MUST BE on AGENCY LETTERHEAD ADOPTION HOME STUDY for (Country Or Program)
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Attachment #3 MUST BE ON AGENCY LETTERHEAD ADOPTION HOME STUDY for (Country or Program) Please Note: Holt requires that all home studies be written in accordance with Hague Convention regulations, regardless of the country’s Hague status. All studies must include all required Hague language as listed in the following outline. For India: Please review the separate India Home Study Guideline Supplement for more detailed information about additional India specific requirements. Applicants: List each applicant’s full legal name (no initials) as it appears on birth/marriage certificates Address: City/State/Zip: County: Telephone: Passport numbers: (Korea only) Date Prepared: Prepared by: (social worker’s name, credentials and licensing number and expiration date if applicable) who is employed by (agency name). List state regulations regarding requirements for direct service workers and state licensing regulations. List license number and expiration date if applicable. If license does not have an expiration date, indicate this. Indicate whether agency is a supervised provider and include date supervised provider agreement was signed by Holt. Add the following statement: This home study is to be used for the sole purpose of an international adoption through Holt International Children’s Services, Inc. Sample wording for SUPERVISED PROVIDERS: “Prepared by (social worker’s name, credentials, and license number and expiration date if applicable,) who is authorized by the State of (list state) to prepare home studies according to (list state statute regarding requirements of social worker who prepare home studies) and employed by(or contract worker for) Children’s Home Society. Children’s Home Society is authorized by the state of (name state and site state regulations that refers to agency licensing) to research and prepare adoption home studies (list license number and expiration date if applicable). Children’s Home Society is a supervised provider for Holt International Children’s Services, Inc. based on an agreement executed on (date supervised provider agreement signed by Holt). In accordance with 22 CFR Part 96, Holt International Children’s Services, Inc. is an accredited agency on file with the Department of State. This home study is to be used for the sole purpose of an international adoption through Holt International Children’s Services, Inc.” Sample wording for BRANCHES: “Prepared by (social worker’s name, credentials and license number and expiration date if applicable) who is authorized by the state of Oregon to prepare home studies- under ORS 413- 220-0040(4) (a)- 413-220-0040 (4) (g) and is employed by Holt International Children’s Services, Inc. In accordance with 22 CFR Part 96, Holt International Children’s Services, Inc. is an accredited agency on file with the Department of State as having the authority to conduct Convention home studies and is licensed by the Department of Human Services of the State of Oregon under ORS 418.205-418.310, 418.325-418.327, to research and prepare adoption home studies. Oregon does not require home study preparers to hold individual licenses. Holt’s current license #0076 expires October 31, 2014. This home study is to be used for the sole purpose of an international adoption through Holt International Children’s Services, Inc.” SUMMARY OF AGENCY CONTACTS Include the date of each visit, where it was held, and who was present for each contact with the family. Include date of application to agency and date home study was referred to social worker. At least one visit must be conducted in the home. There must be at least one face to face interview conducted with each member of the household, including children living in the home. CHINA: four face to face contacts required. OVERVIEW OF THE FAMILY/MOTIVATION TO ADOPT Reasons/rationale family wants to adopt in general and from specific country. Generic references to Africa or Asia are not sufficient. Infertility should be discussed if an issue - particularly how couple has managed loss. Motivation and openness to adopt a child with special needs – discuss in detail specific conditions/special needs the family is open to accepting. Include a clear statement from the social worker assessing the family’s preparedness and suitability to adopt a child with special needs. Also discuss parents’ ability to provide for a child with special needs (e.g., health insurance, training, adequate finances, other resources). Discuss attitude of extended family toward the adoption plans. ADOPTIVE FATHER Date of birth, place of birth; including statement that social worker has verified birth certificate. Naturalized Citizens- U.S. Naturalization Certificate number, date and place of naturalization. Note: If the applicant immigrated, include a summary paragraph noting: 1) Age when immigration occurred, 2) reasons for immigration, 3) significant challenges to the immigration process, 4) adjustments to life in a new country e.g. culture shock, grief and loss, 5) broadness of social interactions outside work, and 6) insights gained from their immigration that may impact their understanding of what child may experience. INDO-AMERICANS ONLY: U.S. Passport with number, date and place of issue. Physical description: Height, weight, eye color, hair color, and statement regarding heritage, racial background or ethnicity. Family background and dynamics: Names of mother, father, siblings, their current residences, occupations, marital status, status of current relationship and knowledge and attitude concerning adoption plans. Single Applicants: must include applicants appraisal of their unmarried status, expectation/desire to be married in the future, discussion of if/how their attitude toward adopted child will change if they marry, statement that the applicant was asked about their sexual preference and the social worker attests to the veracity of their statement that they are not homosexual. Education History, including names of colleges attended, time period at each college (what year to what year), name of degree/certificate received, if no degree/certificate earned state this. Employment History, including name of current employer, position/title held by parent, a description of what type of business or organization it is, and a description of the type of work the parent is responsible for. Significant Life Experiences. Most influential person; discussion of previous marriage/s, include reasons for divorce, dates, names of previous spouse/s and current relationship with ex-spouse. In the event of previous marriages, the study must include a statement that the social worker has verified the divorce decree or death certificate of former spouse(s). Health History and social worker’s assessment of applicant’s mental stability. Include a statement that social worker has seen medical report that indicates applicant is free of communicable diseases, including TB & HIV/AIDS. The description of health/medical issues should be consistent with the medical report/Certificate of Health Examination completed by the applicant’s physician for the country program dossier. 2 Sample Wording: “(Name) was examined by his physician on September 1, 2013. He was found to be free of infectious diseases, including HIV/AIDS and tuberculosis. (Name) was found to be of sufficient emotional stability to parent a child. This report was reviewed by this worker and the above findings are as stated. It is this worker’s assessment that (Name) is emotionally, physically and mentally stable and will provide a loving home for any child placed in this family. Under section 8 CFR 204.311(9), no referrals were made to medical or mental health professionals." Child abuse registries must be checked in any State or foreign country that a prospective adoptive parent or adult member of the household has resided in since that person’s 18th birthday. If the parent has only lived in one state since the age of 18 and has never lived outside the U.S., please state this. (Note: If a state of residence is missed, it will likely be noted by USCIS. Temporary out of state job assignments or studies may have generated records in government databases that are accessible by USCIS.) Include result of check and list State where check was conducted. If no child abuse check is accessible for a specific state or country, write statement attesting to this and list authority who verified there is no registry. Result of background criminal history check performed by state; include name of state agency completing check and date completed. State if record was found or not found. Indicate family was informed of their duty to disclose. Social workers must inform family during the home study process of their duty to provide true and complete information to the home study preparer and the consequences of not disclosing this information. Indicate that applicant was asked each of the following questions and indicate their response: o Have you ever been arrested and fingerprinted, even if the record was sealed, pardoned, or expunged? Note: If applicant answers yes, even if the record was sealed, pardoned, or expunged, or the applicant was a juvenile at the time of the arrest, the incident and the social workers assessment of the applicant’s rehabilitation must be thoroughly discussed and evaluated in the study. o Have you ever received treatment for alcohol abuse? o Have you abused illegal controlled substances or prescription drugs? o Have you ever had any involvement with domestic violence or sexual abuse (even if it did not result in a conviction)? Note: If applicant is the perpetrator, his/her disclosure must be documented in the study. o Do you have a history with child protective services in the U.S. or overseas? o Has Immigration ever refused you visa clearance? o Have you ever been rejected as a prospective adoptive parent? o Have you ever been the subject of an unfavorable home study? If family answers YES to any of the questions listed above, the information must be thoroughly discussed and evaluated in the study.