Mid-Iowa Family Therapy Clinic, Inc.
1201 63rd Street * Des Moines, IA 50311
515-254-1556 or fax 515-254-1559
FAMILY INTERACTION PLAN
Background information (to be completed prior to or at initial family team meeting):
Name:
State ID#:
Interaction plan effective dates: From
To
Placement date for children:
Case outcomes:
1.
2.
3.
Threats of harm requiring interaction be monitored:
1.
2.
3.
Terms of the family interaction (to be completed at initial family team meeting):
Date of initial meeting:
Follow-up meeting date:
Interaction participants:
Length of interactions in hours (circle): 1
1.5
2
2.5
3
3.5
4
Days of interactions (circle):
M
Tu
W
Th
F
Sa
Location of interactions (circle):
Community
Time of interaction:
Name of DHS worker:
Home
Office
Su
R-House
Transportation to interaction provided by:
Transportation from interaction provided by:
Behaviors which will terminate a family interaction:
Who will supervise interaction:
Family interaction outcomes/steps to be achieved: (Usually completed at 4-6 week follow-up meeting)
Parent will:
Demonstrated by:
When: