Case worker - DHHS - Foster Care Review Office

Case Worker – DHHS

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User Information

This survey is for anyone who is providing the 24/7 care of the child/youth, regardless of the placement type.

What is reported in this questionnaire may be included in the local board’s report to the legal parties to the case.

Your Name*

First Last

Name of Child/ren

If responding for more than one child, use the oldest child’s first name and last initial.

Name of Child*

First Last (1st initial only)

Address

City State / Province / Region

Board #: If Known

Meeting Date: If Known

Progress Towards Permanency

What is the permanency objective for the child/ren?

What are the barriers at this time to the permanency plan being successful?

Are the parents attending the team meetings?

What services are the parents participating in?

Are there services that have been offered that the parents are NOT participating in?

Which parents have been adjudicated?

Has paternity been established?

Has child support been ordered?

If the child/ren/youth are placed with their parent on a Trial Home Visit, describe the progress the parent/s demonstrated to determine the child/ren’s safety?

What issues that led to out of home placement still exist?

Have any new issues developed since the initial intervention?

How are the new issues being addressed?

Visitation

What is the current visitation type, location and schedule for the mother and/or father?

Are parent/s participating in all scheduled visits? Concerns?

Is there sibling visitation? (Include type and location of visitation)

Are there any other relatives, paternal or maternal who have visits or contact with the child/ren?

Is continued visitation in the child/ren’s best interest?

Who is the person/agency supervising visitation?

Have all visitation reports been received by DHHS?

Child/ren Update

What services do the child/ren participate in? (IE: therapy/family therapy, IEP, PALS, IL Services, Probation services)

Are there any services needed that have not yet started for the child/ren?

What medications is the child/ren currently taking?

What types of family or community activities do the children participate in with their foster parents or their bio parents?

Are there any concerns you have with the child/ren current placement?

Would the foster parents/placement willing to provide permanency for the child/ren if it became needed?

By returning this document, you confirm that this information is true and accurate and that you understand this information may be shared with the legal parties to the case.