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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