Adoption and Permanent Care Procedures

Information required for referral to the permanent care team

/

Appendix 2

SECTION A

Child's name(s) / Child's name?
Date(s) of birth / Date of birth/s
Date admitted to DHS guardianship / Date of admittance
Current placement / Where is the child/ren currently living?
Region / Region with case planning responsibility
Allocated worker / Who is the social worker involved?
Telephone number / Phone number of worker and/or agency
Current caseplan
Current caseplan.
Proposed caseplan
Proposed caseplan.
Disability services registered
Is the child eligible for Disability Services?

SECTION B

Birth family situation
Structure: names, date of birth, address of parents and siblings. Please include a genogram
Factors supporting the decision of permanency. Difficulties in parents’ situation eg psychiatric history, drug/alcohol problems.
Quality of relationship between parents.
Wishes of the parents/significant others regarding permanent placement. Extent of exploration and preference of parents eg type of parent, location of child.
Wishes of child. Extent of exploration regarding permanency with the child and outcome of exploration.
History of child’s relationship with birth family
Nature and extent of difficulties in relationship between parents and child.
Positive aspects of relationship.
History of home releases and access.
Quality of relationship with siblings.
Child’s placement history
History of moves, including number, length and type of placements. Please include a flow chart.
Child’s emotional development and relationship capacity
Quality of relationship with previous caregivers.
Quality of child’s relationship with current caregivers, including other children in the placement. Comment on the intensity of relationships and extent child is able to give in a relationship.
Comment on the child’s level of emotional security and self image. How has he/she responded to previous separations from parents and caregivers?
Child’s relationship to peers. Difficulties in establishing and maintaining friendships.
Behaviour
Past and present behavioural problems eg bed wetting, soiling, temper tantrums, particular fears or anxieties.
How does the child respond to limits/discipline? What methods of discipline are most effective?
Physical and intellectual development
Brief health history, including disabilities, serious illness or accidents.
Special requirements, including medical treatment, medication, equipment.
Educational history
Academic performance. How is he/she coping academically? Are any special services required or have they been in the past?
How does the child's school describe his/her behaviour? Have there been any particular difficulties?
Access issues
History and current situation. Frequency, quality and type of contact and parties involved. Has access been supervised or unsupervised?
What are the proposed plans for future access in view of the plan for permanency? Have these been discussed with the parties involved?
Other professional and community supports
Note any professional and community supports which have contact with the child and/or birth family.
Note outcome of any assessments which have been undertaken of the child's physical, intellectual and/or emotional development. Please include a copy of any relevant assessment reports.
Other comments
Please add any additional information which is relevant to referral to the permanent care team for permanent family placement.
Name / Worker's name and agency / Date / Date completed

Page 1