ࡱ> b@ Xȏbjbjצצ  !S.T`K`K`K7t oKjbO(OOOOXR\Sb6 8n8n8n8n8n8n$pRSr\nidTOOdTdT\nOOn|X|X|XdT4OOb|XdTb|X|X:>Y,~YO p㼀`KTXjY Y<n0 otY rTpr~Yr~YHdTdT|XdTdTdTdTdT\n\n+:`X:FOSTER CARE STRUCTUREDFC Case #: FORMTEXT      DECISION MAKINGFC Case Name: FORMTEXT      FAMILY REUNIFICATION ASSESSMENTDHS Worker Load #: FORMTEXT      Michigan Department of Human ServicesDHS Worker Name: FORMTEXT      PS Case #: FORMTEXT      PS Case Name: FORMTEXT      Court ID#: FORMTEXT      POS Agency Name: FORMTEXT      POS Agency Worker Name: FORMTEXT      List the household name for each household assessed, indicating First and Last Name for caretaker, whether this is the household the child(ren) was removed from, in the space provided. If there is more than one household, complete this entire section and follow instructions to add another household at the end of this section. Household Assessed FORMTEXT      Date Completed: FORMTEXT      A. Assessment Completed For: FORMCHECKBOX  1. Updated Service Plan FORMCHECKBOX  2. Other FORMTEXT      A1. CPS Investigation/Preponderance of Evidence Incident This Period?Indicate whether there was a CPS investigation of the household during the report period and whether there was a preponderance of evidence in the space provided. If there was an investigation, describe the allegations and investigation outcome. Attach a copy of the appropriate CPS report. (check one)  FORMCHECKBOX  1. None FORMCHECKBOX  2. Investigation FORMCHECKBOX  3. Preponderance of Evidence Explain the incident.   MACROBUTTON [2] "Click Here and Type"   Individual Barrier Reduction: List the primary barriers to reunification identified on the initial or last needs and strengths assessment and any new primary barrier identified in the needs and strengths reassessment. Evaluate progress for each barrier as Substantial, Partial, Poor or Refused.Primary Barriers to Reunification (check one for each barrier) Barrier Name and Code1 Substantial2 Partial3 Poor4 Refused1 FORMDROPDOWN  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 2 FORMDROPDOWN  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 3 FORMDROPDOWN  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Substantial: Caretaker(s) successfully met all treatment plan objectives for the identified barrier and routinely demonstrates desired behavior including interactions with children and others. Or Caretaker(s) actively participating in programs; pursuing objectives detailed in treatment plan and there is significant progress in reducing the identified barrier. Routinely demonstrates desired behavior including interactions with child(ren) and others. Partial: Caretaker(s) participating in, or have completed, treatment plan activities with positive progress but barrier resolution is not complete. Occasionally demonstrates desired behavior including interaction with children and others. Poor: Caretaker(s) unable to participate in treatment plan activities and there is minimal or no progress in reducing barriers. Rarely or never demonstrates desired behavior including interaction with children and others. Or Caretaker(s) participates in, or has completed, treatment plan activities but there is minimal or no progress in reducing barriers. Rarely or never demonstrates desired behavior including interaction with children and others. Refused/ Unavailable: Caretaker(s) refuses, either verbally or in writing, to participate in treatment plan activities. Caretaker(s) unavailable to participate in treatment plan activities. Overall Barrier Reduction: In the individual barrier section, each identified barrier was assessed separately. In this section assess the impact of services and rate the household for progress on all identified barriers. Answer the following question: Has parent/caretaker made progress in addressing barriers that reduce the risk of subsequent harm if the child is returned home? FORMCHECKBOX 1.Yes, caretaker(s) have substantially reduced barriers. FORMCHECKBOX 2.Yes, caretaker(s) have made partial progress in reducing barriers. FORMCHECKBOX 3.No, caretaker(s) progress is poor or they have refused services and barriers have not been reduced. D. Parenting Time Assessment1 Substantial2 Partial3 Poor4 Refused FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Evaluate compliance with the parenting time plan as Substantial, Partial, Poor or Refused. Complete this question only if the child is in out of home placement. Substantial: Maintained parenting time schedule and caretaker-child interaction is appropriate throughout all parenting time. Partial: Generally maintained parenting time schedule. Notified agency if could not keep appointment. No major problems in caretaker behavior or caretaker-child interaction. Poor: Failed to maintain parenting time schedule. Failed to notify if unable to keep appointment one or more times. There has been poor caretaker-child interaction and/or inappropriate caretaker behavior during parenting time. Parenting time canceled due to caretaker behavior or the court has ordered no parenting time or the child refuses parenting time. Refused: Parent/Caretaker(s) refused to participate in the parenting time plan. Is safety assessment of this household required? If the child is in home placement, answer this question based on the results from Overall Barrier Reduction only. If both barrier reduction and parenting time are at least partial, then a Safety Assessment is required. If the barrier reduction and/or parenting time are poor, then a Safety Assessment is not required. If a, b, or c is checked, complete the Safety Assessment (SMI 722.9-B). If d is checked, do not complete the Safety Assessment and go to Permanency Planning Decision Guidelines below. Indicate if a Safety Assessment is required in the space provided.a. FORMCHECKBOX Yes, both (parenting time and overall barrier reduction) are Substantialb. FORMCHECKBOX Yes, both (parenting time and overall barrier reduction) are Partialc. FORMCHECKBOX Yes, one is Substantial, one is Partiald. FORMCHECKBOX No, either is Poor or Refused *If 1, 2, or 3 is checked, complete the Safety Assessment. If 4 is checked, do not complete the Safety Assessment, but complete G below. Safety Assessment Results If a Safety Assessment is required, select the results (Safe, Safe with Services, Unsafe) in the space provided. Briefly describe the reasons for scoring any safety factor and protecting interventions on the Safety Assessment form, FIA-14A. Attach the completed Safety Assessment to the USP.1. FORMCHECKBOX Safe2. FORMCHECKBOX Safe with Services3. FORMCHECKBOX Unsafe4. FORMCHECKBOX Not RequiredG. Child Placement/Permanency Plan Recommendation: Recommen- dations applicable to: Child Placement (code)Change PP Goal? (Y/N) If Change, New PP Goal (code) Override (Y/N) If Override, Reason (code)All Children in case? (check one) If not applicable to all children, list foster care case number and record recommendation for each child below.  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Foster Care Worker s Name:  FORMTEXT       Foster Care Worker s Signature: Date: Supervisor s Name:  FORMTEXT       Supervisor s Signature: Date:Distribution of Plan:   MACROBUTTON [2] "Click Here and Type"   DHS Local Office Name:  FORMTEXT       Date Sent:DHS Local Office Approval: Signature: Date: Title:  FORMTEXT       Date:  FORMTEXT       Department of Human Services (DHS) will not discriminate against any individual or group because of race, sex, religion, age, national origin, color, height, weight, marital status, political beliefs or disability. If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you are invited to make your needs known to a DHS office in your area. AUTHORITY: P.A. 280 OF 1939. RESPONSE: Voluntary. PENALTY: None DHS-147 (Rev. 11-05) MSWord  PAGE 1 DHS-147 (Rev. 11-05) MSWord  PAGE 3 ,.024PRTVXtvxz|0@N 046J࢛jT[hS!hV0UhS!hV05 hS!hS! hS!h j,XhS!UjVhS!UjThS!UjShS!UjdRhS!U hS!hV0jhS!hV0UjhS!UmHnHu.2Vz†ĆJ\S d$IfkdY$$Iflֈ M!$*xC 4 la :$$Ifa$:$IfJLNJnkd\$$Ifl\ !6$* d*U4 la$If6$If $If5kd[$$Ifl**4 la 24\^`}ww6$Ifnkd\$$Ifl\ !6$* d*U4 la$If$If $If JLNXZdډމ,.02468:>Djnp(,.BDFѾѱѐтѐtjbhS!hV0UjT`hS!hV0UhS!h 5hS!hV0mHnHuhS!hV0CJOJQJhS!hV0CJOJQJhS!hV0B*phhS!hV05 hS!hV0jhS!UmHnHujhS!hV0UjD]hS!hV0U-`bd}}$If$If $Ifnkd]$$Ifl\ !6$* d*U4 la؉ډVP $If5kd&_$$Ifl**4 la$Ifnkdz^$$Ifl\ !6$* d*U4 laډ܉މ2468:<SQ 2kd `$$Ifl**4 la2kd_$$Ifl**4 la $$Ifa$6$If65kdt_$$Ifl**4 la<>lnzpkda$$Ifl\~ J6$* T4 la6$If5$If $If  7kda$$Ifl**4 la $If7kda$$Ifl**4 la *,TVbd6$If $Ifpkd9b$$Ifl\ !6$*X *T4 laFPRTbhj~ XZfhjlnpr෬vrl`X`hS!0J8CJjhS!0J8CJU hS!CJhS!h hS!aJhf0J8CJaJmHnHuh hS!0J8CJaJ!jh hS!0J8CJUaJh hS!CJaJhS!hV0CJhS!h 5hjGdhS!hV0UhS!hV05 hS!hV0jhS!hV0UjhS!UmHnHudfhG; $$Ifa$gd :kd e$$Ifl4**4 laf46$If5$Ifpkdc$$Ifl\ !6$*X *T4 laҎ prďƏȏ~ususs~ ) ! |)dqkd\e$$Ifl04*h04 la $If^ ďƏȏ$&(*FHJLNjlnprָظڸŨ|qjNlhaUjjhaUjhhaUjghaUjfhaUjhaUmHnHujehaUhajhaUhS!hV0CJhfhS!hS!0J8CJjhS!0J8CJUhf0J8CJmHnHu('0&P/ =!"#$%@* 00&P/ =!"#$%@' 0&P/ =!"#$%@* 00&P/ =!"#$%@' 0&P/ =!"#$%@DfccasenoEnter Foster Care Case Number CaseInfo.MAIN$$If!vh552 5#v#v2 #v:V l552 5/ / / / /  / 4D fccasenameEnter Foster Care Case Name$$If!vh552 5#v#v2 #v:V l552 5/ / / / /  / 4Dfcworkerloadno&Enter Foster Care Worker Load Number $$If!vh552 5#v#v2 #v:V l552 5/ / / / /  / 4D fcworkernameEnter Foster Care Worker Name$$If!vh552 5#v#v2 #v:V l552 5/ / / / /  / 4DPSCASENO%Enter Protective Services Case Number$$If!vh552 5#v#v2 #v:V l552 5/ / / / /  / 4D PSCASENAME#Enter Protective Services Case Name$$If!vh552 5#v#v2 #v:V l552 5/ / / / /  / 4DCOURTNOEnter Court ID Number$$If!vh552 5#v#v2 #v:V l552 5/ / / / /  / 4DPOSA%Enter Purchase of Service Agency Name$$If!vh552 5#v#v2 #v:V l552 5/ / / / /  / 4Dposw%Enter Purchase of Service Worker Name$$If!vh552 5#v#v2 #v:V l552 5/ / / / /  / 4$$If!vh5f5N 52 5##vf#vN #v2 #v#:V l5f5N 52 5#4R$$If!vh5+#v+:V l4 5+4f4D#Enter Household Assessed NameD datecompleted'Enter Date Reunification Plan completed$$If!vh5 555#v #v#v#v:V l5 5554K$$If!vh5 +#v +:V lL5 +4DeCheck16Check if Assessment completed for Updated Service PlanDe'Check if Assessment completed for OtherDText54,Enter reason for Assessment if Other checked$$If!vh5X5 55 #vX#v #v#v :V l5X5 55 / 4$$If!vh5555#v#v#v#v:V lL55554G$$If!vh5 +#v +:V l5 +4R$$If!vh5+#v+:V l4 5+4f4&DeCheck33XCheck if CPS Investigation / Preponderance of Evidence Incidence for this period is None8DeCheck34aCheck if CPS Investigation / Preponderance of Evidence Incidence for this period is investigationTDeCheck35oCheck if CPS Investigation / Preponderance of Evidence Incidence for this period is Preponderance of Evidence $$If!vh555p5^5'#v#v#vp#v^#v':V l4555p5^5'4f4$$If!vh555b5a #v#v#vb#va :V l555b5a 4G$$If!vh5+#v+:V l5+4G$$If!vh5+#v+:V l5+4G$$If!vh5+#v+:V l5+4c$$If!vh5+#v+:V l5+/  / 4$$If!vh5T5#vT#v:V l5T5/  / / / 4$$If!vh5T55855D#vT#v#v8#v#vD:V l5T55855D/ /  / / / /  / 4lDfSelect #1 Barrier Name and Code S1 Emotional StabilityS2 Parenting SkillsS3 Substance AbuseS4 Domestic RelationsS5 Social Support System(S6 Communication/Interpersonal SkillsS7 LiteracyS8 Intellectual CapacityS9 EmploymentS10 Physical Health Issues%S11 Resource Availability/Management S12 HousingS13 Sexual AbuseS14 Child CharacteristicsDeCheck10!Check if Barrier 1 is SubstantialDeCheck17Check if Barrier 1 is PartialDeCheck18Check if Barrier 1 is PoorDeCheck25Check if Barrier 1 is Refused$$If!vh5555855D#v#v#v#v8#v#vD:V l5555855D/ / / / /  / / 4lDfSelect #2 Barrier Name and Code S1 Emotional StabilityS2 Parenting SkillsS3 Substance AbuseS4 Domestic RelationsS5 Social Support System(S6 Communication/Interpersonal SkillsS7 LiteracyS8 Intellectual CapacityS9 EmploymentS10 Physical Health Issues%S11 Resource Availability/Management S12 HousingS13 Sexual AbuseS14 Child CharacteristicsDe!Check if Barrier 2 is SubstantialDeCheck if Barrier 2 is PartialDeCheck if Barrier 2 is PoorDeCheck if Barrier 2 is Refused $$If!vh5555855D#v#v#v#v8#v#vD:V l5555855D/ /  / / / / 4lDfSelect #3 Barrier Name and Code S1 Emotional StabilityS2 Parenting SkillsS3 Substance AbuseS4 Domestic RelationsS5 Social Support System(S6 Communication/Interpersonal SkillsS7 LiteracyS8 Intellectual CapacityS9 EmploymentS10 Physical Health Issues%S11 Resource Availability/Management S12 HousingS13 Sexual AbuseS14 Child CharacteristicsDeCheck11!Check if Barrier 3 is SubstantialDeCheck16Check if Barrier 3 is PartialDeCheck19Check if Barrier 3 is PoorDeCheck24Check if Barrier 3 is Refused$$If!vh5555855D#v#v#v#v8#v#vD:V l5555855D/ /  / / / / / 4L$$If!vh5 +#v +:V l5 +4DeCheck7>Check if Yes, caretaker(s) have substantially reduced barriersj$$If!vh5&5&5&#v&#v&:V l5&5&4DeCheck8:Check if Yes, caretaker(s) have partially reduced barriersj$$If!vh5&5&5&#v&#v&:V l5&5&4"DeCheck9WCheck if No, caretaker(s) progress poor or refused and barriers have not been reduced.j$$If!vh5&5&5&#v&#v&:V l5&5&4$$If!vh55a505|5#v#va#v0#v|#v:V l55a505|5/ / / / /  / / 4D(Text12D. Parenting Time Assessment - Enter Parent's NameDeCheck36ACheck if parenting time assessment for this parent is substantialDeCheck37=Check if parenting time assessment for this parent is partialDeCheck38:Check if parenting time assessment for this parent is poorDeCheck39=Check if parenting time assessment for this parent is refusedPopUpPrompt1.MAIN$$If!vh55a505|5x#v#va#v0#v|#vx:V l55a505|5x/ / / / / / / 4R$$If!vh5+#v+:V l45+4f4G$$If!vh5+#v+:V l5+4K$$If!vh5+#v+:V lL5+4tDeCheck45E. Is safety assessment of this household required? Check if Yes, both parenting and overall barrier reduction are substantial~$$If!vh555`'#v#v#v`':V l4555`'4f4^De{E. Is safety assessment of this household required? Check if Yes, both parenting and overall barrier reduction are partial~$$If!vh555`'#v#v#v`':V l4555`'4f40DedE. Is safety assessment of this household required? Check if Yes, one is substantial one is partial~$$If!vh555`'#v#v#v`':V l4555`'4f4De[E. Is safety assessment of this household required? Check if No, either is poor or refused~$$If!vh555`'#v#v#v`':V l4555`'4f4L$$If!vh5+#v+:V l5+4G$$If!vh5 +#v +:V l5 +4K$$If!vh5 +#v +:V lL5 +4DeCheck30+Check if safety assessment results are SafeDeCheck319Check if safety assessment results are Safe with servicesDeCheck32-Check if safety assessment results are unsafeDeCheck403Check if safety assessment results are not required0$$If!v h55555555h5 j5 5 5  #v#v#v#v#v#v#v#vh#v j#v #v :V l55555555h5 j5 5  4 kd J$$Ifl  h*d" d6*hj 00004 laP$$If!vh5*#v*:V l5*4h$$If!vh5*#v*:V l5*/  / 4$$If!vh55x5C5 55#v#vx#vC#v #v#v:V l55x5C5 55/ /  / / / /  / 4 DeCheck41UCheck if Child Placement / Permanency Plan recommendation is for all children in case.DeCheck42\Check if Child Placement / Permanency Plan recommendation is for individual children in caseh$$If!vh5*#v*:V l5*/  / 4DEnter Child NamerDf'Select appropriate child placement code 1=Mntn. Out-of-Home Plcmt.$2=Plan to Retr. Home Drg this Period3=Mntn. Own Home Plcmt.Df>Select appropriate response for change is permanency plan goal YesNoDf/If change, select new permanency plan goal code  6=Indpt Living7=Plcmt/Relatives 8=Return Home9=Custodial Care 10=Adoption11=Term. Parental Rights 12=Perm. 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