Independent Living Staffing Outcomes
16 Years Old
Independent Living Staffing Outcomes
|Date of Staffing | |
|Name of Youth | |
|DOB/Age | |
|CDS ILFCC | |
|Current School/Placement | |
|PFSF Family Care Counselor | |
Type of Staffing
16 year old
16 ½ year old
Child’s primary language: __
Translator needed?: No Yes and the following arrangements were made to accommodate.
Is the Child Deaf or Hearing Impaired? No Yes
Translator needed?: No Yes and the following arrangements were made to accommodate.
Does the youth have a copy of:
Birth Certificate Yes No
Social Security Card Yes No
Florida Identification Card/Valid Drivers License Yes No
Medicaid Card Yes No
Youth’s Educational & Career Path (Based on F.A.C.T.) _____________________
_______________________________________________________________________
IL ASSESSMENT RESULTS
|Strengths (please list) |Areas for Improvement (please list) |
| | |
|Skills Training Plan Effective Date | |
|Skills Training Plan Target Date | |
*ATTACH COPY OF CURRICULUM
Skills Training Information Provided to Youth? Yes No
Skills Training Information Provided to Foster Parent? Yes No
Is the youth actively involved with IL Life Skills? YES NO
If yes, what are some of the classes that the youth has completed since the last staffing?
What additional IL services are needed at this time?
If no, what is preventing the youth from completing IL Life Skills training?
______________________________________________________________________________________
|HEALTH STATUS |
MENTAL HEALTH SERVICES
Is the youth receiving mental health services? Yes No
If yes, what is the current mental health diagnosis?
Does the youth wish to continue to receive mental health services after their 18th birthday? YES NO
Will the youth need assistance with referral for mental health services after 18th birthday?
YES NO
Who will provide these services to the youth?
Developmental Disability Services
Does the youth have a developmental disability? Yes No
If yes, has the youth been referred to Developmental Disabilities (APD)?
Who will help the youth apply for benefits?
If applied what is the status of the application?
What documented efforts have been made to ensure that the youth is connected to services when they age out?
What services will the youth be receiving?
Who will provide these services to the youth?
Social Security Benefits
Is the youth receiving SSI/SSA benefits? YES NO
If yes, please explain why?
Has the youth or case manager applied for Social Security benefits? YES NO
Who will help the youth apply for benefits?
If applied what is the status of the application?
Has the youth been provided information related to continuing SSI/SSA benefits?
YES NO
If youth is receiving benefits, has he/she been provided with an accounting of funds in the trust and how to access these funds? YES NO
HEALTH CARE
Does the youth have a regular physician that they can contact if needed? YES NO
Does the youth have a regular dentist that they can contact if needed? YES NO
Will the youth need to apply for KidCare after their 18th birthday? Yes NO
Who will assist the youth with the application?
EDUCATIONAL STATUS
|School Attending/Grade | |
|Grade Point Average | |
|Expected Graduation Date | |
*ATTACH COPIES OF REPORT CARDS
What type of diploma is the youth pursuing?
General High School Diploma
Special Option I High School Diploma
Special Option II High School Diploma
General Education Diploma (GED)
If youth is enrolled in Special Education classes, when was the last IEP completed? ____________
Please attach most recent IEP to staffing form
GOAL PLANNING
___ Entering the 9th grade ____ Initial Goal Planning ____ Goal Change
|Px strengths, needs, abilities and preferences (SNAP): |
|S. | |
|N. | |
|A. | |
|P. | |
Post- Secondary Educational Goals:
Choose one of the following:
Attending a 4-year college or university, a community college plus university,
or a military academy
Receive a two-year post secondary degree
Attain a post-secondary career and technical certificate
Begin employment immediately after completion of high school diploma or its
equivalent or enlist in the military.
Post-Secondary Educational Information Provided to Youth? Yes No
What educational institution would the youth like to attend?
What educational courses are you currently taking that will help you work toward your educational goals?
EMPLOYMENT STATUS
Currently Employed? Yes No
If yes, where?
Does the youth have any other sources of income?
How much does the youth earn weekly/monthly?
Past employment experience:
What is the youth’s career goal?
Short- term goal (Within the next six months)
Long-term goal (Within the next five years)
MENTORING/INTERNSHIPS
Identified Mentor’s name (teacher, employee of DCF/PFSF/CDS or community volunteer):
Identified Internship(s) and/or volunteer work:
BANK ACCOUNT
Does the youth have an opened bank account? Yes No
If yes, amount saved? __________________
Additional Information (including plans to open a bank account):
TRANSPORTATION
How will the youth get to work and school?
What efforts are there to assist youth in this?
PERMANENCY ARRANGEMENTS
What are the permanency arrangements and the child’s wishes regarding adoption?
| |
| |
Any other identified obstacles and needs the child has with regard to IL.:
| |
| |
THE FOLLOWING ACTIONS NEED TO TAKE PLACE
BEFORE THE NEXT REVIEW:
Foster Parent(s)/Group Home Staff:
1. Ensure youth is present for life skills training.
2. Cooperate with life skills training home assignments for the youth.
3. Communicate with ILP staff to discuss ILP progress and difficulties.
PFSF Family Care Counselor:
1. Communicate with ILP staff on youth’s placement status and school progress.
2. Assist ILP staff in obtaining verification of life skills training youth may receive at school.
3. Assist youth in obtaining either a Florida State Photo ID or driver’s license.
CDS Independent Living Staff:
1. Continue to provide independent living life skills training to youth.
2. Maintain communication with the PFSF Family Care Counselor to monitor youth’s placement status and educational progress.
3. Provide BI-ANNUAL STAFFINGS FOR YOUTH.
Youth:
Youth:
1. Continue to attend school on a regular basis and attempt to maintain a 2.0 GPA.
2. Continue to attend life skills training and complete all home assignments for life skills training.
I understand that by signing this document, I am beginning to plan for my future. I understand that the educational goal marked above can be changed at anytime. Signing
I understand that by signing this document, I am beginning to plan my future. I understand the educational goal marked above can be changed at any time. Signing
this does not lock me into a plan, but rather helps me to begin to plan for my future education. I have reviewed all options at this time and agree that the educational goal marked above is my choice at this time. I will continue to plan for my future with the assistance of the CDS Independent Living staff, my PFSF Family Care Counselor, foster parent or other mentor.
I have been given information on:
Scholarships (Bright Futures) Grants
PESS Fee Waiver/Exemption
Aftercare Funds
|Concur With Plan |Title |Signature/Printed Name |
| Yes No |Youth | |
| | | |
| | | |
| Yes No |Foster Parent | |
| | | |
| | | |
| Yes No |PFSF Family Care Counselor | |
| | | |
| | | |
| Yes No |CDS IL Staff | |
| | | |
| | | |
| Yes No |IL Coordinator. | |
| | | |
| | | |
| Yes No |Therapist | |
| | | |
| | | |
| Yes No |Other | |
| | | |
| | | |
|NEXT STAFFING WILL OCCUR |
| |
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related searches
- center for independent living scranton pa
- center for independent living scranton
- senior independent living communities
- corporation for independent living ct
- independent living for autistic adults
- independent living skills worksheets adults
- northeast independent living ma
- northeast independent living program
- teaching independent living skills printables
- independent living support services
- independent living skills activities pdf
- independent living workbook pdf