Making



Juvenile Court Services - Transition Plan from Out-of-Home Placement to Adulthood[Required for all youth age sixteen and older, must be reviewed & approved by Transition Committee by age 17 ?]Youth’s Name: FORMTEXT ?????DOB: FORMTEXT ?????Type of Placement: FORMTEXT ?????Anticipated Date of Exit from Foster Care: FORMTEXT ?????Date of Transition Plan: FORMTEXT ?????Anticipated High School Graduation Date: FORMTEXT ?????Date of Adjudication: FORMTEXT ????? Level of Offense: FORMTEXT ?????List the members of the youth’s Transition Team: FORMTEXT ?????List dates that the team met to develop/update the Transition Plan: FORMTEXT ????? Youth Rights Document: A list of rights with respect to education, health, visitation, and court participation has been discussed with the youth.? Also addressed was the right to stay safe and avoid exploitation.? The Rights document was provided to and signed by the youth, most recently on FORMTEXT ????? (date).? The Rights document was provided to all legal parties of the case and was made part of the case plan.? The document is stored in the case file.STRENGTHS & CONCERNSDate Casey Life Skills Assessment-CLSA Completed FORMTEXT ?????Check the level of competency for each area below, addressing how each need will be met in the action steps:Documented Strengths & Needs MakingNeed Progress SatisfactoryDaily living skills: laundry, cleaning, shopping, cooking FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Self-care: hygiene, access to physical/mental health care FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Housing: awareness of future options and how to obtain FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Money Management FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Social skills development FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Emergency/safety skills FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Community resources: knowing what is available and how to access FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Positive support system FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Employment skills FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Education plan FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Transportation FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Parenting skills (if the youth is pregnant or parenting) FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Other FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Photo ID: FORMCHECKBOX Has FORMCHECKBOX NeedsDriver’s permit/license: FORMCHECKBOX Has FORMCHECKBOX Needs FORMCHECKBOX Doesn’t wantYouth with Mental Health and/or Physical Health Needs: – Check here if Not Applicable and proceed to the next section FORMCHECKBOX Date of the youth’s most recent medical/psychiatric/psychological evaluation: FORMTEXT ?????Diagnosis: FORMTEXT ?????Full Scale IQ: FORMTEXT ?????Current medications: FORMTEXT ?????Will this youth reasonably need adult disability services upon reaching adulthood? FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX UnsureWas the transition plan developed with representation from the adult disability system (i.e. Integrated Health Home or adult case management)? FORMCHECKBOX Yes FORMCHECKBOX NoDoes the youth receive Social Security on a parent’s death or disability? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, has the youth been determined to be disabled? FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX PendingHas Supplemental Security Income (SSI) been applied for (i.e. referral to Maximus)? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, was the youth found eligible? FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX PendingDoes the youth have an IEP? FORMCHECKBOX Yes FORMCHECKBOX No Is Department of Vocational Rehabilitation Services (IVRS) currently involved? FORMCHECKBOX Yes FORMCHECKBOX NoReview of progress:Describe efforts and progress on coordinating with the adult disability service system. FORMTEXT ?????Youth’s Plan for Adulthood:Describe the youth’s plan after out-of-home placement ends in each of the 8 Fostering Connections areas and any progress toward the plan:Housing Plan: FORMTEXT ????? Education Plan: FORMTEXT ????? Employment Plan: FORMTEXT ????? Medical Needs: FORMTEXT ????? Relationships/Supports: FORMTEXT ????? Self-Sufficiency: FORMTEXT ?????Civic/Social Engagement: FORMTEXT ?????Interpersonal/Behavior: FORMTEXT ?????Referrals:Check referrals that will be made to assist the youth in the above plan (add specifics in Action Steps below): FORMCHECKBOX Integrated Health Home (IHH) FORMCHECKBOX Reproductive Health services and education FORMCHECKBOX Housing Assistance FORMCHECKBOX Iowa College Student Aid Commission (ICSAC) program of assistance in applying for financial aid for higher education FORMCHECKBOX Job Corps FORMCHECKBOX Mental health provider FORMCHECKBOX Vocational Rehabilitation Services (IVRS) FORMCHECKBOX Legal Guardian after age 18 FORMCHECKBOX Protective Payee after age 18 FORMCHECKBOX Public Assistance (Food Assistance, Family Investment Program (FIP), Medicaid) FORMCHECKBOX Substance abuse treatment FORMCHECKBOX Workforce Innovation & Opportunity Act (WIOA) FORMCHECKBOX Other: FORMTEXT ?????Discharge Preparation:Youth will have high school diploma/HSED at age 18. FORMCHECKBOX Yes FORMCHECKBOX No If no, does youth plan to remain in care (over age 18) in order to complete high school? FORMCHECKBOX Yes FORMCHECKBOX NoThe youth has been informed that the following supports may be available for youth leaving care at 18 or after: FORMCHECKBOX Title XIX – Expanded Medicaid for Independent Young Adults (EMIYA) coverage group FORMCHECKBOX Education & Training Voucher (ETV) FORMCHECKBOX Iowa Aftercare Services Network (IASN) and/or Preparation for Adult Living (PAL)As required by State and Federal law, youth has been given: FORMCHECKBOX A certified birth certificate FORMCHECKBOX A Social Security card FORMCHECKBOX Foster Care Verification LetterComments: FORMTEXT ?????Action Steps:What steps need to happen that will assist the youth in meeting needs identified above and to facilitate a successful transition to adulthood?What are we going to do? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Who’s going to do it? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????By When? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????This information must be reviewed with the youth and updated with each case review. It must also be reviewed and updated in the 90-day period before a youth reaches age 18, and for youth who remain voluntarily beyond 18, in the 90-day period before the anticipated discharge date. Date this plan was approved by the Transition Committee: FORMTEXT ????? ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download