9 CAR pt. 40, Appendix A
9 CAR pt. 40, Appendix A. Adoption Summary Guidelines
APPENDIX A: ADOPTION SUMMARY GUIDELINES
01/2021
Before placement for adoption, the Division shall compile and provide to the prospective
adoptive parents an adoption summary. An adoption summary is a detailed, written health
history and genetic and social history of the child which excludes information which would
identify birth parents or members of a birth parent’s family. The adoption summary will
be set forth in a document that is separate from any other document containing
information identifying the birth parents or members of the birth parent’s family. The
adoption summary will be clearly identified as such and filed with the clerk before the
entry of the adoption decree. Upon order of the court for good cause, the clerk may tender
a copy of the adoption summary to a person identified by the court.
Child Information in Adoption Summary
A. Birth Information:
1) Prenatal care;
2) Alcohol/drug and tobacco involvement of birth parent during pregnancy and
how it affected the infant;
3) Birth date;
4) Measurements at the time of birth;
5) Description of the delivery (including any complications that occurred and
any congenital abnormalities); and
6) Description of nursery progress, discharge weight, and recommendations of
the doctor on discharge and results of any special health screenings/tests.
B. Physical Description:
1) Race;
2) Height;
3) Weight;
4) Hair and eye color;
5) Complexion;
6) Birthmarks;
7) Bone structure; and
8) Physical disabilities.
C. Developmental and Social History:
1) Social, intellectual, emotional, and physical development of the child (noting
any delays or limitations);
2) Developmental milestones;
a) Cognitive development:
1) Recognition of significant others;
2) Comprehension of fact vs. fantasy;
3) Language development; and
4) Comprehension of concepts such as time, space, and quantity.
b) Motor Development:
1) Head control;
2) Kicking;
3) Lifting chest;
4) Rolling over;
5) Holding toys;
6) Reaching for objects;
7) Waving bye-bye;
8) Sitting up;
9) Eye movements;
10) Walking;
11) Crawling;
12) Running;
13) Coordination;
14) Ability to skip; and
15) Ability to catch ball.
c) Social and Emotional Development:
1) Smiling;
2) Laughing;
3) Cooing;
4) Ability to respond appropriately in social situations; and
5) Self-help skills.
D. Health History:
1) Medical history such as diseases, conditions, disabilities, allergies,
hospitalizations, or serious injuries;
2) Present medical issues or needs;
3) Potential future medical issues or needs;
4) Genetic history;
5) Dental history;
6) Present dental issues or needs;
7) Potential future dental issues or needs;
8) Mental health history;
9) Present mental health issues or needs;
10) Potential future issues or needs;
11) Type of mental health counseling and frequency of sessions;
12) Sickle cell test results for a child with African American heritage;
13) Medications (name, dosage, and reason);
14) Immunization records;
15) How health issues affect child’s life if applicable;
16) Child’s attitude about health issues and concerns if applicable;
17) List of special health care providers and frequency of appointments;
18) Parental demands in relation to providing for child’s special health care needs;
19) Special appliances necessary to meet special needs;
20) Date of female’s menarche if applicable as well as her feelings about it,
related hygiene practices, and any complications; and
21) Statement whether male is circumcised.
E. Personality:
1) General description (such as quiet or outgoing);
2) Interests, likes, dislikes, talents, special skills;
3) Causes of depression and how expressed;
4) Causes of anger and how expressed;
5) What makes child happy;
6) How child gives and receives love and affection;
7) Child’s self-esteem;
8) How child relates to adults, peers, and younger and older children;
9) How child relates to siblings;
10) Type of people the child likes and dislikes;
11) Description of what is enjoyable about parenting the child;
12) Description of what is difficult about parenting the child;
13) Child’s hopes, wishes, and desires;
14) Fears and worries;
15) How child relates to authority figures;
16) Behavioral challenges (e.g., lying, stealing, fire setting, running away,
aggression, destruction, withdrawal, bed wetting, encopresis, self-harm,
suicide attempts, depression, abusiveness to animals, cursing, defiance,
sexual acting out (be specific), alcohol/substance abuse, etc. and, if so,
explain);
17) How easy or difficult it is to discipline the child;
18) Effective and ineffective forms of discipline for the child;
19) How a child responds to discipline;
20) Rules the child is accustomed to following and, of those, the rules with which
the child most easily complies and the rules with which the child struggles to
comply;
21) Eating habits (ability to feed self, table manners, and food likes and dislikes);
22) Sleeping habits (bedtime routine, nightmares, night light, and any sleeping
difficulties);
23) Grooming or hygiene habits;
24) How the child cares for his or her belongings;
25) How the child relates with pets or animals in general;
26) Smoking practices (if tobacco products are used);
27) Play habits;
28) Child’s behavior in social situations (e.g., church, restaurants, or department
stores);
29) Knowledge child has about sex; and
30) Experience with sex.
F. Daily Schedule:
1) Birth to one year old -- Give detailed information regarding schedule. For
example, when discussing sleeping, indicate not only the times the child
sleeps but the length of naps; whether child is rocked, patted, etc., to sleep;
whether child sleeps with a special blanket, pacifier, or toy; type of bed the
child sleeps in and the position child prefers to sleep in such as stomach or
back. Indicate the types of food the child likes and dislikes, and the amount
the child eats and intervals between meals. Include the name of the formula,
as applicable.
2) Over one (1) year old -- Briefly describe the child’s general schedule on a
typical day.
Indicate whether the child follows a daily routine or has a flexible schedule.
G. Clothing:
1) Current sizes of clothing and shoes;
2) Type of clothes the child preferers;
3) Amount of clothing;
4) Condition the child’s clothes are in (good or worn); and
5) Any special requirements in relation to clothing.
H. Out-of-Home Placement Experiences:
1) Date child entered Out-of-Home Placement and for what reasons;
2) Describe any child maltreatment and who was offender;
3) Statement as to how many resource homes or congregate care settings in
which the child has lived and length of time in each placement;
4) Description of reasons for moving from each resource home or congregate
care setting; and
5) Brief profile of current resource family or congregate care setting (e.g.,
resource family composition and lifestyle).
I. School Experiences:
1) Description of the type of school or classes the child is utilizing or attending,
for example: public school, specialized school, school for the deaf, resource
classes, or special education classes, including the child’s class schedule,
regardless if it is a whole day, half day, or certain individual classes;
2) Grade level;
3) History of school attendance (past and present);
4) Experience with schools such as accomplishments, challenges, etc.;
5) Attitude toward school;
6) Best subject areas as well as weak areas;
7) Relationship with school mates and teachers;
8) How teachers view the child;
9) Involvement with school activities, clubs, sports, band, etc.;
10) Potential in relation to school; and
11) Attitude towards homework.
J. Siblings:
1) Provide a brief description which includes first name, birth date, living
arrangement and sibling status (full sibling, half sibling, step sibling, etc.);
and
2) If siblings are not placed together, explain frequency of contacts.
Birth/Legal Parent(s) Information in Adoption Summary
Discuss each parent separately. Obtain as much information about the parents as possible.
Be objective with descriptions of the parents and give factual information about them. Do
not make derogatory remarks.
A. Physical and Personality Description:
1) Race;
2) Ethnic background;
3) Age;
4) Height;
5) Weight;
6) Eye and hair color;
7) Complexion;
8) Outstanding features;
9) General appearance;
10) Dominant physical traits within the larger family group; and
11) Personality description and any special talents, interests, or hobbies.
B. Health:
1) Medical and mental illnesses;
2) Genetic history;
3) Allergies;
4) Alcohol/substance abuse, and any physical disabilities;
5) Medical and mental illnesses within the extended birth family including those
of a hereditary nature;
6) History of neglect, physical abuse, or sexual abuse within the extended family;
7) Description of any alcohol or substance abuse within the extended family; and
8) If the birth or legal parent is deceased, then state the cause and date.
C. Education:
1) Highest educational level achieved;
2) Overall academic performance including best and weakest subjects;
3) Extracurricular activities; and
4) Learning disabilities or any intellectual disabilities in relation to the birth
parent(s) and the extended birth family.
D. Religion:
1) Religious affiliation
E. Employment history.
F. Other Significant Information:
1) Birth family’s lifestyle;
2) History of criminal behavior;
3) Reasons child cannot return to birth or legal family; and
4) Date child last had contact with birth or legal family, type of contact, and
reaction.
Recommendations
A. The Adoption Specialist may describe the type of family the child needs and state
if the child should not be placed in a certain location due to proximity to birth or
legal parents, or relatives.
B. The Adoption Specialist may request the child be placed in a home of the same
racial or ethnic heritage if indicated by an individualized determination that this
placement is needed to advance the best interests of the child.
C. If there are siblings, the Adoption Specialist will explain whether they should be
placed together. If separation is recommended, reasons will be stated.
The Adoption Specialist may state preferences in relation to pre-placement visits
between the child and an adoptive family.