<p> CALIFORNIA CHILD WELFARE SERVICES OUTCOMES AND ACCOUNTABILITY SYSTEM PEER QUALITY CASE REVIEW PROBATION</p><p>CASE SUMMARY</p><p>FACE SHEET Name of County: </p><p>Case Name: Case Number: </p><p>Date Case Record Reviewed: Type of Placement: Relative Foster Care </p><p>Review Team Names: </p><p>CASE INFORMATION Date of minor’s first suitable placement order: Date of most recent suitable placement order: (Date minor ordered into current out-of-home placement, if different: ) NA</p><p>Date minor returned home (if applicable): Date probation terminated (if applicable): </p><p>Minor’s name: Ethnicity: Date of birth: First MI Last</p><p>Mother’s name & age: Father’s name & age: </p><p>In the home? Yes No In the home? Yes No Name of minor’s sibling(s) (full, half, step): In out-of-home placement? Yes No First MI Last Age: </p><p>1. No Yes: 300 600 Other </p><p>2. No Yes: 300 600 Other </p><p>3. No Yes: 300 600 Other </p><p>4. No Yes: 300 600 Other </p><p>5. No Yes: 300 600 Other SECTION I: HISTORY A. General Information</p><p>1. What was the original charge? </p><p>Did the minor receive additional sustained charges after the suitable placement order? 2. Yes No Describe: </p><p>3. Were preventive services provided prior to the suitable placement order? Yes No</p><p>WIC 236 WIC 654</p><p>WIC 725 WIC 790</p><p>3a. If YES, what were those services? Home on probation</p><p>Camp</p><p>Other: ______</p><p>4. Was suitable placement recommended? If YES, date: Yes No</p><p>4a. If NO, what was recommended? </p><p>5. Was there a prior WIC 300 (Dependency) case? Yes No</p><p>5a. If YES, what type of case was it? Neglect Physical Abuse Sexual Abuse ______</p><p>SECTION II: INDIAN CHILD WELFARE ACT (ICWA) Yes No 1. Is the minor a Native American? If NO, go to section III</p><p>2. Was the tribe notified of the minor’s involvement in out-of-home placement services? Yes No</p><p>3. Was the tribe noticed for court hearings? Yes No</p><p>4. Is the minor’s placement with a relative, extended family, or tribal home? Yes No</p><p>4a. If NO, why? </p><p>4b. Is there documentation regarding tribal placement preferences? Yes No</p><p>2 SECTION III: CASE PLAN</p><p>A. Assessment of Needs and Services</p><p>1. Were the needs of the minor assessed and identified while developing the case plan? Yes No</p><p>1a. If the answer is YES, describe the needs identified: </p><p>1b. Did the services listed match the needs identified for the minor? Yes No</p><p>Were the needs of the parent(s) assessed and identified while developing the case 2. Yes No NA plan?</p><p>2a. If the answer is YES, describe the needs identified: </p><p>2b. Did the services provided match the needs identified for the parents? Yes No NA</p><p>Were needs of the out-of-home care provider assessed and identified while developing Yes No 3. the case plan?</p><p>3a. If the answer is YES, describe the needs identified: </p><p>3b. Did the services provided match the needs identified for the care provider? Yes No NA</p><p>Has the minor had a health examination during the last year? 4. If YES, date of last exam: Yes No</p><p>Has the minor had a dental examination during the last year? 5. If YES, date of last exam: Yes No</p><p>6. Is the minor on psychotropic medication? Yes No</p><p>If the answer to Question 6 is YES, is there a current court authorization on file? 6a. Yes No If YES, date of the order: What is the most typical pattern of visits by the DPO? </p><p>Mother: Monthly Less than monthly OR no visits—Why? 7. Father: Monthly Less than monthly OR no visits—Why? </p><p>Minor: Monthly Less than monthly OR no visits—Why? </p><p>3 B. Case Plan Goal </p><p>Is there a current case plan on file? 1. Yes No Date approved by supervisor? </p><p>Was the case plan updated every six months as required? 2. Yes No NA Date of initial CP: Date of update: Date of update: </p><p>3. Is there a concurrent plan in place (working toward adoption and reunification)? Yes No</p><p>Family Reunification</p><p>Permanent Planning</p><p>Long-Term Placement 4. What is the minor’s current case plan goal? Guardianship</p><p>Adoption</p><p>Emancipation 5. How long has the current goal been in place? What factors did the agency consider when making decisions about the case plan goal? 6. Age Behavior Medical Psychological Siblings Relatives Other: </p><p>Was there a compelling reason documented as to why Termination of Parental Rights 7. Yes No was not ordered? If YES, what was the compelling reason? </p><p>Parents or guardians have maintained regular visitation and contact with the child and the child would benefit from continuing the relationship.</p><p>A child 12 years of age or older objects to termination of parental rights.</p><p>The child is placed in a residential treatment facility and adoption is unlikely or undesirable while the child remains 7a. in that placement and continuation of parental rights will not prevent the finding of an adoptive home if the parents cannot resume custody when residential care is no longer needed.</p><p>The child is living with a relative or foster parent who is unable or unwilling to adopt the child because of exceptional circumstances, but who is willing and capable of providing the child with a stable and permanent home and removal from the home of the relative or foster parent would be detrimental to the well-being of the child. (This exception does not apply to a child under six or a child who has a sibling under six who is also a dependent and with whom the child should be placed permanently.)</p><p>Other (explain) </p><p>C. Minor and Family Involvement in Case Planning 1. Did the minor sign the case plan? Yes No</p><p>4 If the answer is NO, is the reason documented? 1a. Yes No What is the reason documented? </p><p>2. Did the parents sign the case plan? Yes No</p><p>If the answer is NO, is the reason documented? 2a. Yes No What is the reason documented? </p><p>D. Transitional Independent Living Plan (TILP) Is there a current TILP on file? 1. Yes No Date signed by the minor? </p><p>Was the TILP updated every six months? 2. Yes No NA Date of initial TILP: Date of update: Date of update: </p><p>SECTION IV: OUT-OF-HOME PLACEMENT A. Placement Stability </p><p>1. How many placements has this minor had? </p><p>1a. Of those placements, how many with a relative? </p><p>1b. Of those placements, how many in a group home? </p><p>What factors contributed to the placement changes? 1c. NA</p><p>2. Were there any incidents of abuse while the minor was in out-of-home placement? Yes No</p><p>2a. If YES, describe: </p><p>B. Family Relationships and Connections What is the proximity of the minor’s current placement to: </p><p>Mother: Same county Out of county Out of state Other: 1. Father: Same county Out of county Out of state Other: </p><p>Siblings: Same county Out of county Out of state Other: Yes No Is the reason for the location of the placement clearly related to helping the minor 2. achieve the case plan goal? Unable to determine</p><p>5 Yes No NA 3. Were efforts made to place the sibling(s) together? Unable to determine</p><p>3a. If not placed together, why? </p><p>What is the most typical pattern of visitation between the minor and his/her family? </p><p>Mother: Weekly Bi-weekly Monthly Less than monthly No visits 4. Father: Weekly Bi-weekly Monthly Less than monthly No visits</p><p>Siblings: Weekly Bi-weekly Monthly Less than monthly No visits</p><p>SECTION IV: SUMMARY</p><p>A. Issues to follow-up with Probation Officer:</p><p>6 PQCR INTERVIEW TEAM OBSERVATIONS</p><p>Use this space to prepare for the debriefing session. Answers need to be specific to the focus topic:</p><p>Identify documentation trends:</p><p>Identify training needs:</p><p>Identify needed systemic/policy changes:</p><p>Identify areas needing state technical assistance:</p><p>Other:</p><p>7</p>
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