Adoption Call to Action Baseline Survey

OMB Control No.: XXXX-XXXX

Expiration Date: XX/XX/XXXX

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) The purpose of this information collection is to understand experiences and outcomes related to the Adoption Call to Action, a Children’s Bureau initiative to support child welfare agencies in improving adoption outcomes. Public reporting burden for this collection of information is estimated to average 20 minutes per respondent, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. A Federal agency may not conduct or sponsor, and no individual or entity is required to respond to, nor shall an individual or entity be subject to a penalty or failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless that collection of information displays a currently valid OMB control number. If you have any comments on this collection of information, please contact Roshanda Shoulders, Children’s Bureau, by e-mail at [email protected].

Adoption Call to Action: Baseline Survey

The following information is being collected as part of the Adoption Call to Action initiative, which is a national effort to support the work of jurisdictions to find permanent families for waiting children and youth. Survey results will be used to understand specific target populations, implementation efforts, and outcomes, as well as challenges that jurisdictions face in these efforts. Participation in this data collection is voluntary and results will be used to inform the technical assistance offered, to include ensuring that technical assistance resources and networking opportunities are targeted at common challenges among participants. By design, instrument questions are primarily exploratory, to provide the Children's Bureau with periodic updates that reflect overall progress and impact of the initiative across all jurisdictions. As such, the results will provide the Children’s Bureau a national picture of the success of the initiative in moving waiting children to adoption. For this purpose, information will be shared with the Adoption Call to Action technical assistance team, which includes the Capacity Building Center for States, Capacity Building Center for Courts, Capacity Building Center for Tribes, AdoptUSKids, and the Children’s Bureau. This survey is expected to take up to 20 minutes to complete. While the items in this survey were designed to accommodate all participating jurisdictions, the Center recognizes that there may be situations unique to your jurisdiction, that would make it more challenging to complete some of the items in this survey. If you need assistance in completing this survey, please contact the Capacity Building Center for States at [email protected].

1. Jurisdiction: [State and territory picklist]

2. The target population for this effort includes children and youth who were waiting for adoption, defined as children with a primary goal of adoption or children who are legally free (except 16 and 17 year-old children with a goal of emancipation) as of 10/1/2019. However, agencies have the option of focusing their efforts on a smaller, more specific group of children. My jurisdiction is using…

1. The national target population (all waiting children in the state as of 10/1/2019)

2. A different target population

*(If respondent selects “a” for Q2, then respondent will skip Q3 through Q6)

3. Which children or youth has your jurisdiction chosen to focus on? (e.g. waiting children and youth who are over the age of 13 and not currently living with a permanent family)

________________________________________________________

4. How many children or youth are in this population?

________________________________________________________

5. What is the timeframe or date this target population was identified? (e.g. waiting children as of 10/1/2019)

________________________________________________________

6. In what geographic area is this target population? (e.g. statewide, in the jurisdiction’s largest office)

________________________________________________________

7. Please provide a short description of the intervention(s) your jurisdiction is using to improve outcomes for the target population.
   
   

________________________________________________________

8. Please describe a process measure or short-term outcome your jurisdiction will use to monitor the intervention, so you will know that the intervention has been implemented. (e.g. number of new listings on the heart gallery, number of new families completing home study applications)
   
   

________________________________________________________

9. Please provide baseline data for the process measure described above from January 2020 or earlier. (e.g. 20 children listed on the heart gallery in last 6 months of 2019)
   
   

________________________________________________________

10. Please provide updated data for the process measure described in the previous question, based on activity between January and June 2020. (e.g. increased the number of photo listed children to 40)
    
    

________________________________________________________

11. Has your jurisdiction experienced any barriers to implementing your intervention(s)?

1. Yes (Please describe):_________________

2. No

12. The national outcome measure for this effort is an increase in the proportion of all waiting children and youth who achieve permanency within the following year. Jurisdictions who have chosen a different target population may also have different or additional outcome measures. Is your jurisdiction using the national target population/outcome measure to assess improvement?

1. Yes

2. No, my jurisdiction is using additional or different outcomes measures

*(If respondent selects “a” for Q12, then respondent will skip Q13 through Q14)

13. Please describe the outcome measure your jurisdiction will use to assess improvements for the target population. (e.g. number and percentage of children exiting to permanency within six months who were waiting for adoption and living in a permanent family on the first day of the fiscal year)

________________________________________________________

14. Please provide baseline data for the outcome measure described in the previous question. If possible, this would include information about outcomes from a period prior to January 2020. (e.g. among children waiting for adoption and living with a permanent family on 10/1/18, 40% exited to permanency within the next 12 months, by 9/30/19)

________________________________________________________

15. Has your jurisdiction experienced any barriers to achieving the desired outcome (s)?

1. Yes (Please describe):____________________

2. No

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