NTI Changes Practice: Equipping Clinicians to Listen when Grief Shows Up

Written by LaShawnda Kilgore, Ph.D.

Published on: May 15, 2026

Category Mental Health

NTI Practice Change #1: Loss and Grief
Foster, kinship care, and adoption begin separation, and separation inevitably brings loss.

NTI is Practice Changing - Loss and Grief

Children and youth navigate separation from their families of origin

Loss is at the heart of every adoption, foster care, and kinship placement. It can be easy to focus primarily on the child’s experience, yet loss touches everyone connected to the adoption story. Children and youth navigate separation from their families of origin. Birth parents, adoptive parents, and kinship caregivers often carry profound grief that goes unrecognized or unspoken. Foster, kinship care, and adoption begin separation, and separation inevitably brings loss.

As we honor Foster Care Awareness Month and Mental Health Awareness Month, we are reminded that supporting well-being means more than providing services or celebrating permanency outcomes. It also means listening when grief shows up, acknowledging the losses that may still exist, and creating spaces where children, youth, families, and caregivers can feel connected, seen, and supported.

When clinicians are not trained to recognize this foundational reality, grief is frequently misunderstood. It may be mislabeled as behavioral problems, resistance, or noncompliance. What looks like defiance may actually be sorrow. What appears to be withdrawal may be unresolved grief. Adoption-competent training shifts this lens, helping professionals see what is truly beneath the surface.

Recognizing Grief as Foundational

Forms of grief shape identity development, attachment, behavior, and family relationships over time. Effective adoption-competent training prepares clinicians to understand that ambiguous loss and disenfranchised grief are not peripheral concerns in foster care, kinship care, or adoption; they are central.

Children and youth have a right to know what has happened to them. They deserve developmentally appropriate information about why they were not raised in their family of origin. Whether placed at birth or during adolescence, young people experience complex and layered losses. These losses often resurface across developmental stages during milestones, transitions, and moments of identity formation. Rather than reacting to these waves of grief as crises, trained clinicians learn to anticipate and normalize them.

Ambiguous loss is particularly powerful in adoption contexts

Ambiguous loss can leave youth suspended between hope and despair. A birth parent may be physically absent yet psychologically present in a child’s daily thoughts. Sometimes there may be no rituals, no clear endings, only ongoing uncertainty. Adoptees may grieve identity, origins, culture, and biological continuity. Adoptive parents may grieve infertility, pregnancy losses, or the child they once imagined. Kinship caregivers may hold both love and sorrow as family roles shift in unexpected ways.

NTI Training equips clinicians to recognize how ambiguous loss presents in families. It helps them distinguish grief from “behavior problems” and support families in holding both/and realities: love and loss, gratitude and grief, connection and longing.

Disenfranchised grief adds another layer of complexity

Disenfranchised grief is the type of grief that is not socially acknowledged or validated. Youth may be told they are “lucky” or “chosen,” leaving little room to express sadness. Birth parents may feel pressure to remain silent about their loss. Adoptive parents may experience sorrow yet believe they are not permitted to voice it. When grief is minimized or denied, it does not disappear. Instead, it can resurface as anger, anxiety, withdrawal, or relational strain. Clinicians trained in NTI learn to validate these complex emotions without pathologizing them. They create space for families to speak the unspeakable and feel what has often gone unrecognized.

From Awareness to Practice

NTI moves beyond theory. It provides clinicians with practical tools to:

Assess grief in foster, adoptive, and kinship families
Facilitate developmentally appropriate life story work
Prepare families for recurring grief across milestones
Support parents in responding to grief without defensiveness
Use structured activities to explore loss safely

This shift in practice is significant. Instead of asking, “How do we stop this behavior?” clinicians begin asking, “What loss might be speaking?” They invite honest conversations about identity, origin, belonging, and connection. Grief is no longer treated as a complication of adoption. It is understood as part of the adoption story itself.

Loss may be at the heart of every adoption. Adoption-competent training ensures that clinicians are prepared to meet that loss with skill, presence, and compassion, supporting healing that honors the full complexity of lived experience.

Feedback assures us that “NTI advances practice for permanency and well-being!”

NTI training provides professionals with strategies, techniques, and tools to advance their practice. Did you know that more than 31,000 participants have enrolled in NTI Training? We know it equips professionals to have difficult conversations with children and youth. The NTI training encourages and supports them to acknowledge and explore losses and grief, help youth understand their own story, and work through their feelings and thoughts. NTI also provides the techniques and tools to help parents and caregivers build the skills they need to support their children! Join the movement to impact children and families across the nation, and help make system change happen!

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