Adoption Risk Worksheet - Page 1

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Risk Factors Worksheet (pg. 1 of 2)


In each category select the one statement that best describes your situation.
1. How the Birthmother Became Involved in This Adoption:
Value
Based on her own desires and efforts.

Based on requested help from her family members.

Based on requested help from a trusted friend.

Based on pressure tied to legal proceedings, incarceration or probation.

Based on pressure from the Birthfather and/or members of his family.

Based on pressure from her mother and/or other members of her family.


2. Counseling in Which the Birthmother Will Participate:
Value
She is eagerly engaged in counseling for five or more months before birth.

She is eagerly engaged in counseling for four months before birth.

She is eagerly engaged in counseling for three months before birth.

She is eagerly engaged in counseling for two months before birth.

She has participated in counseling with the Birthfather more than twice.

She is eagerly engaged in counseling for one month or less before birth.

She has no counseling before birth, but some shortly after birth.

She participates in sporadic counseling before birth.

There will be no counseling, either before or after birth.

The Birthmother says she is just fine and does not need counseling.


3. How Educated is the Birthmother?
Value
She has a college degree.

She is a college Junior or Senior.

She is a college Sophomore.

She is a college Freshman that is living away from home.

She is a college Freshman that is living at home.

She has graduated from high school, and is actively pursueing college plans.

She has graduated from high school, but is not college bound.

She did not complete high school, but has earned her GED.

She is attending high school and is actively working on college plans.

She is currently attending high school but is not college bound.

She did not complete high school and currently is not attending school.

She has developmental and/or learning disabilities and is not in school.


4. An Adoption Plan Was Made by the Birthmother:
Value
Four or more months before the birth of the child.

Two to three months before the birth of the child.

One month before the birth of the child.

Less than one month before the birth of the child.

Within a few days before the birth of the child.

Several weeks or more after the birth of the child.


5. Nature of Support the Birthmother Has From Her Family:
Value
Her parents and family are all supportive of adoption.

She has no parental support, but other family members are supportive.

She has no support from her family, but the Birthfather is supportive.

She has no support from her parents or family, or the Birthfather.

Her parents and family are actively opposing the adoption.

The Birthfather's family and her family are actively opposed to adoption.

She has not told the Birthfather or her family about the pregnancy yet.


6. Support That the Birthmother Has From Her Friends:
Value
She has one or more close friends that are supportive of adoption and will be there by her side through the delivery and the adoption process.

She has close friends that have placed children for adoption and still view those placements as a positive experiences.

She has close friends that have placed children for adoption and were not happy with the experience.

She has current friends who actively oppose the adoption.


7. Birthmother's Plans After the Birth of the Child:
Value
She has clear goals and the motivation and means to follow through.

She has a job that she likes waiting for her to go to after the birth.

She plans to attend school soon after the birth and is already enrolled.

She has goals but her ability and desire to follow through are uncertain.

She has a direction she is going, but has no firm plans or outside support.

She has no plans and little to look forward to. (A baby can fill the void.)


8. The Age of the Birthmother:
Value
Age 30 and over.

Age 25-29.

Age 21-24.

Age 19-20.

Age 17-18.

Age 15-16.

Age 14 and under.


9. Personal Circumstances of the Birthmother:
Value
The Birthmother has already placed one or more children for adoption.

The Birthmother is adopted and it was a positive experience for her.

The Birthmother has other minor children that are cared for by others.

The Birthmother already has other children that are still within her care.

The Birthmother has personally received welfare payments in the past.

The Birthmother is adopted and it was a negative experience for her.

The Birthmother is currently receiving welfare payments.

The Birthmother is an alcohol or controlled substance abuser.

The Birthmother has been diagnosed as having a psychological disorder. (i.e.., bi-polar or borderline personality disorders.)


10. Circumstances of the Birthmother's Extended Family:
Value
The Birthmother's parents are still happily married to each other.

Siblings of the Birthmother are married with children and without welfare.

Siblings of the Birthmother have previously placed children for adoption.

While the Birthmother was young, her mother was on welfare regularly.

The Birthmother was born when her parents were very young.

This child will be the first grandchild for the maternal grandparents.

The Birthmother was raised by a single mother without a good father figure.

Siblings of the Birthmother are currently receiving welfare benefits.

Siblings of the Birthmother are single parented children without marriage.


Visitor Comments (3)
Adding your comments contributes to the adoption community. Please keep all comments on topic and civil. Visitors are invited to comment and vote for or flag comments based on appropriateness and helpfulness. All comments must adhere to our commenting rules and are subject to moderation.
Lee - 3 years ago
0 0 0
I agree with Elaine. This questionnaire is for babies. I'm interested in adopting an older child. #1
Elaine - 3 years ago
0 0 0
I don't feel that any of the questions 1-10 would apply to me nor do I have any knowledge to answer then as I wish to adopt a young girl (12-18) from the foster care system. I would be an older Mom and feel an older child would be most appropriate for my age and hers. #2
Bree - 4 years ago
0 0 0
I am looking at adopting a second cousins child and am concerned about adopting a family members child. #3

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