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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

Through your participation in post-adoption services, you give consent for services to be provided based on your family’s individual needs. Upon onset of services, your adoption specialist will engage your family in a discussion on current strengths, needs, and level of functioning. Following this discussion, your adoption specialist will partner with you to make service recommendations based on family preferences and their professional knowledge. Post-adoption services are offered free of charge to families with an adopted child between the ages of 0-18. These services are funded by a generous grant from the Virginia Department of Social Services.

Your Responsibilities

  • Actively participating in assessment of your family’s strengths and needs in conjunction with the adoption specialist. This is a conversation that will assist the adoption specialist in tailoring services to best suit your family.
  • Communicating changes in family needs to your adoption specialist so services can be adjusted as family circumstances change.
  • Actively participating in the development of an individualized service plan, if warranted and agreed upon. Service plans are only needed during times when families experience challenges or transitions that necessitate more intensive support from their adoption specialist.
  • Cooperating with goals/objectives agreed upon in the service plan, and/or communicating barriers to working on goals/objectives to your adoption specialist. This will help ensure the service plan accurately reflects your family’s priorities.
  • Asking your adoption specialist (or another team member) for assistance in understanding service recommendations, if at point you need clarification.
  • Withdrawing consent to services at any time by notifying a member of the team. Participation in post-adoption services is always voluntary.
Acknowledgement(Required)

NO-COST SERVICES

Post-adoption services are facilitated under a grant by the Virginia Department of Social Services. Services are provided based on an assessment of each family’s individual needs, with the goals of increasing family stability and preventing adoption disruption or dissolution. No-cost services available to all families include:

  • Case management including advocacy, training, non-crisis and crisis support, and referral to community resources.
  • Activity groups/events for parents and youth.
  • Support groups for parents and youth.
  • Respite via parents’ night out activities.
  • Access to educational and training opportunities.
  • Use of adoption lending library (contains books and DVDs).
  • 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
  • Access to telepsychiatry services (connection to a psychiatrist through video conference), in partnership with Centra Health and Carilion Clinic.
Acknowledgement(Required)

REPORTING CONCERNS

Your input regarding the work your adoption specialist will do with your family and children is important. If you are not satisfied with your services, it’s important to talk to your service provider about your concerns. You may also contact Misti Greer, Director of Adoption or Marya McPherson, Vice President of Child and Family Services. Misti Greer can be reached at 276-242-81871. Marya McPherson can be reached at 540-269-0504.

Acknowledgement(Required)

CONFIDENTIALITY

Protecting your confidentiality is important to DePaul Community Resources. All client information is confidential. Written permission is required, by law, in order to release client-related information to outside parties, except in the following cases:

  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
  • to be told about your treatment
  • to have a say in your treatment
  • to speak to others in private
  • to have your complaints resolved
  • to say what you prefer
  • to ask questions and be told about your rights
  • to 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)