Form CFS 574-2 Agency Reporting Form for Adoptive Parent Training Curriculum - Illinois

Form CFS574-2 or the "Agency Reporting Form For Adoptive Parent Training Curriculum" is a form issued by the Illinois Department of Children and Family Services.

Download a PDF version of the Form CFS574-2 down below or find it on the Illinois Department of Children and Family Services Forms website.

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CFS 574-2
State of Illinois
Rev 3/2017
Department of Children and Family Services
AGENCY REPORTING FORM FOR
ADOPTIVE PARENT TRAINING CURRICULUM
Agency Name
Address
Telephone Number
Email
Contact Person
Date Submitted
Date Last Submitted
Agency Accredited:
No
Yes, if so, effective date & by which entity:
Type of Adoption Curriculum (Check one)
International
Private Agency Assisted Domestic – Specify one:
Infant
Older child
Child with Special Needs
DCFS Special Needs/newly recruited
DCFS Foster Care Conversion
PRE-PLACEMENT TRAINING
Total number of hours of pre-placement training
6 complete hours minimum for domestic pre-placement adoption
4 complete additional hours for special needs adoption specific to child’s needs
10 complete hours minimum for international pre-placement adoption
Does your agency require PRIDE training?
Yes
No
(PRIDE Training may not be used to meet Pre-Placement Adoption Training Requirements for non foster-
care conversions, unless the foster parent has completed all components of PRIDE training and is up to
date on CEUs.)
Total number of hours of Home Study process (Must occur separately from training and is not considered
to be training)
Method of training for curriculum-(Check all that apply)
Group Sessions
Individual/Couple Sessions
Web-based
Other (specify)
Name of curriculum, if purchased
(If purchased, provider and curriculum must be approved by DCFS)
Name of provider, if outsourced
(If outsourced, provider and curriculum must be approved by DCFS)
1
CFS 574-2
State of Illinois
Rev 3/2017
Department of Children and Family Services
AGENCY REPORTING FORM FOR
ADOPTIVE PARENT TRAINING CURRICULUM
Agency Name
Address
Telephone Number
Email
Contact Person
Date Submitted
Date Last Submitted
Agency Accredited:
No
Yes, if so, effective date & by which entity:
Type of Adoption Curriculum (Check one)
International
Private Agency Assisted Domestic – Specify one:
Infant
Older child
Child with Special Needs
DCFS Special Needs/newly recruited
DCFS Foster Care Conversion
PRE-PLACEMENT TRAINING
Total number of hours of pre-placement training
6 complete hours minimum for domestic pre-placement adoption
4 complete additional hours for special needs adoption specific to child’s needs
10 complete hours minimum for international pre-placement adoption
Does your agency require PRIDE training?
Yes
No
(PRIDE Training may not be used to meet Pre-Placement Adoption Training Requirements for non foster-
care conversions, unless the foster parent has completed all components of PRIDE training and is up to
date on CEUs.)
Total number of hours of Home Study process (Must occur separately from training and is not considered
to be training)
Method of training for curriculum-(Check all that apply)
Group Sessions
Individual/Couple Sessions
Web-based
Other (specify)
Name of curriculum, if purchased
(If purchased, provider and curriculum must be approved by DCFS)
Name of provider, if outsourced
(If outsourced, provider and curriculum must be approved by DCFS)
1
POST-PLACEMENT TRAINING
Total number of hours of post-placement training
Method of training for post- placement/continuing education (Check all that apply)
Group Sessions
Individual/Couple Sessions
Web-based
Seminars/workshops
Video/audio tapes
Handouts/books
PRIDE/Inservice
Other (specify)
Name of curriculum, if purchased
(If purchased, provider and curriculum must be approved by DCFS)
Name of Provider, if Outsourced
(If outsourced, provider and curriculum must be approved by DCFS)
ADDITIONAL INFORMATION
Does your agency charge a separate fee to prospective adoptive families for any costs or fees related to
this training?
No
Yes (if yes please attach a copy of your agency’s written disclosure policy
regarding fees and refund policies).
Curriculum Submission: Agencies are required to submit a copy of their current curriculum for approval
to DCFS. Submit one form for each of the type of training your agency offers. Once submitted and
approved, resubmission is required at the time of licensure renewal (every four years) or at any time that
there has been a change to the curriculum (including; additions, deletions or any changes in the
number of hours, format or the material that are provided to families).
Submit your curriculum and a brief narrative of your agency’s training requirements for approval to:
DCFS Office of Training and Professional Development
406 East Monroe – Station #122
Springfield, IL 62701
Attention: Adoption Curriculum Reviewer
A copy of the pertinent curriculum must be attached to this form and each of the following curriculum
components must be documented by tabbing and or highlighting the content so that the required
competencies/objectives are easily identifiable. Beginning in 2008, if changes have been made to your
curriculum since last submitted to the Department, make sure that those are clearly identified. The
submitted copy of the materials will not be returned to your agency. Your agency will be notified if any
additional information is required, of its approval status, and any resulting recommendations.
Curriculum Components: Please review the following list of curriculum competencies. Check those that
are covered in your curriculum and indicate where they are found.
If you have other additional
components or competencies not included on the list, or those that you believe fulfill certain
requirements, please indicate so at the end of this section in a brief narrative.
Your agency narrative should include an explanation for requests of exceptions to the required
competency inclusions that you wish to have considered.
2
CFS 574-3
10/2007
State of Illinois
Department of Children and Family Services
INTERNATIONAL ADOPTION
Curriculum Content Checklist
Preparing for Successful Adoption
Defining adoption
How adoption is different:
From forming a family by birth
Making a lifetime commitment
Changing roles and responsibilities
Considering the impact on all members of the family
Considering the impact on extended family and friends
Adoption as a life-long process
Positive adoption language
Other, specify
Process for Completing an Adoption
Criteria used to determine eligibility
Backgrounds checks
Fees, costs and refund policies related to the process
Home study process
Pre-placement requirements
Placement process
Post-placement requirements and supports
Determining readiness for adoption legalization
Intercountry Adoption Act or 2000 pre and post-adoption reporting requirements, if
applicable
Other, specify
Adoption as a Legal Process
Legal specifics regarding the child’s country of origin
Foreseeable delays and/or impediments to adoption
Full and fair child specific disclosure/Confidentiality
Adoptive parent rights and responsibilities
Voluntary and Involuntary Termination of Parental Rights
Adoption Legalization Process
Other, specify
Understanding a Child’s Prior Experiences and How They Effect Adoptive Placements
Characteristics and needs of children awaiting adoption; current and future implications
Conditions of the region or country of origin, if applicable
Orphanage life, institutionalization and/or placement history
Type of care, effects of poor care and/or institutionalization
Pre-placement history, including length of time
Lack of attachment
Other, specify
1
Medical risks
Limited, inaccurate or missing background information
Unknown or undiagnosed medical conditions
Limited access to medical care and the need for immediate care upon arrival
Effects of risk factors associated with the region or country of origin
Malnutrition
Environmental toxins
Genetic, health, emotional and/or developmental risk associated with the region
or country of origin
Drugs and alcohol use during pregnancy
Other, specify
Attachment Issues
Significance of forming healthy attachments
Attachment Disorders
Promoting healthy attachments
Other, specify
Openness as a Continuum in Adoption
Defining openness as a continuum
Respecting past attachments and openness when appropriate
Other, specify
Special Issues in Adoption
Separation/loss and grief
Effects of multiple caregivers and placements
Raising a child of a different culture, ethnicity, race, religion or linguistic background;
current and future implications
Caring for children with special needs (i.e. medical, physical, emotional, behavioral,
developmental, and educational issues)
Child Development, the impact of adoption, and transition to new culture
Parenting and discipline techniques
Adopting the older child
Infant CPR
Subsidy eligibility and post-adoption support services
Preservation
Education
Search and reunion
Support groups
Service referral
Other, specify
Other Issues Specific to Child’s Special Needs, specify
Ensure full disclosure of all known child specific information, including risk factors,
current and future implications
Other, specify
2
CFS 574-4
State of Illinois
10/2007
Department of Children and Family Services
SPECIAL NEEDS AND FOSTER CARE CONVERSION ADOPTION
Curriculum Content Checklist
Preparing for Successful Adoption
Defining adoption
How adoption is different:
From forming a family by birth
From providing foster care
Making a lifetime commitment
Changing roles and responsibilities
Considering the impact on all members of the family
Considering the impact on extended family and friends
Adoption as a life-long process
Universal Adjustment Issues
Predictable Crisis Periods
Positive adoption language
Other, specify
Process for Completing an Adoption
Criteria used to determine eligibility
Backgrounds checks
Fees, costs and refund policies related to the process
Home study process
Pre-placement requirements
Placement process
Post-placement requirements and supports
Determining readiness for adoption legalization
Other, specify
Adoption as a Legal Process
Full and fair child specific disclosure/Confidentiality
Birth parent rights and responsibilities
Adoptive parent rights and responsibilities
Voluntary and involuntary termination of parental rights
Minimum standards for witnessing a consent or surrender
Legal risk placement (if appropriate)
Adoption legalization process
Other, specify
Understanding Birth Parents and their Importance
Raising compassion, respect and understanding of the birth family
Understanding the reasons adoption plans are made for children
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Download Form CFS 574-2 Agency Reporting Form for Adoptive Parent Training Curriculum - Illinois

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