Upbring



Child Status ReportsEach child will need to have at least one “Child Status Report” completed each month. We ask that you do not leave any sections blank. If a section is not applicable, you may write N/A (such as Hospitalizations). Child Status Reports are due on the 5th day of the following month.Behavioral/Emotional/Social Issues: Document entries on a daily or weekly basis when describing the child’s positive and negative behaviors and milestones. When incidents occur, include circumstances leading to the event, behaviors, and method of redirection used. It is important to remember: Frequency, Duration, & Severity. For example, “John became physically aggressive 4 times today with the other foster children due to disagreements over television programming. Each episode lasted approximately 6 minutes and required me to intervene by separating the children to prevent physical harm to one another. I was hit several times in the leg by John while separating them.” Additionally, indicate the frequency of maladaptive behaviors per month and the interventions you applied, along with consequences, and rewards given during the month. Therapy: Document any feedback received from the therapist, either interventions to be used or coping/de-escalating techniques to be implemented.Supervision Provided: At a minimum, select 1 level of supervision. Level of supervision must be consistent with that in the child’s service plan. Describe all types of supervision the child required during the month. Educational: Document any educational achievements or information as provided by the school. Include the child’s homework habits, level of understanding, progress reports, teacher’s feedback, etc. Include any update to the child’s educational portfolio. Recreation & Leisure: Document any recreational and leisure activities the child participated in. Include the child’s response to the activities.Medical/Dental/PsychologicalTherapy/Psychiatric Appointments: Document any appointment dates, type of appointment, provider, and outcome of treatment. Medication Additions/Deletions: Document any change in medication, either change in dosage, discontinuation of medication, or addition of new medicationChanges in Physicians Orders: Document any new orders excluding medication changes.Nursing: Document name of agency providing services and total hours provided per week Hospitalization: Document name of physician, hospital, admission date, discharge date, and reason for visit, and any follow-ups needed. Supportive Services: Document dates ECI, OT, PT, ST services were rendered and progress/recommendations made by provider.Independent Living Skills: Document for children 16 years and old, independent living skills that the child practiced during the month. Document if the child If the child is employed or participates in volunteer work along with the number of hours. , document employer and hours worked. Respite: Document date respite was used, name of provider used, and any feedback regarding behavior observed by provider. Family Contact: Document date of visit, individual’s child visited, location/method of visit, and observations of child’s interaction with individual during visitNutrition, Hygiene & Grooming: Document observations regarding the child’s appetite, hygiene, daily grooming, and the level of assistance needed in any of those areas. If PMN, document formula, rate and any additional oral intake Clothing and Personal Items: Document any personal items and/or clothing purchased for the child. If a child has a change in belongings between admissions and discharge, please note these changes here. If there are changes, the child must sign (if age appropriate). Electronic version of this form is available on the Parent Portal HYPERLINK "" Password – FIT4Med LogsMedication Logs are due on the 5th day of the following month.Every child must have a Medication Log regardless if they are currently on meds.Include all information at the top of the form – Child’s Full Name, DOB, Month/Year of the Med Log, Allergies, Family name and Page numbers. This section of the log should be filled out on the 1st of the month. For each prescribed medication, include all necessary information. We ask that you do not leave any information blank. Medication Name: must match bottleStrength: Must match bottleDosage Instructions: Must match bottleDiagnosis: What is the reason for this medication?Dr. Name: Who prescribed the medication?Record the (T) actual time the medication is given and the (I) Initials of the individual that gave the medication. Must attend Medication Trainings to dispense medication. All individuals that gave medications will need to sign and initial the bottom of the form. If meds are dispensed at school, just put an S for school, on that day. For PRN and OTC medications given, list the date/time, medication, and the reason for the medication on the back side of the form. FSW will review at every home visit.Medical/Dental AppointmentsMedical Forms are due within 24 hours of occurrenceAnnual Physicals – Physicals are to be completed every 12 months. Well Child Checks (WCC) – For children 3 years and younger, follow the guidelines for the Texas Health Steps. 2 weeks, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 2 years and 2 ? years.Dental Examinations: Each child over the age of 6 months, will need a dental exam every 6 months (3 month recalls could be required) Follow up and Referrals:If follow ups or referrals are requested, schedule as soon as possible. Notify your FSW (caseworker) of the appointment.All follow ups & referrals must be completed.Medical/Dental/Vision/Hearing Examination Form must be completed for all appointments. If doctor provides a print out, please complete the Medical form and attach the printout.Page 1 completed by caregiver. Be sure to include caregiver (foster parent) information, CPS caseworker, reason for the visit, and medications. Caregiver must sign page 1.Page 2 - completed by health care provider. - Medications and changes of medications must be listed. - Signature of healthcare provider and contact informationmust be completed.If vaccinations are completed – please obtain and submit a copy of the child’s new immunization records. Electronic version of this form is available on the Parent Portal HYPERLINK "" Password – FIT4RespiteIf babysitting/respite is required, contact your FSW (caseworker) to get pre-approval for each babysitting/respite occurrence. Respite must be with an approved babysitter/respite provider. Complete “Babysitting or Respite Child Care Instruction and Verification Form” to be left with the respite provider. After the occurrence, ensure you have the babysitter/respite provider’s signature (this verifies you have paid the respite provider for services). Submit to your FSW or the office within 10 day of respite occurrence. Office will submit for reimbursement. If you are signed up for direct deposit, the reimbursement will be deposited into your account. If you are not enrolled in direct deposit, a check will be mailed to you. Respite funds are accumulated monthly, based on the number of children in your home. $40 for the first foster child, and $30 for each additional child placed in your home. You may accumulate funds quarterly. Funds that are not used quarterly are forfeited. Jan – Mar, Apr-Jun, Jul-Sept & Oct-Dec. If you have any questions, contact your Family Service Worker, or local office. NUMBER OF CHILDREN MONTHLY RATE 1 $40 2 $70 3 $100 4 $130 5 $160 6 $190 7 $220 8 $250 9 $280 To check the balance of your respite account, contact your Family Service Worker or local office. Serious Incident ReportsALWAYS CALL YOUR FSW OR ON-CALL FIRST PRIOR TO COMPLETEING FORM OR MAKING CALLS TO THE HOTLINE. Non-Reportable Reportable (Hotline call)Due to your FSW or On Call FSW within 24 hours of incidentMust be filled out completely; put N/A as applicable – no blanks Attach any documentation when submitting such as police reports or hospital/medical recordsPut in as much detail as possible as this report is sent to many parties who will have questionsIf hand written, please do so legibly ................
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