Redesigning The Domestic Infant Agency Adoption Process By Changing Book Creation And The Waiting Period
Date: Mar - Dec 2019
Northwestern Thesis Project
Human Centered Design
User Experience Design
Ethical Design Practices
After adoptive parents submit their book* to adoption agencies, they feel cut out of the process of finding a child, where it is difficult to get feedback as to how they're doing and they feel powerless to do anything to help.
*a book is a compilation of photos, personal stories, and recommendation letters that adoptive parents create to give birth mothers a sense of what they're like as a couple and convince the birth mother that they are the right couple to raise her child.
Nancy + Jackson's Story
The adoption process is always as different and unique as there are children, with no two adoptions being the same. However, there are a couple common emotions that come up. For those who aren't familiar with the process, I've included Nancy and Jackson's story here based on the story of one of the couples along with a few adjustments to highlight some of the common experiences of other couples.
When Nancy and Jackson got married, they both knew that starting a family was going to be huge part of their life and they couldn't wait to get started.
However, despite their best efforts trying fertility tricks they found online and using ovulation tracking apps, after a year and a half they found they still couldn't get pregnant. In general, if a couple isn't able to conceive within 6 months of trying they are recommended to consult a specialist. However, Nancy and Jackson were scared so they waited longer than the recommended amount of time.
Nancy and Jackson really wanted to have their own biological child, so they first turned to In Vitro Fertilization. Each round of this cost them $12,000 and over the course of 6 months they did 3 rounds of IVF. This is when the process turned from something fun into something clinical. Nancy had to take regular injections, get tons of doctors appointments to track the cycle and get implanted with the eggs. However after the third try, the doctor told them that they needed to give up. Nancy and Jackson would never be able to conceive a baby.
So instead, they turned to the adoption process. They hit the books to figure out what path would be right for them. Their first thought is that there are so many children that need homes and they could easily be that home for a child. However, that doesn't turn out to be true. For every child put up for adoption in the United States, there are 36 parents waiting for that child. This number isn't true for foster children or adopting an older child, but Nancy and Jackson want to raise an infant. The industry is highly COMPETITIVE. And for international adoption, the prospects aren't much better. International adoption has dropped 72% between 2005 and 2015 in large part because countries use adoptions as a pawn in trade agreements to put pressure on other countries. The chances are looking slimmer and slimmer for Nancy and Jackson. By the time they finally decided to sign up with an adoption agency, they are already feeling POWERLESS. Starting a family has almost entirely been taken out of their control. This feeling only continues to get worse over time.
Nancy and Jackson choose a domestic infant adoption agency, thinking this will be their best shot. One of the couples I interviewed chose surrogacy instead because of the low chances of being matched with a baby. Coming to this decision was one of the hardest conversations they had to make as a couple.
Nancy and Jackson then started filling out the paperwork and paying the bills. Their particular adoption cost $40,000. The cost of adoption ranges from $18,000 to $50,000 depending on the amount of the process you do yourself (such as personal advertising, creating legal documentation, etc.). On top of that, some couples hire professional photographers and writers to ghostwrite their books in an attempt to get themselves to look better to birth parents. All of the cost of adoption make it EXPENSIVE in a way that makes it very inequitable. (It was brought up in the design process that raising a child is an expensive endeavor and that the cost of adoption might act as a filtering mechanism or create a barrier to entry to potential parents. Keeping it expensive would decrease the overall competition especially with the 1:36 ratio of babies to parents. I disagree with this and fought to keep equality as a design principle because a person's income doesn't dictate the quality of a home for a child and a person's income shouldn't dictate someone's ability to have a family.)
One of the most intense forms Nancy and Jackson have to fill out is their list of preferences. Here, parents list what kind of child they would feel comfortable raising. This form covers basically everything, including race, ability, and even cause of conception. These conversations tend to be the most intense for couples, making them find a lot of clarity in what they want. For each item on the list, parents can also mark them as an unsure, postponing when the conversation needs to happen. However this can cause a lot of stress later on during the waiting period.
Nancy and Jackson then need to be approved as capable parents by a psychologist. It is important for the agency to ensure children are going to good parents, but it also can take a large toll on the couple. The entire process of finding a baby by this point can feel very CLINICAL with doctors visits and forms, where they once again have little power.
As a part of ensuring the future child's safety and Nancy and Jackson's capability of being parents, the social worker conducts home visit. The social worker schedules times for the fire department and sanitation to check the house itself every 6 months. They also conduct surprise visits in order to get a sense of how the family's regular life is. This leaves them feeling highly EXPOSED. Nancy and Jackson had their first three visits, but then their social worker told them rather than constantly have home visits, they could wait to schedule one till they were closer to finding a child.
While all of that is happening they begin creating their book. They figure out how to talk about themselves, and what to share with a birth mother. Some of it is easy to collect, but other information is extremely difficult, like what kind of parenting style they have, or even just talking about themselves. Finding a balance between sharing about yourself without seeming braggy or desperate can be very difficult. Once completed, they then submit it the the social worker to publish it. In general there are two ways it gets published: a) as a physical book that stays in the agency and shown to the birth mothers, or b) online, exposing all of the couple’s information to the world. Nancy and Jackson aren’t part of the decision on how the book is published. Once it's published, they sit back and wait.
The wait can last anywhere from 2-7 years. One of the people I interviewed waited for 7 years, getting almost no feedback on on how she was doing until her social worker told her it was time to give up. After the 7 year wait, she felt like it was too late to attempt to start a family. There is nothing that can be done during this period on the adoptive parent's side and they are UNIFORMED as to their progress and if they could be pursuing other options. One of the only forms of contact that Nancy and Jackson get is when the agency has an infant that fits a preference marked as a maybe. The agency typically calls and says that they need an answer in 24 hours. This causes extreme amounts of stress without any information about whether or not this will be their only shot at having a kid.
After two and a half years, they were finally paired with a child and now have two healthy young boys. Even with the positive outcome, the process still has a lot of areas for improvement.
Looking at the journey as a whole, we can see the excitement for starting a family here in blue, and the stress of not having a family in red from start to finish.
As you can see, the stress continually increases overtime while the excitement is constantly dragged down from the start. Looking at this, I understood that I would not be able to completely solve all of the emotional issues that go into adopting but I could have a significant impact on the WAITING PROCESS, so I focused in on specifically book creation and what could be changed around that.
From Nancy and Jackson's story, we can see 6 key problems which I converted into design principles reffered back to them with each decision I made in the process.
To bring these 6 elements to the adoption process, I could make the biggest impact by changing the way the book is formatted and how it is interacted with over time. However, in order to design something for the adoption process, I had to understand what the process looked like for both the social worker and the birth parent.
The Social Worker's Journey
In yellow above you can see some of the key touch points in the social workers process. After they talk with the adoptive parents, their journey is main characterized by organization. They have to collect the different files (mostly done in physical versions), coordinate the psychologists and the fire department for the different things the adoptive parents have to do while signing up. Finally they collect and edit the final copy of the book that adoptive parents submit.
Then, they switch into outreach mode, trying to find birth parents through advertising, planned parenthood, hospitals, their agency website etc. until they find a person looking to give up their child.
They then have a conversation with the birth parent, verify that they are in fact pregnant and the health of the child. Once that is checked, they give the birth mother access to the books that fit with her baby and wait for her to make a decision. The social worker finally starts contact between the birth and adoptive parents, and act as an intermediary until the child is born.
On average social workers handle 20 cases at a time, but it can range up to 50. Across the case load, the social worker is working simultaneously with adoptive parents, searching for birth mothers and as an intermediary once a match has been found.
The Birth Parent's Journey
In red, we can now see the birth parent's Journey. After finding out she is pregnant, the birth mother dives into research of potential options. She ends up contacting an agency who gets her started on prenatal medicine, as well as getting tests done to ensure the health of the baby. She then gets access to people's books and reads through them, often times having in-depth discussions with her care network as to who the right parents might be. Finally she tells the agency a family she likes and gets connected with them.
After understanding what the process look like for all three stakeholders, I was able start designing a tool for adoptive parents during the waiting process
A tool for book creation and updating that allows adoptive parents to stay in the loop through the adoption process, with actionable tasks moving them closer towards starting a family.
Bookcase is a 3 step tool, that encompasses the 6 design principles of being friendly, empowering, fair, warm, secure, and informed.
The first element of Bookcase focuses on the creation of the book in the adoption process. In order to change the waiting period, we have to also change the information that is being shared and present it in a way that is easily understood and created.
The second element focuses on how birth mother's will use the book and how to encourage them to interact with it. By promoting and allowing for organized decision making, we can help the birth parents make decisions they feel good about and collect feedback for the adoptive parents.
The final element of the book is the feedback system, giving data to the social worker who can then share specific and actionable insights with the adoptive parents every month, keeping the birth parents involved and making the waiting process active instead of passive.
This service blueprint breaks down the information being transferred between what stake holders when with Bookcase.
In order to create the book, I had to figure out what information to share. The information that goes into the book can be completely different from agency to agency and state to state depending on agency rules and state laws. The overarching rules are that it needs to communicate who someone is and that it should prevent stalking (avoiding specific towns, colleges, last names, etc.
First is the main profile image. This should be something fun and I made it gifable because a splash of movement draws the eye.
Next is the love story because the birth parent wants to know their kid is going to a happy home. Making it a video helps get the couples personality.
The letter to the birthmother is one of the most important things as it directly addresses the birth mother and is intended to discuss why the couple wants to be parents.
Hobbies and Interests are important because some books say the decision is entirely made on a small detail like enjoying the same movie or having had the same childhood dog.
A lot of times people find it hard to talk about themselves and why they are great, so I have couples record themselves talking about each other and why they like the other person. This has been shown to feel more genuine and leaves a better impression on viewers. Their basic personal information is also important to getting a sense of a couple.
Recommendation letters show what other people feel about an adoptive parent. Social workers suggest having people of the races from which you are willing to adopt from write these letters to show that the child will have people in their lives like themselves. Asking for a rec letter based on a person's background can feel disingenuous for parents so there is an important balance to be struck with asking real friends and showing diversity.
A good understanding of the family dynamic is important for the birthmother because the relationship to the family shows what kind of family the child will have. Emphasizing the time spent with family can also feel forced for some couples who live far away, but there is a pressure to seem like the perfect family.
While it's important for the birthmother to see how her child would be raised, this part is really difficult for couples who haven't had a child yet. Already having a child actually increases the chances of being chosen as adoptive parents, but it will be important to give resources to new parents when it comes to this.
This section is still very new and not always requested by, but it is highly valued by the birth mother. Adoptive parents for home visits with a social worker need to have a kids room planned in their home. This can often times sit empty for years which adds a a physical reminder of their inability to have a child.
Finally sharing their lifestyle is very important to the adoptive parents. It feels personable and easy to share.
Here is the interactive prototype of book creation. The creation page breaks down the different information letting you know how far a user has gotten in a section and the difficulty of creating that content based on how other adoptive parents have felt. There is also a break down of information shared to the public (love story, letter to the birth mother, hobbies + interests, about the individual parents, and generalized location) and shared to only people who have registered with the agency (recommendation letters, what their family is like, parenting style, a home tour, and a description of their lifestyle). Finally there is information that is only shared when the birth mother is down to 2 or 3 options and is trying to make the final decision.
The information is broken down by what information people felt most comfortable sharing balanced the information people felt was most important to making the decision. Because it was difficult to talk to a lot of birth parents about their experiences I had to do a lot of secondary research around their experiences, talking to surrogate parents, job recruiters, and college admissions officers to get a sense of how they judged different profiles and made decisions on who they liked best. In the end what I found was that the small personable details and the basics about the parents were the most important when considering while recommendation letters were hardest to share.
By only sharing certain amounts of information, we are able to make the book feel more secure.
The new format of the book also includes a lot of video content. Not only does this help communicate more of the couple's personality, but the video editor built in helps people create content easily and quickly. While some people might still have their own higher end cameras and what not, by providing editing tools, like a teleprompter with the script you've written as you record, makes the process overall more equitable and fair.
Lastly, because the book gets published digitally, the adoptive parents have the ability to update it as their lives change. Because the wait time can be so long, this digital format is designed specifically to empower adoptive parents to make regular updates with feedback over time from the social worker about overall performance.
The birth mother's first interaction with the book is when she arrives at the agency's website for the first time. There she has the ability to browse through the different families, but only see publically available information. The limited functionality of reading and watching the videos allows a birth parent to get a sense of a couple and potentially reach out to the agency if she likes the couple.
Once registered with the agency, the birth mother gets a handful of additional registration codes to share with her support circle, like the birth father or her own parents. She can get their feedback on potential parents.
First they can click anywhere on a profile to drop a heart for someone they like. These hearts are then recorded and can be returned to in the decision making process as well as help organize profiles in a favorites list in the birth parent's profile.
Any registered browser has the ability to comment on any aspect of the profile to return to later, to facilitate the discussion with anyone else involved in the decision making process, or even bring with them to the first meeting with the adoptive parents to help make a decision.
The registered user can favorite a book. This puts it in a stack of other favorited books in the discussion page. There is also an option to mark as not interested to gray them out in the future searches.
Then with all of this information, the registered user can go to their profile and see all of the actions taken by themselves and any other registered user.
The purpose of all the work till this point has been to get and collect feedback. The book creation and understanding what information should be presented all informed what kind of actions the birth parents could take when looking at the books. Those actions then dictated the kinds of anonymized data we could collect on how content is being received.
The data collected includes mouse position, and heat maps over a section of the page, the number of people that left a page on a particular section, and more. All these different kinds of data goes only to the social worker, who is then able to do the comparison with how well other parents are performing. This way we keep the adoptive parents out of the direct competition feeling while still being able get feedback. The social worker takes this data and decides whether feedback fits into 1 of 3 categories: a quick fix, a longer conversation, or not useful information.
Continuing with Nancy and Jackson as an example, at just over 2 years in, they reupload their love story as now they've adopted a dog and it's a big part of their life they want to share. Overall the video is doing better than the previous one, but the software highlights a section where there is a surprising large drop off in viewers on the video. The social worker is then able to quickly scroll through the video and find that there is a loud audio error at the highlighted moment. They shoot a quick email to Nancy and Jackson, and the issue is quickly corrected.
When feedback is a simple action, it can be sent over email to the adoptive parents with feedback that they are doing well as well and this new edit is performing better than the last one. Positive feedback is key in keeping morale up and helping people understand and accept the negative feedback.
When looking at Nancy and Jackson's individual profile performance over time, the social worker notices something odd. Jackson's profile image (which highlights his career) as well as his career is getting a significantly below average number of likes with registered users. The social worker realizes this Jackson being a firefighter and constantly putting is life in danger is decreasing his likelihood of being chosen. The social worker then has 3 options depending on how well they are performing despite that.
First, they can get Jackson to decrease the amount it's talked about in his profile, making it less prominent. Option two, they can add in a section addressing any concerns about his career. Finally if this is turning away a lot of people and making them not be chosen a lot, the social worker can suggest potentially even changing his career.
When looking at the performance of Nancy and Jackson's family tree, two family members have a lot of people leaving the book after seeing their profiles. Jackson has two fathers, and unfortunately because many of the people who give up children for adoption are religious, having gay family members causes them to leave. Things like homophobia and racism are things that the data could show, but after talking with parents, they only wanted to know what was actionable. The social worker then wouldn't share this information with the
adoptive parents because it couldn't help them in the process. Hearing this would only cause unnecessary stress and arguing for them, so it remains unspoken.
Now with all this information, the adoptive parents can stay involved and active in the process. The social worker would give them feedback once a month on how they're doing with at least one thing they can do. If there aren't any changes to be made, they can send them discussion questions based on types of child they marked as a maybe or ways they might start thinking about updating their book.
This repeated cycle of input and feedback can increase the excitement of having a child while also decreasing the stress about not having a family.
Realistically I believe that these spikes of stress where agencies call looking to see if a parent is willing to accept a child in their maybe category can be decreased with an understanding of how they are performing. The overall stress decreases because they are informed about the process. The excitement also regularly increases whenever there is a task to do to improve book performance.
I believe this solution would work well as a licensed software sold to different agencies. While it would take some convincing to aggregate the data across agencies, we could finally get a look into how the decisions are being made around the world. The process is currently completely black boxed and any information would be extremely helpful to agencies in the future.