NCAP Legacy Interview: Susan Smith, PhD

the pleasure of uh interviewing Dr Susan Smith somebody who I hold in very high regard and um one of the things I'm aware of is that there's just so much about you that I admire your work is just been incredibly impactful to so many of us and so I wonder um if you might like to introduce yourself um and talk a little bit about um your background um what you're doing today uh if you're affiliated with a university and private practice um what things would you like the audience to know about you that would bring them a little bit up to date okay I'm a social worker I've been a licensed clinical social worker and after a couple of years of practicing in family service and adoption agencies in Tennessee and Illinois I went into social work educ ation because at the time it was only the only part-time job I could get in orangburg South Carolina where I lived um I often will tell students they always feel like they need to know exactly what area of social work they want to go into and you know they wrestle with do I want to do child welfare or work with the elderly Etc and I often tell them that it's often just sort of serendipity what trajectory your career takes that you look at what job offers you have and sometimes you only have one and you take that and you work for a while and then you see what else you want to do and it's not like you you know in school plan out exactly what you're G to be doing um and my career was a lot like that I I went into Social Work education thinking I'd really rather be in practice but within maybe five years I really would rather be in Social Work education so you kind of find your way as you go I think yes um after uh teaching in South Carolina and a predominantly black college I moved to Illinois for my husband to go to grad school and I worked for a Lutheran agency um in adoption and then uh first of all I I should say in Tennessee I worked in an adoption agency that also did Family Services counseling so I had a mixture and by the time I started in teaching I had worked with all members of the adoption Triad you know with several cases um I taught for a while um a long while actually in Illinois and ended up retiring from there um and then since that I've worked for The Donaldson adoption Institute for many years and um also have worked on about 15 different federally funded grants projects wow um from everything from you know resit programs for Med medically fragile children uh to uh a long time of post-adoption services so that's pretty much where I come from my goodness what a rich history that's a very rich history oh and I was going to add my my final swan song I completely retired a couple of years ago and I uh worked with the center for adoption support and education uh in co-writing online curricula for um teaching adoption competence to child welfare workers and another one for mental health workers yes I really enjoyed that because I got to kind of pull together every thing that I'd ever done in terms of integrating that with other people's research well I think you as a researcher am I wrong no no I I started actually my uh very first research project was on when I was in the historically black college on the role of white faculty and predominantly black institutions oh and the president of the college facilitated that and wrote to other black college presidents and ask them to help us participate and so forth so um when you get into a tenure track position you have to publish and you know some of my early research was driven by that and then once I got into adoption it was you know wide open in terms of my interests and things that I could do what are some of the projects you've done connected to the field of permanency um my first study was on adoption disruption um and again that was sort of serendipity because I was taking a doctoral research class at the University of Illinois and the professor said DCFS the Department of Children and Family Services wants someone to do a research project on adoption disruption and Jean Howard my longtime research partner and I uh contacted DCFS and ended up doing that um we looked at 74 always before people had said an older age was the primary factor bleeding to disruption older age of the children yeah older age of the child adopted placement and but they were always comparing you know samples with the average age being like six years old to predominantly infant kind of placements which you know to me didn't really address the real issu so we matched uh 74 children who disrupted in their first adopted placement with 74 Children of the same age who had consummated adoptive placements and were adopted and we found that a history of sexual abuse was the one one of the most potent factors associated with disruption um the samples we looked at a behavior problem score with the severity and number of behavior problems and before placement sexual acting out was the only Behavior problem that was more prevalent among the kids that disrupted and we ended up going further and really looking at the experiences of the the kids that have been sexually abused and it was partly their own trauma uh issues and partly that their parents had difficulty accepting some of them um I remember one mom who uh had adopted or had place for adoption an infant and her five-year-old sister and she ultimately they both were moved because she just could not accept the older girl she said she felt terrible about it but she viuer is Tainted and just you know innocent things like drawing pubic hair on a doll was perceived as a stigma you know for a lot of these children so it was not just the child's issues it was also the parents issues do you think that that study helped DCFS to change how they interviewed and prepared families I don't know I would hope so because my goal in research has always been to improve practice and to see what accommodations need to be made in practice that would address the issues you uncover and um I think it we ultimately ended up having another look at this from a qualitative perspective that was published in the social work Journal uh looking at what some of the issues were with sexually abused children and um about many of them about half were not known to have been sexually abused at the time they were replaced for adoption it was like one other thing that had happened to them among many and you know it was because of sexual acting out that they started looking at you know what and this little girl that I mentioned that was five had a vaginal infection and would scratch a lot and that was how that was uncovered but it's just um many of these children have so many things that have happened to them that continue to be threads throughout their development that are not even known to child welfare workers that's such a sad thing for me that we don't have a way to go back and check and see how things are going over time yeah um there used to be something like that in Minnesota called rap and they used to go back every five years or so and double and I I loved that notion of saying we're here to support you how's it going yeah uh so that's such an important piece of research and I know you also have done some research around the birth first parent issues right I did that at donalson um I worked predominantly in in the Lutheran agency in Illinois I worked predominantly with birth parents and I even had um one case where the birth parent had been adopted from this agency where I worked and she was in that particular agency was around Chicago and they had what they called work wage homes where the girl was housed with an upper middle class to upper class family and did some help with babysitting and got free room and board throughout her pregnancy and she was in one of those and her mother had been in one of those and it just was so um weird in a way that she was repeating the same history and it was funny I had she knew nothing about her birth mother and over the course of working with her I asked her if this was something she would be interested and finding out more about and she avoided it for a long time and then later she came and said you know I would would like to know more about my birth mom so so that was neat to be able to provide that to her and did she place when she got that information yes she did she did she had wanted to place from the beginning and her parents were supportive of that um but she was very emotionally disengaged for a long time and then became more so engaged in the planning so when you look at the research which is a foundational piece that so many people go back and look at um what were the what were the the important points that came out of that research that you'd want to share with viewers of the Donald project related to birth parents yes um one thing that's glaring is that there are hardly any post-adoption services for birth families you know whether moms dads their parents whomever and they have continuing on for decades you know a lot of issues and um even in open adoption Arrangements um these things are often sort of set up at the time of the adoption and there's no followup or help to see how it's going what issues there are how they can be help yeah um so I think services for birth and helping them prepare for understanding that um the grief will resurface over the course of their lives and that they may need to access help [Music] um and helping them understand um some of the needs of adopted children of knowing their history and the importance of passing on to the child um you know the the thing that the child always wants to know is did she love me and I remember when I was in adoption preservation a a worker told me that her um client the adopted child she was working with the whole family but the child had um found out that her parents had a letter that her birth mother had written to her but they never shared it with her oh my and the worker asked the parents why she didn't share it with the child and they said well it had poor grammar and we were waiting till she was old enough and we thought she could understand and in a session they read the letter to the girl and she asked her right after that what did she learn that she didn't already know and she said that she loved me oh yeah and I just that that's such a powerful lesson that needs to get communicated um and you know I think birth parents need help both fathers and mothers and another glaring thing is that birth fathers are often not involved in planning even when they want to be um I consulted on a court case in uh North Carolina where a birth father had not been told by the mother they had dated in college for a year or more and she became pregnant and um he graduated and moved back to out of state and um wasn't seeing her very often and she had a baby without telling him that she had become pregnant and the social worker who was a a licensed clinical social worker um pressed her about you know calling him and getting his consent and she never got around to it and they um placed the baby and ended up he his family filed a suit wanting to raise the baby and they won um you know I went back and looked at the Child Welfare League of America standards and it it's very strong in terms of birth fathers and they had not done also he went in before the baby was placed he was visiting her and he went by um wanting to talk to the social worker and she was out that day and they had scheduled the placement of the baby the next day oh my and you know it's just like you know the baby was like five months old I think by the time the court case played out and she was able to be moved to his his family he and his mother and you know it's just fathers are often they may make a sort of a small effort to say they're welcome to come in but they in my view didn't really follow through enough well they are 50% of who we are yeah some of us are much more like our fathers than our mothers and so missing that information as an adopted person can be quite devastating in terms of identity formation and I do think you know if it's a good situation being raised by Ken is preferable and it we always do that in foster care adoption but not in infant adoption right so you know I just I think that's something that needs to be explored in the planning you're touching on such important issues for people viewing this interview have you done other research um while at Donaldson I did a lot of different research I mean it was whatever the the topic was that needed to be looked at you know I I worked with Holly mcginness on a a survey of adopted adults and how important adoption was in their identity at different stages and uh this particular study was half Korean adoptees and half uh quite domestically placed adops and um the importance of adoption identity kept going up you know you always sort of assume it's going to be high in adolescence but it it continued to be important to these people even into their senior years wow and it was obviously something that had significance to them and through adulthood and you know we had just different questions that were really interesting like um most of the Korean adoptees said that at some point in their childhood they wished that they were white um and just I can't remember all the findings but it was just a very eye-opening you know we were really looking at what would have helped them to have POS positive identification as Korean people and so forth and we ask what kinds of services they' had um and what they thought would have helped and you know the title of the thing was beyond culture Camp because often culture Camp was the yes thing they had experienced many of them and um many of them wanted to revisit their birth country um um some had and they felt that was particularly helpful um we looked at how they had role models from their own culture and various aspects um but it was just a very rich um it was a very long questionnaire with some standardized measures embedded and you know I I kept telling Holly you need to cut it down but um she is now doing a followup to that study yes yes yes and and people who are interested can certainly look at the Evan B Donaldson not pardon me yeah no the the national Center for adoption site right and and tap into that particularly we're hoping as many adoptees across the country as can would would want to become a part of that that study you know Evan B Donaldson Institute for those who don't know existed and Now does not exist but all that research that so many of the researchers connected to the D Institute has been brought over to the National Center of adoption permanency so this interview we really haven't talked about research with others this interview that's touching on the highlights of this in really incredible um Treasure of of research can be um tapped into through encap and we would encourage people to do that so much of our of our um flying by the seat of our pants in our field for so many decades has uh started to kind of get us to straighten up and fly right because we now have the proof of things that we you know we've been guessing at sometimes we guessed right sometimes we didn't guess right so you know the role that you've played uh We've also interviewed David brinsky and others who you know did contribute uh some important uh um insights into our practice which is why it's so wonderful to be able uh to talk to you I also know you've written books um yes and I wonder if you could talk a little bit about you know what topic areas I I love the one of course that you've did on siblings I certainly love for you to talk about that you and Deborah edited but um I would love to know more about your writing as well okay um the bulk of my work has been on post adoption services and this was largely because um because we did the study on adoption disruption we were known to DCFS and they were one of the first states to have a Statewide adoption preservation program that had a broad array of services and uh they asked us if we would evaluate it and they had a couple of federal grants over the years we're back in Illinois are we back in yes Illinois okay and we stayed connected to that program we would do periodic re-evaluations and we wrote a curriculum for their workers because often when they hired new workers they didn't have the background in adoption competence and we put together um a self-guided curriculum for them to prepare workers uh that had videos and various books and things in it uh um and we we basically from the whole time I was in Illinois I think we started on this in the early 90s and it continued really through 2010 2014 and wow and even after I retired you know I've gotten calls from Illinois wanting to know you know if I thought the curriculum needed to be updated and all these different things things and I've gone back to do training a couple of times and it's just that Association uh really sparked Gan and my focus on post-adoption services [Music] and agencies that did adoption opportunities grants that were like threeyear to fiveyear demonstration projects they often uh would ask us to evaluate them so over um I I was involved with I was trying to count at least 15 different Grant funded service projects and sometimes I was evaluator evaluating the project other times I helped like I worked on one in Tennessee uh since I retired that was to better serve children with trauma backgrounds and provide link with mental health services to work on the barriers that existed in the state to getting effective Mental Health Services and that was exciting you know I most of the time I started off as an evaluator but then the Donaldson adoption Institute folded and I ended up just being on the committee that sort of designed and I did some qualitative evaluations but it was it was so EX interesting to me because I work for the doson Institute I would do extensive literature reviews on all different kinds of topics from open adoption to uh uh matching children to NEPA iipa the the policies about race and placements uh to adoption and stability we did a study on the proportion of kids that return to the Child Welfare system after adoption some are Foster Care adoptions some are other kinds of adoptions and we looked at you know there had been a lot on disruption but hardly anything on what they call displacement where they left their home either to live in a residential treatment facility or to go back into the child welfare system or on the streets or in the military yeah right and there was a study done called The Long scan study that the Federal government funded over a period of decades and they followed uh children placed from Foster Care into adopted families and compared them with children who stayed in foster care or um basically were in long-term foster care and they found that in the first decade or so when the kids were like 68 they were doing much better the adopting kids than the kids that stayed in foster care but by the teen years many of them were having a lot of problems that weren't being addressed were um and about we looked at we had Penny Maza do research for The Donaldson adoption Institute using the whole National statistics of children in foster care on adoption and she was able to to look at um when kids left their families what happened to them were they reunited uh and so forth and only about 15% came back into Care by the age of 10 so almost all of them were pre- teener teens when they came into the foster care system uh but their rate of being reunited with their adopted families was much lower than other children in foster care like for kids in the general system about 55 57% end up being reunited with their birth families but it was only 33 or something percent for adopted kids um of the ones that they typically didn't have them terminate parental rights unless they were going to try to place the child for adoption unless it was clear that the child could not return home and about 61% of the kids that had gone into care and left care were adopted by another family wow so or they couldn't go home yeah and so but emancipation the odds of being emancipated at 18 or 21 or whenever it was done in the state was three and a half times greater for adopted kids going back into the care system than for nonadopted kids that were in foster care so that's that's so disheartening yeah oh and another study called The Long scan study that I started to talk about uh found that 20 some odd percent they looked at where kids lived when they were 17 and 87% were living with their adopted families at that time but think it was 28% have lived out of the home at some point during their adoption and it's just become clear that the trauma that these children have experienced the issues of identity and loss and various things that they struggle with continue on throughout their development and very few you know I think adopted parents see that there's a period maybe a honeymoon and then a period of struggle but then you achieve an adjustment that goes on and and you know it's like happily ever after but it's not like that these issues e and flow and generally during a adolescence um there was a national survey of adopted parents that was uh done by researchers uh I think in Virginia and they um looked at children adopted from as domestic infant adoptions inter country adoptions and Foster Care adoptions and had a large sample and they found that 30 some odd perc of them received Mental Health Services after adoption and it was higher for adolescents and for those adopted from foster care 57% I think it was were receiving mental Health Services during adolescence and you know there's just a lot of problems that uh providers are typically Community Mental Health agencies they have very little if any background in adoption uh I know David and some other people have done studies on uh content and graduate programs for psychologists and social workers and others and really there's hardly any if any you know they probably learn more about um Eating Disorders than they learn about adoption yeah and many we've done surveys of adopted parents about what services they've had and what they need and what was helpful and what wasn't and so many of them said they felt blamed by the Professionals for their children's problems and that they didn't understand you know all these issues that the children were struggling with and it's that's just something that needs to be remedied and in addition to these kind of adoption education things that we do for a wide range of professionals we need to get program some kind of content in graduate programs and at least help them understand that there are issues that they're probably not prepared to address that they need to learn I mean these things about brain trauma and you know things that really affect attachment and so forth are just few and far between and they're not things you're going to be taught in graduate school for the most part um so we just got to do a lot better for families to be able to get services that work you know you have just covered like the Waterfront I mean so so much material I you're a walking font of statistics of information um you know you say you retired um what are you doing these days and what do you feel like you still want to do um I've done some things like I went back and did home studies for an agency that did in country adoption because I'd had less experience with in country adoption than f adoption and you know I kept working for the adoption Institute until it closed and then I worked on a couple of other Federal grant projects I wrote this curriculum and you know I I'm almost 77 years old and I just decided my husband had been retired for maybe five years and I was still working and I just thought it's time good for you good so basically you know he had a bunch of health problems that kept me pretty much Tod to home and um I haven't really done anything adoption related except talk to people periodically so I mean I would like um maybe something but I haven't figured out what that is well maybe we can talk further about that okay um I feel like none of us ever really leave the field because there's so much left to do and if you were to pick a couple of things that you just we you you've touched on them quite a bit in in the interview but if if they if you had a passion project this is mine my passion project is not to lose the voices of our of our Legacy folks the folks who've laid the foundation you're certainly one of those but um and and I didn't want to lose any more voices so that became at 81 my passion project what what is it that you still feel so deeply about that you want to make sure either you or somebody grabs a hold of I don't know I haven't really given it a lot of thought okay I mean post- adoption services is the thing I feel the most passionate about because I just know you know like interventions that have sprung up like the TBR trust-based relational intervention or the the ones that address brain development there's so many things that just are not taught in most programs and I think they at least need to know that they're out there and what they are and how they help um if they're not going to teach them how to do these specific kinds of interventions at least educate them about their existence so that if they want to learn more later they can that's something you know getting knowledge about adoption into graduate programs is something I care a lot about okay well that's really really helpful when people look back on your career and they're talking about you what would you like them to remember you know if they were writing a um a tribute to you or even a eulogy at some point terms of well in terms of your career not you as a person um what is it that you hope they say I think that I was balanced in my work and fair-minded and that I looked for ways to improve practice you know I was always applying research to what that has to say about better serving families um and again I think birth families are so neglected in our whole post adoption services thing and coming up with ways to do that I know one grant that Jean and I got from the uh adoption opportunities funding they wanted to do a synthesis of the grants they'd funded over a six-year period it was like 1988 to 94 1994 somewhere in there and they had done I think 69 adoption opportunities grants and they wanted us to go look at what had been developed and what they did and what they learned and so forth and I learned so much from that you know from just there were and it was so sad to me that things seemed to just sort of die on the vine after the grant ended and um like there were programs we did some training in South Carolina and they had developed at the University of South Carolina this uh very detailed volume mini volume curriculum um adoption and I don't think anybody that came to this training it was for child welfare workers and there were probably 80 something people there and no one had even heard of this curriculum that was done not that far ago and it's just I mean while some things go on and we build them there's so much knowledge out there that lives in silos you know that we need to let people know about oh amen I mean we've talked about this briefly with another inter interviewee and you know myself I was involved with several federal grants and when they were over they were over and I'd say well what are you going to do with all this information or how do I have access as a professional to all the other programs projects so that I can maybe lean from them something I could add into my own program not there was no real way to get hold of anything there was no real sharing it always felt like a waste of money and I've often wondered why as a part of the grant there isn't when you submit for the grant there isn't some requirement that you talk about when the grant is over this is what we're going to do with the information or the project or how we're going to keep it going if it's successful sustainability is kind of touched on now and in the Children's Bureau but not always I don't think like this one project I did in Tennessee they were supposed to address planning for sustainability of the things that have been developed but I'm not sure that's usual yeah and what I found because I loved your your Gathering of all that information I remember when you and Jean did that and I was a program manager at that time and it was like treasures and what I found is if I reached back to the folks in those organizations most of them were gone or they didn't have the time to talk to me or they didn't know where the material was yeah and there's there were so many of those that were really creative like I remember there was one program I think it was in Minnesota where they develop they over the child's development they would send these little oh R almost like newsletters they were rap yes the families about what what's common for adopted children to be yes doing at that developmental stage and so forth and that could easily have been replicated you know that was the most brilliant thing yeah I just loved that they did that yeah and there was another one I don't remember where was but they used therapeutic graduate students and I think some undergraduates to do an after school program for adopted youth wow um and they you know developed I'm sure there was supervision but they developed and implemented this program one day a week after school and it it was such a neat thing for the students as well as the children and it was a way for them to have relationships with other adopter Ed children which I think is so important for kids well I just I want to thank you because you have contributed so much uh to the you and you you point out in this interview how really precious research is um that now we can't just continue to not validate it always reminds me of that story about the ham you know and do you know that story no I don't think so well it's just a perfect example here of you know the the man gets married and his wife serves him a ham and the ends are cut off and he says to her why are the ends cut off of the ham and she said I don't know it's how my mother did it so the next time they eat at her mother's house and you know he asked the same question mom serves Ham on Sunday night he says how come the ends are cut off she goes I don't know you'd have to ask Grandma my mother so finally they did they asked you know Grandma and grandma said I don't know why they do it I had a small pan so you know I think what we do so much in our field yeah is do what they've done before without questioning is it is it relevant who developed it why was it done why do we keep doing it and that's what research gives us and so I I thank you and Jean Howard and David bradinsky and Hal Grant and Ruth mccroy and all of the Wonder researchers Holly mcginness all of you who really create the framework for our practice and so I I thank you for that thank you and thank you for this interview sure thank you Susan thanks Shar be well and enjoy your retirement okay e e e e e e e