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Season 1, Episode 3: Judith Eckerle, MD the Director of the Adoption Medicine Clinic at the University of Minnesota, discusses the adoption of children with disabilities and medical conditions. She outlines trends in adoption, pre-adoption preparation for families, and the evaluation and support of children, highlighting the innovative interdisciplinary team model utilized at the Adoption Medicine Clinic.

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Information mentioned in the interview


Dr. Emily Helder: Welcome, I’m Dr. Emily Helder, and I’m here with Dr. Judith Eckerle. She’s a pediatrician and the Medical Director at the Adoption Medicine Clinic at the University of Minnesota and her academic work focuses on fetal alcohol spectrum disorder, adoption, and foster care.

 She’s also the co-author of a chapter in the Routledge Handbook of Adoption, on adoption with children who have disabilities or who have medical conditions. So let’s begin by having you tell us a bit about the Adoption Medicine Clinic and your role there.

Dr. Judith Eckerle: The Adoption Medicine Clinic was founded in 1986 by my mentor, Dr. Dana Johnson, who is also a part of this chapter. And he founded it because he adopted a little boy from India, and realized that there just wasn’t very much knowledge about adopted children out there in the medical community. So he started doing research and publishing papers and really founded, kind of, the first, and one of the most well known adoption clinics in the country and at the time was seeing internationally adopted children.

When I actually got randomly assigned to Dr. Johnson as a doctor mentor because I wanted to be a doctor when I was 16, and so as fate would have it, he became my mentor, but I didn’t join the clinic until 2007, after talking with him through medical school and residency about doing this as my career.

And at the time international adoptions were on the decline. We still see many internationally adopted children, but we’ve expanded our scope to include, adopted domestic children and children who are in foster care as well. So now we see a range of children who are in out of home placement.

Dr. Emily Helder: Great. Great, and what, when you took on the greater role at the clinic, you know, what drew you to that role? What do you really find rewarding about the work.

Dr. Judith Eckerle: Well, I am internationally adopted, and, Dr. Johnson and I actually didn’t talk about that part of my medical interest at the time, because he’s a neonatologist, a NICU doctor, by training.

And I thought that’s what I wanted to do initially, but when I found out that he had this other passion for internationally adopted kids, it really struck a chord with me because I am internationally adopted from Korea, and I had done, in my twenties and in my teens, a lot of birth-parents searching, and a lot of investigation personally with a lot of other adoptive groups. So it really spoke to me to help other adopted children and families to just become as healthy as they could, and to optimize, you know, the amazing family resources that so many families have when they come together.

Dr. Emily Helder: Yeah, we were so thankful when your team agreed to write the chapter. As you said, your clinic is really internationally recognized both for your clinical work and the research work that your team does. So when we were putting together the handbook, one of the sections that we had in there was diversity and adoption and, diversity defined really broadly. So we were so excited when your team agreed to write that chapter about disability. 

Dr. Judith Eckerle: You’re welcome

Dr. Emily Helder: Yeah, thanks so much. So we can dive into the chapter a bit. So the beginning of the chapter really gives a wonderful framework of the trends in adoption over time, with a special focus on adoption of children with disabilities. So, what do you see as the highlights of that? How do you see, especially in your work over the last 15 years or so, how do you see those trends coming in, in your own practice?

Dr. Judith Eckerle: Yeah, well, I mean, even going back farther when I was adopted, you know, when there was a whole lot of Korean adoptees adopted in the seventies and eighties, and most of us were relatively physically healthy and didn’t have much in terms of background information, or risk factors or things like that.

And same was true, when I started in 2007, we were seeing thousands of kids being adopted from Guatemala, who were relatively healthy, still many from Korea, still many of the healthy female girls from China, you know, so kind of all of the trends from the early 2000s, and most of them were doing pretty well.

In the time, I would say in the first five years, even that I started the trends dramatically changed such that, you know, China basically, almost closed and now is basically close to, you know, the quote unquote healthy or traditional adoptions, that were going on in the early 2000s, and now has completely special needs.

Guatemala closed. Korea is still doing adoptions, but has much more in terms of special needs or focus or risk factors in their background. And because, you know, just numbers wise, the main children that we see coming from abroad, are, you know, from China, just from numbers perspective and now from India as well.

I would say, you know, more than 90% of the kids that we’re reviewing, have some sort of special need or some risk factors in their background. Probably even more actually.

Dr. Emily Helder: Sure, and say a little bit too, about your domestically adopted populations that you see, how do you see those trends changing over time?

Dr. Judith Eckerle: Yeah, well, you know, we had always seen some domestically adopted children in our clinic, but the name of our clinic was the International Adoption Clinic, just because that’s how it started out, and so I think a lot of social workers and families just didn’t know they could come if they had a child from the domestic adoption system, even though they could always, so when I became director, about six years ago, I actually changed the name to the Adoption Medicine Clinic just to have a broader scope.

But what is interesting is kind of the basis of the medicine that we kind of built or Dana Johnson built, understanding children who had come from early adversity from lack of resources, prenatal exposures, you know, all sorts of different risk factors. Broadly applied to the children that we see in the domestic and the foster care system here in the U S as well.

So we were able to really move our knowledge base from serving internationally adopted children to also serving these kids who were in the domestic foster care system who also have, you know, a number of different, special needs, prenatal risk factors, things like that. So very similar populations in terms of what we see in foster care and domestic versus kind of the international adopted population.

Dr. Emily Helder: Yeah, I’m glad you brought up those changes in international adoption. I’ve been in the international adoption field as well, and it’s been dramatic to see the changes even in the last 15 years or so. What do you see as some of the drivers of those changes and what are the implications of that change and who’s coming for children for families?

Dr. Judith Eckerle: Yeah, I mean, there’s good and bad. I think, you know, in, in everything, some of, I think the relatively positive reasons that we’ve seen a decrease in the, you know, “healthy” children, is that there have been increases in most countries of, adopting children within the country.

And that would always be our goal is to maintain a child within their biological family, if possible, and if not, to maintain a child within their home country and culture, if that’s not possible, then for international or other adoption. So it is positive that China loosened their one child policy so that families are able to keep the children that they were having, or they were able to adopt, as an option.

Same thing  with Korea. One of my very dear friends formed a organization to help, it’s called Mission to Promote Adoption in Korea. And it’s become really widespread and well known there, to just spread the word, to decrease the stigma in Korea as well. So I think a lot of countries are doing really good things to help adoption exist within their own countries.

but they’re adopting the healthy children who don’t have as many risk factors, which then means the children who aren’t adopted within their own countries, tend to be available for adoption internationally.

Dr. Emily Helder: Right, right. Yeah. And so I would imagine that there’s quite a bit of work that you do to prepare families as they’re considering adoption, especially adoption of children with disabilities or medical conditions.

Can you talk a little bit about your process at your clinic, and what families can expect, and also, you know, why, why do you see it as so valuable to have that consultation with a medical professional?

Dr. Judith Eckerle: Yeah, so obviously I’m biased, but I think it’s so important that, if it’s not us, that’s fine, but it’s to talk to somebody about the information that you’re presented, you know, there are physicians in the U S that just don’t have as much experience with syndromes or prenatal exposures.

So I’m not just saying doctors internationally, you know, it’s, you know, anyone anywhere can just lack a certain knowledge base or things like that and miss things, but we’ve had referrals from Korea, which has a very developed medical system that just said normal, healthy child on the bottom.

And when we looked, we really, really didn’t agree, you know, it was obvious signs of a syndrome or, there were prenatal risk factors in terms of the amount of alcohol listed, things like that, and I always tell the residents that I teach that I never tell parents to adopt or not to adopt because that’s not my job at all.

My job is just to describe what I’m seeing, what kinds of longterm things that they’ll have to consider and what, what resources they may need to have readily available for that child, so that we can get the best fit for the child and for the parents, because it’s not really finding children for families, it’s really finding a family for a child and a child for a family, you know, both ways, because if they don’t work together, the, the only times that I can recall seeing a family that actually disrupted or wasn’t able to maintain that relationship as parent-child, was when they adopted a child, just thinking love would be enough.

And they really just didn’t know what, what, what was going to be needed. And I think, you know, I’ve seen parents, one of the first referrals I ever did that I was really shocked about: the parents accepted on Christmas Eve. I’ll never forget it. A referral of a child, who had really horrible hydrocephalus.

So the brain was really swollen, and overcome with fluid. And the child was probably not going to walk, was definitely not going to be independent in their lifetime, was nonverbal, but was adorable and smiley and, you know, the staff loved this child and, and the family already had a child who was going to need longterm permanent care.

And they said, “you know, we can handle one more and we’re ready”. And I was just so I was so happy. I’ll never forget it because it was such a perfect match. The parents knew what they were getting into, they were ready. The child was going into a family that was prepared and able to care for and love that child.

And that’s what we want. We want both sides to be prepared and ready to come together.

Dr. Emily Helder: It seems like a really active component in the move towards trying to prevent adoption disruption, adoption dissolution. It seems like a really active part of that puzzle.

Dr. Judith Eckerle: Right. I totally agree, and we actually, not myself, but Dr. Johnson and a lot of my colleagues at the University of Minnesota did a very large study actually of adoptive families and parents about 15 years ago, right before I came. And one of the questions was about pre-adoption consultation and reviewing the information. And it had dramatically increased the parents’ satisfaction in terms of what to expect and how smoothly the transitions had gone. So I do think that it can be a huge component in just preparing the families to welcome that child into their family.

Dr. Emily Helder: Right. And then once they have, you know, your clinic is involved in some of the assessment of children, so what kinds of things are you as, as a pediatrician, adoption medicine specialist, what are you looking for in those assessments and how do you help families have, you know, accurate expectations about, “Hey, this is something that we can just wait and see, this might improve over time” versus, “Hey, this is something we should get some intervention around.”

Dr. Judith Eckerle: Yeah, well, one of the things I’m the most proud of and, Dana Johnson definitely started this tradition, was to bring a team together to assess the child and so from early on, he had either physical therapists or occupational therapists involved and, he was actively involved in psychology and kind of working together. When I became director, I tried to develop that team approach even more.

And then we wrote a grant, to the  state, to expand our services as well, so that we can be a team for every single child. So for every visit, we have a pediatric psychologist, occupational therapist and a medical provider, and a social worker for older children.

We formed alliances with other therapists and social workers in the community. But, having the psychologist perspective, the occupational therapist’s perspective and the medical person all with eyes on the same child, observing how they’re interacting with the parents. You know, I’ve had times where the occupational therapist says it’s not sensory processing and this isn’t a developmental side and our psychologist goes, “Oh no, absolutely this is the attachment, I’ll take it from here.” So we all are, you know, and I’m ruling out the parasites and the vitamin D deficiency and making sure that I don’t think they also have a syndrome that’s genetically based and things like that, so that we can kind of as a team come together and make sure that we’re approaching that child, not just from, “do they have hepatitis B?”

I mean, I can rule that out. And with some experience I can, at least now sense some of the psychology angles, but I’m definitely not, you know, I’m not a pediatric psychologist. So having somebody who’s so trained and so experienced, being able to recognize exactly what you’re saying, is this a normal transition period type bonding, or is this that the child is totally indiscriminate and running around and trying to sit on my lap, who she doesn’t even know, and we really need to move this like next week, not in six months. So having that team approach has been extremely valuable, I think, to make sure that we’re moving that child in the right direction and not overlooking things and not emphasizing too much, like the occupational therapist side of it, if that’s really not what’s going to help them along.

Dr. Emily Helder: Right. Right. It seems like that partnering with the state would be really valuable. I just personally, in my own clinical experience, reimbursement rates are low. And so to keep your doors open based on your funding for, I I’m assuming anyway, for the families that you’re seeing, that that partnership seems valuable.

Dr. Judith Eckerle: Oh, absolutely. Because I went to our department chairman before we got the grant with my big dreams and plans and his question was, well, how are we going to fund this? Because we lose money on every child we see, so it wasn’t a great business plan for me to approach my chairman and say, let’s see double the number of kids and lose double the amount of money.

So partnering with the state who recognized it really immediately. I mean, I really, I’m so grateful and thankful that they did recognize how important this is for foster care and adopted populations. To step forward and say, yes, we want you to see double the amount of kids. In fact, I think they want us to see even more than that over time.

But to pilot this and to show that we can make it work, we can come together as a team and really the amount of money that we’re talking about in the grand scheme of things is not that much, but you know, we also couldn’t do it without the partnership.

Dr. Emily Helder: Yeah. Well, and especially when you factor all the resources of intensive intervention later, adoption disruption.

Dr. Judith Eckerle: Absolutely. Yes, exactly. Yeah.

Dr. Emily Helder: Yeah. are there resources that you often share with parents that you think are particularly helpful in general that you’d like to share?

Dr. Judith Eckerle: Well, when I started at the University of Minnesota, I wanted to start creating resources. So I wrote, a handbook, it’s  online, I call them chapters.

They’re about one to two pages each. So it’s not anything lengthy or extensive, and they’re really aimed towards families and parents. They’re not, you know, medically-based, necessarily. and I kind of went around the country calling on friends and experts in different fields, to partner with me to write things like on clubfoot or, to write a, a section on Down syndrome and what that might look like in terms of health maintenance and what you’re looking at for longterm.

So that’s available on our website, along with  different guidance in terms of infectious disease testing and other labs that we recommend. So we tried to put together a lot of those resources on our website at So you can always check that out. We partner with a lot of fetal alcohol spectrum disorder resources at the University of Washington and Proof Alliance. So, and all of those are, should be linked there as well.

Dr. Emily Helder: Great. Well, thank you so much for taking the time to speak about your work and about the chapter. Again, we were so thankful to include it, so I appreciate your time.

Dr. Judith Eckerle: Well, thank you for having me. I’m really glad to get the word out.

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