Adoptive Placements

0200-509.35 | Revision Date: 07/18/22

Overview

This policy guide describes the provisions that must be met for an adoptive placement to occur, instructions regarding the preparation of the child’s written assessment, the compilation of the adoptive placement packet, and the presentation of this information to the prospective adoptive parent(s).

TABLE OF CONTENTS

Policy

Adoptive Placements

Written Assessments

Termination of Parental Rights (TPR)

Placement Paperwork

Procedure

Determining if an Adoptive Placement Can Occur

Adoption CSW Responsibilities

Completing the DCFS/A 395 or the DCFS/A 395 A

Adoption CSW Responsibilities

Completing the AD 512

Adoption CSW Responsibilities

Preparing the Adoptive Placement Packet

Adoption CSW Responsibilities

Adoption SCSW Responsibilities

Adoption ARA Responsibilities

Proceeding with an Adoptive Placement

Adoption CSW Responsibilities

Adoption ARA Responsibilities

Referenced Policy Guides

Statutes

Version Summary

This policy guide was updated from the 04/02/15 version to provide current practice and procedures. The timeframe for adoptively placing a child was changed from within ten days to thirty-eight calendar days from receipt of the acknowledgment notification email. Also, the Adoption and Permanency Resources Division was changed to the Adoption Division.

POLICY

Adoptive Placements

Written Assessments

Before or at the time of adoptive placement, the CSW must provide a written assessment of the child to the prospective adoptive parent(s). The assessment must contain all known diagnostic information on the child, including:

All medical reports

Developmental and psychological evaluations

Scholastic information

All known information regarding the child’s family life

All known information regarding the medical/psychological history of the child’s biological parents.

Adoption Level of Care (LOC) assessment

The written assessment and family life history of the child must be completed on the DCFS/A 395, Assessment of Child for Pre-Placement Conference, Presentation and/or Adoptive Placement or the DCFS/A 395 A, Assessment of Attached Child for Adoptive Placement and must be attached to the AD 512, Psychosocial and Medical History of Child, along with all required redacted supporting documentation. Supporting documentation includes medical reports on the child, psychological evaluations, and scholastic information, as well as all known information regarding the child’s developmental history and family life; some information may need to be redacted. The prospective adoptive parent(s) must acknowledge that s/he received this information by signing the AD 512 and the DCFS/A 395 or DCFS/A 395 A.

Termination of Parental Rights (TPR)

An adoptive placement may still occur if an appeal of the termination of parental rights (TPR) has been filed, if that the adoptive parent(s) understand the possible outcomes of an appeal. The Addendum to Adoptive Placement Agreement form must be used in the following situations:

An appeal of the TPR has been filed; or

A notice of the appeal has not been received but the birth parent(s)’ time limit to file an appeal has not yet expired. The time-frames are:

Hearing Officer	No. Days	Situation
Judge	60	From the date the Judge made the order to file the appeal
Referee or Commissioner	70	From the date the Finding and Orders were mailed to file the appeal

Placement Paperwork

The Adoption Division aims to have a child adoptively placed within thirty-eight (38) calendar days from the receipt of the acknowledgment notification email.

The Placement Clerk will prepare the adoptive placement paperwork and return the following documents to the CSW:

For agency adoptive placements:

AD 558, Notice of Placement

AD 907, Adoptive Placement Agreement

Addendum to Adoptive Placement Agreement, if applicable

DCFS/A 74, Consent for Medical, Surgical and Dental Care

Public Counsel’s Adoptions Project Information Letter

Alliance for Children's Rights Adoption Project Information Letter

AD 4320, Adoption Assistance Program Agreement

AAP 1, Request for Adoption Assistance Program Benefit

AAP 6, Adoption Assistance Program Negotiated Benefit Amount and Approval

AAP 7, Adoption Assistance Program Statement of Acknowledgment

AAP 8, Adoption Assistance Program Nonrecurring Adoption Expenses Agreement

For inter-agency and ICPC adoptive placements:

AD 558, Notice of Placement

DCFS/A 171, Inter-Agency Adoptive Placement Agreement

Addendum to Adoptive Placement Agreement (if applicable)

DCFS/A 226, Inter-Agency/ICPC Letter

Public Counsel’s Adoptions Project Information Letter

Alliance for Children's Rights Adoption Project Information Letter

AD 4320, Adoption Assistance Program Agreement

AAP 1, Request for Adoption Assistance Program Benefit

AAP 6, Adoption Assistance Program Negotiated Benefit Amount and Approval

AAP 7, Adoption Assistance Program Statement of Acknowledgment

AAP 8, Adoption Assistance Program Nonrecurring Adoption Expenses Agreement

Back to Policy

PROCEDURE

Determining if an Adoptive Placement Can Occur

Adoption CSW Responsibilities

Prior to completing the AD 512, Psychosocial and Medical History of Child Client Notebook, determine whether either of the following provisions have been met:

Scenario 1

Scenario 2

Parental rights have been terminated; and

The AD 4333, Acknowledgment and Confirmation of Receipt of Relinquishment Documents, has been received from the California Department of Social Services (CDSS); and

One (1) of the following conditions exists:

The child is suitably placed in the home of a foster parent(s) or relative(s) with an approved Parent Child Suitability Summary (PCSS); is/or

An approved adoptive family has been matched with the child and the pre-placement conference, presentation of child information to the prospective adoptive family, and pre-placement steps, have occurred.

The child is already placed with a prospective adoptive parent(s), who is/are an approved resource parents; and

The birth mother and presumed father, if applicable, have signed a relinquishment document; and

The AD 4333, Acknowledgment and Confirmation of Receipt of Relinquishment Documents, has been received from the California Department of Social Services (CDSS).

An action to terminate the parental rights of any alleged natural father has been filed and is pending in court.

ARA approval is needed prior to placement and an ARA signature is require d on the AD907.

Back to Procedure

Completing the DCFS/A 395

The DCFS/A 395, is completed when a child is unattached or has been matched with a prospective adoptive family. The DCFS/A 395 A is completed for an attached child.

Adoption CSW Responsibilities

If any of the above scenarios have been met, complete one (1) of the following and attach to the completed AD 512, Psychosocial and Medical History of the Child.

DCFS/A 395

DCFS/A 395 A

DCFS/A 395	DCFS/A 395 A
Review and update the case record. Ensure that all information in the Client Notebook, Education Notebook, Health Notebook, and Child’s Placement History is current and correct. Consult with Case-Carrying CSW if any changes are needed.	Same as DCFS/A 395
If not already completed by support staff, update the child’s legal status on CWS/CMS in the blue section under "Client Management" on the Parental Rights page of "Existing Family Information"). Include updates on: The child’s legal status The child’s court dependency	Same as DCFS/A 395
Document the child’s history and family life experiences prior to out-of-home care, including any history of abuse or neglect. If this information does not fit in the space provided, attach additional pages as needed.	Same as DCFS/A 395
Document the child’s CWS/CMS Placement History Summary. Summarize the placement history of the child and theirrelationship to any significant caregivers.	Document the child’s CWS/CMS Placement History Summary.
Document Birth Information from hospital records	Not applicable (Birth records are attached to the AD 512)
Describe the child’s medical, dental, developmental, mental emotional, behavioral, and scholastic history, and current status ensuring that any identifying information has been redacted from all reports. Enter information verbatim in the written assessment. Do not interpret or summarize medical terminology or any health condition in the original reports. Refer to and attach the child’s CWS/CMS Health and Education Passport (HEP). Describe the child’s scholastic history including the following and, attach report cards and other relevant scholastic information. Current grade level Overall performance Attendance record Special educational needs, if applicable Developmental needs and services (e.g., Regional Center), if applicable Attach a developmental assessment for any child age four (4) or younger. Attach all psychological evaluations (a psychological evaluation is required for any child age five (5) or older if the child’s history indicates a genetic predisposition for mental illness or if the child’s behavior seems abnormal and symptomatic of mental illness). If a child age five (5) or older does not display symptoms of emotional disturbance, determine whether other available information about the child and/or parent indicates that a psychological evaluation is needed to facilitate the placement and ongoing care of the child. This information may include birth or court records, reports from relatives, foster parents, teachers, medical personnel, or other familiar with the child or birth parent(s). As needed, arrange for psychological evaluation and obtain the results for the case record.	Describe the child’s medical, dental, developmental, mental emotional, behavioral, and scholastic history ensuring that any identifying information has been redacted from all reports. Enter information verbatim in the written assessment. Do not interpret or summarize medical terminology or any health condition in the original reports. Refer to and attach the child’s CWS/CMS Health and Education Passport (HEP). Describe the child’s scholastic history including the following and, attach report cards and other relevant scholastic information. Current grade level Overall performance Attendance record Special educational needs, if applicable Developmental needs and services (e.g., Regional Center), if applicable Refer to dates, diagnosis, treatments, medications, and assessments indicated on reports attached to the AD 512.
Review the Client Notebook for the frequency and for the nature of any contact between the child andtheir birth parent(s) or other members of their extended family since the date of placement in out-of-home care. Update the Client Notebook, as applicable, with whether the child: Would benefit from continuing contact with members of their extended family after the adoption Has any siblings with whom the child should be placed for adoption Has any siblings with whom the child would benefit from maintaining contact	Same as DCFS/A 395
Include the birth parent(s) medical and psychiatric history, if available. If completed, refer to the AD 67, Information about the Birth Mother and/or AD 67A, Information about the Birth Father, or Family Background #1, #2, and/or #3 for birth parent(s)’ medical and psychiatric history. If a birth parent has received psychiatric or psychological evaluations or inpatient psychiatric treatment, information on the diagnosis of their condition, diagnosis, response to treatment and/or prognosis must be documented verbatim.	Same as DCFS/A 395
State the child’s religious or cultural background and any stated religious preference indicated by the birth parent(s). Indicate if the child has been subject of any significant religious or cultural ceremonies.	Same as DCFS/A 395
Include the duration and character of the relationship with the identified prospective adoptive parent(s).	Not Applicable
Include an assessment of the child’s readiness for adoption and a statement from the child regarding placement and adoption. If the child is unable to make a statement due totheir age, physical health, or emotional health, describe the reason that the child cannot make a statement.	Same as DCFS/A 395
Document current profile information.	Not Applicable
Document the child’s eligibility for the Adoption Assistance Program (AAP), the basis for their eligibility, and the amount of the AAP payment.	Same as DCFS/A 395
Print a copy of these redacted supporting documents and attach them to the DCFS/A 395, along with the AD 512.	Print a copy of these redacted supporting documents and attach them to the DCFS/A 395 A, along with the AD 512.

Back to Procedure

Completing the AD 512

Adoption CSW Responsibilities

Consult with the Public Health Nurse (PHN) when the child has one or more chronic medical conditions or is currently being seen by one or more specialists so that the PHN can ascertain that the caregiver understands the child’s current level of care. The PHN can review the Health and Education Passport (HEP) with potential adoptive parents.

Complete all information fields on the CWS/CMS generated AD 512, Psychosocial and Medical History of Child.

Redact the names and addresses of all individuals, including former caregivers, and the source, contained in reports and evaluations unless:

The child is a relative of the prospective adoptive parent(s).

Before the finalization of the adoption, the court has ordered identifying information be provided to the prospective adoptive parent(s).

Photocopy all original reports and evaluations ensuring that all identifying information has been sufficiently blocked out (this may require recopying).

Birth parent(s)’ psychiatric or psychological evaluations or hospitalization records obtained during the adoption investigation of the child and their birth parent(s) should not to be included.

List the name of each report, document, or piece of information to be provided to the prospective adoptive parent(s) in the appropriate columns of the AD 512.

Have the prospective adoptive parent(s) initial in the spaces provided on the left-hand side of the form to identify which items they have received.

Document all recommendations or comments made to the prospective adoptive parent(s) about the child and their family background.

List each unavailable record or document and the reason(s) that they are unavailable.

Attach copies of all the redacted reports to the AD 512 along with the completed DCFS/A 395 or DCFS/A 395 A.

Back to Procedure

Preparing the Adoptive Placement Packet

Adoption CSW Responsibilities

Contact the prospective adoptive parent(s) about the adoptive placement.

If the youth/child is approaching sixteen (16),inform/advise the prospective adoptive parent(s) of the funding consequences of signing before the child's/youth sixteenth (16th) birthday and after the child's/youth sixteenth (16) birthday.

Inform the prospective adoptive parent(s) about the extension of AAP benefits past age eighteen (18) if the child is sixteen (16) or older when the AAP agreement is signed.

Adoptive parents(s) make the final determination about the date of adoptive placement.

If an appeal of the termination of parental rights (TPR) has been filed, or if a notice of appeal has not been received but the parent’s time limit to file an appeal has not yet expired, discuss the possible outcomes of an appeal with the prospective adoptive parent(s).

Inform the prospective adoptive parents(s) that it may take between six (6) months and twelve (12) months or longer from the date a notice of appeal is filed for the appellate court to issue an opinion on an appeal.

Clarify that if an appeal results in a reversal of the termination of parental rights (TPR), it does not necessarily mean the child will go back to the birth parent(s).

Explain that the child may revert back to being in foster care status with reunification services.

If the prospective adoptive parent(s) decide to wait until the appeals process has reached its final conclusion or to wait until the time frame for the birth parent(s)’ to file an appeal has expired, notify the court at the next hearing, and do not proceed with adoptive placement.

To determine whether an appeal has been filed, check the Appellate Courts Case Information website at https://appellatecases.courtinfo.ca.gov/.

Provide the child’s name, court case number, courtroom number, parent’s names, and the date of the order of TPR.

Document the manner in which and the date the information regarding appeal of TPR was released to the prospective adoptive parent(s).

Verify the child’s adoptive name, including spelling.

Set a date and time to meet with the prospective adoptive parent(s) to sign adoptive placement papers.

If it is an inter-agency or Interstate Compact on the Placement of Children (ICPC) placement, contact the outside public or foster family agency (FFA) social worker to arrange a date and time to sign adoptive placement papers.

Prepare the Adoptive Placement Packet, using the DCFS/A 65B, Adoptive Placement Approval/Checklist. Attach the following documents. (If it is an inter-agency placement, attach only the documents that apply to the child or applicant.)

Two (2) copies of the DCFS/A 23, Request for Notice of Placement

The child’s birth certificate

AD 4333, Acknowledgment and Confirmation of Receipt of Relinquishment Documents

AD 512, Psychosocial and Medical History of Child and its redacted attachments

DCFS/A 395, Assessment of Child for Pre-Placement Conference, Presentation and/or Adoptive Placement or DCFS/A 395 A, Assessment of Attached Child for Adoptive Placement

AAP 1, Request for Adoption Assistance Program Benefits

AAP 4, Eligibility Certification Adoption Assistance Program. While needed for all placements, ensure that one (1) copy is brought on the day of signing an inter-agency adoptive placement for the agency representative.

AAP 6, Adoption Assistance Program Negotiated Benefit Amount and Approval Instructions and Form

AAP 7, Adoption Assistance Program Statement of Acknowledgment

AAP 8, Adoption Assistance Program Nonrecurring Adoption Expenses Agreement

AD 4320, Adoption Assistance Program Agreement

AD 67, Information about the Birth Mother

AD 67A, Information about the Birth Father

DCFS/A 195-S, Second Sheet for Approval Letters, if the applicant case is with DCFS

Sign the DCFS/A 65B, Adoptive Placement Approval/Checklist, verifying that the child/applicant case is ready for placement.

Submit the placement packet and attachments to the SCSW at least five (5) business days before the placement date.

For inter-agency placements, submit the placement packet and attachments to the SCSW at least fifteen (15) business days before the placement date.

Inform the case-carrying CSW of the date of the adoptive placement, if applicable.

If the placement does not occur and is not rescheduled, send a copy of the DCFS/A 907, Adoptive Placement Agreement, marked "Canceled" to the Placement Clerk within five (5) business days of the scheduled placement.

Adoption SCSW Responsibilities

Review the adoptive placement packet.

If approved, sign the DCFS/A 65B and forward the approved packet, without the DCFS/A 395 or DCFS/A 395 A, AD 512, and the redacted supporting documents, to the Unit Clerk to fax to the Placement Clerk. Ensure that the packet is faxed to the Placement Clerk with the appropriate number of copies of forms listed on the DCFS/A 65B.

Ensure that the adoptive placement packet is submitted at least three (3) days prior to the date of adoptive placement.

Return the DCFS/A 395 or DCFS/A 395 Aand AD 512 and its all attachments to the CSW.

If not approved, return to the packet to the CSW for missing items.

Adoption ARA Responsibilities

Review the adoptive placement packet, if an action to terminate the parental rights of any alleged natural father has been filed and is pending in court for a relinquishment case.

If not approved, return the packet to the SCSW for additional or missing information.

Back to Procedure

Proceeding with an Adoptive Placement

Adoption CSW Responsibilities

For inter-agency or Interstate Compact on the Placement of Children (ICPC) placements when a face-to-face meeting is impractical:

Participate via phone in the adoptive placement signing.

Sign the:

AAP 4, Eligibility Certification Adoption Assistance Program

AD 558, Notice of Placement

DCFS/A 226, Inter-Agency Letter

DCFS/A 171, Inter-Agency Adoptive Placement Agreement

DCFS/A 74, Consent for Medical, Surgical, and Dental Care

If it is an ICPC placement, cross out and initial "I/We must not take the child out of the State of California without the consent of the agency. I/We agree to inform the agency of extended trips of 30 days or more I/We take outside the county."

If it is an inter-agency placement in Los Angeles County, meet with the agency representative and prospective adoptive parent(s) to review the adoptive placement paperwork and obtain the needed signatures.

Attach the applicable documents for the child/applicant(s).

For ICPC, forward the packet to the private or public agency or prospective adoptive parent(s).

The family’s agency representative will obtain the signature of each prospective adoptive parent, leave an original set of the signed documents for the family, and return another set of the signed documents to the CSW.

At the time placement (all placements), refer to Prospective Adoptive Parent(s) Information to explain the rights and responsibilities of DCFS and the prospective adoptive parent(s), and the availability of resources and services to support prospective adoptive parent(s):

If an appeal of termination of parental rights (TPR) has been filed, or a notice of appeal has not been received but the birth parent(s)’ time frame to file an appeal has not yet been exhausted, review the Addendum to Adoptive Placement with the prospective adoptive parent(s)

Document that the Addendum to Adoptive Placement Agreement form was discussed with the prospective adoptive parent(s).

Mark the appropriate box on the Addendum, indicating if an appeal has been filed or the time frame to file an appeal has not expired.

Explain that the child’s adoption cannot be finalized until the result of any appeal is received.

Provide a copy of the "Grievance Review Process Pamphlet."

Sign the AD 512, Psychosocial and Medical History of Child, and the DCFS/A 395, Assessment of Child for Pre-Placement Conference, Presentation and/or Adoptive Placement or DCFS/A 395 A, Assessment of Attached Child for Adoptive Placement, and two (2) copies of each to indicate that the AD 512 and attachments have been provided to the prospective adoptive parent(s).

Obtain each prospective adoptive parent(s)’ signature in the space provided on the original and copy of the AD 512 and DCFS/A 395 or DCFS/A 395 A, acknowledging receipt of the report and the supporting documents.

Leave the original AD 512, DCFS/A 395 or DCFS/A 395 A and attachments with the prospective adoptive parent(s).

Print and file a copy in the child’s blue adoption folder.

Sign and obtain the completed original AD 907 and two (2) copies.

Leave the original with the prospective adoptive parent(s).
Submit to ARA if their signature is required.

If it is an inter-agency placement, the family’s Agency Representative must obtain the signatures of each prospective adoptive parent(s) and leave the original with them.

If the placement occurs in Los Angeles County, both workers should be present for the adoptive placement and must sign the DCFS/A 171.

If the CSW is not able to be present, obtain a copy of the signed DCFS/A 171 from the family’s agency and file the copy in the blue adoption folder.

Sign and obtain the completed original DCFS/A 74 and two (2) copies.

Obtain prospective adoptive parent(s)’ signature(s) on the original and the two (2) copies.

Leave the original with the prospective adoptive parent(s).

As the Departmental Representative, sign and obtain the completed original AAP 1, AAP 6, Adoption Assistance Program Negotiated Benefit Amount and Approval, AAP 7, Adoption Assistance Program Statement of Acknowledgment , and AD 4320, Adoption Assistance Agreement, and two (2) copies of each.

Obtain prospective adoptive parent(s)’ signature(s) on the originals and the two (2) copies.

Leave the originals with the prospective adoptive parent(s).

Explain the following to the prospective adoptive parent(s):

That Medi-Cal continues to be available to meet the child’s health care needs whether or not they choose to receive AAP benefits

That the Medi-Cal coverage will now be under the child’s adoptive name as reflected on the completed AAP 6 form and not under the child’s birth name.

That once the prospective adoptive parents receive the new Medi-Cal card that reflects the child’s adoptive name, they are to discontinue using the prior Medi-Cal card with the child’s birth name. Explain to the prospective adoptive parents that the MEDS system will now reflect the child’s Medi-Cal eligibility under the child’s adoptive name.

That AAP benefits will be begin as of the date that the adoptive placement agreement has been signed by the prospective adoptive parent(s) and the Department.

That AAP benefits expire when the child turns eighteen (18) years old, unless:

The child has a mental or physical handicap which warrants the continuation of assistance, the benefits may be extended to age twenty-one (21), regardless of the date of adoptive placement, or

The initial AAP agreement was signed when the child is sixteenth (16) years of age or older. If the initial AAP agreement is signed on or after the child's sixteenth (16) birthday, the child will remain eligible for AAP benefits until twenty-one (21) years of age as long as the adoptively placed and/or adopted nonminor satisfies one (1) or more of the following five (5) eligibility criteria:

The nonminor is completing secondary education or a program leading to an equivalent credential.

The nonminor is enrolled in an institution which provides post secondary vocational education.

The nonminor is participating in a program or activity designed to promote or remove barriers to employment.

The nonminor is employed for at least eighty (80) hours per month.

The nonminor is incapable of doing any of the four (4) activities described above due to a medical condition.

Explain that the child can be added to their own health care plan when they become eligible so long as it is not a financial burden to do so, and that Medi-Cal will then be the secondary carrier. Also, explain that if there is a cost, such as a premium associated with adding the child to their health care plan that they can keep Medi-cal as the primary health insurance.

If the prospective adoptive parent(s) have private health insurance they plan to use for primary insurance for the child, provide them with a copy of the DHCS 6172, Health Insurance Premium Payment Application and instruct them to return it to the AAP Unit once the child is enrolled in their program.

If the adopting parent(s) choose to put the child they are adopting on their private insurance, the Health Insurance Portability and Accountability Act (HIPAA) requires administrators of group health care plans to add an adopted child at the time of adoptive placement. The prospective adoptive parent(s) must request special enrollment within thirty (30) days of the adoption placement.

If the prospective adoptive parent(s) choose not to receive AAP benefits, encourage them to sign a deferred adoption assistance agreement by completing the AD 4320, Section II.

If the prospective adoptive parent(s) choose to apply for Medi-Cal benefits only, complete the AD 4320, showing "0" as the amount paid.

Obtain the prospective adoptive parent(s)’ signature on two (2) copies of the AAP 8, Adoption Assistance Program Nonrecurring Adoption Expenses Agreement, with the second box marked, acknowledging that they have been advised of the availability of reimbursement for nonrecurring adoption expenses, up to a maximum amount of four-hundred dollars ($400.00) per child adoptively placed.

Write "pending" on the line for the date of finalization.

Give a copy to the prospective adoptive parent(s) and file the original in the case record.

Remind the prospective adoptive parent(s) that they will receive another AAP 8 after the adoption has finalized and that they must return it with required supporting documentation to request reimbursement.

Advise the prospective adoptive parent(s) to return the AAP 8 even if not claiming reimbursement to acknowledge that they were advised that they have two (2) years from the date of finalization to file for reimbursement.

Inform the prospective adoptive parent(s) that they must save all receipts and supporting documentation to get reimbursed for nonrecurring expenses.

For inter-agency placement, provide the private agency with a copy of the AAP 4, Eligibility Certification Adoption Assistance Program.

Complete Part II of the VS 44, Court Report of Adoption.

Have the prospective adoptive parent(s) verify that the information in Part II is accurate by signing on line 17A.

If Part I was completed prior to the adoptive placement, cover Part 1 with a sheet of paper when the prospective adoptive parent(s) are verifying Part II and signing on line 17A.

Have the prospective adoptive parent(s) sign the VS 44 with Part II completed.

Have the prospective adoptive parent(s) sign three (3) blank copies.

All copies must be retained by the CSW.

Except for the AAP 7, which is to be filed in the Applicant Case Folder, file the copies of all of the aforementioned documents and their attachments in the blue adoptions folder.

Initiate AAP within five (5) business days of the placement.

For ICPC placements, submit the documents to initiate AAP upon receipt.

If the signed adoption placement packet is not received within five (5) days of the scheduled adoptive placement date, follow up with the social worker and/or prospective family.

Conduct post-placement supervision visits. Six months of post-placement supervision is required for all adoptive placements before finalization of the adoption. Inform the prospective adoptive parents that if the child has not been living in the home for six (6) months, four (4) post-placement visits are also required.

Adoption ARA Responsibilities

Review and sign the AD907, if signature is required, and return to SCSW.

If not approved, return the packet to the SCSW for additional or missing information.

Back to Procedure

APPROVALS

SCSW Approval

DCFS/A 65B

ARA Approval

AD 907

HELPFUL LINKS

Attachments

Prospective Adoptive Parent(s) Information

Forms

CWS/CMS

AAP 1, Request for Adoption Assistance

AD 67, Information about the Birth Mother

AD 67A, Information about the Birth Father

AD 512, Psychosocial and Medical History of Child Client Notebook

AD 4320, Adoption Assistance Agreement

DCFS/A 226, Inter-Agency

DCFS/A 395, Assessment of Child for Pre-Placement Conference, Presentation and/or Adoptive Placement

Family Background #1

Family Background #2, DI

Family Background #3, Medical and Social History Information About Birth Mother/Father

LA Kids

AAP 1, Request for Adoption Assistance Program Benefit

AAP 2, Payment Instructions Adoption Assistance Program

AAP 4, Eligibility Certification Adoption Assistance Program

AAP 6, Adoption Assistance Program Negotiated Benefit Amount and Approval

AAP 7, Adoption Assistance Program Statement of Acknowledgment

AAP 8, Adoption Assistance Program Nonrecurring Adoption Expenses Agreement

AD 67, Information about the Birth Mother (Spanish)

AD 67A, Information about the Birth Father (Spanish)

AD 558, Notice of Placement

AD 4320, Adoption Assistance Agreement

DCFS/A 23, Request for Notice of Placement

DCFS/A 65B, Adoptive Placement Approval/Checklist

DCFS/A 226, Inter-Agency Letter

DCFS/A 395, Assessment of Child for Pre-Placement Conference, Presentation and/or Adoptive Placement

DCFS/A 395 A, Assessment of Attached Child for Adoptive Placement

DHCS 6172, Health Insurance Premium Payment Application (Spanish)

Family Background #1

Family Background #2, DI

Family Background #3, Medical and Social History Information about Birth Mother/Father (Spanish)

VS 44, Court Report of Adoption

Hard Copy

AD 907, Adoptive Placement Agreement

AD 4333, Acknowledgment and Confirmation of Receipt of Relinquishment Documents

Addendum to Adoptive Placement Agreement

DCFS/A 74, Consent for Medical, Surgical, and Dental Care

DCFS/A 171, Inter-Agency Adoptive Placement Agreement

DCFS/A 195-S, Second Sheet for Approval Letters

Public Counsel’s Adoptions Project Information Letter

Foster Children’s Adoption Project Information Letter

Referenced Policy Guides

0080-505.10, Transitional Independent Living Plan (TILP)

0080-505.20, Health and Education Passport (HEP)

0100-525.10, Interstate Compact on the Placement of Children (ICPC)

0100-535.25, Extended Foster Care (EFC) Program

0200-506.20, Grievance Procedures for Denial of Adoption Requests or Withdrawal of Approved Applicant Assessments

0200-508.10, Relinquishment Procedures and the Statement of Understanding

0200-509.20, Pre-Placement Process

0200-509.36, Supervision of Adoptive Placements

0200-509.40, Terminating an Adoptive Placement

0200-510.00, Postadoption Services

0200-511.05, Adoption Assistance Program (AAP) Benefits and Medi-Cal Benefits

0200-513.05, Postadoption Contact Agreements

0300-503.25, Removing a Child from the Home of Prospective Adoptive Parent(s)

0300-507.10, Communication with County Counsel Regarding a Writ Petition or Appeal

Statutes

California Code of Regulations (CCROC), Title 22, Div 2, Adoptions Manual, Subchapter 5, Section 35127.1 – Summarized the content of the written assessment of the child being adopted.

CCROC, Title 22, Div 2, Adoptions Manual, Subchapter 5, Section 35195 – Provides the requirements for completing the child’s medical and psychological background information that is provided to the prospective adoptive parent(s).

CCROC, Title 22, Div 2, Adoptions Manual, Subchapter 5, Section 35197 – Summarizes placement requirements.

CCROC, Title 22, Div 2, Adoptions Manual, Subchapter 5, Section 35199 – Gives exception to the requirement that a child be legally freed prior to the adoptive placement.

CCROC, Title 22, Div 2, Adoptions Manual, Subchapter 5, Section 35201 – Summarizes the information that needs to be provided to prospective adoptive parent(s) when completing the adoptive placement agreement.

Family Code (FAM) Section 8706(a)(b) – States that an agency cannot place a child for adoption unless a written report on the child’s medical background, and if available, the medical background of the child’s biological parents, has been submitted to the prospective adoptive parent(s) and they have acknowledged receipt of the report in writing. The report must contain all known diagnostic information including current medical reports on the child, psychological evaluations, and scholastic information, as well as all known information regarding the child’s developmental history and family life.

Public Law (PL) 110-84, Section 604(a)(2) – Amends the definition of an independent student in federal law to include an individual who "is an orphan, in foster care, or a ward of the court, at any time when the individual is 13 years of age or older…"

Welfare and Institutions Code (WIC) Section 366.26(j) – States that a petition for adoption cannot be granted until the appellate rights of the natural parent(s) have been exhausted. The State Department of Social Services of the licensed adoption agency is responsible for the custody and supervision of a child and is entitled to the exclusive care and control of a child at all times until a petition for adoption is granted, except as specified in subdivision (n). With the consent of the agency, the court can appoint a guardian of the child to serve until the child is adopted.

WIC Section 11403(b) – Sets forth the five conditions under which a nonminor adoptee whose adoption assistance program agreement was signed after the nonminor's sixteenth birthday can continue to receive Adoption Assistance Program benefits until age 21.

WIC Section 16120 – Sets forth eligibility requirements for Adoption Assistance Program benefits.

WIC Section 16120.1– Discusses the availability of reimbursement for reasonable nonrecurring adoption expenses, including the maximum reimbursement.

Back to Helpful Links