New episode or relapse? 101 (1)

Side effects pass quickly 101 (1)

Unplanned stoppages of medication 102 (3)

9 The long-term patient 105 (18)

Who should receive long-term treatment? 106 (2)

A symptomatic crisis in a stable patient - 108 (1)

general principles

"The medicine stopped working" - getting back 109 (3)

on TRACCCC

Helping the patient stay well 112 (1)

Missed appointments 113 (3)

When the patient asks for more 116 (1)

Inappropriate requests 116 (1)

Is newer medication better? 117 (2)

Periodic reassessment 119 (1)

Concurrence for a change of medication 119 (1)

Conflicting advice from others 120 (3)

Part III Medicating Special Populations 123 (86)

10 Using medication with children and 125 (15)

adolescents

Outdated views of pediatric mental health 125 (1)

prescription

The scope of pediatric psychopharmacology 126 (1)

Principles of psychotropic prescription with 127 (1)

children and adolescents

Diagnostic and conceptual issues in the 127 (6)

prescriptive process

A child's goals differ from those of adults 133 (1)

Parental power struggles over medication 133 (1)

The medical work-up prior to psychotropics 134 (1)

Practical issues in child/adolescent 134 (6)

prescription

11 Pregnancy and psychotropics - rewards and 140 (19)

risks

Clinician principles for prescribing to the 141 (2)

pregnant woman

Working with the fertile woman, pre-pregnancy 143 (1)

When the patient wishes to get pregnant 144 (1)

While the patient is actively trying to 145 (2)

become pregnant

When pregnancy occurs 146 During pregnancy 147 (1)

Specific conditions and medication groups 148 (3)

Postpartum and lactation 151 (4)

Data will change; the decision process will 155 (4)

not

12 Prescribing psychotropics for older patients 159 (11)

Seniors at risk 160 (1)

Non-compliance - a major problem 161 (1)

Principles of psychotropic medication 162 (1)

prescription in the elderly

Regular re-evaluation 163 (1)

Senior medication problems - general 164 (2)

strategies

Specific psychotropic medication 166 (4)

considerations in the elderly

13 Medication of sleep problems 170 (15)

Facts and definitions 171 (1)

Stages of sleep 172 (1)

Evaluating a sleep problem 173 (2)

Principles of treating sleep disorders 175 (1)

Treatment of sleep problems 176 (5)

Special populations 181 (4)

14 Alcohol and mental health medications 185 (10)

Routine warnings in the non-substance abusing 186 (1)

patient

Signs of alcohol abuse 187 (1)

Evaluation of the intoxicated and withdrawing 188 (1)

patient

Psychotropic medications and dual diagnosis 189 (2)

patients

Psychotropics used in the treatment of 191 (1)

alcohol use disorders

Psychotropics in treatment of alcohol 192 (3)

withdrawal

15 The confused and cognitively impaired 195 (14)

patient - medication pitfalls

General principles of dealing with the 196 (1)

confused patient

Cognitive disorders - delirium and dementia 196 (4)

Management of delirium and dementia 200 (2)

Medication use in delirium and dementia 202 (4)

Psychiatric diseases that may present with 206 (3)

confusion

Part IV Medication Dilemmas and their Clinical 209 (96)

Management

16 Psychotropic medications and side effects 211 (39)

During the initial evaluation 211 (3)

Side effect assessment in follow-up visits 214 (1)

How much of a problem is it? 215 (1)

Other issues to consider in evaluating side 216 (1)

effects

Changing medication due to side effects 216 (1)

Severity of side effects 217 (1)

Side effects and clinical response 218 (1)

The novice clinician and side effects 218 (1)

Side effects seen most frequently 219 (31)

17 Danger zones - areas of risk with 250 (49)

psychotropics

P-450 issues made easy 251 (8)

Serotonin syndrome 259 (3)

Anticholinergic intoxication 262 (4)

Lithium toxicity 266 (3)

QTc interval issues 269 (6)

Extrapyramidal symptoms, neuroleptic 275 (9)

malignant syndrome, and tardive dyskinesia

Monoamine oxidase inhibitor reactions 284 (5)

Other potentially dangerous side effects 289 (10)

18 Medication allergies 299 (6)

Identification of allergic responses 300 (1)

Management of allergy symptoms 301 (1)

Other issues of evaluation when allergy is 302 (1)

suspected

Stopping the offending medication 302 (1)

What else to do 303 (1)

Pills contain more than just the active 303 (2)

ingredient

Part V Competent Clinical Practice 305 (91)

19 Misuse of medication - taking too much and 307 (16)

taking too little

How medication misuse presents 310 (1)

Accidental and careless overutilization 310 (2)

Intentional overdose 312 (1)

Serious overdose 313 (1)

Minor overdose 314 (1)

Using too little medication 315 (1)

Fraud and abuse with psychotropic medications 315 (8)

20 "Difficult" medication patients, and how to 323 (24)

treat them

Overriding principles of managing difficult 324 (3)

patients

The patient who abuses the telephone 327 (1)

The overly anxious patient 327 (2)

The patient preoccupied with side effects and 329 (1)

negative reactions

The minimal contact patient 330 (2)

The non-compliant patient 332 (1)

The patient who needs to be in charge 333 (2)

The information overload patient 335 (2)

The "naturalist" 337 (1)

The borderline patient 338 (5)

Consultation and disengagement 343 (1)

The patient is not always the problem 344 (3)

21 Prescription writing and record keeping 347 (10)

The written prescription 347 (2)

Record keeping 349 (1)

Elements of a clinician's prescriptive note 349 (3)

Systems for note taking 352 (1)

Style items in a medication note 352 (1)

Separate medication lists 352 (1)

Ongoing laboratory monitoring 353 (2)

Confidentiality and security of records 355 (2)

22 Serum blood levels of psychotropics 357 (7)

When blood levels help 357 (1)

Instruction to patients 358 (2)

Frequency of blood levels 360 (2)

Using clinical judgment 362 (1)

Where blood levels do not help 362 (1)

Necessary documentation 363 (1)

23 Generic medications 364 (6)

Generic substitution problems 366 (1)

Generic change without the clinician's 367 (1)

knowledge

Tips for generic use 368 (1)

Serum blood levels and generic substitution 368 (1)

Mandated generics 368 (2)

24 The telephone and e-mail mainstays and 370 (9)

millstones

Being available by telephone 371 (1)

Telephone appointments 372 (1)

Inappropriate use of the telephone 373 (2)

When a patient calls too much 375 (2)

E-mail and the medication prescriber 377 (2)

25 The pharmacist, the pharmaceutical industry 379 (5)

and the clinician

Interacting with the pharmacist 379 (1)

Preauthorization - a fact of American practice 380 (1)

The pharmaceutical industry 381 (2)

Indigent care medication programs 383 (1)

Media advertising and mental health 383 (1)

medications

26 Preparing an office for mental health 384 (5)

prescribing

Mandatory issues 384 (3)

Optional measures 387 (1)

Periodic re-evaluation of image 387 (2)

27 Keeping current 389 (7)

The Internet and clinicians 390 (3)

The Internet and patients 393 (1)

Practice guidelines 394 (1)

Summary 395 (1)

Appendices 396 (40)

Index 436