Attachment I:  Adoptive Family Assessment Recording Outline

Reason for Study:

1. The type of study
2. The motivation of applicant

Summary of Contacts:  Include the date and place of contact and with whom contact was made.

Description of Family Members: Include a description of each household member and all applicable information including:

1. Attitude toward children;
2. Social history;
3. Marital history;
4. Military history;
5. Education;
6. Health;
7. Employment history; and
8. Extended family with emphasis on those who are important to the family's support system.

Family Relationship:

1. Their present marriage, if appropriate - roles, responsibilities and stability;
2. The interaction between parents and/or children;
3. Group activities and shared interests;
4. Religious or ethical beliefs;
5. Methods of discipline; and
6. Communication system.

Financial Status:

1. Total monthly income for family; and
2. Total monthly expenses.

Health Status:

1. Summarize information from medical forms coupled with information gained from interviews.
2. Include information about the age differential between applicant and child(ren) requested.  If the differential indicates the child could not be reared to adulthood, include a description of the plans the applicants have made with the immediate or extended family members to assume this responsibility.

Home and Environment:

1. Description of home and surroundings; and
2. Housekeeping standards.

Family's Understanding of and Response to Agency Policy Regarding:

1. Discussing with the child issues surrounding the adoption;
2. Pre-placement planning and visits;
3. Adoption subsidy payment system;
4. Maintaining, over the child's growth years, relationships with siblings when they are separated, and significant others;
5. The sharing of social, emotional, health information at any time after final decree of adoption is granted; and
6. Continued availability of agency services after the final decree is granted.

Expectations of Adoptive Parenting:

1. Type of child desired; and
2. Any special items that must be considered in the placement decision and subsequent planning.

Summary of References:

1. Highway Patrol and FBI check (arrests and convictions; consider relevance to additional child caring responsibilities. 
2. Review of Family Support Division (FSD) screens.
   • SCLR - Department of Social Services (DSS) data base (Access with name, sex, and date of birth);
   • KDCN - Protective Services (PS) inquiry (accessed by DCN);
   • IPAR - Income Maintenance (IM) information (accessed by DCN);
   • FPAR - Food Stamps (FS) information (accessed by DCN);
   • OVCI - Claims and Restitution (CARS) information (accessed by DCN); and
   • DPAR - Family Support Division participation screen (accessed by DCN).
3. Family Care Safety Registry Report
4. Case net review results

Related Subject:  Section 6, Chapter 3, Attachment H:  Guide for conducting Adoptive Family Assessment Services for instructions on CA/N checks, fingerprinting, Case net and Family Care Safety Registry

5. Personal
6. Employment
7. School

Evaluation

Recommendation

Signature of Worker and Date Signed

Approval of Supervisor Including Signature and Date

Signature of Adoptive Parent and Date Signed

Additional summary of the adoptive record should be completed at least every two years and include:

1. Any changes to the above information;
2. The response to any changes in agency policy;
3. A repeat of step 10, item a through d, in above Summary of References;
4. Reflect reasons why other families were selected for children for whom this family was also recommended (i.e., include information from staffing reports);
5. Evaluation of continued readiness for adoptive parenting;
6. Recommendation;
7. Signature of worker and date signed;
8. Approval of supervisor including signature and date; and
9. Signature of adoptive applicant and date signed.

Chapter Memoranda History: (prior to 1/31/07)

Memoranda History: