Survey of Adoptive Families

from Holt International

INTRODUCTION:   This is a survey to gather some information on the health, education, and occupation of adoptive families and their children. There are also several questions on your use of and potential needs for several different types of post adoption services. The information you provide will be used for general research purposes and to help Holt better serve adoptees and adoptive families.

In exchange for filling out the survey, we will be pleased to send you a check for $60.00.

All the information you give will be used for research purposes only and your responses will be kept completely confidential.  We understand that you may not know the exact answer to each of the questions.  In such a case, please give us your best guess.  Any questions that refer to time of adoption mean the year in which you adopted ________.
 

First we have some demographic questions for you and your spouse.

1) What is your year of birth?

2) What is your gender?  

3) What is your current marital status?

 
 
4) If you are married, what is your spouse's year of birth? 5) Have you divorced or re-married since the time that you adopted your son or daughter? 6) What is your current occupation? (may include homemaker, retired, etc) 7) What is your spouse's current occupation? (may include homemaker, retired etc) 8) What was your occupation at the time you adopted your son or daughter? 9) What was your spouse's occupation at the time you adopted your son or daughter? 10) Which of the following categories represents the highest year of schooling you have completed? 11) Which of the following categories represents the highest year of schooling your spouse has completed? 12) Which of the following categories best describes your household's income? 13) Which of the following categories best describes your household's income as it was at the time your adopted your son or daughter? 14) What is your height and weight?
 
 
 
  15) What is your spouse's height and weight?
 
 
 
  16) Do you have any of the following conditions? (check all that apply) 17) Does your spouse have any of the following conditions? (check all that apply) 18) Which of the following is your current smoking status? 19) Which of the following is your current spouse's smoking status? 20) Which of the following was your smoking status at the time you adopted your son or daughter? 21) Which of the following was your spouse's smoking status at the time you adopted your son or daughter? 22) How many drinks of alcohol do you have in a typical day? 23) How many drinks of alcohol does your spouse have in a typical day? 24) How many drinks of alcohol did you have in a typical day during the year you adopted your son or daughter? 25) How many drinks of alcohol did your spouse have in a typical day during the year you adopted your son or daughter?



 
 
 
 

Now we have some demographic questions regarding your children.  Please answer as accurately as you can.  If you are unsure of certain answers, but could contact your children for assistance with these questions, please do so.

We have provided space for answers for up to five children.  If you have more than five children, please respond for ________ and the four siblings closest in age to him or her.  Please list ______ as child 1 in any of the tables.

26) How many children do you have in total?

27) What are their ages, gender and are they birth or adopted children?  If adopted, please also report the child's age at adoption.  Please list _______ as child 1 in this question and all of the following questions.
 
 
 
Current Age  Gender Adopted? (yes or no) If adopted, age at arrival in US
Child 1  
 
  
  
Child 2  
 
  
  
Child 3  
 
  
  
Child 4  
 
  
  
Child 5  
 
  
  
 
 
  28) What is your children's marital status and number of offspring (ie your grandchildren)?  Please also list your child's occupation and their spouse's occupation (if applicable).  Occupation may include student or homemaker. Please list _______ as child 1. 29) Please tell us the number of years of high school, college, and graduate school that each child has completed.  Also, if they attended college, please list the name of their undergraduate college, university or institution.  Please list _______ as child 1. 30) .  For each child that does not live with you, please circle your best guess as to your child's annual household income 31) For each child, please give us your best guess as to their height, weight, and please note whether the child suffers from any of asthma, diabetes, or high blood pressure. 32) For each child, please tell us whether, to the best of your knowledge, he or she smokes or drinks.
 
 
Smokes (yes or no)? Drinks alcohol (yes or no)?
Child 1  
 
Child 2  
 
Child 3  
 
Child 4  
 
Child 5  
 
  33) Which of the following services that Holt offers have you used? (Even if you have simply contacted us for information, please check "used.")
 
 
Service Description Used?
Search 
 		 Allows birth parents and adoptee to search for one another when adoptee is age 18 or older. 
 		  
Confidential intermediary services Allows communication between adoptee or adoptive parents and birth parents. 
 		  
Documentation services 
 		 Information about citizenship and copies of adoption related documents. 
 		  
Cultural and historical info Information about the cultural and historical forces at work that may lead to a birth parent's decision about adoption. 
 		  
Assessment and referral Holt offers supportive listeners and expert advice.  We can refer individuals or families to professionals, groups, camps, tours, websites, and literature. 
 		  
Networking with other adoptive families 
 
 		 Holt can refer you to adoptive parent groups and to other groups of parents who share your particular concerns.    
Articles, books, newsletters 
 		 Holt publishes a magazine, country newsletters, and has adoption related books for sale. 
 		  
Conferences and workshops 
 		 Conferences and workshops offer the opportunity to network and to learn about adoption related topics. 
 		  
Internet bulletin boards and guest books 
 		 Holt maintains a web site, www.holtinternational.org, with opportunities to connect with others. 
 		  
Heritage Camps 
 		 Holt's Heritage Camps offer international adoptees, ages 9 – 15, the chance to learn about their birth cultures and build friendships with campers and counselors, who are also international adoptees. 
 		  
Heritage Tours 
 		 Holt regularly offers guided tours for adoptees and their families or for adult adoptees to visit the birth country
 		  
Independent travel services As an alternative to the tours, Holt also offers basic travel information about the birth country. 
 		  
   35) Please indicate your level of interest in these services.  Please choose one interest level on each row of the table. 36) Of the services Holt offers, for which would you expect to pay a fee? (Please check all that apply.) 37) If given the opportunity to donate to Holt to support Post Adoption Services, would you do so? 38) When should Holt make an outreach effort to your family? (Please check all that apply.) 39) What suggestions do you have about services that Holt might have provided/could provide as your child matured/matures? 40) What is the best way to for Holt International to stay in touch with you? 41) Do you have a computer with internet access either at home or work? 42) If you answered yes to the above questions, would you be open to staying in touch with Holt via email?