Adoption Disruption Risk Assessment Questionnaire
Adoptive Parent(s) Name(s)
Child Name
Child Age
Date of Assessment
Risk Factors
History of previous placements
Attachment concerns observed
Developmental or behavioral concerns
Medical or mental health issues identified
Adoptive parent(s) support systems
Parental expectations and preparedness
Financial or resource challenges
Current family stressors
Access to adoption preservation services
Risk Assessment Summary
Summary of risk assessment
Recommended interventions