Post Placement Questionnaire

  • Name:

  • Email:

  • Are you a Santa Clara County Foster & Adoptive Parent Association member?
    Yes No    
  • Is your home?
    County Licensed FFA Relative Caretaker
  • Was this placement?
    ESH Concurrent (fost/adopt) Relative Placement
  • Social Worker (use separate form for each SW)



  • Was this Social Worker in:
    DI Worker Continuing Adoptions Unknown
  • Did the Social Worker contact you with 48 hours of placement?
    YES NO    
  • If no - how long before you were contacted?

  • Did the Social Worker provide you contact information for: The child’s DA?
    YES NO    
  • The Social Worker’s Supervisor?
    YES NO    
  • Did Social Worker visit within the first week of placement?
    YES NO    
  • Did Social Worker visit every month?
    YES NO    
  • Where were your monthly visits?
    Your Home Visitation Center  
  • Did the Social Worker return your calls within 24 hours?
    YES NO    
  • Did Social Worker keep you informed about the progress of the case?
    YES NO    
  • Did the Social Worker give you an approximation of when the children may be moved? (for ESH)
    YES NO    
  • Did the Social Worker provide results when presented with a problem?
    YES NO    
  • Did the Social Worker provide results within a timely manner?
    YES NO    
  • Were you treated as part of the Child’s team?
    YES NO    
  • Were you invited to a TDM?
    YES NO    
  • Did you attend?
    YES NO    
  • Were you told that there was to be a matching?
    YES NO    
  • Were you invited to attend?
    YES NO    
  • Were you invited to an emancipation conference?
    YES NO N/A  

  • TRANSITION


  • Was a transition plan implemented when the child was moved from your home?
    YES NO N/A  
  • In your opinion, did the transition plan reflect the child’s needs?
    YES NO N/A  

  • REIMBURSEMENTS


    Were foster care payments/reimbursements prompt?
    YES NO    
  • Were foster care payments/reimbursements accurate?
    YES NO N/A  
  • Did the first check arrive at the end of the FIRST month following placement?
    YES NO N/A  
  • SECOND month?
    YES NO N/A  
  • Still waiting?
    YES NO N/A  
  • Did you contact the Eligibility Worker?
    YES NO N/A  
  • What were the results?

  • VISITATION


    Was visitation set up within the first week of placement?
    YES NO N/A  
  • How often were the visits?
  • Did you transport the child to the visits?
    YES NO N/A  
  • Where did the visits take place?
  • Who supervised?
    Caregiver Social Worker Visitation Staff member
  • Did you feel that your safety or the safety of the child was ever in jeopardy?
    YES NO    
  • If yes, please explain:
  • Please complete the following: I was grateful when the Social Worker:
  • I wish that the Social Worker had:
  • One thing I would have liked to tell the Social Worker:
  • The best thing this Social Worker did:
  • The worst thing the Social Worker did:
  • Additional Comments, thoughts, experiences or recommendations:

  • OPTIONAL

    Caregiver Name:

  • Would you like to be contacted by the Association about your answers?
    YES NO    
  • Would you like to be contacted by DFCS Staff about your answers?
    YES NO    
  • Contact Information: