Policy
Manual Attachment to 46-3-21.7 Format for Social Study for TPR In
Re: (children's names) Superior
Court for Juvenile Matters at: (address) SOCIAL STUDY IN SUPPORT OF TERMINATION OF PARENTAL RIGHTS
PETITION ORSOCIAL STUDY
IN SUPPORT OF NEGLECT AND TERMINATION PETITIONS
[Choose
appropriate title] Date:
(day, month, year) 1.
Children for Whom Petitions are Filed ·
Name ·
Address ·
Date of Birth
Note: Dates of
birth need to be verified through birth certificates. Please put "verified" next to any date of birth for
whom we have a birth certificate. 2.
Parents ·
Name ·
Address (or
last known address) ·
Prison
Identification Number ·
Date of Birth 3.
Minor Siblings for Whom Petitions are not Filed ·
Name ·
Current
placement ·
Current legal
status ·
Date of Birth 4.
Family History
A.
Mother
B.
Father (use separate section for each father)
1.
Birth name, date of birth, place of birth, citizenship, birth order,
parents, relationship to family.
2.
Nationality or ethnic background, including Native American heritage.
3.
Education
4.
Early social history 5.
Employment history 6. Marital history and history of relationships with significant others, including domestic violence history 7. Health history, both physical and psychological. Include any hospitalizations, or chronic illnesses, substance abuse problems 8.
Any traumatic events 9.
Military service 10.
Police record and sex offender history 11.
Anything else that seems important 5.
Child
for Whom Petition is Filed
A. For
each child individually, address: 1.
Date of birth and verification. 2.
Abuse/neglect history and other traumatic events. 3.
Developmental history, including services referred to, provided and/or
completed. State whether child has received a developmental assessment by a
provider with expertise in child development. 4.
Mental health history, including diagnosis and all services provided,
referred to or completed. State whether the child has received a mental health
screening, assessment or evaluation and summarize the results. 5.
Behavioral and developmental problems, including all service providers,
referred to or completed. 6. Physical illnesses and operations, including immunization history and services referred to, provided and/or completed. State whether child has received a comprehensive health assessment since entering foster care, including screening for hearing, vision, communicable diseases, and exposure to lead. State whether the child has a consistent medical provider where s/he receives coordinated, comprehensive and continuous health care. State whether the child is receiving regular dental care. 7.
History of current and previous placements, including efforts
to maintain one consistent placement and whether the current placement is
pre-adoptive. If the current placement is not pre-adoptive, state whether a
pre-adoptive placement has been identified, or what efforts have been made to
identify a pre-adoptive home. 8.
School history, including, where appropriate, whether the child is
enrolled in a high-quality early-educational program with staff knowledgeable
about the needs of children in the child welfare system. State whether the child
is receiving special education services, or any other services related to
education, including any service provided, referred to or completed. 9.
Interests and attitudes. 10.
Relationship with parents, siblings, stepparents, and/or other
significant third parties involved with the child prior to placement. 11.
Relationships with current caretakers and other significant third parties
who became involved with the child subsequent to placement. B.
Siblings for whom petitions are not filed (give any known information relevant
to this TPR) 6.
Planning for Independence (do not include if not applicable) ·
Must be
completed for each child over sixteen (16). ·
Describe efforts made by the worker to help prepare the child for
adulthood. 7.
Relative Resources
Discuss each relative who has been considered as a potential placement
for the child and reasons why child is not currently placed with that relative.
Describe any other relative resources; such as visitation or respite care
providers. 18.
Other Agencies and Providers Name and describe services offered by other agencies to parents and
child[ren], degree of compliance, results of evaluations, etc. 9.
Present Situation
Describe the parents' situation, including financial and interpersonal
relationships, parents' compliance with the agency.
Describe the each child’s situation, including placement, child’s
position regarding termination, permanent plan for child, obstacles to achieving
permanent plan. 10.
Strengths and Weaknesses
[List the strengths and weaknesses of the family which relate to the
parents' ability to care for the children.] 11.
TPR in Best Interests of the Child Describe why termination is in the best interests of the child (in two
or three concise paragraphs). 12.
Recommendations
It is the recommendation of the Department of Children and Families that
the court terminate the parental rights of:
[parent] and appoint the Commissioner statutory parent for [child]. Submitted
by: (Social Worker) Reviewed
by: (Social Work Supervisor) Approved
by: (Program Supervisor) Connecticut Department of Children and Families Effective Date: November 1, 2005 (Revised) |
