Logo Agency/ Company Name

Address
Contact Details

SOCIAL CASE STUDY REPORT

(Applicable for all categories: Regular, relative, step-parent, adult, independent placement.)
For regular, IP and foster adoption, the SCSR should be prepared after the issuance of the Pre-
Adoption Placement Authority (PAPA) and/or completion of the Supervised Trial Custody (STC). For
relative step-parent and adult adoption, the SCSR should be prepared prior to filing of the petition
for domestic administrative adoption.
Date prepared

A. THE CHILD/ADOPTEE- Information covers from admission to the CCA/foster home,

placement to custodian, issuance of CDCLAA until matching

I. IDENTIFYING INFORMATION

Name (First, Middle and Last Name.

For Child Without Known Parents,
indicate the given first and last name
and alias, if applicable)
Sex
Date of Birth/Given Date of Birth
Age
Place of Birth/Place Found
Birth Status
(Marital/Non-Marital/Child)
Category
(Surrendered/Abandoned/Dependent/
Neglected/Without Known Parents,
Orphan)
Legal Status (with issued CDCLAA /
IVC / judicially declared abandoned)
Health condition (healthy or with
special needs, specify)
Date of Admission to the Agency
Date of Placement to Custodian (for
Relative/Stepparent/Adult/FA/IP)
Type of Adoption (Regular, Domestic
Relative, Step-parent, Adult, SIBRA,
ICA Relative, IP, Foster-Adopt)
Current Whereabouts

ll. SOURCES OF INFORMATION AND CIRCUMSTANCES OF REFERRAL - indicate the

circumstances surrounding the referral/admission of the Child/Adoptee to the Child Caring
Agency, foster home, custodian (e.g. reason for referral/entrustment; where the child/adoptee
was referred/entrusted; who was responsible for referral/entrustment; when was the
referral/entrustment made and when was the child/adoptee was admitted/entrusted).

** Information in this section should be written in the past tense.

Page 1 of 8
Logo Agency/ Company Name
Address
Contact Details

III. BACKGROUND INFORMATION (Except for the Current Functioning, all information on the
Description of the Child/Adoptee upon Admission/Entrustment, Medical History and
Developmental History should be written in the past tense)

CHILD/ADOPTEE

Description of Child/Adoptee upon Admission/Entrustment to the CCA/Placement to

Foster Family or Custodian

This section must include the following information which should be presented in a
brief/concise, accurate/factual manner:

1. Age, personality, physical deformities (if any), birthmark/s (if any) and other
significant observations about the child/adoptee upon admission.
2. Data on anthropometric measurements of the child/adoptee.
3. Description of the child/adoptee’s overall appearance to indicate whether the
child/adoptee was properly cared for;
4. Type of clothing and hygiene (e.g. clean or unkempt). (Graphic details should not
be included).
5. For a child/adoptee without known parent/s, the child/adoptee’s condition/physical
appearance, (without including graphic details) behavior when found, information
on who named the child/adoptee and the significance of the child/adoptee’s name.
6. Developmental achievements of the child/adoptee (e.g. fine/gross motor skills,
speech and language, etc.)

Medical History of the Child/Adoptee prior to placement to the adopters:

This section must include summary of the significant medical history or medical
condition of the child/adoptee.

Developmental History of the Child/Adoptee prior to placement to the adopters:

This section must include summary of the overall developmental achievements of the
child/adoptee.

IV. THE CHILD/ADOPTEE’S FAMILY- These tackles the composition and pertinent background
information on the biological family such as:

Family Composition (if applicable):

Relationship
Civil Educational Employment/
Name to the Child/ Age Sex
Status Attainment Income
Adoptee

Family Description (if applicable):

1. Physical description of the family, such as physical appearance of

birthmother/father, body build, height, complexion, hair, eyes, nose, and
disability/deformity (if any).

Page 2 of 8
Logo Agency/ Company Name
Address
Contact Details

2. Health history (physical and mental such as hereditary/non-hereditary illness/es,

medications taken, etc.) For the birth mother, include pre-natal history.
3. Education/occupation/income and earnings
4. Personality, psychological and emotional make-up of the birth parent such as:
5. Character/traits/how he/she is as a person
6. Hobbies, interests, talents
7. Quality of intra-familiar relationship, family dynamic (nature of marital
relationship of birth parents, birth parents’ relationship with their children and
relationship of siblings)
8. Information on the birthparents, such as number of their siblings and their
relationship with each other; how the parents met, and if they were married or
not, etc. If they have medical illnesses, medication that they took and if such
illnesses hinders/affects their parental capability should be specified in the report.
If a parent is detained in jail, the status of the case filed should be stated.
9. Childhood experiences of birthparents (positive/negative that may have an impact
on quality of parenting assessment of mental ability and level of
intelligence/personality)
10. Negative history of substance/alcohol abuse, sexual abuse, domestic violence,
imprisoned parents/criminal record.
11. If the birth mother has history of substance abuse while pregnant, indicate the
frequency, duration, and amount of substance consumption.
12. Birth parent’s attitude towards the child during the time that he was still in her
care.
13. For birth parent/s with history of counseling, psychiatric/psychological treatment,
indicate the reason for the counseling or psychiatric/psychological treatment,
name of institution where the services were availed, name of psychologist or
psychiatrist. A psychological/psychiatric report should be included in the child’s
dossier.

V. TERMINATION OF PARENTAL RIGHTS/FACTS of ABANDONMENT- Summary of the

circumstances of termination of parental rights and/or abandonment, application/petition for
CDCLAA (if applicable), and date of issuance of CDCLAA.

B. THE PROSPECTIVE ADOPTIVE PARENTS (PAPs)- Information covers the period from
application to matching

I. PAPs IDENTIFYING INFORMATION

Female PAP Male PAP

Complete Name
(First, Middle and
Last name)
Date of Birth
Place of Birth
Religion
Civil Status (date
and place of
marriage, if
applicable)
Ethnicity /
Citizenship
Language/s

Page 3 of 8
Logo Agency/ Company Name
Address
Contact Details

spoken
Education
Occupation
Mobile Phone
Home Phone
number (landline)
Work Phone (if
applicable)
E-mail address (if
applicable)
Employer
Employer address
and contact details
Monthly Income
Other sources of
income

II. FAMILY COMPOSITION AND OTHER INDIVIDUALS LIVING WITH THE PAPs

Name Age Relationship Educational Occupation Disability/

to the client Attainment sickness (if any)

III. FAMILY BACKGROUND INFORMATION/DESCRIPTION OF THE PAPs:

This should include information about the PAPs’ parents and siblings, childhood
experiences of the couple and how they were reared by their family and significant
others in their lives. It should also include information about the discipline pattern of the
family including sensitive areas such as history of child abuse, alcohol and substance
abuse and their corresponding sanctioning penalties (please indicate if arrested or
detained or rehabilitated due to substance abuse), vices and coping mechanisms in
handling stress/crisis and conflicts. Further, it should consider the PAPs’ physical
description and personal traits, social relationships, and educational history.

IV. MOTIVATION TO ADOPT: This should address reason/s for wanting to adopt, who,
when, how the decision was arrived at; attitude and resolution of feelings towards
infertility, if applicable and understanding of adoption issues.

V. CHILD CARE AND GUARDIANSHIP PLANS: This should include information on the
duration of parental leave from work, if applicable, day to day care of the child, childcare
arrangement after the parental leave, education of the child as well as how the PAP/s will
manage caring for the adoptive child and other life commitments such as work.

The attitude of the extended families and friends should be indicated, future plans, if
any, for the child are to be included.

This section should also include the PAPs’ thoughts and plans in case a pregnancy occurs
after the process of adoption.

Page 4 of 8
Logo Agency/ Company Name
Address
Contact Details

VI. MARITAL HISTORY/RELATIONSHIP: This section should include the following

information: nature and extent of marital relationship, patterns of resolving conflict,
annulment history/ discussion of circumstances and relationship, children from previous
marriage/s with whom they are currently living, current family relationships, particularly
husband/wife, parent/child, siblings, and their extended families.

VII. CHILD/REN IN THE FAMILY (if applicable) - Description of the child/ren, their
significant traits and characteristics, their role in the home and their preparation for the
coming of another child, their feelings, and attitudes towards adoption. Indicate if
biological or adopted, date/s of birth, age/s, description of characteristics, educational
attainment.

Previous history of adoption disruption, if any.

VIII. OTHER INDIVIDUAL/S LIVING AT THE HOME (if applicable) - Descriptive

paragraph of every person living in the home should also be included, adult family
members should be asked the same questions re: substance abuse, sexual or child
abuse and their responses discussed.

IX. THE ATTITUDE OF IMMEDIATE FAMILY MEMBERS REGARDING ADOPTION: This

should include information on whether the adoption plan was discussed with the
extended family members of the PAP/s, thoughts, and attitude of the extended family
members on the adoption and their involvement with the adoptive child after placement

X. PARENTING AND CHILD CARING EXPERIENCE: The couple’s experience in taking

care of a child/ren whether on temporary or prolonged basis should be indicated. Their
past experience in parenting and/or knowledge of childcare as well as their expressed
disposition and attitude towards disciplining a child, ability to provide nurturing care and
supervision in an atmosphere of affection and moral and material security should be
indicated.

XI. EMPLOYMENT HISTORY/FINANCIAL RESOURCES: The employment history of the

PAP/s should indicate reasons why they moved or changed work. Provide a short
description of the source/s of income, savings, investments, expenditures, and liabilities,
if any, and insurance/s.

XII. DESCRIPTION OF HOME AND COMMUNITY: The home study should describe the
family’s home, child’s accommodation, membership and participation in community
organizations, community projects and activities. Community resources and specialized
facilities for children such as hospitals, clinics, schools, etc. should be included in the
report. Information about peace and order in the community should be given and the
degree of racial tolerance (if applicable) and how this may affect the adjustment of the
child in the community.

XIII. SOCIAL ETHNO-CULTURAL, LINGUISTIC AND RELIGIOUS IDENTITY OF THE

PAP/s: Spiritual/philosophical/moral/religious beliefs, affiliations, and practices.

XIV. HEALTH HISTORY: PAP/s should indicate any serious illness, physical disabilities, or
history of mental illness, if any. A medical report on the family’s health status and health
history should be discussed.

Psychological evaluation report: This should include information on the psychometric

tests done, results of the tests and clinical interviews, assessment summary and
recommendation/s of the psychologist.

Page 5 of 8
Logo Agency/ Company Name
Address
Contact Details

XV. CHARACTER REFERENCES AND CLEARANCES: Summary of character references

including clearances attesting to the PAPs good moral character.

XVI. ADOPTION TRAININGS/FORUM ATTENDED/COMPLETED:

For PAP/s who have undergone pre-adoption trainings, include the title of the trainings,
number of hours, topics discussed and insights/learnings of the PAP/s.

XVII. ADOPTION TELLING AND POST ADOPTION ISSUES: This includes the PAP/s plan on
how they intend to tell the child about his/her adoption story, the PAP/s opinion on the
issue of adoption search and reunion with the birth family.

C. ADOPTION PLACEMENT- Information covers the period from entrustment, supervised trial
custody (if applicable) and before the filing of the petition.

I. PLACEMENT HISTORY

Date of Matching (if applicable)

Name of RACCO/CPA
Date Accepted by PAPs
(if applicable)
Date of entrustment
Age of Child upon entrustment

II. Description of the child/adoptee upon placement/entrustment to the PAP/s or

when the PAPs took custody of the child/adoptee: Summary statement on the
child/adoptee’s overall development (Physical/health, social, emotional, cognitive
functioning)

III. Supervised trial custody report (if applicable) - Summary statement on the
placement including issues/concerns and reciprocal adjustment of the child/adoptee and
the family.

IV. Current Functioning of the Child/Adoptee- This should cover how the child/adoptee
is currently doing relative to the following developmental aspects such as emotional,
social, psychological, and cognitive functioning after placement with the PAPs.

For the physical aspect, indicate current height and weight.

For the emotional and social aspect, include how the child/adoptee relates to his/her
adoptive parents, adoptive siblings (if applicable). How the child/adoptee relates with
the extended family members and relatives of the adoptive parents? How the
child/adoptee relates with other children, caregivers, strangers, or whether the
child/adoptee developed emotional attachment to a specific person in the adoptive
family? What makes the child/adoptee happy/sad? What does the child/adoptee do
when frustrated/angry? Is the child/adoptee able to regulate his/her emotions on
his/her own? Is the child/adoptee able to express himself/herself freely or does he/she
need coaching/encouragement to open up? Is the child/adoptee able to talk about
his/her feelings? How is the child/adoptee pacified? What discipline method works best
for him/her? Does the child/adoptee have any behavioral concerns that the adoptive
parents are concerned about? How do the adoptive parents handle the child/adoptee’s
behavior?

Page 6 of 8
Logo Agency/ Company Name
Address
Contact Details

Description of the child/adoptee’s personality, hobbies, and interests.

For the psychological aspect, strengths and weaknesses of the child/adoptee, level of
confidence and self-esteem, ability to deal with frustrations/challenges, methods/ways
of learning of the child/adoptee, if applicable. For educational aspect, include grade
level, academic performance, and subjects where he/she excels at or needs
improvement. The teacher’s perspective on the child/adoptee’s academic performance
should be discussed.

For a child/ren/adoptee attending play, occupational or speech therapy, information

must be included as to the progress of the child/adoptee resulting from the
intervention/s.

How the adoptive parents support the child/adoptee’s overall growth and development?
The degree of attachment and bonding between the child/adoptee and his/her adoptive
family.

V. ASSESSMENT- Summary statement on the progress of the placement and overall

changes to the PAPs family after the placement.

VI. RECOMMENDATION- Summary statement indicating the social worker’s

recommendation on the placement (i.e. issuance of Order of Adoption/Denial).

Page 7 of 8
Logo Agency/ Company Name
Address
Contact Details

Prepared by: Approved by:

(Signature) (signature)
(Name of Social Worker) Name of Head of Office
(License Number and Validity Date)

Page 8 of 8