Day 1 - Pennsylvania Child Welfare Resource Center



|Identified Child Name: NAME AGE Case/Record Number:       |

|Date(s) of Review: _________________ |

|Review Team: Name Phone |

|Name Phone |

|Scheduler: Name Phone |

|Day 1 |Person and Category |Location of Interview & Phone Number |

|Date & Time | | |

|8:00am - 8:30am |Welcome and Overview |ABC County Children and Youth Services |

| | |1234 Main Street |

| | |Anytown, PA 98765 |

| | |Main Conference Room |

|8:30am – 10:00am |Interview Preparation, Review Case File |ABC County Children and Youth Services |

| |(It is important for schedulers to assure that QSR reviewers|1234 Main Street |

| |have time with the case file prior to their first interview)|Anytown, PA 98765 |

| | |Main Conference Room |

|10:00am – 11:00am |Caseworker/Supervisor Interview |ABC County Children and Youth Services |

| |(It is most ideal for QSR reviewers to interview the |1234 Main Street |

| |assigned caseworker/supervisor prior to all other |Anytown, PA 98765 |

| |interviews) |Caseworker’s office – 2nd floor |

|11:15am – 11:45am |Phone Interview with Child’s Attorney |ABC County Children and Youth Services |

| | |1234 Main Street |

| | |Anytown, PA 98765 |

| | |Phone: 999-888-8888 |

| | |Room: Interview Room C |

|12:00pm - 1:00pm |LUNCH |On your own |

|1:15pm - 1:45pm |Interview with Child’s Therapist |ABC County Children and Youth Services |

| | |1234 Main Street |

| | |Anytown, PA 98765 |

| | |Room: Interview Room C |

|1:45pm - 2:15pm |Travel |See packet of information for directions |

|2:15pm - 3:00pm |Interview with Child’s Teacher |ABC Elementary School |

| | |654 Forest Avenue |

| | |Whoville, PA 01234 |

| | |Guidance Counselor’s Office – Rm. 258 |

|3:00pm – 3:15pm |Travel |See packet of information for directions |

|3:30pm – 4:15pm |Interview with Child’s Grandparents |321 Schoolhouse Lane |

| | |Whoville, PA 01234 |

|4:15pm – 5:15pm |Travel |See packet of information for directions |

|5:15pm – 6:45pm |Interview with Child’s Mother and Father |987 River Street |

| | |Smithville, PA 98765 |

| |

| |

|Day 2 |Person and Category |Location of Interview & Phone Number |

|Date & Time | | |

|8:00am – 8:30am |Phone Interview with Mom’s Attorney |ABC County Children and Youth Services |

| | |1234 Main Street |

| | |Anytown, PA 98765 |

| | |Phone: 999-888-8888 |

| | |Room: Interview Room C |

|8:30am – 9:30am |Interview with Provider Worker |ABC County Children and Youth Services |

| | |1234 Main Street |

| | |Anytown, PA 98765 |

| | |Room: Interview Room C |

|9:30am – 11:30am |Scoring |ABC County Children and Youth Services |

| | |1234 Main Street |

| | |Anytown, PA 98765 |

| | |Large/small conference room |

|11:30am-12:30pm |Prepare for Case Specific Debriefing and Feedback Session |ABC County Children and Youth Services |

| | |1234 Main Street |

| | |Anytown, PA 98765 |

| | |Large/small conference room |

|12:30pm – 1:30pm |LUNCH |On your own |

|1:30pm – 2:30pm |Feedback Session with Caseworker/Supervisor |ABC County Children and Youth Services |

| | |1234 Main Street |

| | |Anytown, PA 98765 |

| | |Caseworker’s office – 2nd floor |

|3:00pm - 5:00pm | |ABC County Children and Youth Services |

| |Case Specific Debriefing |1234 Main Street |

| | |Anytown, PA 98765 |

| | |Large/small conference room |

NOTES:

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