Adoption of Looked After Children: AD1 2014/15
Adoption of Looked After Children
AD1 2014/15
Complete one of these forms for every looked after child in your
Trust on whom an adoption order was made between:
1 April 2014 and 31 March 2015 inclusive
Guidance notes on how to complete the AD1 form can be found on the extranet at
the following link:
http://dhsspsextra.intranet.nigov.net/index/statistics/cib/cib-form/cib-form-children.htm
Completed AD1 questionnaires should be entered on to the secure extranet system
on http://extranet.dhsspsni.local/CIB/ or be passed to nominated data users within your
Trust.
Guidance manuals for using the extranet can be found here
http://dhsspsextra.intranet.nigov.net/index/statistics/cib/cib-data-collection.htm
For help or information contact Iain Waugh on iain.waugh@dhsspsni.gov.uk or
90528446
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Adoption of Looked After Children: AD1 2014/15
Section 1: Child’s Details
Q1a. Social Services Trust name:
--------------------------------------------------------------Child’s SOSCARE reference number
Q1b.
Q1c. Child’s Gender
Q1d. Child’s Date of Birth
Male
D
D
M
Female
M
Y
Y
Y
Y
Q1e. Child’s Religion (tick one box only)
1. Roman Catholic
2. Presbyterian
3. Church of Ireland
4. Church of England
5. Methodist
6. Other Christian
7. Jewish
8. Muslim
9. Other
10. Not Known
11. None
Q1f. To which of these groups does the child belong?
1. White (exc. Traveller)
2. Chinese
3. Irish Traveller
4. Roma Traveller
5. Indian
6. Pakistani
7. Bangladeshi
8. Black Caribbean
9. Black African
Please specify
10. Mixed ethnic group
11. Any other ethnic group
2
____________________________________
Please specify
____________________________________
Adoption of Looked After Children: AD1 2014/15
Section 2: Child’s Circumstances and Care History
Q2a. Please indicate if this child had any special
needs
Yes
No
If yes, please tick all that apply:
Physical Disability
Sensory Impairment
Learning Disability
Severe Learning Disability
Autism Spectrum
Behavioural difficulties
Mental Health difficulties
Emotional difficulties
Other difficulties e.g. Long term illness (please
specify)
Not Known
-------------------------------------------
(including half siblings)
Q2b. How many living siblings does this child have?
Total Number
Number
Adopted within the same
Adopted
placement as the child this form
relates to
Brothers
Sisters
Q2c. Has this child’s adoptive family previously adopted children that are not
siblings of this child?
Yes
No
If No, go to Q2e
Q2d. How many other children not related to this child
did this family adopt?
Number
Q2e. Do the adoptive parent(s) have any dependant
birth children living in the household?
Number
3
Adoption of Looked After Children: AD1 2014/15
Please indicate if the child’s adoptive family is:
1. Single female adopter
2. Single male adopter
3. Same sex couple
3a. Couple are both male
3b. Couple are both female
4. Different sex unmarried couple
5. Married couple
6. Civil Partnership
Q2f.
Q2g. Please indicate the religion of the child’s adoptive
parent(s)
1. Catholic
2. Protestant
3. Other
4. No Denomination
5. Not known
(tick one box only)
Q2h. To which of these groups do the adoptive parent(s) belong?
1. White (exc. Traveller)
2. Chinese
3. Irish Traveller
4. Roma Traveller
5. Indian
6. Pakistani
7. Bangladeshi
8. Black Caribbean
9. Black African
Please specify
10. Mixed ethnic group
11. Any other ethnic group
____________________________________
Please specify
____________________________________
Q2i. Do either of the adoptive parents have a disability?
Yes
No
Please specify (e.g. physical disability)
--------------------------------------------------Q2j.
Please indicate the age of the adoptive parent(s)
Adoptive Parent 1 (years)
Adoptive Parent 2 (years) (if applicable)
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Adoption of Looked After Children: AD1 2014/15
Q2k. Please indicate the date of this child’s
last admission into care
D
D
M M
Y Y Y Y
Q2l. Was a care order: (tick one box only)
1. In place prior to last admission into care
2. Sought during the child’s last admission into care
3. Not required as consent to adoption was obtained under article 16
If (3) go to Q2p.
Q2m. Please indicate the date of the first hearing in
D
D
M M
Y Y Y Y
respect of the application for a care order
Q2n. Was the care order granted?
Yes
Q2o. Please indicate the date of the granting of the
No
D
D
M M
Y Y Y Y
D
D
M M
Y Y Y Y
D
D
M M
Y Y Y Y
care order
Q2p. Please indicate the date of the LAC review, when
it was proposed that adoption was in the best
interest of the child
Q2q. Please indicate the date of the adoption panel’s
recommendation that adoption is in the best
interest of the child
Q2r. Did the panel make a recommendation to proceed under: (tick one box only)
1. Article 16
2. Article 17
3. Article 18
Q2s. Under which Article was the adoption finally processed through the court: (tick
one box only)
1. Article 16
2. Article 17
3. Article 18
Q2t. Please indicate the date of the Trust’s decisionmakers acceptance of the panel’s
recommendation(s)
5
D
D
M M
Y Y Y Y
Adoption of Looked After Children: AD1 2014/15
IF AN ADOPTION APPLICATION WAS MADE UNDER ARTICLE 16, PLEASE
COMPLETE SECTION THREE ON PAGE 6. IF NOT GO TO SECTION FOUR ON
PAGE 7
Section 3: Adoption Application Under Article 16
Q3a. Was the application made with
Yes
No
parental agreement?
If yes, go to Q3c
Q3b. Please indicate the grounds for the application without parental agreement
Parent or guardian (tick boxes as appropriate)
a) Cannot be found or is incapable of giving agreement;
b) is withholding their agreement unreasonably;
c) has persistently failed without reasonable cause to
discharge the parental duties in relation to the child;
d) has abandoned or neglected the child;
e) has persistently ill-treated the child;
f) has seriously ill-treated the child
Q3c. Please indicate date of service of originating
D
D
Parent
M M
Guardian
Y Y Y Y
summons/petition
Q3d. Were other applications heard in
Yes
No
conjunction with the adoption
application?
If no, go to Q3f
Q3e. What other applications were heard?
(a)___________________________________________________________
(b)___________________________________________________________
(c)___________________________________________________________
Q3f. Please indicate any factors that may have delayed the granting of an adoption
order
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
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Adoption of Looked After Children: AD1 2014/15
______________________________________________________________
______________________________________________________________
PLEASE GO TO SECTION FIVE ON PAGE 9
Section 4: Freeing Application Pursuant Under Article 17 or
Article 18
Q4a. Please indicate the date of court issue of
D
D
M M
Y Y Y Y
originating summons/petition
Q4b. Were other applications heard in
Yes
No
conjunction with the adoption
application?
If no, go to Q4d
Q4c. What other applications were heard?
(a)___________________________________________________________
(b)___________________________________________________________
(c)___________________________________________________________
Q4d. Please indicate the date of this judgement
D
D
M M
Y Y Y Y
Q4e. Under which Article was the adoption finally processed through the court: (tick
one box only)
1. Article 17
2. Article 18
Q4f.
If Under Article 18, under what grounds was the freeing order made?
Parent or guardian (tick boxes as appropriate)
a) Cannot be found or is incapable of giving agreement;
b) is withholding their agreement unreasonably;
c) has persistently failed without reasonable cause to
discharge the parental duties in relation to the child;
d) has abandoned or neglected the child;
e) has persistently ill-treated the child;
f) has seriously ill-treated the child (subject para. (4))
If no freeing order was made..............................................
Q4g. Were other applications heard in
Yes
conjunction with the adoption
application?
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Parent
Guardian
No
Adoption of Looked After Children: AD1 2014/15
Q4h. Was another order made?
Yes
No
Q4i. If Yes, please provide details
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
Q4j.
Was there a written judgement?
Q4k. Was an appeal lodged?
Yes
Yes
No
No
If No go on toQ4n
Q4l. Who lodged the appeal? Was it.............: (tick one box only)
1. The Trust
2. Parent(s)
3. Others
Q4m. Was the appeal upheld or
rejected?
Q4n.
Yes
No
Please indicate any factors that may have delayed the granting of an
adoption order
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
___________
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Adoption of Looked After Children: AD1 2014/15
Section Five: Child’s Key Decision Dates
Q5a. Date of the adoption panel’s recommendation that prospective adopters are suitable
to be adoptive parent(s)
D
D
M
M
Y
Y
Y
Y
Q5b. Date of Trust decision maker’s acceptance of the panel’s recommendation that
prospective adopters are suitable adoptive parent(s)
D
D
M
M
Y
Y
Y
Y
Q5c. Date of the adoption panel recommendation that prospective adopters are suitable
for this specific child
D
D
M
M
Y
Y
Y
Y
Q5d. Date of the Trust’s acceptance of panel’s recommendation that adopters are suitable
for this specific child
D
D
M
Q5e. Were the prospective adopters the
child’s former foster carer(s)?
Q5f.
M
Y
Yes
Y
Y
Y
No
If the prospective adopters were the child’s former foster carer(s), please indicate if
the carer(s) were:
a)
b)
c)
d)
e)
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Foster carer (Non-kinship)
Kinship Foster carer (Grandparents)
Kinship Foster carer (Sibling)
Kinship Foster carer (Other relative)
Kinship Foster carer (Non-related connected
person)
Adoption of Looked After Children: AD1 2014/15
Q5g. Date of the child’s placement with the prospective adopter for the purpose of
adoption
D
M
Y
Y
Y
Y
Q5h. Date the adoption order was granted
D
D
M
M
Y
Y
Y
Y
Q5i.
D
Was the child adopted via the
‘Home on Time’ concurrent
planning programme?
M
Yes
No
Thank you for taking the time to complete this questionnaire
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