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Karen,
Good question. Personally, I don't know how much responsibility lies with the agencies. To me, they play the role of bringing the families together, and are responsible for working within the confines of the wishes of the family based on the known information about the children. (In other words, don't refer a child with a condition to an adoptive family that they specifically stated that they did not want to deal with.)
First and foremost, I think it is up to each adoptive family to do their research and know what risk they are facing and be ready to deal with the worst but hope for the best. Bringing children into a family has risks no matter how it is accomplished: whether it is international adoption, domestic adoption, foster care, or by birth. Whatever situation a family finds itself in, to me, the onus is on them to research, study, read, and learn all they can about what they could potentially face.
A pregnant woman more than likely reads the 'what to expect' and the week-by-week pregnancy books so they know what to expect during and after their pregnancy. Why would an adoptive family expect that they could 'skip' this part of their research. They may not need to know about things going on within their body, but they should certainly understand about the process of adoption, and what to expect once they bring their child home based on the circumstances and background of that child.
I also think a responsibility lies with the social worker that is providing the home study. My social worker asked many questions to determine if I knew what the risks were for children adopted from Russia. She had a list of recommended reading. I think that if she thought I was clueless, she might have pressed the point with me a little more before giving me a positive homestudy. I think the homestudy should mean something more than just another document in the paper chase. To me, this is where the counseling belongs to ensure that the adoptive family is truly prepared for best and worst case scenarios.
And finally, I received a lot of paperwork and discussion from my international adoption doctor. Literally, she gave me a stack of papers that was 2 inches thick with all kinds of things to research and study about potential risks of internationally adopted children. This dealt with everything from physical ailments to developmental delays, to full-blown RAD.
Because of these boards, my own research, and the information I received from my IA doctor and social worker, I feel I was prepared. This allowed me to be alert to any warning signs and to know of things that were important to the way that I parented my son because of his background. Fortunately, I did not (so far, knock on wood) have any issues.
So, long story short, I personally don't believe it is the responsiblity of the agencies to prepare the parents. Bottom line, I think the foremost responsibility is on the parents and then the social worker that completes the homestudy.
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