Book Discussion Guide for anyone who works with RAD kids and their families

This book discussion guide for, But, He Spit in my Coffee: A reads-like-fiction memoir about adopting a child with Reactive Attachment Disorder (RAD), is intended for readers who are service providers (case workers, social workers, educators, therapists, pediatricians, etc), policy makers, and advocates. It is for anyone who works with RAD kids and their families.

As you read my memoir, it is easy to focus on my failings and shortcomings as a mother. I own that. But I encourage you to look at the bigger picture. Investigations like USA Today’s Broken Adoptions (2022) reveal that tens of thousands of adoptions are disrupted or fail because families like mine are unable to get effective treatment for their adopted child’s complex needs. The experiences we had within the child welfare and mental health systems are representative of a broken system documented in reports from the New York Times (2022) and USA Today (2021). And, in the post Roe-v-Wade era, even more children are expected to go through the foster care adoption system, making addressing these issues imperative.

This is why I hope you’ll use my memoir as an opportunity to peek behind the curtains into a family in crisis and consider how services can be tailored to better help families. I hope you’ll use it to go behind closed doors of treatment centers and therapist offices to identify dysfunctions and redesign solutions for better outcomes. I hope you’ll ask yourself:

  1. What supports and resources could have made a difference for this family and for others like them?
  2. How can the system be reoriented around the needs of families like these and refactored for better outcomes?

I hope the discussion questions below will be a useful tool in answering these questions. Please contact me if you would like me to participate in a discussion with your group or organization. My son Devon (who is now a young adult) and his birth mother are also willing to participate and provide their perspectives.

Many states have foster parent associations that I would hope would jump at the chance to promote this book to better support their foster, kinship and adoptive families.”
Irene Clements, Advisory Board Member for the National Childhood Traumatic Stress Network

Matching Kids to Families

  1. How did the case worker’s presentation of Devon and Kayla to Keri set her expectations for the adoption? How did it impact her ability to reach out for help going forward? How did it affect her view of herself when she began to encounter challenges? How can we improve outcomes by setting better expectations with adoptive families?
  2. Devon and Kayla were matched to the family based on being a biracial fit and the desire to keep the sibling group together. How was this matching appropriate/not appropriate? Are there ways to be better identify family strengths and children’s needs and match them?
  3. In the case of Devon and Kayla, as well as the family’s previous failed adoption attempt with Eli, information was inadvertently and/or deliberately withheld from the adoptive family about the children’s backgrounds and needs. How did this figure into the outcome? Are there incentives built into the system that result in adoptive parents not being given complete and objective information about the children they are adopting? How can outcomes be improved by presenting information differently to families?
  4. What are the opportunities to improve the family orientation period?

Pre-adoption Training & Preparation

  1. How was the training Keri and Delano received typical or not typical for pre-adoptive/foster parents? What training could have made a difference for the family? How can pre-adoptive training be more reflective of the realities (disorders, behaviors, etc) adoptive parents may face?
  2. What was Keri’s understanding about early childhood trauma, Reactive Attachment Disorder, and therapeutic parenting when she adopted? What additional information pre-adoption could have made a difference for the family? How can families be better prepared for trauma needs and potential extreme behaviors with actionable strategies and tools?
  3. What was Keri’s knowledge about how when and how to reach out for help? If Keri had a better understanding of when and how to reach out for help how could that have helped the family? How can we equip parents to seek help early to prevent the family moving into crisis? How can we make sure parents know when and where to go for help?

School and Educational Interventions

  1. Why were Kayla’s IEP interventions more successful than Devon’s IEP interventions? Why was Devon able to triangulate between his mom and teachers so easily? How can educators gain competency on Reactive Attachment Disorder and adoption?
  2. How well equipped were Devon’s teachers to handle his behaviors (ranging from subtle manipulation to violent outbursts)? What strategies can teachers effectively use in the classroom with children who have RAD?
  3. How did the interactions between Devon’s mom and his teacher go? When Keri was able to work with Devon’s 1st grade teacher to get him under control, what worked and why? How can teachers, parents, and 504/IEP teams have better communication where parents feel less targeted and defensive?


  1. How was Devon’s quality of care impacted by the fact that he was seeing Medicaid providers? How was Medicaid important to Devon’s care? What can be done to insure that the most vulnerable kids have access to the highest quality doctors? How can parity between Medicaid and private providers be achieved?
  2. How did the Medicaid process and requirements impact Devon’s ability to get effective treatment? What policies in Medicaid are preventing kids from getting the right treatment? What opportunities are there for improvement?
  3. Are there financial incentives within the system that can be changed to achieve better outcomes? What processes look good on paper but didn’t work in practice for this family? What can be done to make them better?

Residential Treatment (RTF)

  1. What worked for Devon at Residential Treatment and why? What didn’t work and why? Which problems were due to structural issues and which were due to staff approaches? How did RTF exacerbate Devon’s condition? Are there quick fix opportunities to improve the situation?
  2. Should the family have sent Devon to RTF sooner or waited longer? How could this timing have made a difference for the family?
  3. How did RTF thwart or support reunification? What opportunities are there to change the structure of RTF to promote reunification?
  4. How did the RTFs perceive the family, specifically mom and the child? What were they correct about? What were they incorrect about? How could they have changed their approach to have better understood and addressed the full situation? Were there better ways to deal with Devon? Were there better ways to deal with parents presnting likelike Keri?

Child Protective Services

  1. What underlying and structural factors lead to Devon getting assaulted by a staff member? What preventative solutions can be put into place?
  2. What underlying and structural factors lead to Devon continually making false allegations? What preventative solutions can be put into place?
  3. How Keri’s fears justified or not justified about the risk of false allegations against her? What solutions can be implemented to ensure safety for everyone and promote reunification in these situations?

Post Adoption Support

  1. What post adoption support did Keri receive? What may have been available to her that she didn’t know about and/or take advantage of? How can we insure families are aware of available resources?
  2. What post adoption support would have been helpful to Keri in the first year to help the family get off to a good start? How can we make these types of supports available, accessible, and affordable?
  3. What post adoption support would have been helpful to Keri when the family was in crisis? How can we make these types of supports available, accessible, and affordable?
  4. What, if any, post adoption supports that could have prevented the situation? How can we make these types of supports available, accessible, and affordable?

Working with Parents

  1. What mental health, physical, and other needs was Keri experiencing when the family was in crisis? What early signs were there that Keri was developing PTSD and other needs? What interventions could have helped Keri?
  2. How and why did therapists misunderstand Keri? What clues or signs did therapists miss that could have allowed them to understand that there was more to the story? What tools could the therapists have tried in working with Keri?
  3. What parenting techniques and tools did the therapists offer to Keri? Why did she reject them? Were there ways they could have been presented more favorably? What are other techniques and tools that would have been perhaps more helpful and appropriate?
  4. What did Keri misunderstand about trauma, therapeutic parenting, diagnoses, medication, RTF, etc. How could the people she worked with have communicated better? Were there times therapists could have built brideges and didn’t? How could this have changed the outcome for Devon and the family?

Open Adoption

  1. Why did Sarrah lose her children? Was there an opportunity missed to keep Devon and Kayla with Sarrah? How might their early childhood and outcomes have been different if they had remained with their birth mother instead of going into foster care and being adopted? What are the potential risks and rewards on balance with the inherent trauma that comes with foster care and adoption trauma?
  2. Are there misguided incentives to place children in adoptive homes instead of keeping them with their birth families or reunifying them? Are there misperceptions that unfairly vilify some birth parents and/or view poverty and lack of resources as neglect? Are there opportunities to redirect resources that go to foster and adoptive families to support struggling birth mothers like Sarrah?
  3. How was it positive for Devon and Kayla to have a relationship with Sarrah? How was it negative? How can adoptive parents assess the risk -benefits of these relationships? How can service providers appropriately support open adoption? How are we insuring that adoptive parents are given the information necessary to support open adoption where appropriate?

Families in Crisis

  1. What did the family “look like” when it was in crisis? What were their greatest needs? Are the family’s felt needs the needs the system has identified and is meeting?
  2. How did the family get to the point of crisis? How long did it take? Did they try to get help along the way and why didn’t that work? What infection points along the way were places where this trajectory could have been changed with education, support, or services?
  3. What emotions characterized mom (Keri) once the family was in crisis? Did she seem willing to cooperate and work with the team? Was she actually willing to cooperate and work with the team? How might the outcome for the family have been different if therapists and others had looked beyond how Keri presented (as an angry mom who was the problem) and asked how the the family got to this place without assuming it was a parenting problem?
  4. How did the therapists perceive Devon? What was accurate and what was not? How might the outcome have been different if therapists had objectively consider the situation instead of assuming Devon was being entirely truthful and not manipulative?

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