Concurrent Planning
Date of Removal to 30 Days
Names of Parents:
Date of Removal:
Names and Dates of Birth of Children:
Social Worker:
Full Disclosure
1. In the last 22 months, how long has each
child been in foster care?
Date of Review:
Notes
________________________________
________________________________
2. Which family members have received full
disclosure regarding ASFA timeframes?
Mother
All fathers
Maternal
Paternal
Grandparents
Grandparents
Mother’s siblings
Father’s siblings
Child(ren)
Other family
Other (specify)
supports
________________________________
________________________________
________________________________
________________________________
________________________________
3. How has full disclosure been documented?
1. Have the following fathers been identified for
each child?
Man listed on the birth certificate
Man listed on the Putative Father
registry
Man who acknowledges paternity
Man adjudicated as the biological father
Man living with the birth mother who
identifies himself as the father
Spouse of the birth mother at the time of the
conception and/or birth of the child
Father identified in a child support order
Man identified by the mother as the child’s
father
________________________________
________________________________
4. Have all resource parents received adequate
information to keep each child safe and meet his
or her needs?
Yes
No
Paternity
________________________________
2. Has a referral been made to the Parent
Locator Service for absent parents?
Yes
No
N/A (no absent parents)
________________________________
________________________________
1
Family Engagement/Case Planning
1. Was Family Group Decision Making
utilized?
Yes
No
Notes
________________________________
________________________________
Relatives
1. Has a genogram been completed with the
family?
Yes
No
________________________________
Contacts/Visitation
________________________________
1. Has an adequate visitation schedule been
established with all parents (see standard for
minimums)?
Yes
No
________________________________
________________________________
________________________________
2. Has visitation been arranged with maternal
and paternal relatives?
Yes
No
2. Has an ecomap been completed with the
family?
Yes
No
3. Which maternal and paternal relatives and
fictive kin have been contacted about their
willingness to be a resource for placement or
other support?
________________________________
________________________________
4. Does a Parent Locater Service referral need
to be made to locate relatives?
Yes
No
3. Has visitation been arranged between siblings
who are not placed together?
Yes
No
N/A
________________________________
________________________________
Assessment/Services
A. If no, explain why.
________________________________
1. What poor prognosis and strength indicators
have been identified for the family?
________________________________
________________________________
________________________________
________________________________
2. Has the Child and Family Social and Medical
Information Form been completed for each
child?
Yes
No
3. What reasonable efforts have been made to
prevent removal?
________________________________
4. How have these efforts been documented?
________________________________
________________________________
2
Placement
Notes
________________________________
1. Where is each child placed?
Relative foster home with potential for
permanency
Non-relative foster home with potential
for permanency
Relative, temporary foster home
Non-relative, temporary foster
home
Other (specify)
________________________________
________________________________
________________________________
________________________________
________________________________
2. Which siblings are placed together?
________________________________
3. If all siblings are not placed together, what
efforts are being made to place them together?
________________________________
________________________________
4. Has an ICPC been initiated for prospective
relative placements?
Yes
No
N/A
5. Has an ICPC Regulation 7 been considered?
Yes
No
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
3
Date of Removal to 30 Days
Names of Parents:
Date of Removal:
Names and Dates of Birth of Children:
Social Worker:
ICWA
1. Have inquiries been made to all parents and
extended family members to ascertain if there is
Indian ancestry for the child(ren)?
Yes
No
Date of Review:
Notes
________________________________
D. Has response been received from all tribes
and/or BIA with tribal membership status?
Yes
No
________________________________
________________________________
3. If the child(ren) is Indian, are they placed
according to ICWA placement preferences?
Yes
No
________________________________
2. Does the child(ren) have Indian ancestry?
Yes
No
If yes, have the following tasks been
completed?
________________________________
4. If the child(ren) is Indian, did an expert
witness testify at the adjudicatory hearing?
Yes
No
________________________________
________________________________
A. Biological parent(s) or family member
completed the Indian Status Information form.
Yes
No
________________________________
________________________________
B. Biological parent(s) or family member
completed the Ancestry form
Yes
No
________________________________
________________________________
C. Tribal membership inquiry sent to all tribes
and/or BIA
Yes
No
________________________________
________________________________
________________________________
4
Concurrent Planning – Additional Notes
Date of Removal to 30 Days
_
5
Concurrent Planning
1 to 3 Months
Names of Parents:
Date of Removal:
Names and Dates of Birth of Children:
Social Worker:
Date of Review:
Have all prior concurrent planning action
steps been resolved?
Yes
No
Notes
________________________________
Full Disclosure
________________________________
1. Have the parents, relatives and child(ren)
been informed of both the primary and
secondary permanent plans?
Yes
No
________________________________
________________________________
________________________________
2. Have all resources parents received adequate
information to make an informed decision in
supporting each child in his or her permanency
plan?
Yes
No
Family Engagement/Case Planning
1. Which family members were engaged in the
development of the family’s case plan?
Mother
All fathers
Maternal
Paternal
Grandparents
Grandparents
Mother’s siblings
Father’s siblings
Child(ren)
Other family
Tribe
supports
Other (specify)
________________________________
________________________________
________________________________
2. Is the case plan written in measurable terms
so it is evident when safety threats have been
reduced?
Yes
No
________________________________
Paternity
________________________________
1. Have all absent parents been located?
Yes
No
________________________________
________________________________
6
Contacts/Visitation
1. Has the social worker had adequate contact
with the parents to support them in moving
forward with their case plan?
Yes
No
Notes
________________________________
________________________________
Relatives
1. Have diligent and continuous efforts been
made to locate relatives?
Yes
No
________________________________
2. How have these efforts been documented?
2. Are those contacts adequately documented in
FOCUS?
Yes
No
________________________________
________________________________
3. Have any additional relatives been identified?
Yes
No
________________________________
3. Has the social worker had monthly face to
face contact with each child?
Yes
No
________________________________
________________________________
4. Are those contacts adequately documented in
FOCUS?
Yes
No
________________________________
Assessment/Services
________________________________
________________________________
5. Is visitation between the mother and the
child(ren) occurring per the standard?
Yes
No
________________________________
8. Are any changes to the visitation plan
needed?
Yes
No
2. Have the needs of each child been assessed
and referrals made for services?
Yes
No
________________________________
________________________________
7. Do any barriers to visitation exist?
Yes
No
1. Have the needs for all parents been assessed
and referrals made for services?
Yes
No
________________________________
________________________________
6. Is visitation between the father(s) and the
child(ren) occurring per the standard?
Yes
No
4. Has an ICPC been initiated for out of state
relatives?
Yes
No
3. What has been started for each child’s Life
Book?
________________________________
________________________________
________________________________
7
Placement
1. Mark each child’s primary permanency plan
with a 1 and secondary plan with a 2:
Return Home
Permanent placement with other parent
Adoption by Relative
Adoption by Non-Relative
Guardianship with Relative
Guardianship with Non-Relative
Other Planned Permanent Living
Arrangement
Notes
________________________________
________________________________
Court
1. If there was a judicial finding of aggravated
circumstances, did a permanency hearing take
place within 30 days?
Yes
No
________________________________
________________________________
________________________________
________________________________
2. Are these the same permanency goals
contained in FOCUS and on the most recent
Alternate Care Plan?
Yes
No
________________________________
________________________________
________________________________
3. Is each child in a potentially permanent
placement?
Yes
No
________________________________
________________________________
________________________________
A. If no, what needs to happen in order for each
child to be in a concurrent planning placement?
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
8
1 to 3 Months
Names of Parents:
Date of Removal:
Names and Dates of Birth of Children:
Social Worker:
ICWA
1. If the child(ren) is Indian, has the tribe been
invited to participate in case planning and kept
apprised of what is happening in the case?
Yes
No
N/A
Date of Review:
Notes
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
9
Concurrent Planning – Additional Notes
1 to 3 Months
10
Concurrent Planning
3 to 6 Months
Names of Parents:
Date of Removal:
Names and Dates of Birth of Children:
Social Worker:
Date of Review:
Have all prior concurrent planning action
steps been resolved?
Yes
No
Notes
________________________________
Full Disclosure
________________________________
1. Have case plan progress and permanent
placement options been discussed with all of the
following:
Mother
Father(s)
Child(ren)
Relatives
Resource families
________________________________
________________________________
1. Have the original safety issues been reduced
to a sufficient level so it is probable each child
can be safe with the parent or caregiver?
2. Have the parents made adequate progress on
their case plan to retain reunification as the
primary permanency goal?
Yes
No
________________________________
________________________________
2. Have all resources parents received adequate
information to make an informed decision in
supporting each child in his or her permanency
plan?
Yes
No
Family Engagement/Case Planning
A. If no, has voluntary relinquishment of
parental rights been discussed with the parents?
Yes
No
________________________________
________________________________
3. Will the parents be able to achieve
reunification by 12 months?
Yes
No
________________________________
A. If no, what are the barriers to success?
Paternity
1. Have all paternity issues been resolved?
Yes
No
________________________________
________________________________
________________________________
4. Does the case plan need to be revised before
the next court review?
Yes
No
5. What additional safety issues been identified
since the case has been opened?
11
Contacts/Visitation
1. Has the social worker had adequate contact
with the parents to support them in moving
forward with their case plan?
Yes
No
Notes
________________________________
1. Have any additional relatives been identified?
Yes
No
________________________________
________________________________
2. Are those contacts adequately documented in
FOCUS?
Yes
No
Relatives
________________________________
________________________________
2. If ICPC home study results have not been
received, has assistance been requested from the
Idaho ICPC Administrator to access home study
results and placement recommendations?
Yes
No
________________________________
3. Has the social worker had monthly face to
face contact with each child?
Yes
No
________________________________
________________________________
4. Are those contacts adequately documented in
FOCUS?
Yes
No
________________________________
3. ICPC placement authorizations remain valid
for six months. Has a request for renewal or
assistance been made through Idaho’s ICPC
Administrator to make sure all ICPC placement
authorizations remain current?
Yes
No
N/A (no ICPC renewals needed)
________________________________
________________________________
5. Is visitation between the mother and the
child(ren) occurring per the standard?
Yes
No
________________________________
________________________________
6. Is visitation between the father(s) and the
child(ren) occurring per the standard?
Yes
No
________________________________
________________________________
7. Do any barriers to visitation exist?
Yes
No
8. Are any changes to the visitation plan
needed?
Yes
No
________________________________
________________________________
________________________________
12
Assessment/Services
1. Has information been collected from all
service providers regarding the family’s progress
toward achieving case plan goals?
Yes
No
Notes
________________________________
________________________________
Placement
1. Is each child in a potential permanent
placement?
Yes
No
________________________________
2. Have services been appropriate or helpful to
the family in achieving their case plan
objectives?
Yes
No
________________________________
________________________________
A. If yes, has the family been referred for an
updated PRIDE study which includes an
adoption recommendation or an adoptive home
study?
Yes
No
________________________________
3. Has the Social and Medical Information
Form been updated with additional background
and social history information?
Yes
No
________________________________
________________________________
________________________________
4. For youth age 15 or older, has an AnsellCasey Assessment been completed?
Yes
No
B. If no, what steps are being taken to ensure
each child is moved to a permanent placement?
________________________________
C. If no, does each child have contact and
visitation with a potential permanent caregiver?
Yes
No
________________________________
________________________________
5. For youth age 15 or older, has an
Independent Living Plan been developed and
services put into place?
Yes
No
6. Have the needs of each child been assessed
and relevant services been provided?
Yes
No
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
13
3 to 6 Months
Names of Parents:
Date of Removal:
Names and Dates of Birth of Children:
Social Worker:
Date of Review:
ICWA
Notes
1. If the child(ren) is Indian, has the tribe(s)
and/or BIA responded to tribal membership
inquiries?
Yes
No
2. Is the child(ren)’s tribe participating in case
planning and kept apprised of what is
happening?
Yes
No
_______________________________
5. If the child(ren) is Indian, is their current
placement in accordance with ICWA placement
requirements?
Yes
No
________________________________
________________________________
________________________________
________________________________
3. Has there been tribal (or BIA) notification of
all court hearings?
Yes
No
________________________________
________________________________
4. If the child(ren) is Indian, is their identified
permanent placement in accordance with ICWA
placement requirements?
Yes
No
________________________________
________________________________
________________________________
________________________________
________________________________
14
Concurrent Planning – Additional Notes
3 to 6 Months
15
Concurrent Planning
6 to 9 Months
Names of Parents:
Date of Removal:
Names and Dates of Birth of Children:
Social Worker:
Have all prior concurrent planning action
steps been resolved?
Yes
No
Date of Review:
Family Engagement/Case Planning
Notes
________________________________
Full Disclosure
1. Is progress on the case plan sufficient to
reunify at or before the permanency hearing?
Yes
No
________________________________
1. Have case plan progress and each child’s
identified concurrent plan goals been discussed
with all of the following:
Mother
Father(s)
Child(ren)
Relatives
Resource families
2. Have all resources parents received adequate
information to make an informed decision in
supporting each child in his or her permanency
plan?
Yes
No
________________________________
________________________________
________________________________
________________________________
2. Does the primary permanency goal need to
be changed or updated on the Alternate Care
Plan and/or FOCUS?
Yes
No
3. Has the case been staffed with the
Permanency Committee to confirm or select
each child’s permanency goal and placement?
Yes
No
________________________________
________________________________
________________________________
4. If the permanency goal is Other Planned
Permanent Living Arrangement (OPPLA), have
all other permanency options been exhausted?
Yes
No
Paternity
________________________________
1. Have all paternity issues been resolved?
Yes
No
________________________________
________________________________
16
Contact/Visitation
Notes
Assessment/Services
1. Have the parents maintained frequent
consistent and quality visitation?
Yes
No
________________________________
2. Do there need to be any changes to the
visitation plan?
Yes
No
________________________________
3. Have ongoing visits occurred between
siblings not living together?
Yes
No
________________________________
4. Has each child’s other connections been
maintained (i.e. relatives, friends, cultural)?
Yes
No
________________________________
________________________________
Placement
5. Has the social worker had adequate contact
with the parents to support them in moving
forward with their case plan?
Yes
No
________________________________
1. For each child in a permanent placement,
does the family have a current home study with
a recommendation for adoption?
Yes
No
N/A (no child is in a permanent placement or
the concurrent plan does not include adoption)
________________________________
________________________________
________________________________
________________________________
________________________________
6. Are those contacts adequately documented in
FOCUS?
Yes
No
1. Have adequate services been provided to all
parents to support successful reunification?
Yes
No
A. If not, what barriers exist, services are
needed and what reasonable or active efforts
have been made to overcome those barriers?
2. For each child who is not likely to return
home, has the social history been started?
Yes
No
N/A (each child likely to return home)
________________________________
________________________________
7. Has the social worker had monthly face to
face contact with each child?
Yes
No
________________________________
________________________________
8. During those visits, has the social worker
discussed permanency, safety and well-being
goals with each child?
Yes
No
9. Are those contacts adequately documented in
FOCUS?
Yes
No
________________________________
________________________________
________________________________
________________________________
17
6 to 9 Months
Names of Parents:
Date of Removal:
Names and Dates of Birth of Children:
Social Worker:
ICWA
1. If the child(ren) is Indian, is the tribe
participating in case planning and kept apprised
of what is happening?
Yes
No
Date of Review:
Notes
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
18
Concurrent Planning – Additional Notes
6 to 9 Months
19
Concurrent Planning
9 to 12 Months
Names of Parents:
Date of Removal:
Names and Dates of Birth of Children:
Social Worker:
Date of Review:
Notes
Have all prior concurrent planning action
steps been resolved?
Yes
No
Family Engagement/Case Planning
________________________________
________________________________
Full Disclosure
1. Is progress on the case plan sufficient to
reunify at or before the permanency hearing?
Yes
No
________________________________
1. Have case plan progress and each child’s
identified concurrent plan goals been discussed
with all of the following:
Mother
Father(s)
Child(ren)
Relatives
Resource families
________________________________
________________________________
________________________________
2. Have all resources parents received adequate
information to make an informed decision in
supporting each child in his or her permanency
plan?
Yes
No
________________________________
3. What is each child’s understanding of the
permanent plan?
________________________________
2. Does the primary permanency goal need to
be changed or updated on the Alternate Care
Plan and/or FOCUS?
Yes
No
3. Has the case been staffed with the
Permanency Committee to confirm or select
each child’s permanency goal and placement?
Yes
No
________________________________
________________________________
4. If the permanency goal is Other Planned
Permanent Living Arrangement (OPPLA), have
all other permanency options been exhausted?
Yes
No
________________________________
________________________________
20
Contact/Visitation
Notes
1. Have parents maintained frequent consistent
and quality visitation?
Yes
No
________________________________
2. Do there need to be any changes to the
visitation plan?
Yes
No
________________________________
3. Have ongoing visits occurred between
siblings not living together?
Yes
No
________________________________
4. Has each child’s other connections been
maintained (i.e. relatives, friends, cultural)?
Yes
No
________________________________
5. Has the social worker had adequate contact
with the parents to support them in moving
forward with their case plan?
Yes
No
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
6. Are those contacts adequately documented in
FOCUS?
Yes
No
7. Has the social worker had monthly face to
face contact with each child?
Yes
No
9. Are those contacts adequately documented in
FOCUS?
Yes
No
1. Have adequate services been provided to all
parents to support successful reunification?
Yes
No
2. Has each child received options counseling to
make an informed decision about his or her
permanent plan?
Yes
No
3. Has each child’s social history been
completed?
Yes
No
4. Has each child’s Child and Family Social and
Medical Information Form been updated?
Yes
No
5. Is each child’s Life Book up to date?
Yes
No
6. Reasonable efforts to finalize a permanent
plan
have OR
have not been made.
________________________________
________________________________
Placement
________________________________
1. If a permanent placement has disrupted or
has not been identified, have child-specific
recruitment efforts been started?
Yes
No
________________________________
8. During those visits, has the social worker
discussed permanency, safety and well-being
goals with each child?
Yes
No
Assessment/Services
________________________________
________________________________
________________________________
2. Does judicial consent to utilize media
recruitment efforts need to be requested at the
permanency hearing?
Yes
No
________________________________
21
9 to 12 Months
Names of Parents:
Date of Removal:
Names and Dates of Birth of Children:
Social Worker:
ICWA
1. If the child(ren) is Indian, is the tribe
participating in case planning and kept apprised
of what is happening?
Yes
No
Date of Review:
Notes
________________________________
________________________________
________________________________
2. If the child(ren) is Indian, has the tribe and/or
BIA been notified of the permanency hearing in
accordance with ICWA notification
requirements?
Yes
No
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
22
Concurrent Planning – Additional Notes
9 to 12 Months
23
Concurrent Planning
12 to 15 Months
Names of Parents:
Date of Removal:
Names and Dates of Birth of Children:
Social Worker:
Date of Review:
Have all prior concurrent planning action
steps been resolved?
Yes
No
________________________________
Full Disclosure
________________________________
4. Have the birth parents been given the
opportunity to sign the release of their
identifying information to the adoptive parents?
Yes
No
N/A (the permanency plan is not adoption)
1. Have case plan progress and each child’s
identified concurrent plan goals been discussed
with all of the following:
Mother
Father(s)
Child(ren)
Relatives
Resource families
________________________________
Family Engagement/Case Planning
________________________________
1. Is progress on the case plan sufficient to
reunify at or before the permanency hearing?
Yes
No
Notes
________________________________
________________________________
2. Have all resources parents received adequate
information to make an informed decision in
supporting each child in his or her permanency
plan?
Yes
No
________________________________
________________________________
________________________________
3. Is each child prepared for his or her alternate
permanency plan?
Yes
No
2. Does the primary permanency goal need to
be changed or updated on the Alternate Care
Plan and/or FOCUS?
Yes
No
________________________________
________________________________
________________________________
3. Has the case been staffed with the
Permanency Committee to confirm or select
each child’s permanency goal and placement?
Yes
No
4. If the permanency goal is Other Planned
Permanent Living Arrangement (OPPLA), have
all other permanency options been exhausted?
Yes
No
24
Contact/Visitation
Notes
Assessment/Services
1. Have the parents maintained frequent
consistent and quality visitation?
Yes
No
________________________________
2. Do there need to be any changes to the
visitation plan?
Yes
No
________________________________
3. Have ongoing visits occurred between
siblings not living together?
Yes
No
________________________________
________________________________
Placement
4. Has each child’s other connections been
maintained (i.e. relatives, friends, cultural)?
Yes
No
________________________________
5. Has the social worker had adequate contact
with the parents to support them in moving
forward with their case plan?
Yes
No
________________________________
1. If the identified permanent placement has
disrupted, or has not yet been identified, which
ongoing child-specific recruitment efforts are
being made?
Re-contacting relatives, previous foster
parents and other connections
Internet adoption exchanges (Wednesday’s
Child, NW Adoption Exchange, AdoptUSKids)
Televised Wednesday’s Child production
Wednesday’s Child newspaper feature
Other
________________________________
________________________________
________________________________
________________________________
________________________________
6. Are those contacts adequately documented in
FOCUS?
Yes
No
________________________________
________________________________
7. Has the social worker had monthly face to
face contact with each child?
Yes
No
________________________________
1. Have adequate services been provided to all
parents to support successful reunification?
Yes
No
2. Has each child received options counseling to
make an informed decision about his or her
permanent plan?
Yes
No
2. If the permanent plan is OPPLA, has the
foster parent signed a Declaration of
Commitment?
Yes
No
________________________________
8. During those visits, has the social worker
discussed permanency, safety and well-being
goals with each child?
Yes
No
9. Are those contacts adequately documented in
FOCUS?
Yes
No
________________________________
________________________________
________________________________
________________________________
25
Court
1. Has the termination report to the court been
written?
Yes
No
N/A (permanent plan is not adoption)
Notes
________________________________
________________________________
________________________________
2. Has a petition for termination of parental
rights been filed?
Yes
No
N/A (permanent plan is not adoption)
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
26
12 to 15 Months
Names of Parents:
Date of Removal:
Names and Dates of Birth of Children:
Social Worker:
ICWA
1. If the child(ren) is Indian, is the tribe
participating in case planning and kept apprised
of what is happening?
Yes
No
Date of Review:
Notes
________________________________
________________________________
________________________________
2. If the child(ren) is Indian, has the tribe and/or
BIA been notified of the permanency hearing in
accordance with ICWA notification
requirements?
Yes
No
________________________________
________________________________
________________________________
3. If the child(ren) is Indian, has the tribe and/or
BIA been notified of the hearing to terminate
parental rights in accordance with ICWA
notification requirements?
Yes
No
________________________________
________________________________
________________________________
4. If the child(ren) is Indian and the permanency
plan is adoption, is an expert witness scheduled
to testify at the termination hearing?
Yes
No
________________________________
________________________________
________________________________
________________________________
27
Concurrent Planning – Additional Notes
12 to 15 Months
28
Concurrent Planning
15 to 22 Months
Names of Parents:
Date of Removal:
Names and Dates of Birth of Children:
Social Worker:
Date of Review:
Notes
Have all prior concurrent planning action
steps been resolved?
Yes
No
Family Engagement/Case Planning
________________________________
________________________________
Full Disclosure
________________________________
1. Is each child prepared for his or her
permanency plan?
Yes
No
1. If termination of parental rights has not
occurred, does the case plan continue to address
the parents?
Yes
No
________________________________
________________________________
2. Has full disclosure of each child’s Child and
Family Social and Medical Information Form,
social history, educational, medical and mental
health records been made to the adoptive
family?
Yes
No
N/A (permanent plan is not adoption)
________________________________
________________________________
________________________________
________________________________
3. If yes, have records disclosed been
documented on the Adoption Information
Disclosure form?
Yes
No
________________________________
________________________________
_______________________________
________________________________
29
Contact/Visitation
1. If termination of parental rights has not
occurred, have the parents maintained frequent
contact and quality visitation?
Yes
No
Notes
________________________________
________________________________
Assessment/Services
1. Are supports and/or services for each child
and their resource family in place to ensure a
stable and successful placement?
Yes
No
________________________________
2. Have ongoing visits occurred between
siblings not living together?
Yes
No
________________________________
________________________________
3. Has each child’s other connections been
maintained (i.e. relatives, friends, cultural)?
Yes
No
________________________________
________________________________
4. Has the social worker had monthly face to
face contact with each child?
Yes
No
________________________________
________________________________
5. During those visits, has the social worker
discussed permanency, safety and well-being
goals with each child?
Yes
No
6. Are those contacts adequately documented in
FOCUS?
Yes
No
2. Have the needs of each child been addressed
to prepare him or her for adoption?
Yes
No
N/A (permanent plan is not adoption)
3. For youth age 15 or older, is the Independent
Living Plan current?
Yes
No
A. Are the current Independent Living services
meeting the needs of each youth?
Yes
No
________________________________
________________________________
Placement
________________________________
1. Has the Adoptive Placement Agreement (or
Legal Risk Adoptive Placement Agreement)
been signed?
Yes
No
N/A (permanent plan is not adoption)
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
30
Adoption/Guardianship Assistance
1. Which parts of the adoption or guardianship
assistance application have been completed?
Part 1
Part 2
N/A (permanent plan is not adoption or
guardianship after termination of parental rights)
Notes
________________________________
________________________________
________________________________
________________________________
2. Has an Adoption Assistance Agreement or
Guardianship Assistance Agreement been
signed?
Yes
No
N/A (permanent plan is not adoption or
guardianship after termination of parental rights)
________________________________
________________________________
________________________________
________________________________
________________________________
Court
1. Copies of which documents necessary to
finalize each child’s adoption have been
received?
Three certified copies of all orders
terminating parental rights
Certified birth certificate for each child
Certified death certificate for each deceased
parent
Current (within three years ) criminal
history clearances for the adoptive parents and
any adult residing in their home
Hospital birth records for each child
N/A (permanent plan is not adoption)
2. Has the Adoption Report to the Court been
written?
Yes
No
N/A (permanent plan is not adoption)
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
31
15 to 22 Months
Names of Parents:
Date of Removal:
Names and Dates of Birth of Children:
Social Worker:
ICWA
1. If the child(ren) is Indian, has the tribe been
notified of adoption or guardianship proceedings
in accordance with ICWA notification
requirements?
Yes
No
Date of Review:
Notes
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
32
Concurrent Planning – Additional Notes
15 to 22 Months
33
Concurrent Planning Summary
Names of Children:
Names of Parents:
Date of Removal:
Social Worker:
Full Disclosure
Date of
Removal to 30
Days
Date of Review
Action Needed
Completed/Date
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
1 to 3 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
3 to 6 Months
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
6 to 9 Months
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
9 to 12 Months
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
12 to 15
Months
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
15 to 22
Months
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
34
Paternity
Date of
Removal to 30
Days
Date of Review
Action Needed
Completed/Date
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
1 to 3 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
3 to 6 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
6 to 9 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
9 to 12 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
12 to 15
Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
15 to 22
Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
35
Family Engagement/Case Planning
Date of
Removal to 30
Days
Date of Review
Action Needed
Completed/Date
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
1 to 3 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
3 to 6 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
6 to 9 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
9 to 12 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
12 to 15
Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
15 to 22
Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
36
Contact/Visitation
Date of
Removal to 30
Days
Date of Review
Action Needed
Completed/Date
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
1 to 3 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
3 to 6 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
6 to 9 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
9 to 12 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
12 to 15
Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
15 to 22
Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
37
Relatives
Date of Review
Action Needed
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
12 to 15
Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
15 to 22
Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
Date of
Removal to 30
Days
1 to 3 Months
3 to 6 Months
6 to 9 Months
9 to 12 Months
Completed/Date
38
Assessment/Services
Date of
Removal to 30
Days
Date of Review
Action Needed
Completed/Date
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
1 to 3 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
3 to 6 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
6 to 9 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
9 to 12 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
12 to 15
Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
15 to 22
Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
39
Placement
Date of
Removal to 30
Days
Date of Review
Action Needed
Completed/Date
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
1 to 3 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
3 to 6 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
6 to 9 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
9 to 12 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
12 to 15
Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
15 to 22
Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
40
Adoption/Guardianship Assistance
Date of
Removal to 30
Days
Date of Review
Action Needed
Completed/Date
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
1 to 3 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
3 to 6 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
6 to 9 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
9 to 12 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
12 to 15
Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
15 to 22
Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
41
Court
Date of
Removal to 30
Days
Date of Review
Action Needed
Completed/Date
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
1 to 3 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
3 to 6 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
6 to 9 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
9 to 12 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
12 to 15
Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
15 to 22
Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
42
ICWA
Date of
Removal to 30
Days
Date of Review
Action Needed
Completed/Date
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
1 to 3 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
3 to 6 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
6 to 9 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
9 to 12 Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
12 to 15
Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
15 to 22
Months
____________
____________
____________
____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________
____________
____________
____________
43