During the same period, the Progressive movement swept the United States with a critical goal of ending the prevailing orphanage system. The culmination of such efforts came with the First White House Conference on the Care of Dependent Children called by President Theodore Roosevelt in 1909,[33] where it was declared that the nuclear family represented "the highest and finest product of civilization" and was best able to serve as primary caretaker for the abandoned and orphaned.[34][35] Anti-institutional forces gathered momentum. As late as 1923, only two percent of children without parental care were in adoptive homes, with the balance in foster arrangements and orphanages. Less than forty years later, nearly one-third were in an adoptive home.[36]
The most recent adoption attitudes survey completed by the Evan Donaldson Institute provides further evidence of this stigma. Nearly one-third of the surveyed population believed adoptees are less-well adjusted, more prone to medical issues, and predisposed to drug and alcohol problems. Additionally, 40–45% thought adoptees were more likely to have behavior problems and trouble at school. In contrast, the same study indicated adoptive parents were viewed favorably, with nearly 90% describing them as "lucky, advantaged, and unselfish."[144]

When another family is ready to adopt the child, DFPS and the family complete the adoptive placement paperwork. After children have lived in their new home for six months, the adoptive family and CPS can make the adoption permanent. In many cases, the children may have already been living with the family as a kinship care or foster home so they are familiar with their new family. The adoptive family can submit a document to court called a "petition to adopt" and, if approved by a judge, the adoption becomes permanent (also known as "consummated"). At this point, CPS is dismissed from the child's case, and DFPS will no longer be involved with the child or your family.

The adoptee population does, however, seem to be more at risk for certain behavioral issues. Researchers from the University of Minnesota studied adolescents who had been adopted and found that adoptees were twice as likely as non-adopted people to suffer from oppositional defiant disorder and attention-deficit/hyperactivity disorder (with an 8% rate in the general population).[135] Suicide risks were also significantly greater than the general population. Swedish researchers found both international and domestic adoptees undertook suicide at much higher rates than non-adopted peers; with international adoptees and female international adoptees, in particular, at highest risk.[136]
Identity is defined both by what one is and what one is not. Adoptees born into one family lose an identity and then borrow one from the adopting family. The formation of identity is a complicated process and there are many factors that affect its outcome. From a perspective of looking at issues in adoption circumstances, the people involved and affected by adoption (the biological parent, the adoptive parent and the adoptee) can be known as the "triad members and state". Adoption may threaten triad members' sense of identity. Triad members often express feelings related to confused identity and identity crises because of differences between the triad relationships. Adoption, for some, precludes a complete or integrated sense of self. Triad members may experience themselves as incomplete, deficient, or unfinished. They state that they lack feelings of well-being, integration, or solidity associated with a fully developed identity.[129]
His solution was outlined in The Best Method of Disposing of Our Pauper and Vagrant Children (1859) which started the Orphan Train movement. The orphan trains eventually shipped an estimated 200,000 children from the urban centers of the East to the nation's rural regions.[28] The children were generally indentured, rather than adopted, to families who took them in.[29] As in times past, some children were raised as members of the family while others were used as farm laborers and household servants.[30] The sheer size of the displacement—the largest migration of children in history—and the degree of exploitation that occurred, gave rise to new agencies and a series of laws that promoted adoption arrangements rather than indenture. The hallmark of the period is Minnesota's adoption law of 1917 which mandated investigation of all placements and limited record access to those involved in the adoption.[31][32]
Common law adoption: this is an adoption which has not been recognized beforehand by the courts, but where a parent, without resorting to any formal legal process, leaves his or her children with a friend or relative for an extended period of time.[88][89] At the end of a designated term of (voluntary) co-habitation, as witnessed by the public, the adoption is then considered binding, in some courts of law, even though not initially sanctioned by the court. The particular terms of a common-law adoption are defined by each legal jurisdiction. For example, the US state of California recognizes common law relationships after co-habitation of 2 years. The practice is called "private fostering" in Britain.[90]
The research literature states adoptees give four reasons for desiring reunion: 1) they wish for a more complete genealogy, 2) they are curious about events leading to their conception, birth, and relinquishment, 3) they hope to pass on information to their children, and 4) they have a need for a detailed biological background, including medical information. It is speculated by adoption researchers, however, that the reasons given are incomplete: although such information could be communicated by a third-party, interviews with adoptees, who sought reunion, found they expressed a need to actually meet biological relations.[167] 

Beyond the foundational issues, the unique questions posed for adoptive parents are varied. They include how to respond to stereotypes, answering questions about heritage, and how best to maintain connections with biological kin when in an open adoption.[97] One author suggests a common question adoptive parents have is: "Will we love the child even though he/she is not our biological child?"[98] A specific concern for many parents is accommodating an adoptee in the classroom.[99] Familiar lessons like "draw your family tree" or "trace your eye color back through your parents and grandparents to see where your genes come from" could be hurtful to children who were adopted and do not know this biological information. Numerous suggestions have been made to substitute new lessons, e.g., focusing on "family orchards."[100]
Nevertheless, work on adult adoptees has found that the additional risks faced by adoptees are largely confined to adolescence. Young adult adoptees were shown to be alike with adults from biological families and scored better than adults raised in alternative family types including single parent and step-families.[137] Moreover, while adult adoptees showed more variability than their non-adopted peers on a range of psychosocial measures, adult adoptees exhibited more similarities than differences with adults who had not been adopted.[138] There have been many cases of remediation or the reversibility of early trauma. For example, in one of the earliest studies conducted, Professor Goldfarb in England concluded that some children adjust well socially and emotionally despite their negative experiences of institutional deprivation in early childhood.[139] Other researchers also found that prolonged institutionalization does not necessarily lead to emotional problems or character defects in all children. This suggests that there will always be some children who fare well, who are resilient, regardless of their experiences in early childhood.[140] Furthermore, much of the research on psychological outcomes for adoptees draws from clinical populations. This suggests that conclusions such that adoptees are more likely to have behavioral problems such as ODD and ADHD may be biased. Since the proportion of adoptees that seek mental health treatment is small, psychological outcomes for adoptees compared to those for the general population are more similar than some researchers propose.[141]
Nevertheless, work on adult adoptees has found that the additional risks faced by adoptees are largely confined to adolescence. Young adult adoptees were shown to be alike with adults from biological families and scored better than adults raised in alternative family types including single parent and step-families.[137] Moreover, while adult adoptees showed more variability than their non-adopted peers on a range of psychosocial measures, adult adoptees exhibited more similarities than differences with adults who had not been adopted.[138] There have been many cases of remediation or the reversibility of early trauma. For example, in one of the earliest studies conducted, Professor Goldfarb in England concluded that some children adjust well socially and emotionally despite their negative experiences of institutional deprivation in early childhood.[139] Other researchers also found that prolonged institutionalization does not necessarily lead to emotional problems or character defects in all children. This suggests that there will always be some children who fare well, who are resilient, regardless of their experiences in early childhood.[140] Furthermore, much of the research on psychological outcomes for adoptees draws from clinical populations. This suggests that conclusions such that adoptees are more likely to have behavioral problems such as ODD and ADHD may be biased. Since the proportion of adoptees that seek mental health treatment is small, psychological outcomes for adoptees compared to those for the general population are more similar than some researchers propose.[141]

As the idea of institutional care gained acceptance, formal rules appeared about how to place children into families: boys could become apprenticed to an artisan and girls might be married off under the institution's authority.[19] Institutions informally adopted out children as well, a mechanism treated as a way to obtain cheap labor, demonstrated by the fact that when the adopted died, their bodies were returned by the family to the institution for burial.[20]
Several factors affect the decision to release or raise the child. White adolescents tend to give up their babies to non-relatives, whereas black adolescents are more likely to receive support from their own community in raising the child and also in the form of informal adoption by relatives.[118] Studies by Leynes and by Festinger and Young, Berkman, and Rehr found that for pregnant adolescents, the decision to release the child for adoption depended on the attitude toward adoption held by the adolescent's mother.[119] Another study found that pregnant adolescents whose mothers had a higher level of education were more likely to release their babies for adoption. Research suggests that women who choose to release their babies for adoption are more likely to be younger, enrolled in school, and have lived in a two-parent household at age 10, than those who kept and raised their babies.[120]
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