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Post-Adoption Services Agreement and Consent
Post-Adoption Services Agreement and Consent

Post-Adoption Services Agreement and Consent

Post-Adoption Services Agreement and Consent

PROVISION OF SERVICES AND CONSENT

Participation in post-adoption services is completely voluntary, and our goal is to support your family based on your individual needs. When services begin, your adoption specialist will talk with your family about your strengths, needs, and how things are going. All of the post-adoption services offered in the state of Virginia are available to each family we work with and you and your adoption specialist will work together to decide what services would be helpful. These services are free for families with an adopted child aged 0-18 and are paid for by a grant from the Virginia Department of Social Services. Under special circumstances, youth and families can receive services up to age 21. If you feel your familiy may qualify for extended services, please reach out to your adoption specialist.

Your Responsibilities

  • Participate in a conversation with your adoption specialist to assess your family’s strengths and needs. This helps the specialist co-plan services to fit your family.
  • Let your adoption specialist know if your family’s needs change, so services can be adjusted.
  • Work with your adoption specialist to create a service plan if needed. This plan can be updated as your family’s needs change.
  • Follow the strategies agreed upon in the service plan, or talk to your adoption specialist if there are any problems with the plan.
  • If you have any questions about the services being recommended, ask your adoption specialist or another team member for help.
  • Stay in touch with your adoption specialist at least every three months. If there’s no contact for more than 12 months, the case may be closed. However, it can always be opened again if you continue to live in Virginia and have an adopted child between the ages of 0 and 18 (0-21 in certain circumstances).
  • You can stop receiving services at any time by letting a team member know. Participation is always voluntary.
Acknowledgement(Required)

NO-COST SERVICES

Post-adoption services are paid for by a grant from the Virginia Department of Social Services. Services are based on the needs of each family, with the goal of keeping families stable and preventing adoption disruptions. Free services include:

  • Case management (advocacy, training, support, referrals to community resources)
  • Group activities and events for parents and youths
  • Support groups for parents and youths
  • Parents’ night out events
  • Educational and training opportunities.
  • Access to a lending library including books and online training videos
  • Family Engagement Services (limited):
    • This is a preventative service aimed at improving overall family functioning. Families can expect to receive individualized in-home education and support related to strengthening relationships, improving communication, and developing structure.
Acknowledgement(Required)

ADDITIONAL SERVICES

Families may also access our Community Based Services, which are funded through public and private insurance, and when appropriate, through the Children’s Services Act (CSA) and the Family Assessment and Planning Team (FAPT). These services include:

  • Counseling:
    • Individual counseling
    • Family counseling
    • Substance use counseling
    • Group counseling
    • Intensive in-home
Acknowledgement(Required)

REPORTING CONCERNS

Your opinion about the work your adoption specialist does is important. If you are not happy with services, talk to your adoption specialist. You can also contact:

Acknowledgement(Required)

CONFIDENTIALITY

Your privacy is important to DePaul Community Resources. All client information is private. We will only share your information if you give written permission, except in these situations:

  1. Mandated reporting of abuse, neglect, self-harm, harm to others, duty to warn of threat to harm others, or inability to care for self.
  2. Medical emergency; for the purpose of preventing injury to or death of client or another person.
  3. Subpoena for records, legal counsel, hearings, reviews, appeal or investigation under the regulations of Licensing, Human Rights, or certification or accreditation. (12 VAC 35-115-80)
Acknowledgement(Required)

CLIENT RIGHTS

It is your right to:

  • Be treated with dignity and respect
  • Be informed about your services
  • Have a say in your services
  • Speak privately to others
  • Have your complaints addressed
  • Share your preferences
  • Ask questions and be informed about your rights
  • Get help with your rights
Acknowledgement(Required)

NOTICE OF PRIVACY PRACTICES

Click to view and read our Notice of Privacy Practices.
Acknowledgement(Required)

ACKNOWLEDGEMENT OF ADOPTION SERVICES AGREEMENT, RECEIPT OF PRIVACY PRACTICES, CONSENT TO SERVICES

I acknowledge that I have read and understand the above and agree to receive post-adoption support services through DePaul Community Resources, or subcontracting partners.
Parent Name(Required)
MM slash DD slash YYYY

Signature

First Name(Required)
Last Name(Required)
DePaul will not sell or rent your information to third parties for any purpose. We do not share or sell phone numbers or opt-in consent data to third parties for marketing or promotional purposes. By providing a telephone number and submitting the form, you consent to SMS text messaging and agree to our Privacy Policy. Message and data rates may apply. Reply STOP to opt out. Reply HELP for more info.