Guidelines for Social Worker Written Reports
GENERAL REQUIREMENTS
Note*** Please make sure all reports are on agency letterhead and that reports are
written in a narrative style and in paragraph form. Please do not complete the report
in a question and answer format. Numbers one through eleven should be listed as
shown.
(Family Name) (# of month, i.e. 6 or Six) Month Post Placement Report
1. Child’s Birth Name:
2. Child’s Adoptive Name:
3. Birth Date:
4. Adoption Date:
5. Orphanage/Welfare Institute Name:
6. Health Condition: (Healthy or Special Needs)
7. Adoptive Parents’ Names:
8. Adoptive Parents’ Address:
9. Date Child became U.S. Citizen:
10. Post Placement Report Date:
11. Name of Adoption Agency:
CONTACTS:
Date of Contact:
Length of Contact (should be a minimum of one hour):
Type of Contact (visits must be conducted in the home):
Names of Those Present (all family members living in the home should be present):
DESCRIPTION OF CHILD:
Provide a general physical description of the child.
Describe personality of the child. What words or phrases do parents use to describe their child?
Indicate child’s favorite activities, toys, or interests.
Comment on the child’s behavior and indicate if there are any unusual or problematic behaviors.
INITIAL ADJUSTMENT: (Please label this section as Overall Adjustment for any reports after
the 3 mo. report)
Describe any grieving or loss behaviors the child has shown since placement (extended periods of
crying, sleep disturbances, temper tantrums, hoarding, comfort avoidance, preoccupation with eating or
refusal to eat).
Describe initial adjustments which have been necessary for the parent, child and/or siblings.
What are the child’s sleep patterns?
Has the child had any difficulty eating or issues with food? Does the child have any favorite foods?
Have routines emerged and are they established?
Describe the family’s methods of coping with this new responsibility and changing roles.
Describe any behavioral problems that are difficult for the parents to understand and handle and state
how the parents are specifically handling the problem currently.
Does the child test limits or show resistance to rules?
Does the child enjoy hugs and closeness from the parents?
Does the child initiate any hugging or closeness to the parents?
Does the child make good eye contact?
Does the child demonstrate indiscriminate affection with strangers?
Does the child appear to be making progress in bonding and attachment with parents?
CONCERNS:
FAMILY & CHILD INTERACTION:
Describe the parent, child and sibling relationships and the dynamics of these interactions. What is the
adjustment like at this time?
Describe the child’s general physical, social and emotional development since the first visit. Has the
child acquired new skills?
Does the child have any annoying or troublesome behaviors?
Has discipline been necessary, and if so, what has been used? Did the parents’ actions produce the
desired results?
Has the level of bonding and attachment between the child and each parent grown? What has been the
adjustment to siblings?
Has there been any crisis or has the family experienced any unusual changes since the last visit?
What currently is the most challenging part of the placement for the parents?
What has been the most enjoyable part of the placement for the parents?
CONCERNS:
HEALTH & DEVELOPMENT OF CHILD:
Indicate the child’s:
Height:
Weight:
Complexion:
Birth Marks/Scars:
Hair Color:
Eye Color:
Head Circumference (if child is under 6 years old):
Condition of Teeth:
How do these measurements compare to those at the child’s arrival/last visit?
Describe any visits to Health Professionals:
Dates of Pediatric, Dental & Optometric visits:
Names of Attending Physicians & other Medical Professionals:
Dates & types of Inoculations & Immunizations:
Current Medical/Physical concerns, Treatments & Prognosis:
Describe the Child’s:
Fine Motor Skills:
Gross Motor Skills:
Expressive Language Skills:
Receptive Motor Skills:
Sensory Integration:
Emotional / Social Development:
Does the Social Worker observe any signs that the child may have one or more learning disabilities?
CONCERNS:
EDUCATION & CHILDCARE:
Describe parents’ current childcare and/or education plan.
Is the child in an ESL class (English as Second Language) or does the child have an IEP (Individual
Education Plan)?
If the child is in school, how does the child get along with peers?
CONCERNS:
COMMUNITY & EXTENDED FAMILY:
Has this child been accepted by the community?
What has been the response to the child by the extended family and friends of the family?
Has the family experienced any cultural difficulties or prejudice?
CONCERNS:
LEGAL PROCESS: (address all relevant questions)
Has the family filed a petition with the court for re-adoption or validation of the foreign adoption?
Does the family have information about filing for citizenship for their child? Have they obtained or
received their child’s Certificate of Citizenship?
Does the family know the difference between an IR3 Visa and an IR4 Visa when seeking “automatic”
citizenship? What Visa did the child travel home on?
Does the family know about the new $10,000 Federal Tax Credit for adoption?
Does the family know how to file for a Social Security Card?
Has the family received their “Green Card” (Permanent Resident) for their child?
FINAL ASSESSMENT, EVALUATION & RECOMMENDATION:
Please summarize the family’s adjustment to the child including social, emotional and financial.
Is bonding and attachment occurring?
Indicate any parental concerns about the placement.
Any community resources needed to assist parents and child in bonding and attachment or other areas
including:
Support Group:
Sensory Integration Therapist:
Occupational Therapist:
Speech Therapist:
Family Therapist:
Learning Disability Resource:
Speech / Language Resource:
Attachment Specialist:
Parenting Education:
Educational Resources:
Do parents have support group (extended family, church, other adoptive families, etc.) in area to
encourage them?
What suggestions or recommendations have been made to the family by the Social Worker to assist
them with placement and bonding?
Are there any further observations or concerns of Social Worker