calswec.berkeley.edu · Web viewGenogram and/or ecomap were created or reviewed/ updated at least...

SET FM/FR Case Review ToolTo be used for all cases unless a permanent plan has been ordered as the current

permanency goal

Case Name

CWS/CMS #(19 Digits)

Region: Program:

SW’s/Regions assigned during Review Time Period (RTP):

Length of time case has been in current Region:

Reviewer’s Name and Title:

Date(s) of Review:

Time Period Reviewed (RTP):

Documents Reviewed (Check all that apply):

Investigative Narrative Case Notes Case Plan Safety Plan(s)

Delivered Service Log TDM referral/results form SDM Safety/Risk Assessments

Case Consultation Forms History of Child Placements Genogram: in CWS/CMS in Hard

File Court Reports (list) Imported SOP Tools (list)

Emergency Response Document (ERD) SDM Hotline Tool FSNA

List any additional documents:

List the family members being reviewed (ex: Jane/mother; Jack/mother’s boyfriend; Tommy/child):

List the substitute care providers during the RTP:

Brief Summary of Case:

Directions: The purpose of this case review tool is to determine if case practice is consistent with the CWS Safety Enhanced Together (SET) key expectations. The case record will be reviewed to evaluate case practice. The case record refers to everything that is available in CWS/CMS and Structured Decision Making (SDM) reports. Please remember that if the review is on a family that has multiple children involved, then the reviewer should check the siblings’ cases in CWS/CMS to ensure that all forms or imported documents are reviewed. Reviewers may look at the hard file, but it is not required. If any concerns about safety or risk are identified while conducting this review, the reviewer is to notify their supervisor in a timely manner. The review time period (RTP) will start at the beginning of the month, for the six-month period.

For example: If a SET Review is assigned in November 2015, the review time period will be 5/1/2015-10/31/2015

CQI Case Review Tool (6/16 v24: Case) 1 County of San Diego/HHSA/CWS

The reviewer is to consider the work done with the entire family when completing the tool. The “target child” is the child whose name/case number was assigned to the reviewer to complete the review. For each question the reviewer will answer “Yes,” “No,” or “N/A.” The reviewer will then rate the question on the Likert scale below each question. For any “No” or “N/A” answers, please put a brief reason why that answer was chosen in the comments box below the question. For questions with multiple participants/ placements being rated, the reviewer can mark “Yes” for the question even if it only applies to one participant/ placement. If the question does not apply to some family members/placements being rated, write “NO” or “N/A” next to the names of those family members/placements that do not apply. If none of the family members/placements apply or meet criteria, mark the entire question as “No” or “N/A,” do not complete the Likert scale, and the reviewer can move on to the next question. The questions that require separate ratings will be identified by the specialized instructions included just above the rating scale.

For questions rating family members/placements, the name and rating are to be written on the lines above the comments box for each family member/placement. For any additional key adults/placements, the reviewer may write their name/relationship in the comments box with the rating next to their name. For questions that rate all children in the family, each child must be scored unless an exception applies. See example below.

Please note, that when the reviewer is rating a placement that falls under the RTP, but the placement began before the RTP started, the reviewer is asked to look outside the period under review to gather information related specifically to that placement.

Examples:

Rating multiple family members would look like this:

Yes____ rate belowNo_____N/A____

Below the Likert Scale Mark:

Mother: Sara/Emerging__ Father: Paul/ No Other: Step-Father Jack/ Emerging

Child: Tommy/Emerging Child: Katie/ N/A non-verbal

Comments: Father: Richard/ N/A – whereabouts unknown

Rating multiple placements would look like this:Yes____ rate belowNo_____N/A____

Below the Likert Scale Mark:

Placement 1: Smith LFH/Novice Placement 2: Jones LFH/No Placement 3: N/A (PCC)

Comments:


Only mark one box on the Likert scale for each question. When selecting a box on the scale, choose the highest box where all criteria within the box have been met. If only some of the criteria have been met for a box, the box should not be marked. This scale is cumulative, and to meet the criteria for the higher boxes, you must also have done everything in the lower boxes.

For example:

If all of the expectations for Novice have not been met, then mark “No” for the question and do not mark any of the boxes on the Likert scale.

If all the criteria for Novice have been met, then determine if the criteria listed for Emerging have been met too. If all of the criteria for Emerging have not been met, then select Novice for the rating. If all the criteria for Emerging have been met, then move to Accomplished and so on.

To achieve a score of Master, you would have to have met all the criteria in the boxes for Novice, Emerging, Accomplished, and Distinguished.

Exceptions: There are specific circumstances where only applicable criteria need to be met in each box. One example is if the reviewer is rating a non-verbal child. Only criteria in each box that relates to non-verbal children would need to be met to move to the next box.

Comment boxes may be utilized to note positive practices or areas where practice could be improved. For any N/A answers, please note the reason why it does not apply in the comments section. The reviewer has the option to complete the box at the end of the form to capture any overall feedback.

Please only consider the target child in ratings when the target child was in a specialized program (e.g. Adoptions, Residential Services, San Pasqual Academy, or Extended Foster Care) and the siblings were in a different program on the date the review was assigned to the reviewer. If this exception applies, only rate the target child on this tool and put the reason in the comments box.

***If the case being rated is a Permanent Plan case at the time the case was assigned for review, please use the Permanent Plan Tool instead of this Case Tool to rate the case.

*Do not complete this review tool if the case being reviewed is a money-only guardianship case. If there is another reason this case is not able to be reviewed, please put a brief description on the line below.

List reason(s) Review was not completed:

Section 1

*Complete Section 1 (questions 1-3) if the case opened during the review time period (RTP). If the case opened prior to the beginning of the RTP, begin at Section 2 (question 4)

Was this case opened (did the case begin) during the review time period?

Yes (Start the review at question #1)

No (Start the review at question #5 – Section 2)


1. Were the safety threats and Agency’s concerns described to the family?

Yes rate below

No

N/A (circle all that apply) – Parent’s whereabouts were unknown for the entire RTP; Parents’ were unresponsive to outreach; Other (specify the reason in the comments box below)

*** Rate this question for each parent that is involved with the case. The ratings are to be written on the lines above the comments box. If an explanation to a parent is not given, it should be noted why not in the comments box.

Connection to key expectations – Open and Clear Communication; SOP; Family Partnerships

Novice Emerging Accomplished Distinguished Master

The family was given an explanation about the need for Agency intervention

In addition to Novice Practice:

Used the terms of safety, harm, and danger when explaining the need for Agency Intervention

In addition to Emerging Practice:

Included behavioral detail in the harm and danger statements

Included impact to the child

In addition to Accomplished practice:

Asked the family about their understanding of safety, harm and danger as it related to their case

The child(ren)/youth and family’s voice was included in the safety, harm, and danger statements

In addition to Distinguished practice:

An attempt was made to hold a Family Centered Meeting (FCM)

Safety, harm, danger, and impact to the child were discussed with the family more than once during the RTP

The family was asked for their perspective on the above concepts at more than once during the RTP

Please write in the name/rating for each applicable family member:

Mother: Father: Other: Other:


Comments:

2. Was the family assisted with identifying a support system/safety network?

Yes rate below

No

N/A (circle all that apply): Parent’s whereabouts have been unknown for the entire RTP; Other (specify the reason in the comments box below)

Connection to key expectations - Support Systems/Safety Networks; Open and Clear Communication; Family Partnerships; Comprehensive Assessments Enhanced by Agency Tools

Novice Emerging Accomplished

Distinguished Master

At least one family member was asked about their support system


Explained to the family why the information on their supports was being obtained and what network members need to know

Contact information for the identified supports was documented


An ecomap and/or Circles of Safety and Support Tool was used to identify support system / safety network members and their relationship to the family

Formal and informal supports were identified

In addition to Accomplished Practice:

Asked all verbal family members involved in the case about their support system / safety network at least once during the RTP

Contact with the identified supports was attempted during the RTP

In addition to Distinguished Practice:

Attempted to set up a meeting with identified support system / safety network members during the RTP

Specific Roles were identified by the support system / safety network members and documented

Discussed methods for keeping everyone informed/ in contact

Comments:


3. During the initial case planning process, did we partner with the family to address the identified harm and danger?

Yes rate below

No

N/A (circle all that apply) – Whereabouts of the parents unknown; parents refused to meet with the worker to create the case plan at any point during the RTP; No services were ordered to both parents; Other (Specify the reason in the comments box below)

Connection to key expectations- Behaviorally Descriptive Case Plans; SOP; Family Partnerships; Open and Clear Communication; Cultural Responsiveness; Child/Youth Voice; Comprehensive Assessments Enhanced by Agency Tools


Attempts were made to obtain information from the parent(s)


The parent(s) involved in the case were asked to share their ideas of what changes needed to be made or what services should be included in the case plan

SOP and/or Solution Focused Questions were used to assist in case planning with at least one family member


Met with each parent involved in the case and at least a portion of the meeting was focused on case planning

Met with all verbal child(ren) to discuss case planning in age-appropriate terms

Spoke with parent(s) about harm and danger, as well as the safety goal(s)


Explanations of various types of programs and services were given

Input was obtained from the parent(s) about formal and informal services they would find helpful


Case Plan included the voice of the child/youth and family

Case plan was discussed with parent(s) and any verbal child(ren), if developmentally appropriate) at least once per month to assess progress

Comments:


4. Were questions asked regarding the cultural factors present in the family system?

-Culture is defined as: The sum total of an individual’s or family’s identity, including the learned behavior of a group passed on from generation to generation, e.g., valued, beliefs, lifestyle, traditions, historical trauma, race, ethnicity, language, religion/spirituality, sexual orientation, gender expression, class, etc.

Yes rate below

No

N/A (circle all that apply): children non-verbal and no family members could be located; other (describe in comment box)

Connection to key expectations- Cultural Responsiveness; Open and Clear Communication; Family Partnerships


Distinguished

Master

The race / ethnicity of the family was documented

Asked the family members about their language of preference and made arrangements as needed so they could communicate in their identified language of preference

There is documentation that efforts were made to identify relatives-ie: asked about any additional relatives at least one time during the RTP

Asked if the family has Native American heritage (NAH)


Asked additional questions about cultural norms / practices / beliefs / traditions

Identified strengths from the family’s culture

Genogram and/or ecomap were created or reviewed/ updated

If questions on NAH were asked, attempted to gather specific information on family members and tribal affiliation so noticing could be done and tribal contacts could be established


Attempted to provide culturally appropriate resources / referrals to the family-e.g. researched / made inquiries to find appropriate referrals, or made referrals if resources were already known

If the child is placed out-of-home, discussed the child’s culture with the substitute care providers


Referrals were made to culturally relevant services OR

Discussed the family’s culture with any service providers


Followed-up at least once a month with the family on appropriateness of the services

Made adjustments, if needed, based on the family’s feedback

If the child is placed out-of-home, followed-up with the substitute care provider(s) at least once per month to see if they were initiating or maintaining cultural connections for the child / youth


Comments:

Section 2

5. Were ongoing efforts made to support and honor the family’s culture?

-Culture is defined as: The sum total of an individual’s or family’s identity, including the learned behavior of a group passed on from generation to generation, e.g., valued, beliefs, lifestyle, traditions, historical trauma, race, ethnicity, language, religion/spirituality, sexual orientation, gender expression, class, etc.

Yes rate below

No

N/A (circle all that apply): children non-verbal and no family members could be located; other (describe in comment box)

Connection to key expectations- Cultural Responsiveness; Behaviorally Descriptive Case Plans; Comprehensive Assessments Using Agency Tools; Connection Preservation


Distinguished

Master

There is documentation that efforts were made to identify relatives-ie: asked about any additional relatives at least one time during the RTP

Asked about NAH again if any of the following apply:-a new sibling was born-Contact with a parent is established (especially if their whereabouts were previously unknown)-any new information on possible NAH


Cultural questions were incorporated in at least one meeting or interaction with the family members involved with the case during the RTP

Genogram and/or ecomap were created or reviewed/ updated at least once during the RTP to include current information

If applicable, embraced support from any of the family’s identified cultural community


Culturally respectful objectives, safety actions, and services were included in the case plan(s)

Referrals were made to culturally appropriate services as neededAND/ORAny existing service providers were educated about the family’s culture

Talked to the CASA, tribe, mentor, extended family, and/or other


Respect was shown during interactions by following the parent(s) / child(ren)/ youth/ and/or caregiver(s)’ identification of their norms, values and customs-e.g. use of eye contact, use of first or last names, removing shoes, language, male-female relationships, etc.

Partnered


Questions about culture were incorporated in more than one meeting or interaction with the family members involved with the case during the RTP

Discussed ways that the child(ren) / youth could stay connected with their culture with parent(s) / verbal child(ren)/ youth/ and/or substitute care provider(s)


becomes known

that are already involved or were attempting to become involved with the family

Discussed ways that the child(ren) / youth could stay connected with their culture with parent(s) / verbal child(ren)/ youth/ and/or substitute care provider(s) at least once during the RTP

significant people in the child(ren)/ youth’s life to discuss ways they could help connect or maintain connections for the child(ren) / youth to their culture/ traditions

with families when creating plans that respect the cultural aspects of the family and include the family’s voice in all plans-e.g. visitation plans, case plans, transition plans, etc.

more than once during the RTP

Comments:

6. Were attempts made to engage the family by using Safety-Organized Practice (SOP) tools/ interventions during the review time period?

Yes rate below

No

N/A (specify in comments box below)

Connection to key expectations – SOP; Family Partnerships; Child/Youth Voice; Support Systems/Safety Networks; Open and Clear Communication


Distinguished

Master

Attempted Solution Focused Inquiry (SFI) or use of other SOP tools


Used SOP tools and/or SFI with more than one family member


Used SOP tools and/or SFI to discuss strengths, safety, resources and any acts of protection with all parents included in the


Included child’s voice when discussing strengths, safety, resources, and any acts of protection


Gathered or reviewed information on the family’s support/safety network and made any needed


case plan with the parent(s)

updates/ changes

Attempted to contact the identified support system/safety network at least once during the RTP-if parent(s) give permission

Comments:

7. Was a Family Centered Meeting (FCM) held during the review time period?

Yes rate below

No

N/A (Specify in the comments box below)

- Attempts were made to schedule a FCM, but one was not held

Connection to key expectations – Comprehensive Assessments Enhanced by Agency Tools; Community Partner Collaboration; Family Partnerships; Child/Youth Voice; Open and Clear Communication; Support Systems/Safety Networks; Aftercare Plans


Distinguished

Master

A FCM was held, -e.g. TDM, mapping, Family Group Conferencing, etc.


The FCM only included or attempted to include informal supports


The FCM included or attempted to include formal and informal supports for the family


Followed-up with family on action plan agreed upon in the meeting

The child(ren)’s / youth’s voice


Followed-up with all parties on agreed upon actions

Information obtained from parties was used to


was incorporated in the meeting (child(ren) to be present if possible)

make adjustments in the plan and/or provide feedback to parties on progress on goals

Comments:

8. Were the family’s strengths, acts of protection, and/or protective capacities identified?

Yes rate below

No

N/A (Specify reason in the comments box below)

*To answer this question, reviewers may need to look outside the RTP.

Connection to key expectations – Comprehensive Assessments Enhanced by Agency Tools; SOP; Family Partnerships; Child/Youth Voice


Distinguished

Master

At least one family strength was identified during the RTP


At least one act of protection or protective capacity for the family was identified

Attempted to use Solution Focused Inquiry or SOP tools with at least one family member involved in the case during the RTP


One or more act of protection or protective capacity was identified during the RTP

There was documentation on how these acts of protection have mitigated some or all safety threats and/or concerns

Used Solution Focused


Identified acts of protection were used to discuss safety planning

Included the child(ren) / youth’s voice in documentation during RTP


Assessed the family’s progress in utilizing acts of protection more than once during the RTP -e.g. During visits, during supervision, while writing Court Reports, etc.

Asked the family Solution Focused Questions more than once during the RTP


Inquiry or SOP tools with more than one family member during the RTP-e.g. both parents

Comments:

9. Was the family assisted with maintaining a support system/safety network?

Yes rate below

No

N/A (circle all that apply): Parent’s whereabouts have been unknown for the entire RTP; Other (specify the reason in the comments box below)

*To answer this question, reviewers may need to look outside the RTP.

Connection to key expectations - Support Systems/Safety Networks; Open and Clear Communication; Family Partnerships



Asked at least one family member about their identified support system / safety network during the RTP


Contact with the identified supports was attempted during the RTP


Asked all verbal family members involved in the case about their support system / safety network at least once during the RTP

Attempted to set up a meeting with identified support system / safety network members during the RTP


Held a FCM with the identified support system / safety network to discuss progress and any concerns

Confirmed methods for keeping everyone informed/ in contact


Checked in with the support system / safety network monthly during the RTP to assess effectiveness

If needed - made adjustments by adding or removing network members or changing their responsibilities during the RTP


Comments:

10. If the child required out of home placement, was the family given an explanation about reunification timelines, concurrent planning, and permanency for their child?

Yes rate below

No

N/A (circle all that apply): Child in home; Unable to locate parent; parent(s) refused to meet with SW; Other (specify the reason in the comments box below)

***Rate this question for each parent that is involved with the case. The ratings are to be written on the lines above the comments box. Please note, that when the reviewer is rating a placement that falls under the RTP, but the placement began before the RTP started, the reviewer is asked to look outside the period under review to gather information related specifically to that placement.

Connection to Key Expectations- Family Partnerships; Open and Clear Communication; Connection Preservation; Child/Youth Voice


Explained reunification timelines to the parent(s)

There is documentation of discussing the concepts of concurrent planning and long term planning for child or youth


Attempted to hold a FCM

Had a discussion with the parent(s) about the child(ren) / youth’s need for permanency and stability


Parent(s) were given an explanation about reunification timelines and concurrent planning in clear, specific way

Obtained input from parent(s) about their desire for the child(ren) / youth’s permanency if reunification does not occur


Discussed with the family ways the youth/ child(ren) can maintain relationships with their family and other important people in their life if reunification is no longer the plan

Discussed with all verbal child(ren)/youth the concepts of reunification timelines, concurrent planning, and permanency in age-appropriate ways if developmentally appropriate


The family was given an opportunity to voice their understanding of reunification and concurrent planning

The voice of the child/youth was discussed regarding reunification and concurrent planning

Please write in the name/rating for each applicable parent:



Comments:

11. If the child required out of home placement, was the substitute care provider given an explanation of family reunification timelines, concurrent planning, and permanency?

Yes rate below

No

N/A (circle all that apply) Child in home; Child was placed in a Licensed Group Home, PCC, or Juvenile Hall and there were no other placements; Other (specify the reason in the comments box below)

***Rate this question for each Foster Home/REL/NREFM placement the target child had during the RTP. The ratings are to be written on the lines above the comments box. They should go in order, starting with the most recent placement. Do not rate placement episodes for Licensed Group Homes, PCC, or Juvenile Hall. If a child runs away and returns to the same placement, it is to be considered only one placement. When the reviewer is rating a placement that falls inside the RTP, but the placement began before the RTP started, the reviewer is asked to look outside the RTP to gather information related to that placement.

*How many placements did the target child have during the RTP?

Connection to key expectations - Open and Clear Communication; Kinship and Resource Family Teaming; Connection Preservation; Child/Youth Voice


Explained reunification timelines to the substitute care provider(s)

Discussed concurrent planning and permanency for child(ren) / youth with the substitute care provider(s)


Attempted to hold a FCM which included the substitute care provider

Discussed in detail what permanency would mean for the child(ren) and if there would be barriers to providing that permanency

If any barriers were


Substitute care provider(s) were given an explanation about reunification timelines and concurrent planning in a clear, specific, concise way

A FCM was held to discuss the child(ren) / youth’s need for permanency and stability


The substitute care provider was asked to voice their understanding of reunification and concurrent planning

The voice of the child/youth was discussed regarding reunification and concurrent planning


There was more than one conversation with the substitute care provider(s) about providing permanency for the child(ren) / youth

There was more than one conversation with the substitute


identified by the substitute care provider(s), the SW attempted to problem solve with the them

Discussed with the substitute care provider ways the child(ren) / youth could maintain relationships with their family and other important people in their life if reunification is no longer the plan

care provider(s) about ways the child(ren) / youth could maintain relationships with the important people in their life

Please write in the name/rating for each applicable placement:

Placement 1: Placement 2: Placement 3:

Comments:

12. If there were concerns about the stability of the placement during the RTP, was anything done to support the substitute care provider and prevent a placement disruption?

Yes rate below

No N/A (circle all that apply): There were no concerns about placement disruption during the RTP; child in the home/FM; Other (specify the reason in the comments section below)

***Rate this question for each Foster Home/REL/NREFM placement the target child/youth had during the RTP. This only applies if there were concerns about the stability of the placement. Do not rate children who were in stable placements. Ratings should go in order, starting with the most recent placement. Do not rate placement episodes for PCC or Juvenile Hall. If a child runs away and returns to the same placement, it is to be considered only one placement.

*How many placements did the target child have during the RTP?

Connection to key expectations - Kinship and Resource Family Teaming; Child/Youth Voice; Community Partner Collaboration; Support Systems/Safety Networks


Discussed placement issues only if


The


A TDM was held




they were brought up by the substitute care provider(s)

The substitute care provider(s) were asked at least one time during the RTP if they had any concerns or needs

substitute care provider(s) were asked on a monthly basis if they had any concerns or needs

Followed-up with any referrals that were made to try and expedite service delivery

Provided the substitute care provider(s) with information on foster and kinship care trainings or other supportive services at least one time during the RTP

OR

If in treatment level home, discussed referrals/ resources provided by Agency staff or other SW/provider (ex: FFA SW) at least once during the RTP

which included the substitute care provider(s), child(ren)’s service providers, CASA, parent(s), or other relevant parties (that were assessed to be safe to include)

Checked-in with the substitute care provider(s) to see if there were any barriers to accessing any services they were referred to

Attempted to problem solve with the substitute care provider(s) if any barriers were identified

Followed-up with the TDM participants on the action plan agreed upon in the meeting

The child(ren)’s / youth’s voice was incorporated in the meeting (child(ren) to be present if possible)

Information obtained from participants was used to make adjustments in the plan as needed

Provided feedback to the participants on progress of action plan items

Provided the substitute care provider(s) with information on foster and kinship care trainings and support groups on a monthly basis

OR

If in treatment level home, discussed any referrals given by any other SW/provider on a monthly basis

Attended at least one training / support group that Agency substitute care providers get referred to (in order to be well-versed in the content and make better referrals)

Please write in the rating for each applicable placement:

Placement 1: Placement 2: Placement 3:

Comments:


13. If a removal or a change of placement occurred, was anything done to reduce trauma and support the child(ren)’s well-being?

Yes rate below

No

N/A (circle all that apply): There was no change of placement during the RTP; Other (specify the reason in the comments box below)

***Rate this question for each child in the family. The ratings are to be written on the lines above the comments box.

Connection to Key Expectations- Kinship and Resource Family Teaming; Child/Youth Voice; Connection Preservation; SOP; Open and Clear Communication

Novice Emerging Accomplished Distinguished

Master

The child was asked about their feelings concerning the removal or change of placement

The child was asked what family / friends they would like to maintain contact with

If the child was non-verbal, the child’s voice was used in documentation and with the new substitute care provider(s) acknowledging the child’s trauma


Discussed the plan for the move with the child / youth and prospective substitute care providers

Followed-up with the substitute care provider and child/ youth within two days of the move


Used “All About Me” form / three houses / other family engagement tool

Asked the child / youth and substitute care provider(s) if they had any needs and provided assistance if any were identified

Discussed a plan to maintain contact with the important people in the child’s life that have been approved by the SW


Discussed child’s / youth’s voice when talking to parents / substitute care providers to assist with transition


Checked-in with the substitute care provider and child / youth at least once per month during RTP about the placement

Followed-up with anything that was identified as a need at the last visit

Followed-up on the plan to maintain contact with the important people in the child / youth’s life and made adjustments as needed

Child: Child: Child: Child:


Comments:

14. During regular meetings with the child/youth was an assessment done on their safety and needs? If the child was pre-verbal, were interactions observed and information about child’s


functioning obtained in order to assess the child’s safety and needs?

Yes rate below

No

N/A (specify reason in comments box below)

***Rate this question for each child in the family. The ratings are to be written on the lines above the comments box. This question applies to both FR and FM cases.

Connection to Key Expectations- Child/Youth Voice; Comprehensive Assessments Enhanced by Agency Tools; SOP; Open and Clear Communication


At least once per month, the child/ youth was asked about safety concerns and any issues that were brought up were addressed-e.g. Asking the child / youth if they feel safe in their placement or during contact with their parents, etc. -Asking questions related to the protective issues as needed

Child / youth was asked if there was anything they needed

If the child was non-verbal, the worker documented the child’s behaviors and interactions with parents/


Worker attempted to use SOP tools or SFI to elicit a better understanding of child / youth’s concerns, thoughts, and needs at least one time during the RTP

If the child was non-verbal, the parent and/or substitute care provider were asked about the child’s behavior / needs


SOP tools or SFI were used to elicit an understanding of the child / youth’s concerns, thoughts, and needs at least once during the RTP

Follow-up questions were asked based on the information obtained by using the SOP tools-e.g. asked child to talk about their drawing

The child / youth was seen in more than one environment during the RTP and were asked about safety

Any concerns mentioned by the child / youth were addressed


Case documentation consistently represents the child’s voice-e.g. It is written in more than one place - Court Reports, contacts, case notes, Case Consult forms, TDM forms, etc.


Worker encourages child / youth’s active involvement in meetings and Court

Worker represented the child/ youth’s voice if they could not be present for meetings, Court, etc. or if they were non-verbal

Re-assessment was done at least once per month to see if the child / youth’s feelings thoughts, needs change

If child is non-verbal, the parent/ substitute care provider and any other adults in the child’s life were


family / and any substitute care providers

Documented the child/ youth’s voice in at least one place

If the child was non-verbal, also asked the parent(s) / service providers / daycare providers or any other important adults in the child’s life about the child’s behavior / needs

contacted at least once per month about the child’s needs and were observed interacting with the child

Please write in the name/rating for each child:



Comments:

15. Was the impact of trauma on the child/youth’s emotional, social, and physical development assessed? Yes rate below

No

N/A (specify the reason in the comments box below)

***Rate this question for each child in the family. The ratings are to be written on the lines above the comments box.

Connection to Key Expectations – Comprehensive Assessments Enhanced by Agency Tools; Child/Youth Voice; Behaviorally Descriptive Case Plans; Support Systems/Safety Networks; Community Partner Collaboration


Information was gathered at least once per month from the


Child / youth’s interactions with parent(s)


Had a trauma-informed discussion with verbal child(ren) / youth

In addition to Accomplished practice:

Attempted to get support


Assessed child / youth’s


substitute care provider(s) and teachers, parent(s) or other people in the support system who may have contact with the child/ youth

Attempts were made to obtain records or reports about child / youth’s emotional, social, and physical functioning

and substitute care provider(s) were observed at least once during the RTP

Followed-up on information provided by child / youth’s support system and referrals were made to service providers as needed-e.g. For services such as developmental services, counseling, social skills group, etc.

about how they are doing

At least once during the RTP, the child / youth was asked if current services being provided and service providers were helpful

At least once during the RTP, discussed with the child(ren) / youth what changes could be made

If non-verbal, asked substitute care provider(s) and any involved parent(s) if current services being provided and service providers were helpful

system (substitute care provider(s), family members, and service providers) together to assess progress and address any issues-e.g. Child and Family Team Meeting, treatment team meeting, wrap team meeting, or other FCM

emotional, social, and physical functioning at least once per month during the RTP

Made any changes to services, goals, or service providers as needed

Attempted to hold meetings with support system at least twice during the RTP

Please write in the name/rating for each child:



Comments:

16. Were Case Plan(s) behaviorally descriptive? Yes rate below

No

N/A (circle all that apply) –Other (Specify the reason in the comments box below)

***Rate this question based on all case plans during the RTP. Ex: if two case plans fell into the RTP, then both would have to meet criteria for novice for the reviewer to mark novice.

Connection to key expectations- Behaviorally Descriptive Case Plans; SOP; Family Partnerships; Open and Clear Communication; Cultural Responsiveness; Child/Youth Voice; Comprehensive Assessments Enhanced by Agency Tools



At least one objective on the case plan was behaviorally specific


SOP and/or Solution Focused Questions were used to assist in case planning with at least one family member


Spoke with parent(s) about harm and danger, as well as the safety goal(s)

Case Plan is aligned with the safety threat(s)

Culturally respectful objectives, safety actions, and services were included in the case plan


The Case Plan Field Tool was used to assist in identifying case plan objectives and services

More than one objective on the case plan was behaviorally specific

Included the voice of the child(ren) / family


The case plan included clear and accurate harm and danger statements, safety goals, behaviorally specific objectives, and formal and informal services and supports

Comments:

17. Was the family given the opportunity to review their Case Plan at least once per month? Yes rate below

No

N/A (circle all that apply): parent(s) whereabouts were unknown; other (specify the reason in the comments box below)

*** Rate this question for each family member on the case plan. The ratings are to be written on the lines above the comments box. Explanations to verbal children should be done in a way that is appropriate for their age and developmental level (non-verbal children would not apply). If an explanation to a family member is not given, please note why not in the comments box.

Connection to Key Expectations – Comprehensive Assessments Using Agency Tools; Behaviorally Descriptive Case Plans; Family Partnerships; SOP


Met with the case plan participants at least once per month during the RTP-in some cases contact


Documented progress for each case plan participant at least once per month


Attempted to use solution focused questions or other SOP tools when


Documentation of discussion with each family member included specific information on


SFI or other SOP tools were used to discuss progress on the case plan at least once per


with parents may be by phone

Discussed the services in the case plan with each participant at least once per month-e.g. spoke with the mother about what services were in her section of the case plan and then spoke to the father about his services, etc.

-e.g. mother attended therapy and is making progress

Made additional referrals for services as needed

discussing progress on the case plan at least once during the RTP

Reviewed Safety Goal during the RTP

progress-e.g. mother attended therapy four times in the last month and has developed the following relapse prevention plan…

Documentation included the family member’s voice on what factors were contributing to the progress or lack of progress in Service Objectives

month with case plan participants

SFI or other SOP tools were used to review the Safety Goal at least once per month during the RTP

Developed an action plan if any new needs were identified

Adjusted case plan as needed

Please write in the name/rating for each applicable family member:



Comments:

18. Were child and family visits observed by a social worker in different environments in order to better assess family relationships? Yes rate below

No

N/A (circle all that apply): both parent’s whereabouts unknown; documented attempts to arrange but both parent’s did not show up; both parents are deceased; child is an infant and there are no other children in the family; There is a no contact order for both parents, It is an FM case where both parents reside in the home and the child(ren) are infants; other (specify the reason in the comments section below)

***Rate this question for each parent that is involved with the case. The ratings are to be written on the lines above the comments box.

Connection to Key Expectations- Family Partnerships; Comprehensive Assessments Enhanced by Agency Tools; Open and Clear Communication; Connection Preservation; Kinship and Resource Family Teaming



Visits between the parent(s) and child(ren)


There was a description of


A visitation


Specific


The assigned


were observed in at least two locations during the RTP -e.g. TDM’s, home visits, visit locations outside the parent or substitute care provider’s home, court, etc.

the family’s interaction and/or relationships at visitation-e.g. The mother and father visited with the child. The visit went well and there were no issues.

plan was created/ updated and included in the case plan and Court Report

More than one visit was observed by the assigned social worker during the RTP

There was a detailed description of the family’s interactions during visits and assessment of the family’s relationships for each visit

Strength-based terms were used in the documentation

suggestions / coaching were given to the parent(s) to improve interactions/ relationships after each observed visit

Family’s positive changes were recognized

If the family responded defensively to coaching, efforts were made to maintain focus on steps to improve

Attempted to hold a FCM to collaboratively develop the visitation plan with any or all of the following: the parent(s), substitute care provider(s), relatives, or other important parties to the case

social worker supervised at least one visit per month during the RTP

Held a FCM which included a discussion to collaboratively develop the visitation plan with any or all of the following: the parent(s), substitute care provider(s), relatives, or other important parties to the case

Plan included parameters for the visit including: content, time, length, and frequency of visits



Comments:

19. During the RTP, was an assessment done to determine if the level of visitation should be changed or maintained?

Yes rate below

No

N/A (Circle all that apply): There was no safety threat; Other (specify in the comments box below)

both parent’s whereabouts unknown; documented attempts to arrange but both parent’s did not show up; both parents are deceased; There is a no contact order for both parents, It is an


FM case where both parents reside in the home and the child(ren) are infants; other (specify the reason in the comments section below)


Connection to Key Expectations- Comprehensive Assessments Enhanced by Agency Tools; Connection Preservation



At least once during the RTP, an assessment was made about changing or maintaining current level of visitation and placement -E.g. increasing the number and length of visits, moving from supervised to unsupervised; unsupervised to overnights; overnights to a 60 day trial visit; 60 day trial to case closure

If it is a high risk case, a case consultation was held if the request was to change the level of visitation from supervised to unsupervised


Visits between the parent(s) and child(ren) were supervised / observed by the assigned SW more than once during the RTP-this would include supervised visits being attempted by the SW, but the parents did not show up

At least once every three months, during the RTP, an assessment was made about changing or maintaining current level of visitation and placement

Asked the parent(s) and child (if verbal) their thoughts on how visitation was going

Attempted to


At least one time per month, during the RTP, an assessment was made about changing or maintaining current level of visitation and placement

Visits between the parent(s) and child(ren) were supervised / observed by the assigned SW at least four times during the RTP


Visits between the parent(s) and child(ren) were supervised / observed by a SW at least once per month during the RTP


During the RTP, an assessment was made about changing or maintaining current level of visitation and placement more than once per month


collect information from any other parties supervising visitation to include in the assessments

Facts were included in the Court Report to back-up any recommendation for “no visitation” or “supervised visitation”



Comments:

20. Were attempts made to set up meetings and facilitate interactions between the parent(s) and the child’s school, doctor, therapist, or other service providers?

Yes rate below

No N/A (circle all that apply): FM case with children in home and parent scheduling these appointments; both parents whereabouts unknown; parent was incarcerated; Child not in school and not participating in any formal services; No contact order between child and both parents; other (specify the reason in the comments box below)


Connection to Key Expectations- Open and Clear Communication; Support Systems/Safety Networks; Community Partner Collaboration; Family Partnerships; Kinship and Resource Family Teaming


Had a discussion with parents about maintaining contact with school officials,


The parent(s) were encouraged to maintain


The parent(s) attendance was facilitated


Debriefed with the parent(s) on


Helped the parent(s) outline plans


doctors, and / or service providers at least once during the RTP

contact and interaction with school officials, doctors, and/or service providers at least once during the RTP

The parent(s) were informed of any upcoming doctor’s appointments and/or school activities by the SW or substitute care provider

OR

Discussed any upcoming appointments that were set by the parent(s)

by performing at least one of the following: -assisted with transportation,-arranged for the parent(s) to appear by phone,-spoke with the parent(s) about agenda / purpose of the meeting,-answered parents’ questions, -asked if the parent(s) wanted a support person to attend with them

Attempted to use SFI or other SOP tools when talking to the parent(s) and /or substitute care providers

the outcome of an appointment (whether or not the parent(s) attended the appointment)

If the child is out-of-home, there was at least one documented conversation with the substitute care provider(s) where they were encouraged to inform the parent(s) about upcoming appointments and asked if the substitute care provider(s) were open to anything further -e.g. such as assisting with transportation

for working with schools, doctors, or other service providers-e.g. exploring if there were members of the support system that could help with transportation or supervising the contact

There was more than one conversation with the substitute care provider(s) about communicating with the parents on upcoming medical appointments, school activities, or other service provider meeting

At least one time during the RTP, the social worker attempted to attend an appointment with the parent at the school, doctor, or other service provider




Comments:

21. Did the worker develop an aftercare plan with the family/substitute care provider(s) to provide support and structure after the case closes?

Yes rate below

No N/A Circle all that apply): There was no safety threat; Other (specify in the comments box below)

***Rate this question for each parent that is involved with the case. The ratings are to be written on the lines above the comments box. If this is a youth that is aging out of the system with no parent involvement, then the question can be rated for that child specifically and the independent living plan can be considered a type of aftercare plan.

Connection to Key Expectations- Aftercare Plan; Support systems/Safety Networks; SOP; Family Partnerships; Kinship and Resource Family Teaming; Community Partner Collaboration; Child/Youth Voice


Told the family they need an aftercare plan when the case closes and told them what the plan would be without eliciting their feedback


Attempted to use SFI or other SOP tools to obtain information about family’s aftercare plan –e.g. who will be involved and what services may continue to be available to them

A plan was written-up

If applicable, The plan addressed the previous protective issue to prevent re-occurrence of abuse/neglect


Developed an aftercare plan that was specific and included behavioral details about family members’ responsibilities


Attempted to hold a Family Centered Meeting to develop an aftercare plan with the family, support system, substitute care provider(s) and/or service providers

Included the voice of the child in the written aftercare plan


Held Family Centered Meeting to develop an aftercare plan with the family, support system, substitute care provider(s), and / or service providers

Discussed with the family ways to modify plan if needed once jurisdiction is terminated



Comments:

Section 3


Was there an investigation on a new referral that identified a Safety Threat?

Yes (complete Section 3)

No (Skip Section 3 and go to last page to provide overall feedback on the case)

22. If during the course of the case a new safety threat was accurately identified, was an assessment done?

Yes rate below

No N/A (Circle all that apply): There was no safety threat; Other (specify in the comments box below)

Connection to Key Expectations- Comprehensive Assessments Enhanced by Agency Tools; SOP; Child/Youth Voice; Family Partnerships; Open and Clear Communication


Distinguished

Master

All safety threats were accurately documented in CWS/CMS


All safety threats were identified and documented in CWS/CMS and SDM


Safety threats were documented in CWS/CMS using behaviorally descriptive language demonstrating the extent and impact of the safety threat


The family was given an explanation of the impact and extent of safety threats

The family was involved in safety planning conversations


The voice of the child/youth and family was used when describing the impact of the safety threats

Comments:

23. Were safety interventions developed to address the new safety threat(s)?

Yes rate below

No

N/A (specify the reason in the comments box below)

Connection to Key Expectations- SOP; Family Partnerships; Support Systems/Safety Networks

Novice Emerging Master


Accomplished Distinguished

Interventions or a safety plan were developed that addressed the safety threat(s)


The interventions or safety plan was behaviorally specific


Interventions or a safety plan was developed which was:-SMART - specific, measurable, attainable, relevant, and time-bound

There was documentation that the parent(s) were included in the development of the plan


Attempts were made to include the safety network in the interventions or safety plan


At least one follow-up was conducted on the effectiveness of the interventions

Changes were made if any issues were identified

Comments:

*Complete box below if there is any overall feedback from the review)

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