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NJ DCF Logo with reverse copy

 

New Jersey Department of Children and Families Policy Manual

 

Manual:

CP&P

Child Protection and Permanency

Effective Date:

Volume:

X

Forms

Chapter:

A

Forms

5-10-2010

Subchapter:

1

Forms

Issuance:

14.174

CP&P Form 14-174, Adoption Disruption Report

 

Click here to view or print the CP&P Form 14-174, Adoption Disruption Report.

 

WHEN TO USE IT

 

Use this form when an adoption is disrupted. The CP&P Form 14-174, Adoption Disruption Report:

 

·         Identifies the child and adoptive family

·         Summarizes the circumstances of the placement

·         Indicates the reasons for failure of the placement as assessed by the assigned

CP&P Worker, the adoptive family, the child (if able to verbalize), the assigned Resource Family  Support Worker, and other CP&P staff or community providers, as appropriate

 

HOW TO USE IT

 

·         Print the CP&P Form 14-174 from the on-line Forms Manual (11-20).

·         Complete the form in a meeting, which includes the assigned CP&P Worker, his or her Supervisor, the Casework Supervisor, the assigned Resource Family Support Worker, and the Resource Family Supervisor.

·         All staff designated in the "Approvals" section are required to sign the completed form.

 

TIPS FOR COMPLETING THE FORM

 

·         Complete all questions giving specific circumstances and details, if appropriate.

·         For "Type of resource home,” select from the following: Adoptive, Foster/Adoptive, Foster Care, Family Friend, Relative, Non-CP&P Adoption          Exchange Home or Exchange Home.

·         Note that when the Division has placed a child out-of-state, that some states approve homes and do not license homes.

·         Regarding the "type" of child requested or recommended, state the specific sex, race, ages, interest in sibling groups, acceptable or non-acceptable physical, emotional, or intellectual challenges, sexual orientation, etc., in the responses to the following questions:

-       The types of children originally requested by the family

-       If another child is being requested by the family for a future placement

-       The type of child being recommended by the Resource Family Support Unit or CP&P for the family for a future placement 

·         If the family requested this specific child, list how they learned about the child (Example: the type of recruitment event that was used to recruit the home, such       as adoption exchange, etc.).

·         Regarding pre-placement visits, list each visit and note if it was held in the resource or adoptive home, Local Office, or other location.

·         Obtain a report from the agency that provided post adoption counseling.

·         If the placement was problematic from the beginning, give details of the problems that occurred and note what efforts were employed by the Worker to resolve the problem (e.g., family was resistant to counseling or other supports offered; family was not realistic about the nature of the child's problems).

DISTRIBUTION

 

Original

-

Office of Adoption Operations, Exchange Supervisor

Copy

-

Child's case record

Copy

-

Resource Family's record

Copy

-

Resource Family Support Worker