Appendix 7260 FosterAdoptive Home Study GuidelinesWord格式.docx

1、CITY:COUNTY:STATE:ZIP:PHONE:ADDITIONAL PHONE:Heads of HouseholdNAME:AGE:DATE OF BIRTH:SEX:ETHNICITY:LANGUAGES SPOKEN:EDUCATION:OCCUPATION:MARITAL STATUS:DATE MARRIED （if married）HOME ANNUAL INCOME:Other Household MembersDATE OF BIRTHROLE IN HOME:（Note: If there are more than two “Other Household Mem

2、bers,” then repeat the “Name” through “Role in Home” sequence.）Initial Inquiry Date:Pre-Service Training and ConsultationsAttended Pre-Service Training From:ToDates of ConsultationsLocationsWith Whom_ _ _Note: The topic above addresses the following minimum standards:Interviews for a foster home scr

3、eening, a pre-adoptive home screening, or post-placement adoptive report for family applicants may be conducted in at least two in-home visits.You must document in the record all interviews and attempts to interview persons listed above.You must make at least one visit in the home when all members o

4、f the household are present.Additional Information Needed:Pets List the names and species of each pet.Directions to the Home Provide directions on how to get to the resource home. Use a landmark as the starting point, such as a DFCS office.A. MotivationState the applicants initial reasons for wantin

5、g to become foster and/or adoptive parents. Include the length of time they have been considering foster care and/or adoption.Include the applicants stated reasons for deciding to commit to foster care and/or adoption after receiving preparatory training. B. Family Well-BeingMother/Fathers HistoryA.

6、 Description of Applicant. Describe the applicants appearance （include height and weight） and personality. Provide details about the applicants educational background, work history, and present employment.Include the applicants citizenship and length of time she/he has spent at current residence.B.

7、Parents. Include the applicants description and feelings about her/his parents or parent figures. （Include information about absent parent, if appropriate.） Describe the quality of her/his parents marital relationship, support/nurturance, and decision-making. Address the applicants understanding of

8、the effects her/his parents had on her/his life.C. Childhood. Present the applicants description and feelings about her/his childhood, including the way she/he was disciplined and her/his feelings about it. Address both the happiest and most traumatic memories of her/his childhood, and her/his overa

9、ll feelings regarding her/his childhood.Discuss the applicants birth order, her/his relationship with siblings （past and present）, and which sibling（s） she/he feels closest to. Does the applicant believe all siblings were treated equally and fairly? How was sex education handled in the applicants fa

10、mily of origin? Include the effects on the applicants current feelings and how she/he would handle （or has handled） this with her/his own child（ren）. D. History of Child Abuse and Neglect. Discuss the applicants history of child abuse （physical and sexual） and neglect, if any, and her/his resolution

11、 of this experience.History of Drug and Alcohol Use. Discuss the applicants history of drug or alcohol use, if any, and her/his resolution of this experience. （Address these issues regarding other members of the family if appropriate.）E. Abuse/Neglect and Criminal History Checks. Explain any crimina

12、l history and subsequent rehabilitative activities. Document the results of both checks.F. Health and Disabilities. Discuss any disabilities, and physical and mental concerns that affect her/his ability to care for a child. Summarize the results of the Mental Health Questionnaire, Stress Index and S

13、ensitive Issues Inventory. Discuss any pertinent findings which may impact resource parenting.C. Family InteractionChildren in the home. Include a brief summary of the physical （health） statement and the case managers observations of the childs general well-being for each child living in the home in

14、 relation to the familys ability to provide foster and/or adoptive care. Ask children how they are disciplined, what the rules are in the family, their opinions/perceptions of the familys decision to foster/adopt, etc. （Report their perceptions, your own, and your observations of the childrens inter

15、action with parents.）Current relationships. Describe the applicants interactions as husband and wife or as partners. Describe the history of the relationship including how they met, their courtship, and decision to marry or commit. Report the date and place of marriage. Discuss any separations and/o

16、r marital counseling. Address their decision-making processes （including financial）, how they handle disagreements, their support for and nurturance of one another, and their individual feelings about themselves as spouses. Discuss the effects of adding a child to the home. Describe the strengths an

17、d needs of their marriage, including their perceptions and your own. Describe other emotional support systems each applicant has.Previous relationships. Include discussions of previous significant relationships and all marriages and/or partnerships. Include discussions of children by previous marria

18、ges, partnerships and/or significant relationships, parental visitation, and child support. How were the relationships ended and resolved? Include date and place of divorce（s）, if applicable.Other household members. Discuss other household members, including any who reside in the home part-time. （In

19、clude grandparents, college children, exchange students, and part-time or full-time help.） Also include the results of both abuse/neglect and criminal history checks of each person 18 years of age and older in the home.Parenting. Include the applicants feelings about themselves as parents. How do th

20、e applicants describe each of their children? Describe the realism of the applicants expectations of each of their children and the foster and/or adoptive children. Couples with children. Address the same issues as noted above with current relationships. Describe the applicants interaction as parent

21、s. Address their decision-making processes, their agreements about parental discipline, their disagreements and how they are resolved, their support for one another as parents, and any other issues of possessiveness, excessive control, and so forth.Single parents. Discuss the applicants single-paren

22、t support system. Describe the applicants significant relationships with both men and women, including sexual relationships.Infertility Issues. Discuss applicants condition of infertility, their feelings about infertility, how infertility was and/or is handled, and how this has been resolved. Family

23、 operations. Discuss in regard to expectations, responsibilities, division of labor, nudity, privacy, etc. Discuss family rules, roles and boundaries. Explain how family members handle stress and express negative feelings. Be specific. Include examples of statements and behaviors that support your a

24、ssessment.Extended family. Describe the applicants interaction with their extended family and the community. Describe the applicants relationships with members of their extended family, friends, neighbors, church, and community. Discuss the attitudes extended family members have toward the applicant

25、s becoming foster and/or adoptive parents, including their degree of acceptance.Religion. Describe the familys religious background and practices. Discuss the familys ability to be accepting of religious practices other than their own. Also discuss the familys willingness to take a child to the chur

26、ch of his or her choice.D. Home EnvironmentHome and neighborhood. Describe the income level and age group of residents, the racial makeup, and the maintenance of the property.In the description of the applicants home, include sleeping arrangements and physical descriptions of the foster and/or adopt

27、ive child（ren）s room（s）, as well as the applicants housekeeping standards.Address the applicants home and neighborhood as an environment for childcare, including the adequacy of space for children to play both inside and outside.Observation of home environment. Describe the home environment observing the following:Soundness of physical dwelling （address all visible/known dangers: roofing, porches, steps, doors,