FORMAT OF HOMESTUDY REPORT (HSR) FOR PROSPAECTIVE ADOPTIVE PARENTS (PAP’s) IN INDIA

CARINGS RESIGTRATION NO. PrMa34410686

DATE OF REGISTRATION 26th June 2015 AADHAR CARD 538418264642 / 409077233378 NAME OF THE SOCIAL WORKER Sr. Fatima Lopes DATE OF HOME VISIT 28th July 2015

PART – I SELF ASSESMENT

A. Identifying information about the PAP’s and their family background :

Particulars of information Male Applicant Female Applicant

Full Name Stephen Dsouza Lavina Dsouza

Date of Birth & age 08/10/1970 , 45 years 01/02/1980 , 35

years

Place of Birth Mumbai Mangalore

Complete Address with E-mail

ID

( Present & Permanent

Address)

A/2,Jagdish Apt, Marol

Military Road, Andheri East,

Mumbai 400059

A/2,Jagdish Apt,

Marol Military Road,

Andheri East,

Mumbai 400059

Country of Origin India India

Country of Citizenship Indian Indian

Passport Number K5414355 G5831421

Religion Christian - Roman Catholic Christian - Roman

Catholic

Language(s) Konkani, English, Hindi,

Marathi

Konkani, English,

Hindi, Marathi

Date of Marriage 05/01/2005 05/01/2005

Date of Earlier Marriage ( if

any)

NA NA

Date of Divorce ( if any ) NA NA

Present Educational B.Com B.Com

Qualification

Employment/ Occupation Service Service

Name & Address of Present

Employer / Business concern

Zee Entertainment

Enterprises

Ltd.135,Continental Bldg,

Dr. Annie Besant Road, Worli,

Mumbai-400018

IPM India Wholesale

Trading Pvt.Ltd.

B 403,Citipoint,

J.B Nagar,

Andheri Kurla

Road,Mumbai-

400059

Annual Income Rs.10 Lacs Rs.2.50 Lacs

Health Status Physically Fit Physically Fit

B. Family Background Information :

Details about Parents of Applicants

Male Applicants Female Applicants

Father Mother Father Mother

Name in full Xavier Dsouza

Dulcine Dsouza

Jerome Mascarenhas

Victoria Mascarenhas

Age Expired 65 years 63 years 61 years

Nationality/ Citizenship Indian

Indian Indian

Occupation --------- Housewife Retired Housewife Previous occupation ---------- Housewife Steward Housewife

Presently residing with ---------- Sister My Brother

(2) Adopted / Biological Children:

Name of the child Sex Date of Birth Education Status

N.A

(3) Please describe how you believe the prospective adoption of a child will affect the

lives of your existing children. Not Applicable

(4) Please indicate whether there are any other family members residing in the family

home. - No

(5) If yes, please complete the following table including the age, gender, occupation

and nature of the familial relationship of the other residing family members

Name Nature of the Relationship

Age Gender Occupation

NA NA NA NA NA

(6) Please describe how you believe the prospective adoption would affect these family

members. – Not Applicable

(7) Please indicate whether there are any other non-related adults/ children in the

home - No

(8) Please describe how you think the prospective adoption will affect non-related

adults / children residing in the familial home. – Not Applicable

C. Professional/ Employment Details (Professional details for last 5 years : Please

complete the following details relating to your professional career.

Male Applicant

Organization Employer Details (Name & Address )

Job Title From - To

Zee Entertainment Enterprises Limited

135, Continental Building, Dr.A.B.Road, Worli,

Mumbai -400 018.

Manager – Credit Control

Nov 2008 - Till Date

Lintas India Private

Limited

Phoenix, 3rd Floor,

S.J. Marg, Lower Parel (West) Mumbai

Senior Executive-

Commercial

June 2006 – Nov

2008

Female Applicant

Organization Employer Details (Name & Address )

Job Title From - To

IPM India Wholesale

Trading Private Limited

B-403, Citi Point,

Andheri Kurla Road, Andheri

(East), Mumbai

400059

Admin Asst. May 2015 – Till

Date

IBM India Private

Limited

C/o.Idea Cellular

India Private

Limited, Windsor

House, 4th Floor, Kalina, Santacruz

(East), Mumbai

PMO

Co-ordinator

June 2010 –

Sept 2014

D. Financial Position ( Give a short description of your income from all sources , saving investments ,expenditure and liabilities)

Ownership of 1BHK flat at Andheri East.& 2BHK flat at BhabolaNaka, Vasai. andJewellery (1) Please provide your most recent tax invoices, bank statements etc. and the

taxable income of you and your partner.- Already provided

(2) Do you have any outstanding debts, mortgages etc. – NO

E. Description of Home and Neighborhood: (Describe the accommodation

details and neighborhood relationship)

Cordial and affectionate, we reside on the ground floor with

immediate neighbors

(1) How many rooms do you have in your home and describe the play area

available for the child.

We have 1BHK Area 525 Sq feet, with society area for leisure.

(2) Please describe the neighborhood in which you reside, including any aspects

that you believe makes it child friendly.

Friendly and harmonized neighborhood /societies with open grounds

for outdoor games / activities.

F. Current marital relationship and quality of marital relationship (if

applicable) (Give details about the marriage, legal separation , if any,

reasons for such separation, present marital life and decision making

procedures) – Healthy Relationship

(1) Please circle the term the best describes your marital status

(a) Married

(b) Single

(c) Live in

(d) Widowed

(e) Other, please specify ------------------------------------------------------------

(2) Please describe the procedures you and your partner use to reach a decision.

After invasive trials of infertility tests the desire and the hope of a child

in our lives. As a couple we have been praying fervently for a gift of a

child. In our prayer life together we have totally surrendered ourselves to

the good Lord and have come to this decision of adopting a child.

G. Attitude and Motivation of PAP’s for adoption

(1) Please circle the term which best describe the reason why you wish to

adopt, you may circle more than one option, if applicable:

a) Provide a companion to your other children

b) Infertility

c) Provide an impoverished child with a happy home

d) None of the above

e) Other, please specify--------------------------------------------------

(2) Please circle the statement which describe how you think the adoption will

improve the lives of your other children, you may circle more than one, if

applicable:

a) They will be less lonely b) They will learn to be more accommodative c) They will become more empathetic d) Not applicable as I have no other children e) Other, please specify-------------------------------------------------------

H. Attitude of grandparents /extended family members, other relatives and significant others towards the recent adoption: (Give a short description about the opinion of other important persons towards adoption who would have impact in the child rearing process when the child arrives in the receiving country) – Family members are supportive for adoption decision.

I. Anticipated plans of the PAPs for adopted child and rearing in the family:

1) Please describe how you will manage caring for the adopted child and other life Commitments such as work.

Currently plan is to take 3 months leave from office, after which my mother will be take personal care of the baby while I am at work.

2) Who will be responsible for caring for the child when you are at work, or absent from the Familial home (Domestic help, grandparents, spouse)

Grand mother (maternal mom)

3) Please describe your disciplinary approach to parenting. By nature we are calm and loving personalities. We would nurture our child the way our parents raised us. Disciplinary and tenderly.

4) In case the adopted child demonstrates adjustment difficulties, please

describe the steps that you plan to take to ease his/her transition into the family.

We are certain that such a situation may not arise. And if so, we will take the guidance of our near family members (Parents)

5) Would you be prepared to utilize additional family counseling if the adopted child continues to have difficulties adjusting?

a) Yes b) No

J Preparation and training for adoption: (Give details about the counseling

sessions the PAPs have Undergone on adoption, child care, handling of the needs of the children, etc. and their capacity, PAPs training and /or experiences in parenting children with their special need if any.

None

K Possible rehabilitation plan for the child in case of any eventuality with PAPs: (Give a short description about your plan for the security of the child in case

you face any short or long term eventuality. In case you are a single PAP, please give a short description about the close relative who would be giving undertaking for the security of the child)

My brother will hold guardianship and full responsibility of the security of the child. 1 Does your work require you to travel?NO 2 Who would care for the child in your absence? Please provide a brief –

description including his/ her age, gender, occupation and relationship. Grandmother from maternal side, she is 61 years old, house wife.

3 In the event of unforeseen misfortune do you have someone who would take legal guardianship of child? If so, details thereof:

Brother from maternal side. He will be the legal guardian.

4 In case relationship does not work out would you part with custody of this child/ren to someone else, send back to homes, consult a counselor.

Never L Plans for disclosure of facts of adoption of the child:

1. We have planned to tell the facts of his/her adoption as soon as the child begins to understand things in a story form.

2. M Health status (Emotional and physical) (Give details of the state of emotional

and physical health status of the applicant (s), if any. If a family member

suffers from a particular disease, condition or syndrome, describe how the family copes with it and how this might affect any proposed adoption. None.

PART - II ASSESSMENT REPORT OF THE SOCIAL WORKER

1. Factual Assessment

(i) Have you verified the contents of the facts mentioned in Part I of the template

Yes /No

(II) Are you satisfied about the facts mentioned in the documents vies-a-visa

observation Yes / No

2. Psychological Assessment :

2.1 Interaction with PAP’s

(i) Have you interacted with PAP’s individually and /or jointly?

The social worker on her home visit was able to meet both. While on home visit the

social worker interacted with the PAPs individually as well as jointly.

(ii) Are the PAP’s well prepared for adoption? In case of single PAP, please

mention about family support system.

The couple has deep desire and longing to have their own child. The couple shared

that Mrs. Lovina has already had four miscarriages and that she has been under

treatment ever since they are married. Since 10 years of marriage they have not been

able to have their own biological child. They want to complete their family and

adoption is the only option by which they can complete their family.

(iii) Do you think that PAP’s have expressed their genuine feeling for parenting

Yes / No

2.2 Home Visit findings

(i) When did you visit the home of the PAP’s / Who were there the members

present during the visit ?

The worker went for Home visit to the PAPs on the ……….. On her Home visit she was

happy to meet both husband and wife.

(ii) Whom did you interact during the visit?

During the first visit the worker interacted with the PAPs.

(iii) Have you met any neighbor / relative? Give a detailed about the interaction

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The worker was happy to meet some neighbors during her Home visit and interact

with them. The neighbors had a very positive image of the PAPs. They shared that

both Lovina and Stephen bear a good character, they are very generous, sensitive and

helpful to all the neighbors to the extent of going out of their way to be of help to

someone who is in need. They both take a very active part in organizing various

activities in their neighborhood. The worker was also happy to know that Lovina

takes great care of one of their neighbor who is old and stays alone.

(iv) Whether the home environment is conducive for the child? If no, what steps

can be taken to improve the situation? Have you advised the PAP’s?

The couple lives in one of the well a maintained secure area called Jagdish Apartments

CHS. at Marol Military Road, Andheri (E), Mumbai 400 059. It is a 4 Storey building.

The couple lives on the ground floor. The couple has 1 BHK with a built up area of 525

sq.ft. The couple also owns one more flat at Vasai Road. Around the building there is

enough open space to park vehicles and open place to play. For education purpose

there are schools like St. John the Evangelist, Divine Child, Canossa High School, in the

same vicinity. For medical needs they are very close to Holy Spirit Hospital, Seven Hills

Hospital. Besides, there are private doctors easily available. They are also very close

to Andheri station and to new Metro railway line. The social worker observed that

the overall atmosphere and the environment of the Home was very friendly, loving

and welcoming.

(v) Are the PAP’s well prepared for adoption?

The worker has spent time in interviewing and counseling the PAPs in preparation for

the adoption. During the interviews the PAPs have been very open in sharing. The

worker very strongly feels that the PAPs are well prepared to adopt a child.

(vi) Do you think that the PAP’s have expressed their genuineness during the

interaction ?

Stephen and Lovina were married on 5th January, 2005. Theirs was an arranged

marriage. Stephen met Lovina at a get together ever since he was interested in her

and later on he approached her family members and proposed for Lovina. Ever since

their marriage the PAPs are very much interested in starting a family. They both

shared that they have a very happy married life. They shared that marriage is an

opportunity to know each other at a deeper level. They are indeed a very happy to

have each other as their life partner. All the important decisions are taken jointly by

both. Stephen shared that Lovina is very loving, caring and home loving person. She

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has concern for others need, helps to keep the family together. On the other hand

Lovina expressed that Stephen is a very caring and supportive husband, very

trustworthy and reliable person. There is much openness in their sharing with each

other.

(vii) Did the PAP’s have any doubts about parenting issues or any other issues?

Have you cleared their doubts?

During the Home visit the PAPS did not have much doubt about parenting. The PAPs

came across as well prepared with much knowledge about how to parent an adopted

child. The only question that the PAPs had during the interview and the Home visit

was how to disclose to the child about the adoption. The social worker spoke to them

at length and advised this as to how and when they should disclose this.

2.3. Interaction with the family members

(i) Have you interacted with the family members of the of the PAP’s? What is

their opinion about the proposed adoption? Are they positive about the

adoption?

The worker has interacted with the other family members. Before making this final

decision about adopting a child the PAPs have discussed this matter with their family

members and taken their consent. The family members are very happy with this

decision of the PAPs. The worker observed that the family members are eagerly

waiting for a child.

(ii) Are there any other family member (s) whom you could not interact but they

might have a large role in the proposed adoption? If so, how did you interact?

Would you plan to take their views?

The worker on Home visit met close family members, especially those have an

important role to play in the adoption of a child. There is no issue about it at

all.

(iii) Have you interacted with older child/children present in the home of the PAP’s

If yes, please give details.

The PAPs do not have any biological /adopted child. The children of PAPs

brothers and sisters are eagerly waiting for a child. One more companion to

play with them.

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(iv) Have you noticed any adverse remark from the family members? If so, how far

those remarks may have an impact on the adoption process?

The worker has not noticed any adverse remarks from any of the family members on

the contrary they are indeed happy and excited to have an adopted child in their

family and are very willing to take care of the child.

2.1 Financial Capacity

(i) What is your opinion about the financial status of the PAPs? Are they

Financially sound to welcome another member into their family.

The worker feels that the PAPs are financially sound to look after the adopted child.

Mr. Stephen works for ZEE Ent. Enterprises and earns Rs.70.000/- p.m. and Mrs.

Lovina works for Manpower Group Services India Pvt. Ltd. And earns Rs.25, 000/- p.m.

Besides their monthly income they have fixed deposits in LIC policy and gold worth

Rs.2, 50,000/-. They also own one more BHK flat at Vasai. The worker strongly feels

that the PAPs are capable of parenting a child and looking after his educational,

physical and medical needs.

(ii) Have you observed any financial situation which is hidden in the template?

During the interview and the Home visits the PAPs was very open and transparent in

their sharing. There is nothing hidden about their financial situations.

2.2 Physical and emotional capacity

(i) Are the PAPs in good physical & emotional state to take care of a child?

The PAPs have been medically examined by Dr. ………… who confirms that they are

physically and mentally fit. Their blood reports for Australia Ant igen and HIV I & II

confirms that they are negative. They both do not suffer from any contagious

diseases. They are medically fit to adopt a child and to take care of a child.

(ii) Have you observed any physical or psychological issues with the PAPs or any

other family members that is going to affect the life of the upcoming child? If

so, give details.

The worker has not observed any physical / psychological issues with the PAPs or any

family members that is going to affect the life of the child. There is a strong bond

between the family members. Regularly family comes together for social gathering.

The PAPs frequently visit other members.

(iii) Are the PAPs emotionally equipped enough to take care of a child?