Appendix 7260 FosterAdoptive Home Study GuidelinesWord格式.docx

Appendix 7260 FosterAdoptive Home Study GuidelinesWord格式.docx

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CITY:

COUNTY:

STATE:

ZIP:

PHONE:

ADDITIONALPHONE:

HeadsofHousehold

NAME:

AGE:

DATEOFBIRTH:

SEX:

ETHNICITY:

LANGUAGESSPOKEN:

EDUCATION:

OCCUPATION:

MARITALSTATUS:

DATEMARRIED（ifmarried）

HOMEANNUALINCOME:

OtherHouseholdMembers

DATEOFBIRTH

ROLEINHOME:

（Note:

Iftherearemorethantwo“OtherHouseholdMembers,”thenrepeatthe“Name”through“RoleinHome”sequence.）

InitialInquiryDate:

Pre-ServiceTrainingandConsultations

AttendedPre-ServiceTrainingFrom:

To

DatesofConsultations

Locations

WithWhom

________________________

________________

_________________

Note:

Thetopicaboveaddressesthefollowingminimumstandards:

Interviewsforafosterhomescreening,apre-adoptivehomescreening,orpost-placementadoptivereportforfamilyapplicantsmaybeconductedinatleasttwoin-homevisits.

Youmustdocumentintherecordallinterviewsandattemptstointerviewpersonslistedabove.

Youmustmakeatleastonevisitinthehomewhenallmembersofthehouseholdarepresent.

AdditionalInformationNeeded:

Pets

Listthenamesandspeciesofeachpet.

DirectionstotheHome

Providedirectionsonhowtogettotheresourcehome.Usealandmarkasthestartingpoint,suchasaDFCSoffice.

A.Motivation

Statetheapplicants'

initialreasonsforwantingtobecomefosterand/oradoptiveparents.Includethelengthoftimetheyhavebeenconsideringfostercareand/oradoption.

Includetheapplicants'

statedreasonsfordecidingtocommittofostercareand/oradoptionafterreceivingpreparatorytraining.

B.FamilyWell-Being

Mother/Father’sHistory

A.DescriptionofApplicant.Describetheapplicant’sappearance（includeheightandweight）andpersonality.Providedetailsabouttheapplicant’seducationalbackground,workhistory,andpresentemployment.

Includetheapplicant’scitizenshipandlengthoftimeshe/hehasspentatcurrentresidence.

B.Parents.Includetheapplicant’sdescriptionandfeelingsabouther/hisparentsorparentfigures.（Includeinformationaboutabsentparent,ifappropriate.）Describethequalityofher/hisparents’maritalrelationship,support/nurturance,anddecision-making.Addresstheapplicant’sunderstandingoftheeffectsher/hisparentshadonher/hislife.

C.Childhood.Presenttheapplicant’sdescriptionandfeelingsabouther/hischildhood,includingthewayshe/hewasdisciplinedandher/hisfeelingsaboutit.

Addressboththehappiestandmosttraumaticmemoriesofher/hischildhood,andher/hisoverallfeelingsregardingher/hischildhood.

Discusstheapplicant’sbirthorder,her/hisrelationshipwithsiblings（pastandpresent）,andwhichsibling（s）she/hefeelsclosestto.Doestheapplicantbelieveallsiblingsweretreatedequallyandfairly?

Howwassexeducationhandledintheapplicant’sfamilyoforigin?

Includetheeffectsontheapplicant’scurrentfeelingsandhowshe/hewouldhandle（orhashandled）thiswithher/hisownchild（ren）. 

D.HistoryofChildAbuseandNeglect.Discusstheapplicant’shistoryofchildabuse（physicalandsexual）andneglect,ifany,andher/hisresolutionofthisexperience.

HistoryofDrugandAlcoholUse.Discusstheapplicant’shistoryofdrugoralcoholuse,ifany,andher/hisresolutionofthisexperience.（Addresstheseissuesregardingothermembersofthefamilyifappropriate.）

E.Abuse/NeglectandCriminalHistoryChecks.Explainanycriminalhistoryandsubsequentrehabilitativeactivities.Documenttheresultsofbothchecks.

F.HealthandDisabilities.Discussanydisabilities,andphysicalandmentalconcernsthataffecther/hisabilitytocareforachild.SummarizetheresultsoftheMentalHealthQuestionnaire,StressIndexandSensitiveIssuesInventory.Discussanypertinentfindingswhichmayimpactresourceparenting.

C.FamilyInteraction

Childreninthehome.Includeabriefsummaryofthephysical（health）statementandthecasemanager’sobservationsofthechild’sgeneralwell-beingforeachchildlivinginthehomeinrelationtothefamily’sabilitytoprovidefosterand/oradoptivecare.Askchildrenhowtheyaredisciplined,whattherulesareinthefamily,theiropinions/perceptionsofthefamily’sdecisiontofoster/adopt,etc.（Reporttheirperceptions,yourown,andyourobservationsofthechildren’sinteractionwithparents.）

Currentrelationships.Describetheapplicants'

interactionsashusbandandwifeoraspartners.Describethehistoryoftherelationshipincludinghowtheymet,theircourtship,anddecisiontomarryorcommit.Reportthedateandplaceofmarriage.Discussanyseparationsand/ormaritalcounseling.Addresstheirdecision-makingprocesses（includingfinancial）,howtheyhandledisagreements,theirsupportforandnurturanceofoneanother,andtheirindividualfeelingsaboutthemselvesasspouses.Discusstheeffectsofaddingachildtothehome.Describethestrengthsandneedsoftheirmarriage,includingtheirperceptionsandyourown.Describeotheremotionalsupportsystemseachapplicanthas.

Previousrelationships.Includediscussionsofprevioussignificantrelationshipsandallmarriagesand/orpartnerships.Includediscussionsofchildrenbypreviousmarriages,partnershipsand/orsignificantrelationships,parentalvisitation,andchildsupport.Howweretherelationshipsendedandresolved?

Includedateandplaceofdivorce（s）,ifapplicable.

Otherhouseholdmembers.Discussotherhouseholdmembers,includinganywhoresideinthehomepart-time.（Includegrandparents,collegechildren,exchangestudents,andpart-timeorfull-timehelp.）Alsoincludetheresultsofbothabuse/neglectandcriminalhistorychecksofeachperson18yearsofageandolderinthehome.

Parenting.Includetheapplicants'

feelingsaboutthemselvesasparents.Howdotheapplicantsdescribeeachoftheirchildren?

Describetherealismoftheapplicants'

expectationsofeachoftheirchildrenandthefosterand/oradoptivechildren.

Coupleswithchildren.Addressthesameissuesasnotedabovewith"

currentrelationships."

Describetheapplicants'

interactionasparents.Addresstheirdecision-makingprocesses,theiragreementsaboutparentaldiscipline,theirdisagreementsandhowtheyareresolved,theirsupportforoneanotherasparents,andanyotherissuesofpossessiveness,excessivecontrol,andsoforth.

Singleparents.Discusstheapplicants'

single-parentsupportsystem.Describetheapplicants'

significantrelationshipswithbothmenandwomen,includingsexualrelationships.

InfertilityIssues.Discussapplicants'

conditionofinfertility,theirfeelingsaboutinfertility,howinfertilitywasand/orishandled,andhowthishasbeenresolved.

Familyoperations.Discussinregardtoexpectations,responsibilities,divisionoflabor,nudity,privacy,etc.Discussfamilyrules,rolesandboundaries.Explainhowfamilymembershandlestressandexpressnegativefeelings.Bespecific.Includeexamplesofstatementsandbehaviorsthatsupportyourassessment.

Extendedfamily.Describetheapplicants'

interactionwiththeirextendedfamilyandthecommunity.Describetheapplicants'

relationshipswithmembersoftheirextendedfamily,friends,neighbors,church,andcommunity.Discusstheattitudesextendedfamilymembershavetowardtheapplicantsbecomingfosterand/oradoptiveparents,includingtheirdegreeofacceptance.

Religion.Describethefamily'

sreligiousbackgroundandpractices.Discussthefamily’sabilitytobeacceptingofreligiouspracticesotherthantheirown.Alsodiscussthefamily’swillingnesstotakeachildtothechurchofhisorherchoice. 

D.HomeEnvironment

Homeandneighborhood.Describetheincomelevelandagegroupofresidents,theracialmakeup,andthemaintenanceoftheproperty.

Inthedescriptionoftheapplicants'

home,includesleepingarrangementsandphysicaldescriptionsofthefosterand/oradoptivechild（ren）'

sroom（s）,aswellastheapplicants'

housekeepingstandards.

Addresstheapplicants'

homeandneighborhoodasanenvironmentforchildcare,includingtheadequacyofspaceforchildrentoplaybothinsideandoutside.

Observationofhomeenvironment.Describethehomeenvironmentobservingthefollowing:

∙Soundnessofphysicaldwelling（addressallvisible/knowndangers:

roofing,porches,steps,doors,