Department  of  Health  and  Human  Services 
OFFICE  OF 

INSPECTOR  GENERAL 

IN-HOSPITAL  VOLUNTARY  PATERNITY 

ACKNOWLEDGMENT  PROGRAM 

Effective  Practices  in Parent  Outreach 
JUNE  GIBBS  BROWN 
Inspector  General 
AUGUST  1997 
OEI-06-95-00163  OFFICE  OF INSPECTOR  GENERAL 
The mission  of the Office of Inspector  General  (OIG), as mandated  by Public Law 95452,  as 
amended,  is to protect  the integrity  of the Department  of Health and Human  Services  (HHS) 
programs  as well as the health and welfare  of beneficiaries  served by those programs.  This statutory 
mission  is carried  out through  a nationwide  network  of audits,  investigations,  and inspections 
conducted  by three OIG operating  components:  the Office of Audit Services,  the Office of 
Investigations,  and the Office of Evaluation  and Inspections.  The OIG also informs  the Secretary of 
HHS of program  and management  problems  and recommends  courses  to correct  them. 
OFFICE  OF EVALUATION  AND INSPECTIONS 
The OIGs Office of Evaluation  and Inspections  (OEI) conducts  short-term  management  and program 
evaluations  (called inspections)  that focus on issues of concern  to the Department,  the Congress,  and 
the public.  The findings  and recommendations  contained  in these inspection  reports  generate  rapid, 
accurate,  and up-to-date  information  on the efficiency,  vulnerability,  and effectiveness  of departmental 
programs. 
OEIs Dallas Regional  Office prepared  this report under  the direction  of Chester  B. Slaughter, 
Regional  Inspector  General. 
Project  Staff included: 
DALLAS REGION  HEADQUARTERS 

Ruth Arm Dorrill,  Project  Leader 
 Ann OConnor,  Program  Specialist 

Lisa Lesh,  Intern 

Marnette  Robertson 

For additional  copies of this report,  please contact the Dallas Regional  Office at (800) 848-8960.  Department  of Health  and  Human  Services 
OFFICE  OF 

INSPECTOR  GENERAL 

IN-HOSPITAL  VOLUNTARY  PATERN ITY 

ACKNOWLEDGMENT  PROGRAM 

Effective  Practices  in Parent  Outreach 
JUNE  GIBBS  BROWN 
Inspector  General 
AUGUST  1997 
OEI-06-95-00163  EXECUTIVE  SUMMARY 
PURPOSE 
This report  describes  State best practices  in outreach  to and education  of unmarried  parents 
on voluntary  paternity  acknowledgment. 
BACKGROUND 
Federal  law requires  that States implement  hospital-based  programs  for the voluntary 
acknowledgment  of paternity,  seeking  to facilitate  at-birth  paternity  establishment  for children 
born  to unmarried  parents.  Paternity  researchers  agree that the most opportune  time for 
paternity  establishment  is the  happy hour  in the hospital  immediately  following  the birth 
and before  the release  of the mother  and child.  State child  support  agencies  are required  to 
make  available  materials  for educating  parents,  and hospital  staff must provide  mothers  and 
fathers  with both  written  materials  and oral explanations  regarding  the rights  and 
responsibilities  of paternity  establishment.  In addition,  parent  outreach  materials  must be 
made available  at vital  records  and child  support  offices,  and are encouraged  to be distributed 
to others  who interact  with unmarried  parents. 
FINDINGS 
In collecting  information  nationwide  for our companion  report  on State agency  and birthing 
hospital  implementation  of paternity  acknowledgment  programs,  we found that most State 
child  support agencies  (IV-D) had launched  efforts  to inform  parents  of the paternity  effort. 
This  report  describes  effective  or innovative  parent  outreach  and education  practices  and 
materials.  These highlighted  practices  in no way represent  all efforts  nationwide,  but give a 
snapshot  of practices  and materials  that have been reported  to us by State agencies  and 
hospitals  in the course  of our study. 
Guidelines for  Creating  and  Utilizing Parent  Outreach  Materials 
Outreach  materials  should clearly  communicate  the benefits  and consequences  of paternity 
acknowledgment,  and not just  the mechanics  of documentation. 
Thoughtful  outreach  materials  should be specifically  relevant  to the target population, 
reaching  unmarried  parents  of varied  languages  and backgrounds. 
Multiple  outreach  opportunities  can be used to reach  a broader  segment  of the target  group 
and to introduce  early,  and reinforce  through  repetition,  a clear  message  on paternity 
acknowledgment. 
Brochures  and information  sheets may be used effectively  to educate parents,  but they  should 
be brief  and engaging  and accompanied  by interactive  outreach  methods. 
1  Hospital  staff may be able to enhance  acknowledgments  by personalizing  outreach  efforts 
using  information  from patient  surveys  or birth  certificate  worksheets. 
Proactive  hospitals  offer  multiple  opportunities  for parents  to learn  about voluntary  paternity 
acknowledgment,  using pre-registration  and hospital  admittance  to take advantage  of early 
contact  with parents. 
A few States have begun to place child  support employees  on-site  at high-risk  birthing 
hospitals  to help hospital  staff and to communicate  directly  with unmarried  parents. 
Direct Contact Between  Hospital  Staff  and  Unmarried  Parents 
Hospitals  report  parents  are largely  open to talking  about paternity  issues,  so direct 
discussion  appears to be an important  tool  for encouraging  acknowledgment. 
Talking  with the mother  alone  initially  may allow  for greater  privacy  and a clearer  focus on 
paternity  issues. 
Supplementing  prepared  outreach  materials  with discussion  encourages  understanding  and 
allows  hospital  staff to be responsive  to individual  parent  questions. 
Pre-arranging  a time for the father  to sign or receive  information  may avoid problems  of 
timeliness  and coordination,  and allow  staff to talk with both parents  at once. 
Hospital  staff should be prepared  to make clear  the benefits  of acknowledging  and answer 
related  questions  not covered  in outreach  materials,  using  related  topics  such as the babys 
surname  to introduce  the idea of acknowledgment. 
Prenatal  Education 
Since many  hospitals  already  provide  childbirth  classes,  some States are able to include 
paternity  acknowledgment  education  as part of pre-existing  class curriculums. 
Medical  clinics,  physicians  offices  and schools  are valuable  venues  for addressing  paternity 
acknowledgment  during  prenatal  education. 
Follow-Up  After Discharge 
Timely  follow-up  with mothers  after hospital  discharge  reintroduces  the idea of 
acknowledgment  at a less hectic  time and provides  a method  for supplying  additional 
outreach  materials  and documentation  forms. 
ii  AGENCY  COMMENTS 
We have worked  in close partnership  with the Office of Child  Support Enforcement  (OCSE) 
throughout  the conduct  of this inspection.  Although  we did not receive  formal  comments 
from  ACF on our draft reports,  they demonstrated  through  their  collaboration  a general 
agreement  with this report  and the companion  reports.  We worked  with OCSE in developing 
a research  methodology,  provided  extensive  briefings  on study findings  and created  additional 
documents  to meet agency  needs.  We appreciate  their cooperation  and guidance  and will 
continue  to work  with them on the issues raised  in these reports. 
. . . 
111  TABLE  OF  CONTENTS 
PAGE 
EXECUTIVESUMMARY  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  i 
INTRODUCTION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 
FINDINGS 
Guidelines  for Parent  Outreach  . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 
Direct  Contact  between  Staff and Parents  . . . . . . . . . . . . . . . . . . . . . . . . . .  7 
Prenatal  Education  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  10 
Follow-Up  After  Discharge  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  11 
CONCLUSIONS  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  13 
APPENDICES 
A.  Typical  Questions  and Answers  ..........................  A-l 
B.  Sheet for Parents  Initials  ...............................  B-l 
C.  Typical  Brochure  ....................................  C-1 
D.  Parent  Information  Sheet  ..............................  D-l 
E.  Parent  Statements  ....................................  E-l 
F.  Patman  Comic  Excerpt  .................................  F-l 
G.  Certificate  Worksheet  ................................  G-1 
H.  Evaluation  .......................................  H-l 
I.  Follow-up  Letter  ....................................  I-l  INTRODUCTION 
PURPOSE 
This report  describes  State best practices  in outreach  to and education  of unmarried 
parents  on voluntary  paternity  acknowledgment. 
BACKGROUND 
The Omnibus  Budget Reconciliation  Act of  1993 (OBRA) amends the Child  Support IV-D 
Title of the Social  Security  Act,  requiring  States to implement  hospital-based  programs  for 
the voluntary  acknowledgment  of paternity.  The objective  of these programs  is to 
facilitate  at-birth  paternity  establishment  for children  born to unmarried  parents. 
Establishment  of paternity  at birth  has many  administrative,  financial  and emotional 
benefits.  Mothers  often lack information  about the importance  of and methods  for 
establishing  paternity.  Consequently,  they  may not seek to establish  paternity  until  a point 
at which the process  becomes  more  difficult. 
Paternity  researchers  agree  that the most opportune  time for paternity  establishment  is the 
happy  hour  in the hospital  immediately  following  birth  and before  the release  of the 
mother  and child.  Within  this narrow  window  of exposure  to unmarried  parents,  birthing 
hospital  staff must be prepared  to inform  parents  about the option  of voluntary 
acknowledgment.  Additionally,  parent  outreach  materials  must be made available  at State 
vital  records  office,  child  support agency  offices  and are encouraged  to be distributed  to 
other public  agencies  that  interact  with unmarried  parents.  Without  an establishment  of 
paternity,  unmarried  mothers  may never  obtain  a child  support order  and gain access to 
the enforcement  services  of their  child  support  office. 
Under  OBRA,  State child  support  agencies  must,  among  other  requirements,  make 
available  voluntary  acknowledgment  outreach  materials,  including  information  on parental 
rights  and responsibilities,  and materials  for training  hospital  staff.  State child  support 
agencies  must monitor  birthing  hospital  compliance  on at least an annual  basis.  The 
Personal  Responsibility  and Work  Opportunity  Reconciliation  Act of  1996 (PRWORA) 
expands the role of hospital  staff by requiring  them to provide  mothers  and fathers  with 
both written  materials  and oral explanations  regarding  the rights  and responsibilities  of 
paternity  acknowledgment.  As interpreted  by the Office  of Child  Support  Enforcement 
(OCSE),  the intent  of both  OBRA and PRWORA  is to make voluntary  paternity 
acknowledgment  part of the birth  registration  process. 
This report,  which describes  State efforts  to provide  education  and outreach  to unmarried 
parents  is one of four in a series on hospital-based  voluntary  paternity  acknowledgment 
programs.  In-Hospital  Voluntary  Paternity  Acknowledgment  Programs:  State Agency 
and Birthing  Hospital  Implementation  (OEI-06-95-00160)  details  nationwide  program 
participation,  In-Hospital  Voluntary  Paternity  Acknowledgment  Programs:  Hospital 
Experiences  in Sample States  (OEI-06-95-00161)  describes  program  usage using  survey 
1  responses  from birthing  hospitals  and State agencies  in 15 sample States,  and  In-Hospital 
Voluntary  Paternity  Acknowledgment  Programs:  Effective  Practices  In Hospital  Staff 
Training  (OEI-06-95-00164)  highlights  State efforts  to educate  birthing  hospital  staff on 
voluntary  paternity  acknowledgment  procedures. 
METHODOLOGY 
After preinspection  research,  we administered  comprehensive  mail  surveys  on the 
voluntary  paternity  acknowledgment  process  to State child  support and vital  records 
agencies  in every  State and the District  of Columbia  and to 566 birthing  hospitals  in a 
sample of  15 States.  In addition  to completing  the surveys,  which provided  data for our 
primary  reports  on implementation  and hospital  experiences,  agencies  sent examples  of 
paternity  acknowledgment  education  and outreach  materials,  training  materials,  and 
photocopies  of their  birth  certificates  and voluntary  paternity  acknowledgment  forms.  We 
received  completed  surveys  and supplemental  materials  from both  agencies  in every  State 
and from 78 percent  of birthing  hospitals  sampled. 
The supplemental  materials  for parent  outreach  and education  included  brochures, 
information  sheets,  and videos.  We conducted  telephone  follow-up  approximately  six 
months  after receiving  these materials  to request  any supplemental  outreach  materials  and 
received  a number  of new or updated  items.  Content  analysis  of the materials  was 
conducted  and a smaller  number  of materials  and innovative  ideas were judgmentally 
selected  for inclusion  in this report. 
This study was conducted  in accordance  with the Quality  Standards  for Inspections  issued 
by the Presidents  Council  on Integrity  and Efficiency. 
2 
 FINDINGS 

In collecting  information  nationwide  for our companion  report  on State agency  and 
birthing  hospital  implementation  of voluntary  paternity  acknowledgment  programs,  we 
found that most State child  support  agencies  (IV-D) had launched  efforts  to inform 
birthing  hospital  staff of the paternity  effort  and to provide  outreach  and education 
materials  to supplement  communications  with unmarried  parents.  This report  describes 
effective  or innovative  parent  outreach  and education  practices  and materials.  These 
highlighted  practices  in no way represent  all efforts  nationwide,  but give a snapshot  of 
practices  and materials  that have been reported  to us by IV-D and vital  records  agencies 
and by hospitals  in the course  of our data collection. 
Parent  outreach  and education  is an important  and vital part of the hospital-based  paternity 
acknowledgment  program.  Several  States and hospitals  have made exemplary  efforts  to 
educate  their unmarried  mothers  and fathers  about establishing  paternity.  These efforts 
have  included  prenatal  education,  guidance  for direct  contact  with mothers  in the hospital, 
and the dissemination  of written  materials.  Parent  outreach  and education  helps unmarried 
parents  gain knowledge  about their  rights  and responsibilities  as parents.  It is vital  for 
them to have the opportunity  to become  educated  and ask questions  before  making  the 
important  decision  to acknowledge  paternity. 
GUIDELINES  FOR  PARENT  OUTREACH 
Outreach  Materials  Should  Clearly  Communicate  the Benefits  and  Consequences  of 
Paternity Acknowledgment,  Not Just  the Mechanics  of Acknowledgment  Documentation. 
Brochures  and information  sheets are the most common  outreach  vehicles  created  by State 
child  support  agencies  and provide  the primary  context  for parents  understanding  of 
paternity  acknowledgment.  A typical  brochure  contains  explanatory  statements  answering 
what,  why,  and how to establish  paternity.  Appendix  A includes  a listing  of typical 
questions  and answers  contained  in written  materials. 
A complete  explanation  of why  it is important  to establish  paternity  should point out 
benefits  the child  may be eligible  for,  such as Social  Security,  veterans  funds,  health  care 
coverage,  life insurance,  any military  allotments  or military  medical  insurance,  injured 
workers  payments,  and inheritance.  Other benefits  to the child  in establishing  paternity 
are knowing  the identity  of the father,  the family  medical  history,  and securing  child 
support. 
Thorough  written  materials  should  address  not only  the benefits  to the child  but also 
outline  paternity  rights  and responsibilities.  For ease of explaining  the rights, 
responsibilities  and benefits,  Massachusetts  has an information  sheet which parents  must 
initial  before  signing  the affidavit  (See Appendix  B).  Outreach  materials  should  also 
provide  information  on how fathers  may undergo  genetic  testing  and any costs associated 
with  such a test.  Additionally,  brochures  may briefly  address establishing  paternity  for 
3  older  children  and provide  contact  telephone  numbers  for  information.  A typical  brochure 
is included  in Appendix  C and a typical  information  sheet is included  in Appendix  D. 
States might  also add clarity  and better communicate  with parents  by segmenting  their 
brochures  into portions  which  discuss the unique  perspectives  of the mother  and father. 
One State labeled  these sections  Questions  Mom Ask and  Questions  Dads Ask. 
Fourteen  States sent us separate  brochures  for the mother  and father  which emphasize 
concerns  unique  to each,  including  Nebraska  which created  a folder  Paternity  for 
Parents  enclosing  the two brochures  along with the affidavit.  The State of Virginia  even 
separately  outlines  the rights  and responsibilities  statements  for each parent  on the front  of 
the affidavit  (Appendix  E).  Beyond  the basics of acknowledging,  typical  materials  for the 
father  discuss genetic  testing,  payment  of child  support,  custody  and visitation  issues, 
adoption  proceedings,  and the emotional  benefits  of fatherhood.  Brochures  for the mother 
address  issues such as eligibility  for public  assistance,  relationship  questions  such as living 
arrangements  or marrying  a man other  than the father,  and paternity  acknowledgment  for 
siblings. 
Other materials  are designed  specifically  for young  parents.  For example,  the State of 
Washington  created  a comic  book  to explain  paternity  establishment  to minors  (See 
Appendix  F for excerpts).  The book,  entitled  Patman:  Protector  of Childrens  Bights, 
illustrates  a story  of two young  parents  trying  to decide  whether  or not to acknowledge 
paternity. 
Thoughtful  Outreach  Materials  Should  be Specifically  Related  to the  Target Population, 
Reaching  Unmarried  Parents  of All Relevant  Languages  and Backgrounds,  Predicting 
and Addressing  Parent  Questions About Related  Issues. 
Cultural  and lingual  differences  present  challenges  in outreach  efforts,  and it is important 
for all unmarried  parents  to have a clear understanding  of the benefits  and consequences 
of acknowledging  paternity,  regardless  of their  background.  Outreach  materials  should be 
available  in languages  appropriate  to the population  and should  be sensitive  to cultural 
differences.  A Colorado  hospital  uses a telephone  translation  language  line to help parents 
and staff communicate,  and some hospitals  require  their  birth  registrars  to learn prominent 
alternative  languages  such as Spanish.  Outreach  materials  and any discussion  between 
hospital  staff and parents  should  also be sensitive  to misinformation  about paternity  that 
may be communicated  through  the patients  social network.  For example,  one State has 
reported  some confusion  over whether  common  law marriages  negate the need to 
acknowledge  paternity  by affidavit.  In this case,  it is necessary  for hospital  staff to 
technically  distinguish  between  a common  law and legal marriage  and to explain  to the 
parents  the implications  of their  status pertaining  to establishing  legal paternity. 
4 
 Videos are  Useful Supplements  to Oral Discussion  and  Written Materials,  especially  in 
Cases  Where Staff  have  Limited  lime  for  Interaction  with Parents. 
Watching  a video  can give unmarried  parents  a better understanding  of why 
acknowledging  paternity  is important  and allow them to hear  directly  from other 
unmarried  parents  who have chosen  to establish  paternity.  Watching  role-playing  on 
video  gives them the sense that they are not the only  ones who have faced this kind  of 
decision.  Because they  may not be able to visit all hospitals  in their  State, videos  allow 
State child  support  agencies  to reach  a wider  audience  using  an interactive  medium. 
Videos can be sent to schools  and clinics  as well.  Videos may be especially  helpful  for 
outreach  to parents  with low education  levels  or poor communication  skills  who may not 
fully  understand  written  materials  and oral discussion. 
Hospital  rooms  are often equipped  with video equipment  because  they rely  on videos to 
provide  information  on other parent  and child  issues.  Videos  received  from  Arkansas, 
Colorado,  Kansas,  Nebraska,  New Hampshire,  and Oregon  use a variety  of formats, 
usually  dramatizing  a hospital  scenario  and emphasizing  the emotional  and legal benefits 
to acknowledgment.  Nebraskas  video  includes  explanatory  segments  with a clinical 
psychologist,  a judge,  an obstetrics/gynecologist  physician,  and a registered  nurse who 
give their  various  perspectives  on the benefits  of paternity  acknowledgment. 
Hospital  Staff  May be Able  to Personalize  Outreach  Efforts  By  Using Information  From 
Patient Surveys  or Birth  Certijicaie  Worksheets. 
Because birth  certificate  worksheets  are widelv used,  they  serve as a valuable  source  of 
information  to hospital  staff in targeting  the snecific  needs of individual  narents. 
Often a birth  certificate  worksheet  is the formal  tool used to find out whether  or not the 
mother  is legally  married  and therefore  introduce  the paternity  acknowledgment  program 
(see Appendix  G for birth  certificate  worksheet  sample).  We found  in our companion 
report  on hospital  experiences  that 84 percent  of hospitals  use birth  certificate  worksheets. 
These forms  may be a barrier  to acknowledgment  if the parents  fill them out alone  with 
no interaction.  However,  if used properly,  they can serve as a springboard  to discussion 
about paternity. 
For example,  a California  birth  registrar  requests that the mother  fill out the birth 
certificate  worksheet  upon arrival  when possible  so he will have time to review  the 
information  before  talking  with the parents  post-delivery.  Whether  hospital  staff knew of 
a mothers  unmarried  status before  or not,  they use the occasion  of completing  the 
worksheet  and the mothers  subsequent  responses  to personalize  their  outreach  to parents. 
Another  hospital  describes  getting  as much  information  as possible  from the computer  and 
compiling  it on the worksheet,  then talking  with the mother  to add other  information  and 
check  for correctness,  at which  point  the paternity  information  is given to her to read and 
consider.  Hospitals  which do not use birth  certificate  worksheets  learn  the patients 
marital  status during  hospital  registration. 
5 
 One hospital  reports  using; a questionnaire  to assess parents  needs before  discussing 
paternity  acknowledgment. 
An innovative  Colorado  hospital  uses a brief  patient  evaluation  form  to determine  parents 
specific  needs and circumstances.  The hospital  records  basic  information  about the 
parents  and baby and whether  the father  is present  at delivery.  The idea behind  the 
survey  is to help  open lines of communication  with the mother  and to consider  each 
mothers  situation  before  discussing  paternity  with her.  The form  also serves to monitor 
hospital  effort  in explaining  paternity  to parents  by recording  whether  the parent  talked 
with a staff member  about paternity,  watched  the paternity  outreach  video,  or took  a 
prenatal  class.  Additionally,  the form  includes  a checklist  of possible  reasons  why parents 
dont acknowledge.  Compiling  this information  in aggregate  could help hospital  staff and 
the State child  support  agency  analyze  what factors  influence  parents  to acknowledge  in 
order  to better  meet the needs of future  clients.  The patient  evaluation  is included  in 
Appendix  H. 
Proactive  Hospitals  Offer  Multiple  Opporfunities for  Parents  to Learn  about  Voluntary 
Paternity Acknowledgment,  Using Pre-Registration  and Hospital  Admittance  to T&e 
Advantage  of Early  Contact  With Parents. 
Hospitals  should use a combination  of methods  to educate parents,  providing  multiple 
opportunities  for parents  to receive  paternity  information.  This  is valuable  because 
mothers  may respond  to different  methods  of outreach.  One mother  may be willing  to 
look  at the materials  after delivery,  but for another  the prime  time may be before  labor or 
even during  pre-registration.  An Arkansas  hospital  provides  three  opportunities  for a 
parent  to learn  about and acknowledge  paternity:  parents  are introduced  to the idea of 
paternity  by hospital  admissions  staff and given written  outreach  materials;  nursery  staff 
mention  acknowledgment  in the course  of completing  the birth  certificate  with the parents; 
mother  and child  discharge  through  the birth  registrars  office  and are given  a final 
opportunity  to sign and notarize  the affidavit.  These multiple  entry  points  need not unduly 
pressure  parents  to acknowledge.  Rather,  they may serve as convenient  reminders  during 
a busy and confusing  time  and increase  the likelihood  that the father  will be present  when 
signing  and notarizing  are possible. 
Several hospitals  provide  information  about the program  during  the admissions  or pre-
registration  process.  One hospital  places  paternity  brochures  and an affidavit  in the 
admissions  packet  to allow  parents  to consider  the issue before  the maternity  nurse talks 
with them.  The nurse  said,  Often,  by the time I see them they  have  already  made up 
their  minds  and myself  or another  person  can go ahead and notarize  the affidavit. 
Another  hospital  with a high  rate of acknowledgment  confirms  that the earlier  parents 
learn  about acknowledgment  the more  likely  they  are to sign.  A medical  records  director 
in Texas contends,  They  are not here  long,  so the mother  receives  the information  at pre-
registration  before  admission.  
6 
 Some hospitals  report  pre-registering  mothers  for delivery  six months  in advance.  When 
the mother  arrives  for the actual delivery,  if she is in early  labor the nurse  will ease her 
into thinking  about paternity,  saying things  like  have you thought  about or are you 
planning  on claiming  paternity?  It is mandatory  that the labor and delivery  nurse ask if 
the father  will attend the birth,  so discussing  paternity  acknowledgment  can normally 
follow  that line of questioning.  Following  pre-registration,  the mother  goes to the mother-
baby unit,  where  a social  worker  visits to help her  in meeting  financial  and home  care 
needs.  This staff member  also discusses paternity  acknowledgment  with the mother, 
particularly  if she has questions.  If the mother  has not decided  about acknowledgment 
after talking  with the social  worker,  the prenatal  secretary  is responsible  for discussing  it 
with parents  at admittance.  She refers  to herself  as the catch-all,  meaning  the final 
person  responsible  for ensuring  paternity  has been discussed  with all unmarried  parents. 
A Few States Have  Begun  to Place  Child Support Employees  On-Site at High-Risk 
Birthing  Hospitals  to Help  Hospital  Staff  and to Communicate  Directly with Unmarried 
Parents. 
Two full-time  child  support  employees  in Colorado  visit hospitals  specifically  to provide 

outreach  and education  on paternity  establishment.  They  are instructed  to be respectful  of 

hospital  routines  and one respondent  refers  to herself  as a guest in the hospital  and 

mothers  rooms.  This type of  out-stationing  is still unusual  but is practiced  in a few 

States,  including  Illinois  and Florida.  Those  who advocate  this labor-intensive  strategy 

claim  that it eases the burden  on staff in those hospitals  which  assist a large  number  of 

nonmarital  births.  In addition  to out-stationed  employees,  other  child  support  staff 

communicate  via telephone  with the hospitals  which  have questions. 

In Florida,  out-stationed  child  support caseworkers  in high-Medicaid  hospitals  are 

typically  officed  in the hospitals  medical  records  or Medicaid  payment  offices  and work 

in conjunction  with the birth  registrars,  who still handle  the actual birth  registration  and 

documentation.  A typical  experience  would be for the birth  registrar  to give the mother  a 

paternity  outreach  brochure  along  with the birth  certificate  worksheet.  The child  support 

caseworker  then approaches  the mother  later  in the day to follow-up  and answer  questions. 

Whenever  possible,  the caseworker  will try to schedule  the visit when the father  is 

present.  These on-site  caseworkers  offer  a child  support connection  to the mother  for 

other  siblings  who might  also need paternity  establishment  or help in establishing  support 

orders. 

DIRECT  CONTACT  BETWEEN  STAFF  AND PARENTS 

Hospitals  Report Parents  are Largely  Open to Talking  About Paternity Issues,  so Direct 
Discussion  Appears  to be an Important  Tool for  Encouraging  Acknowledgment. 
When  hospital  staff discuss acknowledgment  with parents,  in addition  to giving  them the 
materials  to read,  they  are more  likely  to fully  grasp their  option  and to understand  the 
implications  of signing  the paternity  affidavit.  This oral discussion  is not only  beneficial 
for parents,  but as previously  mentioned,  is mandated  in PRWORA.  Although  the amount 
7  of time available  for discussion  varies,  depending  on the mothers  hospital  stay and 
staffing,  hospitals  report  most mothers  are open in asking  questions  concerning 
acknowledgment  and the paternity  affidavit,  The written  materials  serve as a catalyst  to 
prompt  questions  and promote  discussion.  After  giving  them time to review  the materials, 
one nurse  schedules  herself  to be available  to talk with parents  when both mother  and 
father  can be there  for questions.  Hospitals  report  parents  often ask questions,  regardless 
of whether  they are already  familiar  with paternity  acknowledgment  or if it is new to 
them.  Hospitals  active  in attempting  to meet the needs of parents  provide  opportunities  to 
discuss paternity  acknowledgment  in order  to encourage  parent  understanding. 
Hospital  staff should be prepared  to clarify  the numerous  benefits  of acknowledgment  and 
to answer related  questions  not covered  in outreach  materials.  Predicting  and addressing 
issues such as child  support  helps  relieve  parents  anxiety  and gives them a clearer 
understanding  of paternity.  Even when thorough  outreach  materials  are available,  parents 
may be unwilling  or unable  to comprehend  various  issues and concerns.  Parents  may 
understand  the literature  but be confused  about how it relates  to their  particular  situation. 
We found  in our companion  report  on hospital  experiences  that both the child  support and 
the vital  records  agencies  rate hospital  staff as largely  capable  and willing  to address 
issues with parents,  and hospitals  report  parents  are usually  receptive  to discussion  and 
advice.  Therefore,  hospital  staff must be versed  on important  paternity  issues and be 
clear  on their  responsibility  to communicate  with parents. 
Hospitals  surveyed  generally  report  the same types of questions  were asked,  regardless  of 
the parents  circumstances,  so the body of information  to master  should not be exhaustive. 
Most commonly  asked questions  deal with the babys  surname,  eligibility  for public 
assistance,  paternity  establishment  for siblings,  payment  of hospital  bills,  custody  and 
visitation,  and issuance  of child  support.  The importance  of explaining  these  corollary 
issues should not be underestimated,  as they  may have a dramatic  effect  on decision-
making.  Concern  about the babys  surname,  for example,  may  lead parents  to 
acknowledge.  At a minimum,  staff must be capable  of referring  parent  questions  to the 
appropriate  public  agency. 
Talking  with the Mother  Alone  Initially May Allow for  Greater  Privacy and a Clearer 
Focus  on Paternity Issues. 
A number  of hospital  respondents  prefer  to talk first with the mother  alone,  giving  her 
time to broach  the subject of paternity  with the father  privately,  and then follow  up with 
additional  information  and discussion  with both parents  when possible  and necessary. 
Talking  with the mother  alone  gives her privacy  in assessing  her unique  concerns  related 
to paternity  acknowledgment.  A birth  registration  clerk  in Texas reports,  The mothers 
tend to be more anxious  when the father  is in the room,  wondering  what hell  say.  
Talking  with the mother  alone  may also increase  the comfort  level  of the hospital  staff 
member.  One respondent  said she can better  approach  the subject  and learn  the mothers 
wishes when she is alone,  saying  Even  sometimes  when the father  is there  I might wait 
8 
 for a time when the mother  is alone because  Im afraid  it might be an abusive  situation.  
Mothers  may also be unsure  of the fathers  identity  and would therefore  value private  time 
to answer  questions. 
Pre-arranging  a  Time For  the Father  to Sign or Receive  Information  May Avoid 
Problems  of  Timeliness  and  Coordination,  and Allow Staff  to Talk  with Both  Parents  at 
Once. 
Most hospitals  report  the best time to locate the father  is right  after delivery.  At this 
time,  hospital  staff may choose  to pre-arrange  a time with both parents  present  to discuss 
paternity  and sign the acknowledgment.  An Illinois  hospital  respondent  talks with the 
father  if he is present  or gives the mother  an opportunity  to telephone  the father  and bring 
his picture  identification  so he can sign the affidavit  or at least be given paternity 
information.  Another  hospital  phones  the mother  in the hospital  room  and offers  to 
arrange  a meeting  time.  Pre-arranging  a time for the father  to sign or receive  information 
is beneficial  for both parents  as well as hospital  staff in cases where  a notary  is only 
available  at certain  times.  Another  obvious  advantage  to hospital  staff in talking  with both 
parents  together  is saving  time by making  only  one contact. 
Hospital  Staff  Should  Recognize  and Adapt to the Influence  of  Others on Parental 
Decision-Making. 
Others present  in the hospital  setting,  such as maternal  and paternal  grandparents,  may 
heavily  influence  parents  when deciding  whether  or not to acknowledge.  Hospital  staff 
may be able to use these people  to serve as translators  of the paternity  message. 
Discussing  paternity  with a mother  can be a very  sensitive  issue,  and the presence  of the 
maternal  or paternal  grandparents  may either  hamper  or encourage  discussion  about 
paternity.  One health  information  systems administrator  said Grandparents  can make  it 
difficult  to talk with the mom.  It is more uncomfortable  talking  with her  if the 
grandparents  are in the room. n  Another  hospital  respondent  commented,  Yes,  many 
times the girls parents  are there  and they are into the issue and it can get sticky. 
A number  of different  strategies  may be employed  to handle  the presence  of grandparents. 
Another  hospital  respondent  says she explains  the law to the grandparents  and adds that it 
is the mothers  responsibility  to make decisions  for her own child.  Sometimes  a birth 
registrar  may need to ask very personal  questions  of the mother  about past pregnancies. 
A Virginia  respondent  simply  asks the unmarried  mother  whether  or not she wants others 
to be present  when she talks to her.  When grandparents  favor  acknowledgment,  they  can 
be powerful  allies  for hospital  staff and serve in a translation  role.  For example,  a 
California  birth  registrar  likes the grandparents  present  because  the unmarried  parents  may 
be very young  and may not fully understand  what  paternity  means.  One registrar 
reports,  ccA lot of times the mother  of the unmarried  mom is there  and she is a big 
influence  in encouraging  the mother  to acknowledge.    Because the birth  registrar  isnt 
intimately  familiar  with the parents  it makes sense that parents  might  rely on others, 
especially  if the parents  are young.  Many parents  want to use all of their  available 
9 
 resources  in making  a decision  about paternity,  including  close  friends,  grandparents,  and 
public  assistance  caseworkers. 
Where Hospital  Staff  Choose  to Go Beyond  Informing  Parents  to Serving as Advocates 
of Acknowledgment,  they Should  Be  Careful  to Preserve  its Voluntary Nature. 
While  some hospital  staff may simply  inform  parents  about the option  of acknowledging, 
others perceive  their  role  as that of counselor  and advocate.  These  latter must maintain  a 
balance  to preserve  the voluntary  nature  of paternity  acknowledgment.  Although  it is 
most important  that hospital  staff provide  parents  with timely  and accurate  information  on 
the process  of acknowledging  paternity,  a number  of hospital  respondents  reported  more 
personal  levels  of communication  with unmarried  parents.  Some hospital  staff feel 
strongly  about the societal  benefits  of paternity  establishment  and are therefore  especially 
motivated  to encourage  parents  to acknowledge.  Those  hospital  respondents  who choose 
to go beyond  merely  informing  parents  about paternity  by serving  as advocates  of 
acknowledgment  vary  in their  degree  of encouragement. 
In the process  of distributing  paternity  outreach  materials,  hospital  staff who choose  to 
serve as advocates  may discuss the details  of a patients  circumstances  and relate  the 
benefits  of acknowledgment  to their  situation.  Staff who are involved  at this level  appear 
to come more often from  the obstetrics  than the medical  records  departments.  This may 
be due to their  greater  interaction  during  the mothers  hospitalization  or because  obstetrics 
staff members  are already  heavily  involved  with patients  regarding  other highly  personal 
issues such as baby care and postpartum  recuperation.  The decision  to take on this 
broader  role  is likely  to vary  from patient  to patient.  When  staff determine  that it is 
appropriate  to take on the role of advocate  rather  than educator,  it is important  to not 
mislead  or coerce  parents  into acknowledging  or giving  advice  that goes beyond  the 
parameters  outlined  in staff training  and outreach  materials. 
PRENATAL  EDUCATION 
Nearly All Hospitals  Offer  Childbirth  Classes,  and Some  Include  Paternity 
Acknowledgment  Education  in their Prenatal  Curriculums. 
Prenatal  education  gives unmarried  mothers  more time to think  and prepare  for a decision 
concerning  the paternity  affidavit  prior  to delivery.  This advance  notice  allows  the mother 
to encourage  the father  to be present  at delivery  and to bring  identification  needed  for 
notarization.  A number  of hospitals  include  paternity  acknowledgment  information  in 
childbirth  education  classes.  This strategy  can reach  a large proportion  of the target 
population  due to widespread  acceptance  of the importance  of childbirth  classes.  In some 
States,  mothers  on public  assistance  or Medicaid  are required  to take such classes. 
Paternity  acknowledgment  information  may be included  in the parent  tour of labor  and 
delivery  facilities  required  by many hospitals.  A Massachusetts  hospital  offers  a separate 
childbirth  class just  for teenagers  which  focuses  more  on paternity  acknowledgment  than 
the general  childbirth  course. 
10 
 Medical  Clinics,  Physicians  Offices  and Schools  are  Valuable  Venues for  Addressing 
Paternity Acknowledgment  Issues  Prenatally. 
Once outreach  materials  are produced,  States would be well-served  to market  them beyond 
the hospital  environment.  Mothers  must,  of course,  seek medical  care during  pregnancy, 
and this provides  a number  of entry  points  for providing  outreach  to mothers  at a less 
stressful  time than the hospital  stay.  Some States have targeted  only  high-risk  clinics  for 
this outreach  and some have taken  a broader  approach  by distributing  materials  and 
presenting  workshops  at clinics,  physicians  offices  and schools  statewide.  Materials  may 
also be placed  in other  social  service  offices  and in child  care centers.  Outreach  to 
schools  may be particularly  effective  because  it involves  the father  as well as the mother 
and because  it reaches  young  people  who are not yet pregnant.  Colorados  child  support 
agency  is currently  developing  specific  curriculum  for its public  schools  on paternity 
establishment  so outreach  may be conducted  within  the framework  of health  or parenting 
classes.  Although  the regulations  written  for interpreting  OBRA focused primarily  on in-
hospital  paternity  acknowledgment,  there  is a clear  intention  to broaden  paternity  outreach 
beyond  the hospital. 
FOLLOW-UP  AFTER  DISCHARGE 
Timely Follow-up  with Mothers  After Discharge  Reintroduces  the Idea  of 
Acknowledgment  at a Less  Hectic  Time and Provides  a Method for Supplying Additional 
Outreach  Materials  and Documentation  Forms. 
When  hospitals  or child  support  agencies  make the effort  to follow-up  with parents  who 
do not acknowledge  during  the hospital  stay,  parents  are afforded  another  opportunity  to 
acknowledge  before  the birth  certificate  is filed.  Often,  hospitals  routinely  call all 
mothers  anyway  to check  on the babys progress  and the mothers  post-par-turn care.  The 
mother  and childs  hospital  stay may be very  brief,  making  a full discussion  of the 
paternity  acknowledgment  process  difficult.  Through  follow-up,  hospitals  allow  parents 
more time to understand  the benefits  of acknowledgment. 
Follow-up  may consist  of phone  calls,  letters  or both.  When  follow-up  letters  are used, 
they may include  the following  information:  number  of days they have to establish 
paternity,  the fee for late acknowledgment,  and legal  information  regarding  time  limits  for 
registering  the birth  and for changing  the babys  surname.  An example  of a follow-up 
letter  is included  in Appendix  I.  Hospitals  usually  place phone  calls within  two weeks, 
and may send letters  following  phone  contact.  The amount  of time allowed  depends upon 
when the birth  certificate  information  is due to the vital  records  agency.  Because parents 
may relocate  quickly  after the time of birth,  prompt  follow-up  is important. 
In some States, privacy  statutes prohibit  the child  support  agency  from receiving 
information  on nonmarital  births until  they become  a part of the IV-D caseload.  Indianas 
child  support agency  purchases  lists of parents  from  hospitals  as would a diaper  service  or 
a parenting  magazine.  They  then notify  all mothers  who have not listed a fathers  name 
or have provided  different  surnames  for the father  and the child. 
11  Another  common  method  of encouraging  acknowledgment  after discharge  is holding  the 
birth  certificate  for a few days in case the parents  change  their minds or if the father  was 
not available.  Several  hospitals  give the mother  outreach  information  and/or  the paternity 
affidavit  and tell her to contact  them if she decides  to acknowledge  or can locate  the 
father.  One hospital  gives a discharge  packet  of materials  containing  a form  letter  stating 
they can still acknowledge  paternity  without  a fee if the parents  return  within  a certain 
number  of days.  Follow-up  may be even more crucial  when the birth  registration  clerk  is 
not there  on weekends  to notarize  acknowledgments. 
12 
 CONCLUSIONS 

Although  many  States are still early  in their  implementation  of in-hospital  voluntary 
paternity  acknowledgment  programs,  a number  of State child  support agencies  have made 
great  strides  in addressing  parent  outreach  and education.  Based upon our analysis  of the 
materials  and practices  reviewed  in this report,  we draw the following  conclusions  about 
parent  outreach  and education: 
CONTENT  OF MATERIALS.  Outreach  should  explain  the benefits  and  consequences 
of paternity  acknowledgment  as well as the mechanics  of acknowledging,  and  written 
materials  should  be supplemented  with discussion.  Not only  is oral communication  of 
paternal  rights  and responsibilities  mandated  by PRWORA,  but direct  contact  between 
hospital  staff and parents  clarifies  the concept  of paternity  and allows  parents  to better 
relate  issues to their  own circumstances. 
INDIVIDUALIZED  APPROACH.  Hospital  staff should  attempt to personalize  outreach 
efforts, using information  about  the parents  to better meet their needs.  Different 
approaches  are appropriate  in speaking  to the parents  about paternity  according  to the 
timing  of the presentation,  the availability  of the father,  the visitors  in the room,  the 
mothers  interest,  and cultural  or language  barriers. 
USE OF MULTIPLE  OUTREACH  VENUES.  Multiple outreach  opportunities  can be 
used to reach  a broader  segment  of the target group  and to introduce  early,  and 
reinforce  through  repetition,  a clear  message  on paternity  acknowledgment.  States 
should use a variety  of entry  points  for introducing  paternity  acknowledgment  information. 
Parents  may receive  paternity  acknowledgment  information  at the physicians  office, 
during  a childbirth  class,  hospital  pre-registration,  or upon  admittance  prior  to delivery, 
rather  than only  during  the hospital  stay for delivery. 
FOLLOW-UP  AFTER  DISCHARGE.  Timely follow-up  with mothers  after  discharge 
provides  additional  encouragement  to acknowledge,  and opportunity  to re-distribute 
documentation  forms.  Many parents  may leave the hospital  without  acknowledging 
because  of the unavailability  of the father  or of a notary.  They  may also need more time 
to make the decision  to acknowledge  and would  value a reminder  and the availability  of 
new documentation  materials. 
13 
 AGENCY  COMMENTS 

We have worked  in close partnership  with OCSE throughout  the conduct  of this 

inspection.  Although  we did not receive  formal  comments  from ACF on our draft 

reports,  they demonstrated  through  their  collaboration  a general  agreement  with this report 

and the companion  reports.  We worked  with  OCSE in developing  a research 

methodology,  provided  extensive  briefings  on study findings  and created  additional 

documents  to meet agency  needs.  We appreciate  their  cooperation  and guidance  and will 

continue  to work with them on the issues raised  in these reports. 

14 
 Appendix  A:  Ouestions  and  Answers 

Typical  Questions  and  Answers' 
Questions  Answer8 
Why  cant the father just  sign the birth  Having  the fathers  name on the birth 

certificate?  certifkate  is a good first  step, but it does 

not make him the legal father.  When  the 

father  signs the affidavit  he is saying  that 

he is the babys biological  father.  It is best 

if the father  signs both the birth  certificate 

and the acknowledgment  of paternity. 

Whose  name will  be on the birth  Example:  If the babys  mother  and father 

certificate?  complete  the affidavit  of paternity  at the 

hospital,  the fathers  name will appear  on 

the birth  certificate  based upon the 

information  the hospital  sends to the Center 

for Health  Statistics  (Alabama). 

What if I am not yet  18 years  old?  You can still be named as the father.  You 

can also be ordered  to help the mother 

support the child.  Even with limited 

income,  fathers  should be required  to 

provide  regular  financial  support for their 

children. 

What if the mother  and child  live  in a  States have an agreement  which  allows  the 

different  State from  the father?  mother  to prove  who the father  is even if 

he lives  in a different  State.  The 

agreement  also covers  coIkcting  child 

support from  absent parents  in other  States. 

Genetic testing  Genetic  tests can be performed  to 

determine  the paternity  of a child.  These 

tests will  show that a man is not the father 

of a child  or indicate  the probability  that he 

is the childs  father.  The test results 

provide  reliable  information  to aid parents 

and judges  in parentage  decisions. 

1  When m answer is referred to as an example, specific State laws appear to dictate the response 
and the answer should not be considered viable for all States. 
A-l  Who pays  for the blood  tests? 	 Answer  varies  by State such as the father, 
AFDC,  child  support arranged  payments, 
or private  arrangements  with the hospital 
or a paternity  testing  laboratory.  Parents 
may ask hospital  staff for information. 
What about  Visitation  and Custody? 	 Issues concerning  custody  and visitation  are 
not a part of the paternity  establishment 
process.  If they become an issue then they 
may be resolved  by a voluntary 
arrangement  between  the parents  or by 
court  action. 
What  if the child  is receiving  government  If the child  is receiving  APDC  (welfare)  or 
assistance  (welfare  or Medicaid)? 	 medical  assistance,  the mother  must assist 
the agency  to establish  paternity.  When 
the parents  sign the Affidavit 
Acknowledging  Paternity,  a copy  is sent to 
the child  support office. 
Can I sign the acknowledgment  if I am  A father  can sign the affidavit  is he is 
married  to someone  else? 	 married  to someone  else.  A denial  of 
paternity  form  is available  for a mother 
who is married  to someone  who is not the 
biological  father. 
Why is establishing  paternity  important? 	 Explanations  include  identify,  benefits, 
money,  medical,  etc. 
How is paternity  established? 	 -Voluntary  Acknowledgment  of Paternity 
Affidavit  in the hospital. 
-Paternity  AfElavit  after  discharge  from 
the hospital. 
-Seek State Child  Support  Agency 
Example:  When the baby is born  the 
hospital  staff must get information  for the 
babys birth  certificate.  They  will  have the 
Affidavit  Acknowledging  Paternity  form 
for the mother  and father  to sign saying 
that he is the biological  father.  The 
parents  must show a picture  ID,  such as a 
drivers  license.  Both parents  must give 
the hospital  staff their  social  security 
numbers. 
_  A-2 
 Does there  have to be a trial?  Example:  No,  not when you and the 
mother  both agree that you are the father. 
Even  for those cases which go through  the 
court,  there  is usually  no trial.  It is easiest 
to establish  paternity  when the mother  and 
father  have a good relationship.  If you 
have any doubts,  you may ask for paternity 
blood  tests to be sure you are the father 
(Colorado). 
What if the father  thinks  the pregnancy  was  Example:  Texas law says that a father  is 
an accident?  responsible  for  supporting  his children. 
This means that once the court decides  he 
is the biological  father,  the man must pay 
to help  support  his child,  even if the 
pregnancy  was an accident. 
The mother  of the child  said she was using  Example:  Legally,  you are responsible  for 
girth control.  I do not think  I am  supporting  the child  if you are his or her 
responsible for the pregnancy,  so why do I  biological  father.  It does not matter 
iave  to pay?  whether  you agreed  to the pregnancy. 
What about child  support?  Example:  The law requires  that both 
parents  provide  for the financial  needs of 
their  child.  By receiving  assistance  from 
both parents  a childs  chances  for  success 
are greatly  improved. 
)oes the father  have to pay  child  support?  Example:  Yes.  Once paternity  is 
established,  the father  has a legal 
obligation  to support  his child  through 
minority  and /or  as otherwise  allowed 
under  law. 
f I am afraid  of the father,  do I have to  If you are asking  for public  assistance  or 
lame him?  help with paternity  establishment,  you must 
name the father.  However,  you may  not 
be required  to establish  paternity  if you can 
show risk to yourself  or the child.  This  is 
called  GOOD CAUSE.  Include  contact 
telephone  numbers  for more  information. 
A-3 
 Appendix  B:  Sheet  for  Parents  Initials 
WHATD-OESIThfEANlFYOC'SlGNTHLS  FORM? 
6~ stgning  this  acknowledgment  of parentage.  you  are establishing  your  childs  legal patcrtuty.  Paterruty  means fatherhood 
For parents  who  are not married  to one another,  paternity  may  be established  legally  only  by  signing  this  form  or by gomg 
10 court  Otherwae.  your  child  ~111 have  no legal  father. 
Slgrung  dus form  IS volun~  Smcc  thus form  has legal  consequences.  you  may  warn  (0 consult  an anomey  before  sigrunf 
.  If your  child  IS under  SK months  of age when  you  s1g1-1tlus  form.  patemny  IS established  on the dare both  ~DG 
h+vt  signed  this form  unless  either parent  quests  blood  or genetic  marker  MU  within  OIK year  of signing.  Such 
blood  or genetic  marker  tests must  be rquested  through  the proper  court  or the State Child  Support  Enforcemem 
Division.  Once  signed  by  both  parents  and notaruai.  thus form  has the same btnding  effect  1s a court  Judgrnenl  of 
pat~tity  ad  the birth  record  will  not be changed  withour  a court  order. 
.  If YOU  child  is six  months  of age or older  when  you  sign  this  form,  pstensity  is u&bii~bcd  00 the  date  both 
pUal&  &WC S@d  this  form.  You  cannot  request  blood  or genetic  marker  tests later.  If  you  want  t0 have  a blood 
or gmtic  marker  teat to verify  paternity,  do oot  sign  this  form  until  you  have  received  the results  of the teSl  Once 
signal  by  both  parents  and notarized,  this  form  will  have  rbe same binding  effect  as a coun  judgment  of paterrury 
Thts acknowledgment  allows  a parent  to seek a child  support  order  wlrhout  funher  court  proceedings  to establish  patenut? 

T?USaChWkigment  my  be fikd  in court  and serve  1s the basts for  orders  of custody  or vtsitatton. 

If this  form  is not signai  in the hospital,  the fathers  name will  not  appear  on the birth  cemficare  unless  the blah  c~filfi~e 

IS amc&d  at a later  due.  If  you  want  to add the fathers  name later.  you  musf complete  rlus  Volwuary  Achnowledgmeru qf 

PUWIUU~C - FosM~~I  form.  YOU must  then  file  the completed  form  WI&I the cny  or town  clerks  offxe  where  the ch.tld NX 

born  or go to court  to vnend  the childs  birth  certificate. 

TIus  acknowMgma?t  is not  a public  record.  It wtll  be available  only  10 the parents  and child  namal  on this  form.  the 

childs  legal guardian  or legal  rcprcsentarlve.  or grvemmenr  officials  tn the conducr  of their  official  duties. 

If another  WS  name  is alrudy  on the birth  ccnificate  ud  you  want  to amend  the birth  cenifiute  to include  the father 

named on rhIs form.  you  must  file  this form  with  the court. 

WHAT  ARE  YOUR  RIGHTS  AND RESIONSIBILITIES  AS PARENTS? 
Both parents  are required  by  law  to support  their  child  from  birth.  If your  child  does not live  with  you.  you  m?y  be ordered 
by the court  to pay  child  suppon  until  the childs  eightccnrb  btrthday.  or beyond  III some circumstances. 
A parent  who  does not  live  with  the child  may  have  the rtght  to visit  and establish  a relationship  with  the child  as you  both 
agree or as ordered  by  the court. 
For children  born  of wmarricd  parents.  the mother  has custody  of the child  unlas  otherwise  ordered  by  the court. 
HOW  WILL  YOUR CHILD  BENEFIT IF YOU SIGN THIS FORM? 
Every  child  has the right  10 hw  his or her mother  and father  and benefit  from  a relationship  with  both  pventJ 
1.our child  ha.5 a right  to fuunclal  support  from  both  of you  until  age cightan.  or beyond  in some circumstances 
Ir will  be easer  for  your  child  to learn  the maIlcal  hlsror1c.s of both  parents  and 10 benefit  from  health  care coverage 
available  co you 
II WIII be tlSler  for  your  child  to receive  benefits  such as dependent  or survivors  benefits  from  the  \ etefans  AdnuNstratlon 
or from  the Social  Security  Admmistratlon 
Ir will  be easier for  your  child  to mhertt  through  you.  Mother's Initials  Father's hilids 
QWSUOIU  Egudmg  the buth  ~;~ISUXUOD  procu~  should be auutcd  to the Reglsrry of vital  R&ords  and 9atistx.s  it  617-727JNJ6 
@ZS~IO~E  R@rdmg  ctuld supCran should  be duesred  I@ rhc MA  Dcpr  of  Revenue. Cfuld Suppon  Enforuwnt  DW  11 1-8@-33?-273! 
B-l  What Is Patemlty?  How  Da  WI  Eatiblish  Paternity? 
Paternity means fatherhood.  EatabW&bgpaWmity  Then  arc  several  ways  that  paternity  may  be 
meanrapersoftMmcd~thththcrd~drlldhr  m.  A kM  tip&r&ion  of each of them is 
been legally  dctemrlnrd  to k  thr bthW  d  @Chit&  Usted below.  If you kve  questions about any one 
method or md  help to determine  which may best 
Establishment  of ~8terrdty  is tKQIuIJ  e  when 
the mother  is not ma&d  to thr  bthrr of tht child.  meet your needs, you may contaci the Child Support 
Liforcernrnt  office, legal counsel or your local Clerk 
dcouri. 
II  1111 
Why  Is Estabw  Paternity Importlnt?  Parentsdonot agnx tovolunt.~rily t*2rtdbh-h patcvnlty. 
B-North  Carolina provides  legal  action  my be filed  with  thLeWU~I  IO c>tabiA 
Both parents have a right and a need to know  that  theopportunity  fora father toacknowledge  paternity  paternity for a child.  After  ,111t*vidrnkr  I> ~vevnt~~d, 
they have  contributed  to the future development  of  at the time  of a childs  birth.  This  is a simple  a iudge will decide  If patcrnlty  ~I~OUIJ hc cmI~*nxt 
their child.  procedure  whereby  parents sign the  Affidavit  of 
Parentage  form  in the hospital.  This allows  the 
Do  We Need  To Establish  fJtrrnity  Now? 
ldfntifv  - b%kall have a basic need to know who we  fathers name to be placed on the birth certificate,  and 
JW and who our family  members are.  By knowing  also serves as a legal acknowledgment  of paternity. 
both parents we have a better undccstondingof  our 

own identity  and pasL  Establishing  paternity  will  Paternity  may  be established  by  signtng  thir 

help to strengthen  a childs  emotional  growth  by  affidavit  if: 

providing an added sensed  security as well as aiding 

in the childs  social and pychd~gid  development.  the mother was unmarried  when 

she became pregnant and when 
&&,tj  -Yourchild  needs tobe w~ofhisparents  the child was born, & 
rnrdicd  history  This is important  as your child may  What  Abe-It  Visitation  And  Custody? 
have inherited  diseases or diisordcn which may not  the father is willing  to sign an 
be detected at birth or in chiidhood.  affidavit  stating that he is the 
father of the child. 
w  - Your child has the right to benefits from 
both parents.  These  may  in&de  Sod81 sccU?it~,  This Affidavit  of parentage  is filed  with  thr  State 
insurance benrfits,  inheritan- rights, Hterans  and  Registrar  (Vital  Records) and legally  declares  the 
other types of benefits.  Your child may not receive  paternity  of your child. 
these fnlm his father unless paternity hasbeen legally 
How  Do  I Find  Out  More  Information  On 
Jcknowlrdged  or established.  p  *  I  _  Ifyoudid  Paternity  And  Other 
not rstablirh  paternity at the time of birth, you may 
Child  Support  Services? 
w  The Irw  requires that both parents provide  choose todoso  at a later datr. The mothrr and father 
for the financial  needs of their child.  By receiving  sign documentsacknowledging  they are the parents 
.Issistance from both parent5 achilds  cham  for  of a child.  These signed statements are presented to  If you  have  morv qurstlons  rvgardtng  p,ltvrnlty  .ln<l 
success are greatly improved.  ;  the court and an Order of Paternity is entered  lhls  other  child  support  issues +ou m.ly contact  tht* Loc.ll 
Child  Support  Enforcement  ofttce  whtch  FCWO  yc,ur 
lrgally  establishes patqmity  for a child. 
county  The  staff can answer  any  furthcar quc+~c~~ 
FJther?;as well as mother;  have the right to know  : 
that you may have on patrrmly  .I\ well  ,I> cxpl.~~n ~11 
their child and a responsibdity  t0 SUppOrt them.  CpnrhE  - If there  a~  any  doubts  regarding 
other  child  support  svrv\cvb  that  rlrv .~v.~ll~hlt 
the paternity  of a child,  you should  not sign any  Appendix  D:  Parent  Information  Sheet 

How  a Decltmtion  of  Puternity 
Can  HelpYou  andYour  New  Baby 
What  is a Dcclamtion  The Declaration qffafemr!y  is a legal document that, when signed by 
of Paternity?  both parents, says the man ts the natural father of the child. 
How  Can a Dtclamtion  of  When the parents of a child are not married at the beginning of the 
Paternity  help me?  pregnancy or at the birth of the child, the father may NOT be considered 
a legal parent with rights or responsibilities for the child. Even signing 
the childs birth certificate will not make him the legal father. 
To help you gain legal tights asyour childs father, you can sign the 
Dechztion  of Paternity In most cases,signing the form will make it 
easier to establish paternity in court later. 
Why  should  I sign  To show your child that you are proud to be his or her father! 
the declaration?  To help you have a bond with yourchild. 
To get a legal paper that saysyou are presumed 
to be the childs father under California law. 
To giveyourchild your legalname ifyou choose, 
To helpyou be able to add yourchid to yourhealth insuranceplan. 
To help make surethat your socialsecurityor veteransbenefitsare 
paid to your child in caseyoudie or aredisabled. 
To help protect your childs right to inherit from you. 
wh8tdoesitmeanwilen  After both parentshave signedthe Lkhation  of Pattmiq,  the form 
I sign the declaration?  and other appropriatepaperworkmaybe filed with the courtto establish 
paternity.Oncepaternityis established,youwill havethe legalrightsand 
Bnancialresponsibilitiesof a parent underCalifbmia law. Siig  this 
declarationwill help yourchild havethe samerightsthat he or shewould 
haveif youweremarried to the other parent. 
Howdol.flIIoutthe  sectionsA,BuldDshouldbefiucdoutbythepvrntsof~echildThe 
: 	 t!eclu8donr  witnesswill fill out sectionE. Seethe inshucGonson the declarationfor 
:  mom detailx 
cs9lO  (It%.)  Appendix  E:  Parent  Statements 
PATEKNITY  ACKNOWLEDGEME?, 
RJGHTS AND RESPONSIBILITIES  STATI3IEN-I 
RlGHTS  AND RESPONSIBILITIES  OF FATHER 
I have read or was told.of  the follo\%ing matters  before signmg  the acknouledgement  of patemit?,  on the reverse  side of thus 
form 
I 	 I understand  that my signature  on this form establishes  that I am the natural  parent  of the named  child  for all 
legal purposes 
2  1sign  the Acknowledgement  of Patemit!  voluntarily  and understand  that l am under  no obligation  to do so  No 
pressure  is being  or has been placed  upon me to sign  I understand  I may take the followmg  actions  instead  of 
signing  this form 
seek the advice  or representation  of legal ccunsel 

::  request  that blood  tests be taken  and 

have the matter of patemi&  determined  by the court 

C 
3  I understand  that I will have the responsibility  10 provide  support  for rn>child 
4 	 1 understand  l will be responsible  to pay such support  until  the child turns  I 8 years of age or beyond  if required 
by law. 
5 	 I understand  that after palernie  is established  1ha1.e the right to request  visitation  with and custody  of the child 
Custody  and visitation  are decided  in legal actions  separate  from the issues  of paternie  and child  support 
6  I understand  that the Acknowledgement  of Patemit?. may be used rn any legal proceeding  regarding  my child 
7 	 I understand  that I have the right to talk to a staff person  to clat-if? information  on this form and answer  an> 
questions I have. 
RIGHTS  AND RESPONSlBlLlTlES  OF MOTHER 
I have read or was told of the following  matters  before signing  tile acknowledgement  of paternity  on the reverse  side of this 
form. 
I. 	 I understand that my sibwahlre on this form means  that I swear that f am the mother  of named  child  and the 
Person signing as the father is the biological  father of the child. 
2. 	 I sign the Acknowledgement  of Paternity  voluntarily  and understand  that 1 am under  no obligation  to do ~0. No 
Pm  is being or has been placed upon me to sign  I understand I mav take the following  actions *ad  of 
signing this form. 
a.  seek the advice  or representation  of IegaI counsel 
b  request that bled  tests be taken and 
C  have the matter o Ipatemiv  determined  by the court 
3 	 1 understand  that a&r  patemitv  is established  the father has the right to request  visitation  with and cudY  of the 
child.  Custody and vi srtation he decided  in legal  actions separate loom the issues of paternity and child SuPpOfl 
4. 	 1understand  that I h.?ve the right to talk to a staff person  to clarify  information  on this form and answer  any 
questions  I have. 
E- 1  Jon and Mary just had a baby. Its a joyous occasion. 
Thafre  still young, and this is going td be a major test 
ol their maturity... 
Jon 
Baby 
Young. confused and  Jon 81 Mary;newborn 
WImtiq  to mrkc the  bay.  wa  they adish 
rlghi choict.  paternity?  Maybe! 
-7 
1 
. 
Dinah 
&privcd  daughter 
VI 
of Ann and .--? 
b-! 
4 
i 
Ernie 
TIP 
! .wkpJ  tar  love in all  He liva  a lift of *me  T6mns 
The product al looking ~SI 
;!:r  wrung  places.  He hks  his b~ka  name  love in ah the wrong piacq  Appendix  G:  Certificate  Worksheet 
BIRTH  CERTIFICATE  WORKSHEET 
Sonora Community Hospital 
Delivered  By:  Medical  Record Number:  -
I have named my baby: (rti)  (middle)  O-t) 
SexofChild:~M  --  F  Single -Twin  -Triplet  Length  inches 
Date ofBirth:  ---  /  /  Time of Birth:  :  a.mJp.m.  Weight  Ibs.-oz. 
Information  on Father:  (nm)  (middle)  0-0 

State of Birth:  Date ofBirtb:  ---  /  /  Last grade of education complete& 

Information  on Mother:  (n,,t)  (middle)  @uiIkn) 

State of Birth:  DateofBirth:  /  /  Last grade of education  completed: 

  Race of H&w  6Ui-j:  White  /  Black  /  Asian  /  American  Indian  /  Other 
Spanish  or Hispanic  in background?  No  /  Yes  WHY)  Social Security  Number: 
Occupation  of Father:  Type of Industry: 
Race of Mother wdu):  White  I BIack  I Asian  I American  Indian  i  Other 
Spanish  of Hispanic  in Background?  No /  Yes  WICCWY~  Social  Security  Number: 
Occupation  of Mother:  Type of Industry: 
Home Address  of Mother:  I 
mlrrr*  w.=-.zlp-
MaiIing Address  of Mother:  I 
sbrup.0.Box  CltY.sbt*up-
County  of Fksidence:  Telephone  Number:  (  )  -
Dateoflastnormal  Inenhldpeliod:  /  /  Month prenatal  care began w llsti*): 
Numbeorf  psxsata.i visii  !hurce  of payment  for care:  Private Pay  /  Muli-Cal  I Blue Cross/  E=Tvate
I have -otherchildnnwhoycnowliving(&lt-tbb~r~~~~ 
Ibave- otherchildren~omrrborn~ebut~enowdead(~lc-~Um~rld~~ 
I have had  miscarriages  before the Wth month of pregnancy.  I have had - miscarriages  after the Gfth month of 
Pregntney.--
Date of birth ofyoungest  cbild~~rtcrttuaudr..,~~~  /  /  . 
Dateoflastmiscarriage:  - I -d  I 
p0 you want a soti  security  number  for (your new baby?  Yes  _  No.  May the Social  Security  Administration  share 
ti~theDeparbnentofHe.&hServices.  -Yes-No. 
Signature  of Mother or Father:  Dated:  I  I 
G-l  Appendix  H:  Evaluation 

BABY INFORMATION 
Name:  Babys DOB:  1  ! 
First  Middle  Last 
MOTHER  INFORMATION 
Name:  Mothers DOB:  1  ! 
First  Middle  La.St  Maiden 
County of Residence:  Race:  Years of Education: 
Marital Status:  Occupation: 
1 -Married to FOB 
2 -Married but not FOB  Worked during pregnancy:  l-Yes  ~-NO  O-Dont know 
3 -Common law with FOB 
4-Notmarried  Number of other children: 
Language Barrier:  Pre-natal care: 
l-No  I- No pre-natal care 
2 -Yes...  I- Spanish only  2 -Pre-natal care, not at this facility 
2-other  3 -Pre-natal care at this facility 
Mothers social security number: 
FATHERS  INFORMATION 
Name:  Fathers DOB:  /  ! 
First  Middle  Last 
RXXX  Years of Education: 
PROJECT  INFORMATION 
Was father present at delivery:  Reasons Paternity Affidavit Not Completed  011thatapply) 
(CWC 
l-Yes  1 -Mother doesnt want him on (abusive/fears/dislikes father) 
~-NO  2 -Father uninterested,  not involved 
0 -No information  3 -Father incarcerated 
4 -Father out of state 
Was the paternity affidavit signed:  5 -Father not at hospital 
1 -Both parents signed  6 -Both interested, but want to wait 
2 -Mother signed  7 -Mother wants father to marry her Brst 
3 -Neither signed  8 -Mother wants boyf?iend to adopt the baby 
8-Other  9 -Adoption by third party 
10 -Father doesnt believe the baby is his 
RR Present?  CSE-6 Gives?  11 -Neither parent interested 
l-No  l-No  12 -Wants  iuf&mal payments, can do better financially  alone 
2-Yes  2-Yes  13 -Doesnt kttow who father is 
14 -Mother doesnt want him on, no reason given 
# Video  # In-person  # Class  15 -Married, but not to FOB 
16 -Cannot determine 
17-Other 
H-l  Appendix  I:  Follow-up  Letter 
Dear 
Our records indicate that your baby was born on 
to date we have been unable to register the babys birth for the following 
reason(s): 
Parents of the child have not signed the birth certificate  and/or the 
acknowledgment  of parentage. 
Mother of the child has not signed the birth certificate and/or the 
acknowledgment  of parentage. 
Father of the child has not signed the birth certificate  and/or the 
acknowledgment  of parentage. 
Parent(s) have not completed a birth certificate worksheet.  Please 
find worksheet  enclosed.  Fill out immediately  and return to the 
medical records department at the hospital. 
Other: 
Your immediate  attention is required on this matter.  Please contact me 
with any questions  you might have. 
The babys incomplete  birth certificate will  be sent to the town hall on 
if we do not hear from you.  At the town hall the birth 
certificate will  be pi  into a pending file until this matter is taken by you. 
Thank you. 
Birth Registrar 
I-l