Referrals

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How Do Referrals Happen?

As children become available for adoption in a foreign country, they are matched with prospective parents who can best meet the needs of a particular child. The more flexible you are in terms of the child’s nationality, age, and medical status, the faster you can be matched with a child. (Note: Some countries, more notably Ukraine and Kazakhstan, do not allow pre-identification of children. Adopting parents meet the referred child only during their visit to the country. For more information on individual country programs, see our Country Programs information.)

Getting “The Call”

When you have been matched with a child, your adoption agency will call your social worker, and your social worker will call you. Usually you don’t get much information over the phone, just the basics like the age and sex of the child and any special needs the child may have. Your social worker will want to meet with you as quickly as possible to go over the child’s file.

The referral file usually contains photographs of the child, a medical report, and the child’s social history. Depending on the country, you may have more (or less) information about the child. Some countries include videotapes of the child and the medical history of the child’s birthparents, while others offer very little about the medical or developmental history of the child. Based on the research you conducted prior to choosing a country, you should know the type of information to expect in the referral file.


Some agencies (and social workers) make a point of withholding the photos until you accept the referral – they don’t want you to make a quick emotional decision based on how cute the child looks. Other agencies and social workers let you see all the photos beforehand. Although it is extremely tempting, try not to make an instant decision about accepting the referral. It’s a good idea to take the file home with you so you can read – and read and read again – everything. Most agencies ask that you take at least 24 hours (and no more than a week) to make a decision on the referral.

Getting the Facts

When a child is offered for placement, make sure you have all available information – especially information concerning the child’s health and orphan status. If you have any questions, get the answers before you accept the referral. If your agency can’t (or won’t) provide a translation of the referral or medical documents, don’t give up! Call a local college or university – chances are they have students who speak and read the language. You may be able to find a student who will be happy to earn a little extra money in exchange for translating the documents for you.

Don’t put yourself in the situation of having already fallen in love with a child only to learn the USCIS will not classify the child as an orphan – and therefore you can’t bring the child into the country. International adoption is stressful enough without piling on this kind of grief!

If you have any doubts about the child’s orphan status or medical condition, by all means request more information. You have the right to see all available information about the child – don’t allow yourself to be pressured into committing to a placement if you do not feel you have sufficient information or if you feel you have been rushed into making the decision.

There are many experienced physicians in the United States who evaluate medical records for children born abroad, including children cared for in orphanages. This additional review by an American physician may help you make a better informed decision about whether to accept the referral. U.S. physicians who specialize in evaluating medical records and videotapes of international adoptees usually provide their services very quickly after receiving the medical information.

In some countries, you can ask that the child be examined by a “panel physician”— a physician used by the U.S. embassy or consulate for the required immigrant visa medical examinations. This examination will only ensure that the child is free of diseases or signs of serious retardation. If any significant illness or disability is discovered, you will be provided with information on the condition.

Despite precautions, certain conditions, such as any learning disabilities and the delayed effects of early neglect or prenatal substance abuse, can only be identified over time. This is a particular concern for those adopting an infant or very young child. For those adopting an older child, a psychiatric evaluation may help to identify serious emotional or mental problems.

In some adoption programs, you are responsible for the cost of the child’s medical expenses and care in a foreign foster home or orphanage once you accept the referral. To assure yourself that the child is receiving the benefit of the funds you provide, ask your adoption agency to provide you with an itemized list of foster care or orphanage expenses and proof that the funds you sent are actually being used by the orphanage or foster family caring for the child.

How Do You Decide?

Although most developing countries do have child welfare systems, many still struggle to provide a minimum standard of care for dependent children. Children who spend formative early periods (or many years) in large orphanages with few caretakers will usually show the effects of institutionalization and lack of stimulation. In institutions such as orphanages, it is the strong children who survive. Many children exhibit remarkable recovery from developmental delays after they have received proper nutrition and medical care and are in a loving, attentive family setting. In contrast, other children show long-term delays and will require therapy to help correct the damaging effects of spending lots of time in an orphanage. Loving care notwithstanding, some children who have suffered prolonged neglect or abuse in orphanages may require expert help over long periods of time.

To make the best choice about a child referral, you must educate yourself about the potential impact on children of the physical and emotional conditions they encountered in their young lives. All are factors that can affect a child’s physical, developmental, and emotional growth. Here are some tips for understanding the medical reports:
  1. Gather all the facts. Get as much information as possible about the pregnancy and delivery, premature birth, growth measurements, specific illnesses and diagnoses, specific physical findings, lab results, other testing, and developmental milestones
  2. Weigh These Facts. Determine what information is (and isn’t) trustworthy.
  3. Get a Professional Opinion. Find out what the medical jargon in the reports actually means in terms of day-to-day life.
  4. Get More Info. You’re entitled to ask your agency for more information.
  5. Know Yourself. Know what your family can (and can’t) handle – be realistic.

Learn about the resources that are available to you in your community in case the child you adopt needs professional help to address – and hopefully make up for – early delays. Talk to other families who have adopted from international orphanages or the same orphanage to see how their children are doing. In the end, trust your gut instinct. If you have any qualms at all about a particular referral, turn it down. You won’t be a bad person for doing so, and you won’t have to go back to the end of the list to wait for another referral. In fact, you will be doing the right thing for the child because there will be someone else out there who is ready and willing to parent this particular child. (Of course, turning down multiple referrals for trivial reasons can spell trouble for your adoption journey.)

Additional Resources:

Credits: Excerpted from "International Adoption Guidebook," Mary M. Strickert, 2004

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