Historic forced adoption - scoping study: service delivery paper

3. Overarching considerations for service design

Introduction

This chapter outlines the key issues to consider when planning support services for people affected by historic forced adoption in Scotland. It covers: whether support should be delivered via a single front door service; issues around national and local provision; one-to-one or group delivery; remote and in-person support; sensitivity and empathy; professionals’ awareness of historic forced adoption, its impact and the help available; flexibility of services; capacity and funding; involving volunteers; financial assistance for people affected; the role of organisations involved in historic forced adoption; and involving people with lived experience in service planning.

Chapter 4 considers issues about support with search and reunion and accessing records, and Chapter 5 explores emotional and psychological support.

A single front door service

In this model, a person affected by historic forced adoption would access support via a national organisation responsible for assessing the individual’s needs and referring or signposting them to support in their local area.

The support landscape in Scotland is complicated, with multiple organisations offering different services. As such, people affected by historic forced adoption are not always aware how to seek assistance. Some stakeholders and people affected by historic forced adoption felt a single point of contact would make it easier for people to access support.

“There should be a single point of access. There should be a very simple way.” - Adoptee

“A one-door service. If you're only promoting one place, it's more likely that people will get that message… there could be three or four centres that offer it across Scotland, but maybe if there's one phone number, they can be redirected to wherever is closest to them… I think that might be a format that would work well.” – Stakeholder

Stakeholders consulted as part of Higgins and colleagues’ Australian scoping studystressed the need for a centralised information point, integrated services, and clear referral pathways within and across agencies^[iv]. In Australia, a national helpline number, answered locally, provides a first point of contact for people seeking support with forced adoption^[v].

Similarly, the Victims and Survivors Service (VSS) in Northern Ireland established a new service in September 2022 to support people impacted by forced adoption in Mother and Baby Institutions, Magdalene Laundries and Workhouses^[vi]. VSS works with the WAVE Trauma Centre and Adopt NI to offer a ‘one-stop shop’ to access support. A Health and Wellbeing Caseworker assesses individuals’ needs before referring or signposting them to the necessary support, including family tracing, psychological therapies, complementary therapies and befriending.

We have set out the research team’s understanding of the potential advantages and disadvantages of establishing a single front door service.

Advantages of a single front door

• Individuals would have a single point of contact, regardless of the type of support they seek. This would help overcome challenges around people being unaware of how to access support.
• Single front door organisation staff would be trained and develop experience related to historic forced adoption, ensuring people are treated sensitively and empathetically.
• Staff would be aware of support services across the country and would be able to refer people appropriately.
• Staff could deliver some support services, such as emotional support, advice and information.
• If another organisation took on this role, this approach could overcome some people’s reluctance to access support delivered by post-adoption support services.

Disadvantages of a single front door

• The cost of this approach would need to be considered carefully, as this gatekeeper role would be an additional expense on top of the support services required.
• The capacity required – and the cost – could be difficult to predict because there is no data on how many people were affected by historic forced adoption.
• If the service, or the support it refers people to, are not adequately resourced, people affected by historic forced adoption may have to wait to access support.
• Staff would require detailed knowledge and training about the impact of historic forced adoption and the support services available. This could be expensive and time-consuming.
• Close partnership working would be required between the single front door organisation and the organisations that deliver support to coordinate referrals.

National and local support

Our research has found a potential role for a national organisation to act as a single front door and coordinate support for people affected by historic forced adoption. However, participants were also clear that local organisations should have a role in delivering support too.

Australia takes a similar approach, where the federal government provides funding for support delivered in local areas by funded organisations^[vii].

A few suggested a ‘hub and spoke’ model, where support workers would be based centrally but cover several communities. One idea focused on establishing two ‘centres of excellence’ in Glasgow and Edinburgh to deliver advice, support and therapy for parents and adoptees.

One-to-one or group support

The clear consensus was that support should be available on a one-to-one basis and in group settings so people can access assistance in a way that suits them. Some people affected by historic forced adoption prefer one-to-one support given the sensitive and complex nature of their experience, while others like groups so they can share experiences with others in a similar situation. Some individuals may prefer different approaches at different times.

Remote or in-person support

Similarly, people affected by historic forced adoption and stakeholders felt support should be available in-person and remotely, depending on the individual’s preferences. Remote methods such as telephone calls and online video calls are more affordable for services and can be more convenient for service users, especially in rural areas. However, some described in-person support as more appropriate due to the sensitivity and complexity of the issues and lack of familiarity or confidence with online platforms among some interviewees.

Sensitive and empathetic support

Some people with lived experience of historic forced adoption reported a positive experience of being supported by empathetic staff, but others felt judged and stigmatised.

“It was a very negative, negative experience… I ended up feeling quite diminished and dismissed, told to get a life… that was not very sympathetic.” - Mother

“There was a woman that offered it [support with reuniting with parents], but I fell out with her because of her approach, and the information she was providing which, to me, didn’t fulfil the needs for a more rounded and trauma-informed approach to a really difficult reunion of birth family that happens with many adoptees because of the layers of trauma attached to the severance. I found her quite aggressive in her attitude to me, and it just made me back off from her. It happened twice with two different people and the second time it was done in a social work office which was really triggering for an adoptee who went through a traumatic severance of birth family in the past which was operated by social workers originally.” - Adoptee

Stakeholders and people with lived experience described a sensitive, empathetic and trauma-informed approach among workers supporting people affected by historic forced adoption as crucial. Higgins et al’s paper reinforces this: it states that “best practice suggests service providers should approach all clients as if they might be trauma survivors” and includes a set of good practice guidelines for professionals supporting people affected by historic forced adoption^[viii].

A sensitive and empathetic approach is required so people affected by historic forced adoption can talk openly and confidentially about their experiences without judgement or stigma.

“The ambition for it would sit within what we're saying around that national ambition around developing trauma-informed systems, services and workforces.” – Stakeholder

“They need to be listened to by a non-judgemental practitioner and have their feelings and emotions validated.” – Stakeholder

Professionals’ awareness of the impact of historic forced adoption and the support available

As noted in Chapter 2, it is important that professionals who support people affected by historic forced adoption understand the impact of historic forced adoption and be aware of referral pathways to other support services.

Research participants called for more training and awareness raising among key professional groups, including GPs, psychologists, psychiatrists and social workers, which we explore further in Chapter 5. Some advocated for the Scottish Government to produce guidelines for support services to outline the support they should provide.

In Australia, the federal government has produced good practice guidelines and resources to help build professionals’ skills and capacity^{[ix], [x]}.

“I do feel that awareness needs to be raised among GPs and mental health professionals about the impacts of historic forced adoption… to get an awareness that this person who's been suffering most of their life, what might have caused that and to get appropriate help.” - Adoptee

Similarly, Critchley et al highlighted the need for regular supervision to support professionals working in this field, given the emotionally demanding nature of this work^[xi].

Flexibility

Interviewees, particularly stakeholders, emphasised no one size fits all solution exists: different people have different needs, and an individual’s needs might change throughout their life. Consequently, services must be flexible enough to meet each individual’s needs.

“It affects everybody individually, in different ways. So it’s about how do you offer a bespoke service when everybody’s got slightly different needs.” – Stakeholder

Some people with lived experience said support should be available as long as an individual requires it, and should not be limited by time or number of sessions.

“I feel that if the Scottish Government were to address counselling and psychotherapy, professional psychotherapy, for those impacted, I feel that it should not be limited to so many sessions. It should be [available] as long as the person needs it.” – Adoptee

Stakeholders reported it is important to deliver support at a pace appropriate for the individual, recognising that some might want to pause search and reunion activity until they feel able to resume it.

“I think it’s just taking it at someone’s pace as well… sometimes we have lots of initial conversations with people, and they can be an hour long on the phone or an hour and a half, and we may never hear from them again for another five years, but that’s okay. I think it’s just about pacing it at where someone is in their lives.” – Stakeholder

Capacity and funding

Ensuring support services can meet demand was a common theme in the research. However, there is no data on how many people were affected by historic forced adoption, so need will be difficult to predict. Consequently, it will be challenging to plan the resources required.

Interviewees were clear people affected by historic forced adoption should not be charged for the support they access. Therefore, deciding if and how far services should be funded or provided by central or local government is essential.

Research participants argued that services should have the capacity to support people immediately, without waiting lists, but acknowledged this would involve increased funding.

“It would need to be available when a person needs it. If you’ve just been rejected by your birth family again, you don’t want to be told, ‘we’ll get back to you in two months’. That person is going through trauma there and then… It’s just awful for them.” – Adoptee

In Australia, a small grants programme is available nationwide to help organisations build their capacity and skills to support people affected by forced adoption^[xii].

Volunteers

Some research participants suggested volunteers could support service delivery, providing a cost-effective way of improving organisations’ capacity. This could be particularly suited to peer support services if volunteers have lived experience of historic forced adoption.

However, there could also be some potential disadvantages:

• Volunteers would need extensive and high-quality training.
• Careful recruitment is required to ensure volunteers have the skills, experience and attributes to support people effectively.
• Certain types of support may be unsuitable for volunteers. For example, volunteers would not be able to deliver mental health support normally provided by psychiatrists, psychologists or psychotherapists, unless the volunteer happened to have the necessary professional qualifications.
• Volunteers would need regular support and supervision to ensure they are coping with their role and delivering it effectively.
• Regular evaluation would be required to monitor the quality of support volunteers provide.

Financial assistance to cover the costs of support

We reported above that participants felt people affected by historic forced adoption should not have to pay for support. Similarly, another important consideration is whether people affected by historic forced adoption should be provided financial assistance to cover any costs associated with their support.

Some people affected by historic forced adoption reported accessing private therapies, such as mental health counselling and creative and alternative therapies. However, the cost of these services can be prohibitive. In addition, a few interviewees said they were charged for some search and reunion services. This was not a common issue among research participants, but some organisations charge a fee to access records they hold, or ask for donations to support their work and administration costs, and Scotland’s People (the official Scottish Government site for searching government records and archives, maintained by National Records of Scotland) charges a small fee to access some documents. In addition, there were a few examples where agencies in other countries (including England) charged fees to help individuals to search for family members who had moved away from Scotland.

The research team suggests, based on our findings, that enhancing the capacity of public and third sector providers to meet demand and reduce the need for private services is one option, but providing financial grants to support people to access private sector services could be another. These options’ relative costs, advantages and disadvantages would need to be considered further. If grants are provided, processes such as application procedures and eligibility criteria would need to be carefully designed to ensure equitable access.

The role of organisations involved in historic forced adoption

As discussed in the scoping study report, there were mixed views about the involvement of organisations that engaged in historic forced adoption practices in delivering support.

Some were highly satisfied with the support they received from these organisations.

“They have been brilliant! As far as I’m concerned, I couldn’t have got in contact with anyone better. And the person who has been dealing with me through it all has been amazing. [The worker] puts you at ease. She’s just great. I don’t know how to explain it. She’s brilliant.”- Adoptee

“[The support worker] was really, really good. She was really empathetic… And the support has been good... I have felt valued throughout the whole thing… It was all dealt with sensitively and openly.” – Adoptee

However, others were opposed to those agencies delivering support. For example, MAA Scotland has urged caution around who provides therapeutic support and called for an independent central body to offer mediators during search and reunion activities^[xiii]. SAAM also suggests that mediators should “have no past or present connection to forced adoption practices” ^[xiv].

“Consideration should be given to the appropriateness of organisations with current or past involvement in arranging adoptions, continuing to be the gatekeepers of access to adoption records and support services. There is something concerning about adoption organisations having this power and not being accountable to any independent body.” – Mother

“It has to be independent of any adoption agency. I don’t think any other mothers or fathers would want to go.” – Mother

Evidence from our literature review reflects a similar concern. Higgins and colleaguesidentified a potential conflict of interest, where agencies involved in historic forced adoptions now support those affected. They describe the “deep feelings of mistrust” individuals may feel towards these agencies and called for careful consideration about which providers are allocated funding to deliver support services^[xv].

Conversely, the organisations previously involved in historic forced adoption now have extensive expertise supporting people affected by those practices, particularly in search and reunion activity. Some interviewees warned this expertise may be lost if they were no longer involved in delivering support.

As suggested in the scoping study report, it could be beneficial to facilitate meetings between these organisations and the campaign groups opposed to their involvement to explore any improvements or changes that could be made to encourage more people to access this support. If this is not possible, at least some support will need to be provided through organisations with no link to historic forced adoption so individuals can access support from an organisation they feel comfortable with.

Involving people with lived experience in planning

In Wales and Northern Ireland, people with lived experience are involved in planning the support for people affected by historic forced adoption. An Independent Panel in Northern Ireland includes academics, legal experts, and people with lived experience. In Wales the Big Adoption Conversation gives all people affected by adoption (including current and recent cases as well as historic adoptions) an opportunity to share their views on the support required^{xvi], [xvii]}.

The findings suggest that engaging with people with lived experience of historic forced adoption in Scotland is crucial, including mothers, fathers, adoptees and wider family members. This could be a valuable forum for reviewing the scoping study’s findings, considering options for service delivery, and deciding how best to implement the necessary improvements.