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Children's Voice Article, November/December 2003

Should We Photolist Waiting Children?

Internet photolistings of children waiting for adoptive parents raise challenging ethical issues.

by Sarah Gerstenzang and Madelyn Freundlich

As of September 2000, 75,000 children in foster care were free for adoption-a number that continues to grow each year, placing greater demands on child welfare systems to find adoptive families. State and local agencies have used different strategies to recruit adoptive families-including photolistings, which allow potential adoptive parents to view pictures and read short descriptions of available children.

Since 1994, photolistings have been posted on the Internet, either on individual states' websites or the federally funded website known since 2002 as AdoptUsKids. This national website currently lists 3,000 children in foster care who are available for adoption.

Before the Internet, families interested in adopting children from foster care typically visited child welfare agencies and reviewed photographs and biographies of children who were available for adoption in their own states. Later, agencies partnered with local newspapers and television stations to develop feature articles and television spots such as "Wednesday's Child" to alert the public to the needs of waiting children.

Unlike these earlier approaches, however, the Internet has the capacity to reach millions of people and interest families who may never have been made aware of children in foster care who needed adoptive families. Among its benefits, the Internet offers ready access to information in a cost-efficient manner, and privacy for families who may be in the early stages of considering adoption but not be ready to contact a social service agency.

As child welfare systems have recognized the benefits of this new means of recruiting families for waiting children, practitioners have confronted some ethical issues, particularly regarding the type of information shared about children in the very public venue of the Internet.

Red Flags

In a random downloading of Internet postings, samples of actual photolistings illustrate the types of information posted about children and raise several ethical issues to consider when the Internet is used as a recruiting tool for adoptive families:1

Frequent use of clinical terms to describe children and their behavior or status.
[Isabelle] experienced a chaotic life and as a result has been diagnosed with and receives medication and therapy for attention deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, and post-traumatic stress disorder.
These diagnostic terms aren't likely to be clear to the average reader and lack any context that helps the reader understand the how these conditions affect the child.

Highly detailed descriptions of behavior problems, and interpretative comments about the child's behaviors.
A very quiet Daquan [age 5] who remains that way for an extended period of time is an indication that he is upset. He might sulk for a long time before he brightens up again.
Such descriptions, which may describe typical behaviors for children of the age of the featured child, nevertheless seem to suggest a more serious problem.

References to the child's suspected history, and details about actual past traumas.
David entered care as a result of neglect and has experienced many moves in his short life. He is diagnosed with global developmental delays, and it is suspected that he was drug exposed in utero.
Even when described as "suspected," the reference to prenatal drug exposure raises questions about the child's physical and developmental status when, in reality, there is no certainty his history includes this situation.

Highly positive language that sounds like product marketing.
[Harold] is a clean-cut child with good manners, good personal hygiene, and an appreciation for what is done for him.
By highlighting physical and personality aspects that convey he is a "good" child, such language suggests the child is a commodity to be marketed.

Descriptions that reinforce stereotypes.
Michael [a 10-year-old African American boy] has no physical impairments, and his gross muscle [sic] are well developed.
Observations about the muscle development and athletic prowess of African American children appear in many descriptions.

Overly prescriptive comments on necessary parenting styles.
Shirley's foster family says she needs a lot of structure in her life or things can quickly get out of hand. Shirley will need a family that has the patience to keep after her to finish tasks such as homework and household chores. She will need consistency, clearly set guidelines with consequences, and lots of structure.
These types of descriptions, coming in the first introduction to a child, assume the child's response to a foster family will carry forward into her relationship with an adoptive family.

Equally troubling is how such descriptions in a public venue might affect the featured children. Many people object to photolistings as distasteful "marketing" of children. Most parents would not permit their own child to appear with such detailed personal information in a public forum, and they don't find it appropriate to feature other children this way.

On the other hand, considering the growing number of children in foster care, the ongoing desperate need for thousands of adoptive families, and continued limited funding for recruitment, using every opportunity to expand the pool of adoptive families is imperative. The question is how to make Internet technology work for children in an ethical manner. Recent experiences in Canada provide some insight.

More than 4,700 children in foster care in Alberta were freed for adoption in 2002, but only 116-less than 3%-were adopted. In an attempt to increase the number of adoptions, Alberta Children's Services launched a website featuring waiting children in February 2003. The website, which included photographs, written profiles, and video clips of the children, sought families only within Alberta unless exceptional circumstances dictated otherwise.

The website generated tremendous controversy. Aside from a general anxiety about whether the listings would attract sexual predators, several concrete practice concerns arose. Featured children were teased at school by classmates who had read some of their medical and social histories online, and some children weren't aware that families were being sought to adopt them.

Alberta's privacy commissioner ordered that details about the children's medical and psychiatric problems and their histories of abuse be removed from their profiles. The Ministry of Children's Services delayed featuring additional children until the site was evaluated after a three-month trial.

Despite these problems, less than two weeks after the website's launch, the agency removed 13 of the 93 children originally featured because 40 potential adoptive families had expressed interest in adopting a featured child. By May, three months into the first year of operation, 48 children had been matched with potential adoptive families, including 12 who weren't actually listed on the website.

Ethical Guidelines

The goal of photolisting is straightforward: to find families for children. To achieve this goal, photolistings have several objectives:
  • alert families to waiting children;

  • provide potential adoptive families with individualized descriptions of featured children;

  • provide information to interested families on steps to take to learn more about the child and the adoption process; and

  • interest families in adopting other children from foster care if a featured child is no longer available for adoption or the family is not a good fit for the child.
Where does information posted on the Internet fit within the continuum of information sharing in the adoption process? Professionals generally agree that photolistings on the Internet serve as a recruiting tool and should include some information about the child. The question is, how much information?

Disclosing information to adoptive parents about children's backgrounds and status is important from an ethical perspective, but the very public venue of the Internet raises questions about the extent to which personal information on children should be shared in that forum. "Too much information too soon" seems to have become all too frequent, raising the need to closely examine what is best practice.

In developing guidelines for providing information on the Internet about children in foster care, we need to address three issues:
What Information Should Be Included?

Professionals have access to both objective and subjective information for children featured in photolistings. Objective information includes a child's appearance, or an actual photograph, and the child's age or birth date, racial and ethnic background, and any diagnosed medical conditions. Objective information in a photolisting usually doesn't raise ethical concerns.

Subjective information, however-such as a child's strengths, problems, challenges, disabilities, or needs regarding an adoptive family-is often far more problematic. Any subjective information that may be posted should be carefully assessed for its

usefulness and appropriateness. Is the information actually "known," being reasonably guessed at, or very speculative? Even if it is "actually known," the information should be examined critically to determine whether it is complete, up-to-date, and from a reliable source.

This issue is important in constructing initial Internet postings and in ensuring the accuracy of postings that remain on the Inter-net for a length of time. Photolistings are usually updated infrequently-often just yearly. Agencies using photolistings should take care to ensure information remains fresh and accurate.

Consider the following description of a 6-year-old:
John began taking classes under the Early Childhood Intervention program and will need to continue these classes until he enters kindergarten.
Although the listing agency updated the child's age, it failed to update information written before he entered kindergarten. Thus, the listing not only misstates his current school status, it suggests the issues for which he received early intervention services persist, which may or may not be accurate.

How a child's photolisting is developed is also critical. Has the writer of the child's description ever met the child? How was the information collected? Has someone who knows the child, such as a foster parent, reviewed the information for accuracy? Did the child help write a descriptive paragraph? These issues are critical because information can be easily misconstrued.

Case in point: Sarah Gerstenzang, a foster parent and one of the authors of this article, adopted a child in her care in September 2002. The medical summary prepared from the child's case record in preparation for adoption stated the child was "examined on January 5, 2002,…and was found to have the following conditions…" Two of the conditions listed were "prenatal exposure to illicit substances" and "mild to moderate developmental delays."

As the girl's foster parent, Sarah knew the January exam was just a check-up and was unremarkable; that there was no evidence the child had ever been exposed to illicit substances, although there was some family history; and that the referenced developmental delays were noted in an exam in 2000 when the child was 4 months old. At age 2, the little girl was thriving, but the medical summary was so intimidating and inaccurate that Sarah's lawyer advised the child be classified as "special needs."

The presentation of the information is equally important, given the goal of attracting families. To ensure against misspellings, typos, or missed or repeated words, child profiles should be proofread before posting.

Privacy Concerns

Limits on sharing information based on privacy may be either ethical or legal. Ethically, officials must consider the child's age, her understanding of the photolisting process, and her grasp of the possible implications of being photolisted. Birthfamily, friends, and community members may be able to access the child's personal information. Officials must acknowledge the child's understanding of the process and such possibilities as school friends seeing her on the Internet and reading about her background.

Decisions about posting specific health and mental health information should be based on several considerations-the seriousness of the condition; how recent the occurrence; the relationship, if any, between the problem and the child's current environment; and how the condition would affect the child and the prospective family.

Listings that include diagnostic labels without any context for such information is of particular concern. Pediatrician Lisa Albers, with the Developmental Medicine Center and Adoption Program at Children's Hospital in Boston, emphasizes that childhood emotional and behavioral disorders are diagnosed through observations and reports of behaviors and tend to be less definitive than a medical diagnosis based on an x-ray or blood test:
Sometimes the diagnosis is well described by an alphabet soup (RAD, PTSD, ODD, ADHD, etc.), but in my experience, those letters only shed light on one facet of any given child. In addition, children with any one of these diagnoses may present very differently from another child with the exact same diagnosis or diagnoses.2
Legal constraints also limit publicly sharing certain information. Privacy laws in most states prohibit sharing information about adult members of the birthfamily. Some states require a court order to photolist a child. By law, a child's HIV status may not be disclosed publicly. Finally, privacy regulations under the Health Insurance Portability and Accountability Act (HIPAA) could significantly limit the types of information posted in photolistings. HIPAA sets rigorous standards to protect individuals' health information from disclosure. States thus far have varied in their interpretation of how or whether this law applies to child welfare issues.

Can Practice Support Appropriate Information Sharing?

Because the Internet makes possible the transmission of information to millions of people, it raises unique practice issues. Internet photolistings allow families who may be in the early stages of considering adoption to view children anonymously, bring significantly greater attention to the needs of waiting children, and alert families to waiting children in other states.

Child welfare's capacity to meet the response that Internet photolistings can generate, however, remains undeveloped. In many communities, social workers are overwhelmed with the number of inquiries generated by newer, more effective transmissions of information. In some communities, photolistings provide extensive negative information about children to dissuade families whom officials may view as inappropriate

resources from contacting the agency. If they are to use the Internet to recruit families, child welfare agencies must be able to respond to inquiries, provide information, and engage families in the adoption process.

Strengthening Photolistings

Photolisting websites can be strengthened to more effectively alert families to the needs of waiting children and educate them about adopting. These websites should contain information-or links to sites with accurate information-that helps potential adoptive families understand such complexities as
  • the definition of the term special needs-from a physical or mental health disability to the child being placed for adoption as a member of a sibling group-and how states define special needs differently;

  • general qualifications to adopt, such as marital status, age, and other requirements;

  • the availability of adoption subsidies and tax credits for special needs adoption;

  • a basic explanation of foster care, termination of parental rights, and the adoption process;

  • interstate adoptions, transracial adoptions, and adopting older children; and

  • perhaps most importantly, information about the number of families who adopt successfully each year from the foster care system, including profiles of families who have done so and links to foster and adoptive support groups nationwide.
We need to understand much more about the effectiveness of Internet photolistings as a recruitment tool, especially compared with other recruitment methods. Do users of photolisting websites obtain the information they need? How does the quality or uniqueness of children's biographies influence adoptive families' decisionmaking? How do caseworkers' responses to calls resulting from photolistings affect families' decisions to go forward?

Sarah Gerstenzang is Policy Analyst, and Madelyn Freundlich is Director of Policy, for Children's Rights, New York, New York. They invite comments on the issues raised in this article: E-mail sgerstenzang@childrenrights.org. Standards for Internet photolistings are available from AdoptUsKids (www.adoptuskids.org) and the Adoption Exchange Association (www.adoptea.org).

  1. Children's names throughout this article have been changed.
  2. Lisa Albers. (Summer 2001). Medical Matters: PST, RAD, OCD, ADHD…An Alphabet of Childhood Psychiatric Diagnoses. Fostering Families Today 1 (2). Available online at www.adopting.org/fosteringfamilies/medicalmatters.html or www.adoptinfo.net/fft/medicalmatters.htm.

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