CHILD'S SERVICE PLAN
|CHILD'S SERVICE PLAN |
|Initial Plan |
|Initial Service Plan / Intake Study / Initial Assessment Report |
|OVERVIEW |
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|A. |
|General: |
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|Religion |
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|Date This Plan Completed |
|Date of Next Review |
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|Note: This plan has been reviewed based on this child's special strengths and needs. Services have been planned to meet the |
|child's needs. |
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|Worker Who Completed Form |
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|B. |
|Long-Range Goal For Permanency (See last page for definitions.) |
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|Permanency Goal |
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|Projected Date for Achieving Permanency |
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|Estimated Length of Stay in Substitute Care |
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|If there is a discrepancy between the estimated length of stay in substitute care and the projected date of permanency, explain: |
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|C. |
|Concurrent / Alternative Goal for Permanency (See last page for definitions.) |
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|INTAKE HISTORY |
|A. |
|Initial Child History |
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|B. |
|Initial Family/Genetic History |
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|RESULTS OF INITIAL ASSESSMENTS / PROGRESS SINCE REMOVAL |
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|Caregiver observations about child's personality, behavior, special interests, and talents |
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|Basic needs |
|All children in placement have basic needs. They require food, shelter, and clothing; routine medical and dental care; safe, |
|stimulating, and nurturing home environments; and friendships and recreational activities appropriate to their ages. FPS expects |
|each child's caregiver to meet the child's basic needs without specifically identifying those needs in the case plan. |
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|Specific needs |
|Social and Emotional Needs |
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|Educational Needs |
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|Developmental Needs |
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|Medical and Dental Needs |
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|Special Physical Needs |
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|Psychological/Intellectual/Mental Health Needs |
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|Recreation, Community Interaction, Religious Needs |
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|Appropriateness and Safety of Placement / Expected Outcomes |
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|Progress/Efforts Made Toward Permanency |
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|Visitation/Contacts Summary |
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|Child's Culture Heritage |
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|Discharge Planning |
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|Relationship Issues |
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|High Risk Behaviors |
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|Emergency Conditions |
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|FPS has determined that one of the following emergency conditions continues to exist for this case and, therefore, services |
|continue to be necessary: |
|A child is at risk of abuse or neglect, as determined by FPS; |
|A child has been removed from his/her home and placed in FPS care; or |
|A child formerly in FPS care is at-risk of being returned to FPS care. |
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|PLANS |
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|Plans to address Permanency |
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|Specific needs |
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|Plans to Address Social and Emotional Needs |
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|Plans to Address Educational Needs |
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|Plans to Address Developmental Needs |
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|Plans to Address Medical and Dental Needs |
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|Plans to Address Special Physical Needs |
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|Plans to Address Psychological/Intellectual/Mental Health Needs |
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|Plans to Address Recreation, Community Interaction, Religious Needs |
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|Plans to Address Safe and Proper Care / Expected Outcomes |
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|Plans to Address Future Visitation / Contacts |
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|Plans for Preserving Child's Cultural Heritage |
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|Discharge Planning |
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|Plans to Address Relationship Issues |
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|Plans to Address High Risk Behaviors |
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|Supervision / Special Actions |
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|Behavior Management (Discipline) |
|The child's discipline must suit the child's age, circumstances, and developmental needs. Methods of discipline may include: |
|establishing routines, setting reasonable limits, modeling appropriate behavior, offering choices, giving explanations. repeating|
|instructions, taking ''time-out'', enforcing or permitting logical or natural consequences, and reinforcing desired behavior. |
|Physical punishment is not permitted. Additional strategies for managing the child's behavior are specified below. |
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|Travel |
|The child may travel to participate in normal activities (examples: church, school events). Any trips that last more than 48 |
|hours must be approved in advance by the child's worker. Trips outside the state or country must be approved in advance by the |
|child's worker and by the court.The child must be restrained in a car safety seat or seat belt, whichever is required by law |
|based on the child's age. Additional stipulations regarding the child's travel are specified below. |
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|Support Services to the Caregivers |
|Identify the support services to be provided to the caregiver to help them meet the child's needs and to ensure that the child |
|receives safe and proper care. Include the planned frequency of worker visits to the child and to the caregiver's home. |
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|INVITED PARTIES AND PARTICIPATION INFORMATION |
|NAME |
|RELATIONSHIP TO CASE |
|DATE OF NOTIFICATION |
|TYPE OF NOTIFICATION |
|DATE COPY GIVEN |
|DATE OF PARTICIPATION |
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|EXPLANATION IF NO PARTICIPATION BY CHILD, MOTHER, FATHER OR CAREGIVER |
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|INFORMATION NOT AVAILABLE: |
|If information was not available regarding any area of the plan, describe efforts that were made to obtain the information. |
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|OTHER ASSESSMENTS: |
|If not otherwise specified in the plan, the following assessments have been recommended. If none, please state "none". |
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|Signature-Worker |
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|Date |
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|Signature-Child (Optional) |
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|Date |
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|Signature-Supervisor |
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|Date |
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|Signature-Program Director |
|(Required for initial placement only) |
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|Date |
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|Attach a copy of the following updated items to the plan shared with the caregiver, unless this information has already been |
|provided or obtained by the caregiver: |
|medical log |
|education log |
|medical/developmental history, and |
|the record of immunizations |
|Permanency Goal and Concurrent Goal: DFPS plans and backup plans for your child |
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|DFPS wants children to be happy in a permanent, safe and loving place after they leave foster care. To achieve this, DFPS |
|creates something for each child called a Plan of Service. This defines the child's Permanency Goal and Concurrent Goal. |
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|A goal means where the child will live when DFPS services are done. DFPS must think about these issues for where the child will|
|live: |
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|Will the child be safe? |
|Is it family-like? |
|Will it be forever--a permanent relationship as the young person matures through the years? |
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|The Permanency Goal is the plan DFPS thinks would be best. If it cannot be done, DFPS also has a backup plan called the |
|Concurrent Goal. There can be more than one backup plan. DFPS works on the Concurrent Goal at the same time as the Permanency|
|Goal. |
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|DFPS could choose the following goals for your child, as either a Permanency Goal or a Concurrent Goal: |
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|Family Reunification - The parent gets the child back. This may be the parent the child was living with before DFPS care or it |
|may be a parent the child was not living with. |
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|Alt Family: Relative/Fictive Kin, Adoption - A relative, close family friend or a person/family already known to the family or |
|child adopts the child. For this to happen, the court has to end parental rights of both parents or accept the parents giving up |
|their parental rights. |
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|Alt Family: Relative/Fictive Kin, Conservatorship - A relative, close family friend or a person/family already known to the |
|family or child gets permanent custody of the child. |
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|Alt Family: Unrelated, Adoption - The family who did not know the child before foster care adopts the child. For this to happen, |
|the court has to end parental rights of both parents or the parents give up their parental rights. |
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|Alt Family: Unrelated, Conservatorship - A person who is not a relative or kinship caregivers gets permanent custody of the |
|child. |
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|APPLA: Foster Family, DFPS Conservatorship - DFPS gets permanent custody of the child. The child would live in a foster home |
|until he or she reaches adulthood. For this to happen, the court may or may not end parental rights of both parents or the |
|parents may or may not give up their parental rights. |
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|APPLA: Other Family, DFPS Conservatorship - DFPS gets permanent custody of the child. The child would live in the least |
|restrictive and most family-like setting possible. For this to happen, the court may or may not end parental rights of both |
|parents or the parents may or may not give up their parental rights. |
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|APPLA: Independent Living - The youth would be in DFPS care until he or she is age 18. |
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|APPLA: Community Care - A youth with a developmental disability would stay in DFPS care until age 18. When these youth reach |
|adulthood, a legal guardian will need to look after their well-being. |
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|Alt Family = Alternative Family |
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|APPLA = Another Planned Permanent Living Arrangement |
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