Title IV-E Foster Care Eligibility Reviews, Child and Family Services Reviews

	U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Administration on Children, Youth and Families Children’s Bureau		CASE NAME:
			REVIEWERS
			FEDERAL:
			STATE:
			CASE DEBRIEFED:

Child and Family Services Reviews

Onsite Review

Instrument and Instructions

July 2003

Children’s Bureau

Child and Family Services Reviews

Onsite Review Instrument Instructions

The Onsite Review Instrument is used to review both foster care and inhome services cases during the onsite review component of the child and family services reviews of State child welfare agencies.

The process for gathering information to complete the Onsite Review Instrument includes conducting case record reviews and case-related interviews with children, parents, foster parents, caseworkers, and other professionals involved with the child.

The instrument is organized into a Face Sheet and three sections. On the Face Sheet, reviewers document general information about a case, such as the type of case.

The three sections focus on the outcome domains that form the basis of the child and family services reviews: safety, permanency, and child and family well-being. For each outcome, the reviewers collect information on a number of “items” related to that outcome.

Reviewers will include the names of individuals on the Face Sheet only and should use titles (for example, mother) when documenting the ratings for the items and outcomes. Reviewers should note one exception to this instruction, which appears in item 1. For this item, reviewers should include on the chart the first name of the child(ren).

While reviewers use the Onsite Review Instrument to review both foster care and inhome cases, they complete the permanency section only if the case under review is a foster care case.

For children in foster care, reviewers should consider items 21–23 only as they apply to the specific child whose case is under review. For children receiving inhome services, reviewers should apply those items to all the children in the family who are residing with, and included in services to, the family.

Quality Assurance Checklist

Once reviewers have completed an Onsite Review Instrument, they must apply the quality assurance review process (see the Quality Assurance Review Checklist) before turning in the instrument to the Local Site Leader. The Local Site Leader will provide feedback to the reviewers. If the Local Site Leader provides feedback requiring reviewers to make revisions or additions to the instrument, the reviewers will then apply the quality assurance review process to the revised instrument. The Local Site Leader must then re-review the Onsite Review Instrument to ensure that the requested changes have been made.

Face Sheet

In Section B of the Face Sheet, “Case name,” reviewers should document the case name used by the State agency, for example, the mother’s name.

In Section I of the Face Sheet, “Type of case reviewed,” reviewers should document the type of case being reviewed. Reviewers should check “Foster care” if the child was in care during any portion of the period under review, including placement with relatives in unlicensed homes. If the case was opened for inhome services for at least 60 days during the period under review, reviewers should check “Child protective services” (even if the child was in foster care before the period under review).

The “Period under review” begins with the first day of the sampling period used to select the cases for the onsite review, and continues through the date of the actual review. The Team Leader will clarify for the review team the “Period under review.”

In Section J of the Face Sheet, “Is/was the child whose case is under review a child in need of supervision or a delinquent,” reviewers should check yes if the case being reviewed is/was a child in need of supervision (CHINS), person in need of supervision (PINS), family with service needs (FWSN), family in need of supervision (FINS), or delinquent case. Reviewers should check no if the case being reviewed is/was an abuse/neglect case.

In Section L of the Face Sheet, “Date of most recent removal from home (foster care cases only),” reviewers should use the date of the current foster care placement episode. They should not use the date of the original placement. For example, if a child was placed in care in March 1997, returned home in March 1999, and then returned to care in October 1999, the current placement date is October 1999. If the child had never returned home, the current placement date would be March 1997.

In Section N of the Face Sheet, “Date case closed,” reviewers should document the date the case was actually closed, not the date a child returned home.

Rating the Case

Reviewers must answer the Core Questions for each item.

Reviewers should use the Exploratory Questions listed under each item to determine the responses to the Core Questions and then mark responses in the non-shaded boxes next to each. Reviewers can use the Exploratory Questions in examining the case record and in conducting case-related interviews.

In addition to answering the Core Questions, reviewers should document relevant and supporting information under the Core Questions, where applicable, and in the large white box that appears below the Instructions for each item. It is critical that reviewers document in this space the information gathered from the case record and interviews that supports the responses to the Core Questions and indicate the source of the information (for example, during the interview with the birth mother she stated that she visits with the child weekly). All documentation should be written legibly and provide specific information related to the Core Questions. While the instrument provides directions on where to find information, reviewers should use their professional judgment to determine how best to gather all the relevant information.

Using the information gathered through the case record review and interviews, reviewers then rate each item as either a strength, an area needing improvement, or not applicable. Reviewers will need to consider all the information gathered for each case to make these determinations and weigh the following factors: (1) the result or outcome of services or interventions for the child(ren) or family; (2) the extent to which the child(ren)’s or family’s critical needs were met; (3) the appropriateness of the agency’s actions relative to the child(ren)’s or family’s needs and to applicable agency policies (reviewers should give primary consideration to the needs of the child(ren) or family in the event that existing agency policies do not appear responsive to those needs); (4) recent practice, primarily considering the period under review unless otherwise directed in the instructions. Reviewers should address only the focus of the item being rated.

In a number of items, the expression “is/was” is used to frame a question. This is done to account for cases that are closed for services at the time of the review, but were open during the period under review. If the case is open for services at the time of the review, the term “is” refers to the current situation, unless the instructions indicate otherwise. If the case is closed at the time of the review, the term “was” refers to the last or most recent situation occurring before case closure, unless the instructions indicate otherwise.

Once reviewers have completed the items related to each outcome, they then complete the Discussion of Outcome portion of the instrument. Reviewers must determine whether each outcome has been substantially achieved, partially achieved, or not achieved. The criteria for determining the level of achievement appear in the Level of Outcome Achievement section within each Discussion of Outcome portion. Reviewers should check the level of outcome achievement and document the rationale for this rating in the space provided.

At the end of the Onsite Review Instrument is a Case Rating Summary sheet. Reviewers use this sheet to summarize the ratings for each outcome and item. They should use this sheet to prepare to present information on cases during daily onsite debriefings with their team.

Further direction for answering the Core Questions and rating each item and outcome is provided on the page for each item/outcome.

Reviewers must turn in to their Local Site Leader a completed Onsite Review Instrument for each case record reviewed.

Child and Family Services Reviews Checklist for Completing the Quality Assurance Review of Completed Onsite Review Instruments
Name of child/family:
Reviewers:
Local Site Leaders:
Reviewers	Local Site Leaders	Quality Assurance Activity
		Have all the sections of the Face Sheet been completed (for example, has the case been correctly identified as a foster care or inhome case and have the names of the children been filled in, with an asterisk by the name of the child whose foster care case is under review)?
		Have all the core questions under each item been answered (including questions requiring answers for both the period under review and the life of the case)?
		In the safety section, were answers and information for all the children in the family provided (not just the child whose case is under review)?
		Has each item been rated as one of the following: “strength,” “area needing improvement,” or “not applicable”?
		Has appropriate justification been provided for any items rated “not applicable”?
		Do the notes reflect information obtained from all the sources available, including the case record and case-related interviews?

			Do the notes under each item support the rating assigned to that item?
			Were the correct criteria used to rate each of the seven outcomes?
			Do the notes under each outcome discussion support the rating of the outcome?
			Does the documentation on the Onsite Review Instrument cite the source of the information and is the documentation legible?
				Are names and other identifying information included only on the Face Sheet and not elsewhere in the Onsite Review Instrument?
				Has the Case Rating Summary at the end of the instrument been completed?
After applying the Quality Assurance Checklist to the completed Onsite Review Instrument, review pairs should place their initials in the appropriate box below. Following the application of the checklist by review pairs, the Quality Assurance Reviewer (for example, the Local Site Leader or the Team Leader) also will apply the checklist to the instrument and place his or her initials in the box below. Review pairs and Quality Assurance Reviewers should apply and sign off on the checklist after each round of changes.
Quality Assurance Review 1:					Review Pair (Please initial): ____________________ Quality Assurance Reviewer (Please initial): ______
Quality Assurance Review 2:					Review Pair (Please initial): ___________________ Quality Assurance Reviewer (Please initial): ______
Quality Assurance Review 3:					Review Pair (Please initial): ___________________ Quality Assurance Reviewer (Please initial): ______
Quality Assurance Review 4:					Review Pair (Please initial): ___________________ Quality Assurance Reviewer (Please initial): ______
Quality Assurance Review 5:					Review Pair (Please initial): ___________________ Quality Assurance Reviewer (Please initial): ______

July 2003 OMB Control No: 0970-0214 Expiration date: 10/31/2006 CHILD AND FAMILY SERVICES REVIEWS ONSITE REVIEW INSTRUMENT Face Sheet

A.

Name of State and county

B.

Case name

C.

Period under review

D.

Reviewers Federal: State:

E.

Date case reviewed

F.

Child(ren)’s name(s) (For foster care cases, place an asterisk next to the child whose case is under review) First Name Last Name

G.

Child(ren)’s race and ethnicity

H.

Child(ren)’s date(s) of birth (MM/DD/YY)

I.

Type of case reviewed

Foster Care (Child was in foster care for all or some portion of the period under review)

Child Protective Services (No child in the family was in foster care for any portion of the period under review)

J.

Is/was the child whose case is under review a “child in need of supervision” or a “delinquent”? Reviewers should check no if this is a child welfare case opened because of abuse and neglect, or another reason other than a child in need of supervision.

Yes No

K.

Date of most recent case opening (MM/DD/YY)

L.

Date of most recent removal from home (foster care cases only) (MM/DD/YY)

M.

Date child returned home from most recent foster care episode (foster care cases only) (if applicable) (MM/DD/YY)

N.

Date case closed (if applicable) (MM/DD/YY)

O.

Indicate the cause of the agency’s initial involvement with this child or family. Check all that apply and place an asterisk next to the primary reason.

Physical abuse

Abandonment

Substance abuse by child

Sexual abuse

Mental/physical health of parent

Domestic violence in child’s home

Emotional maltreatment

Mental/physical health of child

Child in juvenile justice system

Neglect (not including medical neglect)

Substance abuse by parent(s)

Other (specify)

Medical neglect

Child’s behavior

P. Persons interviewed (list below)

Name

Relationship to Case

Date of Interview

Type of Interview

In-Person

Phone

In-Person

Phone

In-Person

Phone

In-Person

Phone

In-Person

Phone

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104–13)

Public reporting burden for this collection of information is estimated to average 8 hours per response, including the time for reviewing instructions, reading case files and conducting interviews, and reviewing the collection of information.

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

SECTION I: SAFETY

Outcome S1: Children are, first and foremost, protected from abuse and neglect.

Item 1. Timeliness of Initiating Investigations of Reports of Child Maltreatment (Case Record, Interview With Caseworker)

Core Questions

Over the Life of the Case?

During the Period Under Review?

A.

How many reports of suspected abuse or neglect have been received on children in the family (including reports accepted or screened out by the State)? Reviewers should record the total number of reports of child maltreatment for all children in the family, not just the child in foster care who is documented through the case record under review.

B.

In how many of the reports assigned for a response were the investigations initiated in accordance with the State’s timeframes and requirements for a report of that priority?

C.

In how many of the reports was face-to-face contact with the child(ren) made by the investigating worker within the timeframes designated by State guidelines?

Exploratory Questions How many reports were received (including reports accepted or screened out by the State)? What was the priority level assigned to each report? What are the agency requirements for initiating an investigation by priority level (for example, timeframes)? What are the agency requirements for having face-to-face contact with the child(ren) who are the subject(s) of reports received? When did the investigating worker initiate the investigation?

Rating for this indicator: (Check one)

Strength

Area Needing Improvement

Not Applicable

List below the reports of suspected abuse or neglect during the period under review and six months prior.

Report Date

Child(ren) First Name

Allegation

Priority Level Assigned by the State (if applicable)*

Date Assigned*

Date Investigation Was Initiated*

Date of Face-to-Face Contact (if applicable)*

Relationship of the Alleged Perpetrator

Disposition

(Continued)

*Reviewers should complete the columns marked with an asterisk only for the reports received during the period under review.

Instructions for Item 1: Timeliness of Initiating Investigations of Reports of Child Maltreatment

This item focuses on the timeliness of investigations of all reports of child maltreatment, including those assigned to receive an alternative response.

Reviewers should focus on all children in the family.

Reviewers should note the following definitions when completing this item:

• “Life of the case” refers to the entire time the case was known to the agency.
  
  

• “Face-to-face contact” refers to in-person contact with all of the children in the family who are the subject of the report. If different dates are recorded for different children, reviewers should explain the reason why in the documentation section.
  
  

• “Date assigned” refers to the date the report is assigned for investigation or to receive an alternative response.
  
  

• “Alternative response” refers to an agency’s approach to addressing child maltreatment reports that meet agency criteria for acceptance but at the initial screening do not meet the agency’s requirements for a mandated investigation. For example, the agency’s policy may be that reports that appear to present low to moderate risk to the child may be referred for a family assessment, rather than an investigation. Under such a response, no determination of child maltreatment is made.
  
  The alternative response may include an assessment to determine the safety of the child(ren), the risk of maltreatment, and the family’s strengths and needs. The assessment may lead the State agency to provide services to eliminate or lessen the safety concerns and maltreatment risks. Reviewers should note that reports that are “screened out” should not be considered as an alternative response. Also, if reviewers determine that there was a risk that warranted the provision of services by the agency, they should treat the report as they would an indicated or substantiated report, even if no formal disposition was made.
  
  

Reviewers should determine whether investigations noted in each of the reports were initiated within the timeframe specified in the State’s policy for a report of that particular type or priority.

Reviewers also should examine whether the caseworker actually saw the child(ren) who were the subject of the report as a part of the investigative activities.

Reviewers should rate this item based on the period under review, not the case history.

Reviewers should rate this item as not applicable if there were no reports of child maltreatment during the period under review. For example, a case might have a long Child Protective Services (CPS) history but no reports during the period under review. In that circumstance, reviewers should document the case history information as background in the space provided below (noted as “life of the case”), but rate the case not applicable in relation only to the period under review.

Provide documentation that supports the rating for item 1

This item is rated as a(n) _______________________________________ because:

Outcome S1: Children are, first and foremost, protected from abuse and neglect.
Item 2. Repeat Maltreatment (Case Record, Interview With Caseworker)
Core Questions						Yes	No			Not Applicable
A.	During the period under review, was there (1) at least one substantiated or indicated report of maltreatment on any child in the family or (2) at least one report of maltreatment on any child in the family handled by an alternative response that resulted in the State later determining that the child(ren) either had been maltreated or was at risk of being maltreated?
B.	If the response to question A is yes, (1) within a 6-month period before or after the report identified in question A, was there at least one additional substantiated or indicated report of maltreatment on any child in the family or (2) within a 6-month period before or after the report identified in question A, was there at least one report of maltreatment on any child in the family handled by an alternative response that resulted in the State later determining that the child(ren) either had been maltreated or was at risk of being maltreated? Reviewers should answer yes to question B if there was any combination of reports handled by a traditional child protective services investigation or by an alternative response if the result of the investigation or alternative response led to a conclusion that the child(ren) who was the subject of the reports had been maltreated or was at risk of being maltreated.
C.	If the response to question B is yes, did the reports identified in Questions A and B involve: The same perpetrator or The same general circumstances
Exploratory Questions What was the nature of each report? What is/was the relationship of the perpetrator to the child? When were the reports received? What type of response was provided to each report (for example, investigation or alternative response)?
Rating for this indicator: (Check one)			Strength		Area Needing Improvement				Not Applicable
Instructions for Item 2: Repeat Maltreatment This item focuses on substantiated/indicated reports of repeat maltreatment and reports of repeat maltreatment addressed through an alternative response system that lead to opening a case for services due to risk of harm to the child(ren). Using the information documented on the chart for item 1, reviewers should determine whether children in the family have had multiple substantiated or indicated reports of maltreatment arising from the same general circumstances or by the same perpetrator. Reviewers should focus on all children in the family. (Instructions continue on the next page)

Reviewers also should note the following definitions (which are the same as those used for the National Child Abuse and Neglect Data System [NCANDS]), when completing this item:

• “Substantiated” refers to an investigation in which the allegation of maltreatment or risk of maltreatment was supported or founded according to State law or State policy.

• “Indicated” means the allegation of maltreatment was indicated, or there was reason to suspect maltreatment, but it was unfounded under State law or State policy.

Reviewers should respond to the Core Questions with regard to repeat maltreatment as defined below.

• Repeat maltreatment refers to:

1. Two or more substantiated or indicated reports of maltreatment within a 6-month period, with at least one of the reports occurring during the period under review;

2. Two or more reports of maltreatment within a 6-month period, with at least one of the reports occurring during the period under review, where the reports were assigned to an alternative response, resulting in a decision that the child had either been maltreated or was at risk of maltreatment; or

3. A combination of reports described in 1 and 2 above within a 6-month period, with at least one of the reports occurring during the period under review.

• “Alternative response” refers to an agency’s approach to addressing child maltreatment reports that meet agency criteria for acceptance but at the initial screening do not meet the agency’s requirements for a mandated investigation. For example, the agency’s policy may be that reports that appear to present low to moderate risk to the child may be referred for a family assessment, rather than an investigation. Under such a response, no determination of child maltreatment is made.
  
  The alternative response may include an assessment to determine the safety of the child(ren), the risk of maltreatment, and the family’s strengths and needs. The assessment may lead the State agency to provide services to eliminate or lessen the safety concerns and maltreatment risks. Reviewers should note that reports that are “screened out” should not be considered as an alternative response. Also, if reviewers determine that there was a risk that warranted the provision of services by the agency, they should treat the report as they would an indicated or substantiated report, even if no formal disposition was made.

• If a report of maltreatment is handled by an alternative response and following its assessment the agency determines that the case should be opened for services, reviewers should consider that report as substantiated/indicated.

Reviewers should consider substantiated/indicated reports of maltreatment and reports handled by alternative response that lead to a case opening based on the report. However, reviewers should count substantiated/indicated reports of maltreatment by foster care providers and staff of placement facilities only if there were two or more incidents of maltreatment in the foster care placement within a 6-month period since this item refers to repeat maltreatment that is due to the same general circumstances or the same perpetrator. Therefore, reviewers should address a single incident of maltreatment by a foster care provider or placement facility staff in item 4 if it is unrelated to prior incidents of maltreatment by circumstances or perpetrator.

Reviewers should not consider multiple reports that occurred as a result of the same maltreatment incident as repeat maltreatment.

Reviewers must distinguish between reports that occurred during the life of the case and the period under review.

Reviewers should rate the item as a strength if (1) there were no substantiated/indicated reports during the period under review and there was a prior substantiated/indicated report of child maltreatment, (2) there was a substantiated/indicated report during the period under review, but no other substantiated/indicated reports within 6 months before or subsequent to the report during the period under review, (3) the repeat occurrences of maltreatment do not involve the same perpetrator or the same general circumstances, or (4) reviewers conclude that the agency’s interventions to protect the child following the initial report could not have prevented the subsequent maltreatment.

(Instructions continue on the next page)

Reviewers should rate the item as an area needing improvement if a report of maltreatment was received 6 months before or after the initial substantiated/indicated report and (1) the additional substantiated/indicated report was due to the same general reasons or same perpetrators or (2) the agency’s response to the initial report was not sufficient to prevent future maltreatment.

Reviewers should rate this item as not applicable if over the life of the case there were no reports of maltreatment for any children in the family (for example, a Juvenile Justice case).

Provide documentation that supports the rating for item 2

This item is rated as a(n) ____________________________________ because:

DISCUSSION OF SAFETY OUTCOME #1
Outcome S1: Children are, first and foremost, protected from abuse and neglect.
Check the level of outcome achievement that best describes the extent to which this outcome is being or has been achieved, based on the case record reviews and interviews. In the box, provide documentation that supports the level of outcome achievement selected for each item.
Level of Outcome Achievement
	Substantially Achieved:	All applicable items are rated as strengths (disregard items rated as not applicable).
	Partially Achieved:	One of the applicable items is rated as an area needing improvement, and one is rated a strength (disregard items rated as not applicable).
	Not Achieved:	All applicable items are rated as areas needing improvement (disregard items rated as not applicable).
	Not Applicable:	Both of the items are rated as not applicable.
Instructions for Safety Outcome #1: Children are, first and foremost, protected from abuse and neglect. Reviewers should clearly record the link between their ratings and item 1 (timeliness of initiating investigations of reports of child maltreatment) and item 2 (repeat maltreatment). For example, “Safety Outcome #1 was substantially achieved because all reports were investigated in the required timeframe and the child was seen following the report in accordance with the State guidelines. During the 6-month period following the initial report, there were not multiple substantiated or indicated reports of maltreatment that were due to the same circumstances.”
Provide a summary of the documentation that supports the rating for items 1 and 2 Safety Outcome #1 is rated as __________________________________because:

Outcome S2: Children are safely maintained in their homes whenever possible and appropriate.
Item 3. Services to Family To Protect Child(ren) in Home and Prevent Removal (Case Record, Interview With Caseworker, Parent(s), Service Provider)
Core Questions							Yes		No		Not Applicable
A.	For the period under review, when there were the following:
	(1)	Substantiated or indicated reports of abuse or neglect or
	(2)	Risks of harm to the child(ren) in the family (including the identification of risk through an alternative response to reports of maltreatment)
	Did the agency provide or arrange for services to the family to protect the child(ren) in his/her own home before removal, if applicable (including family preservation, family support, or other placement prevention services)? Reviewers should check not applicable in the following situations: (a) the case is/was not a case of abuse or neglect; (b) there is/was no risk of harm to the child(ren); or (c) the child(ren) entered foster care before the period under review and there are no other children in the home. Reviewers should check no if services were not provided, even if there was an appropriate reason, and then note the reason why under question B. Reviewers must use their professional judgment to explore and document the appropriateness of services in relation to the child(ren)’s needs. It is not sufficient to simply list the services being provided.
B.	If the answer to question A is no, state the reason.
Exploratory Questions What is/was the degree of risk of harm present to the child(ren) in the home? What types of services were provided or arranged to protect the child(ren)? Were inhome services appropriate for the family? Why were services not provided? Why was the case open if it is not a case of substantiated or indicated abuse or neglect or apparent risk of harm to children?
Rating for this indicator: (Check one)				Strength		Area Needing Improvement				Not Applicable
Instructions for Item 3: Services to Family To Protect Child(ren) in Home and Prevent Removal This item focuses on the services to the family to protect the child(ren) and prevent removal from the home. Reviewers should assess services provided to the family during the period under the review, including to parent(s) who reside outside the home and who have contact or are involved with the child(ren).
(Instructions continue on the next page)

Information related to this item is used to help identify whether reasonable efforts were made to prevent removal of the child(ren) from the home initially, and subsequent removals following the reunification of a child with the family.

Reviewers must determine whether the agency provided services to protect the child(ren) in the home as an alternative to a foster care placement, when appropriate. If some of the children from one family are/were in foster care and others are/were being served in the home, reviewers should provide an explanation of the services provided under both conditions.

Reviewers should rate the item as a strength if appropriate services were offered to prevent removal or if the agency’s decision to remove the child from the home without providing services was based on the immediate safety needs of the child.

Reviewers should rate the item as an area needing improvement in the following situations:

1. When the case was opened for inhome services, no services were provided, and the child was later removed on an emergency basis.
   
   

2. If the agency should or could have provided services to prevent removal of the child from the home.
   
   

If a case is/was open for voluntary services during the period under review and there are/were no reports of abuse/neglect but there is/was an apparent risk of harm, the item should be rated on the services provided to reduce the risk of harm.

Reviewers should rate the item as not applicable in the following situations:

1. If a case is/was open for services for a reason other than a substantiated or indicated report of abuse or neglect or apparent risk of harm to the child, for example, a juvenile justice case.
   
   

2. If there were no substantiated or indicated reports of abuse/neglect, or apparent risk of harm during the period under review.
   
   

3. If the child was in foster care during the entire period under review and there are no other children in the birth family home.
   
   

4. When it is/was not a case in which the child was maltreated or at risk of harm.

Reviewers should, however, explore the risk of harm to a child even when the child is/was noted as a “child in need of supervision” or “delinquent.” Reviewers should not simply rate these cases as not applicable.

Provide documentation that supports the rating for item 3

This item is rated as a(n)_____________________________________ because:

Outcome S2: Children are safely maintained in their homes whenever possible and appropriate.
Item 4. Risk of Harm to Child(ren) (Case Record, Interview With Caseworker, Parent(s), Service Provider)
Core Questions							Yes		No		Not Applicable
A.	For the period under review, was there a risk of harm to the child(ren) in the family that necessitated:
	(1)	the provision of services to the family or
	(2)	placement of the child(ren) in foster care?
	Reviewers should check not applicable if the child(ren) and family are being served due to reasons other than risk of harm.
	Reviewers should focus on the existing risk of harm in the family of origin that brought the child into foster care and requires the child to remain outside the home. Reviewers should not, for example, state that there is/was no risk of harm simply because the child is/was in foster care.
B.	If the response to question A is yes, were efforts made by the agency to reduce or remove the risk of harm through specific interventions? Reviewers should check not applicable if there is/was no risk of harm to the child(ren). Reviewers should select their answer on the basis of whether the State demonstrated efforts to remove the risk of harm to the child through specific interventions. For example, if a State provided services for a period of time, stopped due to lack of progress, and then petitioned for termination of parental rights, reviewers would select yes as the response to this question.
C.	Are there indications that case decisions and planning for removal of the child(ren) from the home or reunification were based on concerns about the child(ren)’s health and safety? Reviewers should check not applicable if there is/was no risk of harm to the child.
Exploratory Questions What is/was the nature of the risk of harm? What is/was needed to reduce or remove the risk of harm? How is/was the risk being addressed through services or other interventions? What decisions have been made or plans are under way regarding removal or reunification? Are/were there any reports of maltreatment requiring a response by the agency during the period under review?
Rating for this indicator: (Check one)				Strength		Area Needing Improvement				Not Applicable
Instructions for Item 4: Risk of Harm to Child(ren) This item focuses on whether the child(ren)’s safety is/was the primary concern in the case and examines how the State is managing the risk of harm that necessitates continued out-of-home placement or services to an intact family. Reviewers should assess services provided to the family, including to parent(s) who reside outside the home and who have contact or are involved with the child(ren). Reviewers should document whether the agency conducted a risk assessment or developed a safety plan. (Instructions continue on the next page)

Reviewers should determine whether, during the period under review, there was risk of harm to the child(ren) in the family’s home that warranted the child(ren)’s placement in foster care, or continued placement in foster care if placement occurred before the period under review (foster care cases). This includes an ongoing risk that precludes reunification. For children receiving inhome services, reviewers should determine whether the risk of harm to the child(ren) in the home is/was sufficient to necessitate the provision of services by the agency to protect the child(ren). Reviewers should note that this item is applicable to both a child(ren) receiving inhome services when a decision was made not to remove the child(ren) from their home and to a child(ren) who was removed.

When risk of harm to the child(ren) is/was present, in either instance, reviewers must determine whether the agency provided or arranged for services that targeted the identified risks with the goal of reducing them.

Reviewers should document concerns about the agency screening out reports of maltreatment or not taking formal reports on cases already opened for services.

Reviewers also should document whether the agency closed the case prematurely.

For a child(ren) placed in foster care, including a child(ren) for whom his/her parent’s rights have been terminated, reviewers should assess the child(ren)’s risk: (1) of being abused or neglected in foster care; (2) of being harmed while visiting with family members; and (3) of being reunified with a family member while safety concerns exist.

Reviewers should rate this item as a strength if the agency terminated the child’s parent’s rights as a means of decreasing risk of harm for the child (for example, a termination of parental rights would prevent a child from being returned to a home in which the child would be at risk) and has taken action to minimize other risks to the child (for example, preventing contact with individuals who pose a risk to the child’s safety).

If a case is/was open for services for a reason other than a substantiated or indicated report of abuse or neglect, or apparent risk of harm to the child(ren) (for example, a juvenile justice case), reviewers should document this information and rate the item as not applicable. Note, however, that for a child(ren) noted as a “child in need of supervision” or “delinquent,” reviewers should explore and determine whether there is a risk of harm to the child, in addition to the other reasons the case may be opened, prior to rating it as not applicable.

Reviewers also should not rate this item as not applicable simply because the child’s parent’s rights have been terminated.

Provide documentation that supports the rating for item 4

This item is rated as a(n) _______________________________________ because:

DISCUSSION OF SAFETY OUTCOME #2
Outcome S2: Children are safely maintained in their homes whenever possible and appropriate.
Check the level of outcome achievement that best describes the extent to which this outcome is being or has been achieved, based on the case record reviews and interviews. In the box, provide documentation that supports the level of outcome achievement selected for each item.
Level of Outcome Achievement
	Substantially Achieved:	All applicable items are rated as strengths (disregard items rated as not applicable).
	Partially Achieved:	One of the applicable items is rated as an area needing improvement and one is rated a strength (disregard items rated as not applicable).
	Not Achieved:	All applicable items are rated as areas needing improvement (disregard items rated as not applicable).
	Not Applicable:	Both of the items are rated as not applicable.
Instructions for Safety Outcome #2: Children are safely maintained in their homes whenever possible and appropriate. Reviewers should clearly record the link between their ratings and item 3 (services to the family to protect child[ren] in the home and prevent removal whenever possible and appropriate) and item 4 (risk of harm to child[ren]). For example, “Safety Outcome #2 was substantially achieved because the agency provided family preservation services, family counseling, and other services to prevent the children from being removed from their home and to reduce their risk of harm. Services were appropriately matched to the family’s needs.”
Provide a summary of the documentation that supports the rating for items 3 and 4 Safety Outcome #2 is rated as __________________________________ because:

SECTION II: PERMANENCY
Outcome P1: Children have permanency and stability in their living situations.
Item 5. Foster Care Re-entries (Case Record, Interviews With Caseworker, Parent(s))
Core Questions						Yes		No		Not Applicable
A.	Did the child enter foster care at least once during the period under review?
B.	If the response to question A is yes, did any foster care entry for the child during the period under review occur within 12 months of the child being discharged from a prior entry? Reviewers should check not applicable if the child has entered foster care only one time during the life of the case or entered foster care before the period under review.
C.	Were any of the multiple entries identified in responding to question B due to the same reason? Reviewers should check not applicable if there were no foster care entries during the period under review. Reviewers should examine the reasons why a child had multiple entries. If the child re-entered care for the same reason each time (for example, abuse), then reviewers should check yes. If the child entered care for abuse and then re-entered care for delinquency, reviewers should check no.
Exploratory Questions Why did the child enter foster care each time? What are/were the timeframes for the child’s entries into foster care?
Rating for this indicator: (Check one)			Strength		Area Needing Improvement				Not Applicable
Instructions for Item 5: Foster Care Re-entries This item focuses on the child’s re-entries into foster care. This item applies only to children in foster care. Reviewers should note the following definitions (which are the same as those used in the Adoption and Foster Care Analysis and Reporting System [AFCARS]) when responding to this item: “Entry into foster care” refers to a child’s removal from his/her normal place of residence, by court order or a voluntary placement agreement, and placement in a substitute care setting, or the removal of custody from the parent or relative guardian, which permits the child to remain in a substitute care setting. “Multiple entries” refers to two or more admissions into the foster care system. Reviewers also should note the following definition when responding to this item: “Discharge” refers to the point when the child is no longer in foster care under the care and responsibility or supervision of the State agency. If the State agency retains supervision of a child and the child returns home on a trial basis, for an unspecified period of time, the child should be considered discharged from foster care after a 6-month period of time. Reviewers are asked to determine: (1) whether a child had multiple entries into foster care, (2) whether those re-entries resulted from the same general reason or circumstance, (3) how many entries the child had in foster care during the period under review, and (4) whether any entries during the period under review occurred within a 12-month period of the child being discharged from another foster care entry.
(Instructions continue on the next page)

Reviewers must distinguish between multiple entries that occurred during the life of the case and the period under review and are asked to consider how the agency maintained the child safely in the home and prevented the child’s re-entry into foster care.

A return to a foster care placement after a brief trial visit home does not count as a re-entry unless the State has discharged the child from foster care. If the following variables apply, however, a case would be considered a re-entry into foster care: a child remains on a trial home visit beyond 6 months, there is no court order extending the visit beyond 6 months, and the child comes back into foster care.

If during the period under review, a child does not have an entry into care within a 12-month period from being discharged from another entry into foster care, reviewers should rate this item as a strength.

Reviewers also may rate this item as a strength if a re-entry was an isolated incident during which the agency did what was reasonable to manage the risk following reunification but the child re-entered care for another reason (for example, the death of a parent).

Reviewers should rate this item as an area needing improvement if re-entries occurring within a 12-month period are/were due to the same general reasons or same perpetrators.

Reviewers should rate this item as not applicable if: (1) the child entered foster care before, and remained in foster care during, the period under review; or (2) the child entered foster care before, and exited foster care during, the period under review and there was not another entry into foster care during the period under review.

Provide documentation that supports the rating for item 5

This item is rated as a(n) ______________________________________ because:

Outcome P1: Children have permanency and stability in their living situations.

Item 6. Stability of Foster Care Placement (Case Record, Interviews With Caseworker, Foster Parent(s))

Core Questions

Yes

No

A.

Did the child change placement settings during either the current or most recent episode of foster care? If there were multiple foster care episodes during the period under review, reviewers should consider placement changes associated with all episodes during the period under review.

B.

If the response to question A is yes, note the number of placement changes that occurred during the period under review.

Yes

No

No Changes

C.

Did any of the placement changes during the current foster care episode occur for reasons not directly related to helping the child achieve the goals in his/her case plan? Reviewers should examine and record the reasons for placement changes during the period under review and determine whether those reasons were directly related to helping the child.

D.

Is/was the placement setting stable (for example, no apparent threat of disruption)? Reviewers should determine whether the current, or most recent, placement setting appears stable. This includes exploring the provider’s commitment to maintaining the placement, how the child is doing in that placement, and the level of support the agency is giving the foster care provider. Reviewers also should identify any significant risks of placement disruptions that are present in the current placement.

Exploratory Questions What is/was the reason for placement changes? What are/were the timeframes of these changes? Were there efforts to prevent unnecessary moves, if applicable? Are/were the placement settings related and appropriate to the child’s needs? What is/was the agency’s support of the current placement? What are/were the reasons for instability of placement, if applicable?

Rating for this indicator: (Check one)

Strength

Area Needing Improvement

Not Applicable

List below information about the child’s placement history

Placement Date

Placement Type

Reason for Change in Placement Setting

(Continued)

Instructions for Item 6: Stability of Foster Care Placement

This item focuses on the stability of the foster care placement.

This item applies only to children in foster care.

Reviewers should note the following definitions (which are the same as those used in the Adoption and Foster Care Analysis and Reporting System [AFCARS]) when responding to this item:

• “Entry into foster care” refers to a child’s removal from his/her normal place of residence, by court order or a voluntary placement agreement, and placement in a substitute care setting, or the removal of custody from the parent or relative guardian, which permits the child to remain in a substitute care setting.
  
  

• “Current episode of foster care” refers to a child’s current stay in foster care based on the most recent removal of the child from his/her normal place of residence, resulting in his/her placement in a foster care setting, and ending upon the child’s discharge from foster care.
  
  

• “Placement” refers to the physical setting in which a child in foster care resides. A new placement setting results when the foster care setting changes, for example, when a child moves from one foster family home to another or to a group home or institution.
  
  

Reviewers also should note the following definitions when responding to this item:

• “Changes in placement” refers to a change in the place where the child lives during an episode of foster care, excluding trial home visits. Reviewers will count any placement that lasts more than 24 hours while the child is in foster care under the supervision of the State agency. This includes emergency or unplanned moves, such as shelter care, treatment facility, and juvenile justice placement. If, however, the foster family with whom the child is placed moves, and the child moves with them, this does not constitute a change in placement. Reviewers should not consider a runaway episode as a placement change, or other temporary living conditions that are not placements, but rather represent a temporary absence from the child’s ongoing foster care placement, including visitation with a sibling, relative, or other caretaker (for example, pre-placement visits with a subsequent foster care provider or pre-adoptive parents), hospitalization for medical treatment, acute psychiatric episodes or diagnosis, respite care, day or summer camps, and trial home visits.
  
  

• “Discharge” refers to the point when the child is no longer in foster care under the care and responsibility or supervision of the State agency. If the State agency retains supervision of a child and the child returns home on a trial basis, for an unspecified period of time, the child should be considered discharged from foster care after a 6-month period of time.

• The “stability of the foster care placement” refers to the extent to which the child’s current placement is determined to be free from the risk of an unplanned disruption, or a move not directly related to the achievement of the child’s permanency goal, in the foreseeable future.

Reviewers should document any changes in placement settings (for example, moves from a shelter to foster family home or moves between foster family homes.)

Reviewers should examine why the change(s) in placement occurred. Some placement changes are planned in accordance with the child’s permanency goals, for example moving from an institution to a family-based setting.

Reviewers should rate this item based on the period under review. If there were no changes in placement during the period under review, and the current placement is considered stable, then reviewers should rate this item as a strength.

(Continued)

Provide documentation that supports the rating for item 6

This item is rated as a(n) ______________________________________ because:

Outcome P1: Children have permanency and stability in their living situations.

Item 7. Permanency Goal for Child (Case Record, Interview With Caseworker)

Core Questions

Permanency Goal

A.

What is the child’s current permanency goal (or if the case is closed, what was the most recent permanency goal before the case was closed)?

Yes

No

Not Applicable

A1.

If the goal is “other permanent planned living arrangement,” have other more permanent goals been considered and ruled out?

Reviewers should explore and document below the reasons why other permanency goals were not considered and/or were ruled out.

B.

How long has the current or most recent permanency goal been in place (or if the case is closed, how long was the last goal in place)?

Yes

No

C.

Is the permanency goal (or the one that was in effect before the case was closed) appropriately matched to the child’s individual needs for permanency and stability?

D.

Indicate below how many prior permanency goals the child has had and for what lengths of time.

Permanency Goal

Date Goal Established

Length of Time Goal Was in Effect

Yes

No

Not Applicable

Exception Noted (Specify)

E.

If the child has been in foster care 15 of the most recent 22 months (or was before the case was closed) or meets other Adoption and Safe Families Act (ASFA) criteria for termination of parental rights (TPR), has the agency filed or joined a petition to terminate parental rights? Reviewers should check not applicable if the child has been/was in foster care less than 15 of the most recent 22 months. (Instructions for this question continue on the next page)

	Reviewers will need to determine whether a child: (1) has been in foster care for 15 of the past 22 months, (2) is an abandoned child, or (3) is a child whose parents have been convicted of one of the felonies designated in Section 475 (5)(E) of the Social Security Act. (This would include if the parent had (1) committed murder of another child of the parent; (2) committed voluntary manslaughter of another child of the parent; (3) aided or abetted, attempted, conspired, or solicited to commit such a murder or such a voluntary manslaughter; or (4) committed a felony assault that results in serious bodily injury to the child or another child of the parent.) Reviewers then make a determination about whether a TPR petition or an exception to the TPR requirements is/was required.
	Reviewers must be familiar with the ASFA TPR requirements and exceptions. Reviewers should document if the child has been in care for the maximum time or if another ASFA criterion for TPR exists. In other words, either a TPR must be filed or an exception noted in the case record. Exceptions include the following: (1) at the option of the State, the child is being cared for by a relative, (2) the State agency has documented in the case plan a compelling reason for determining that a TPR would not be in the best interests of the child, and (3) the State has not provided to the child the services that the State deemed necessary for the safe return of the child to the child’s home if reasonable efforts of the type described in Section 471 (a)(15)(B)(ii) of the Social Security Act are required to be made with respect to the child.
Exploratory Questions What is/was the history of the permanency goals? Are/were there notable changes or lack of changes in the child’s permanency goals? What are/were the reasons for changes in the child’s permanency goals? What factors did the agency consider when making decisions about the child’s permanency goals? Has the child been in foster care for 15 of the most recent 22 months, is the child an abandoned infant, or does the child have parents who have committed a felony requiring TPR under ASFA? Has/was an exception to the TPR requirement been made and, if so, what was the basis for the exception (for example, the child is being cared for by a relative or the State has not provided services that the State deemed necessary for the safe return of the child to the child’s home)?
Rating for this indicator: (Check one)			Strength		Area Needing Improvement					Not Applicable
Instructions for Item 7: Permanency Goal for Child This item focuses on the process of establishing the most appropriate permanency goal for the child. This item applies only to children in foster care. Reviewers should rate this item for the goal(s) in place during the period under review. If a previous goal was in place and unachieved for a considerable length of time before the most recent change, this should be documented below and taken into consideration when rating the item (for example, 3 months before the onsite review, the goal was changed to adoption; however a goal of reunification was in place and unachieved for 5 years). Reviewers should examine the appropriateness of a goal that ultimately rules out adoption, guardianship, or return to family. Reviewers must assess whether the child’s best interests were thoroughly considered by the State agency in setting a goal of other planned living arrangement, and that such a decision is/was continually reviewed for ongoing appropriateness.
(Instructions continue on the next page)

If the State agency is using concurrent planning for the child, the permanency goals recorded for this item should reflect the child’s primary permanency goal outlined in the case plan. If there are two permanency goals, and the State’s policy dictates that the goals have equal weight, reviewers should record both.

For purposes of determining if a child was in foster care 15 of the most recent 22 months, reviewers should consider the date the child entered foster care as the earlier of the following: (1) the date of a judicial finding of abuse or neglect or (2) 60 calendar days after the child’s removal from the home. Reviewers should calculate time cumulatively over a 22-month period and should not include trial home visits or runaway episodes.

Due to changes in circumstances, a caseworker may have identified and provided services in support of a new goal for the child, which is/was not approved by or changed with the court. In this case, reviewers should rate the item based on the goal identified by the agency even if it is/was not the official goal of record with the court.

Provide documentation that supports the rating for item 7

This item is rated as a(n) ______________________________________ because:

Outcome P1: Children have permanency and stability in their living situations.

Item 8.

Reunification, Guardianship, or Permanent Placement With Relatives – Complete only for children with a current or most recent permanency goal of reunification, guardianship, or permanent placement with relatives (Case Record, Interviews With Caseworker, Child, Foster Parent(s))

Core Questions

Reunification

Guardianship

Placement With Relatives

A.

What is/was the child’s most recent permanency goal?

Yes

No

B.

Has/was the child been in foster care for at least 12 months since his/her most recent entry into foster care?

C.

Has the child’s permanency goal been achieved? Reviewers need to identify whether the most recent permanency goal was achieved. For example, if the goal is reunification and steps have been taken toward that goal but the child remains in foster care, then the goal has not been achieved.

C1.

If the response to question C is yes, was the goal achieved within 12 months of the child’s most recent entry into foster care?

C2.

If the response to question C is no, what are the barriers to achieving the goal? Since this item measures achievement of the permanency goal within 12 months of the child’s most recent entry into foster care, reviewers should consider barriers outside the period under review if the child was already in foster care at the onset of the period under review.

C3.

If the response to question C is no, what steps is the agency taking to achieve the goal?

Exploratory Questions What is/was the length of time the child has been in foster care? To what extent has the child’s permanency goal been achieved? What was the length of time to achieve the child’s permanency goal? What factors positively affected or delayed goal achievement? What are/were the agency’s efforts to support the child’s permanency goal achievement?

Rating for this indicator: (Check one)

Strength

Area Needing Improvement

Not Applicable

Instructions for Item 8: Reunification, Guardianship, or Permanent Placement With Relatives This item focuses on the achievement of a child’s goal of reunification, guardianship, or permanent placement with relatives. This item applies only to children in foster care. Information about a child with a goal of other permanent planned living arrangement where the agency retains care and placement responsibility of the child in a relative’s home should be documented under item 10 (Permanency Goal of Other Planned Living Arrangement). (Instructions continue on the next page)

Reviewers should note that a “permanent placement with relatives” is defined as a plan for the child to be discharged from foster care to the permanent care of a relative.

Reviewers should review for and document the reasons for any delays in the child’s achievement of the permanency goal.

If the response to question B is yes and the goal is not yet achieved, reviewers must provide substantial justification to rate the item as a strength.

Provide documentation that supports the rating for item 8

This item is rated as a(n) _____________________________________ because:

Outcome P1: Children have permanency and stability in their living situations.
Item 9.		Adoption – Complete only for children with a current or most recent permanency goal of adoption (Case Record, Interviews With Caseworker)
Core Questions							Yes		No		Not Applicable
A.	Was the child’s adoption finalized within 24 months of the most recent entry into foster care? Reviewers need to identify whether the most recent permanency goal has been achieved. If steps have been taken toward the goal of adoption (for example, termination of parental rights, child placement in a pre-adoptive home) but the adoption is not finalized, then the goal has not been achieved. Reviewers should check not applicable if the child has not been in foster care for 24 months and has not been adopted.
	A1.	If the response to question A is no, what were the barriers to the child’s adoption being finalized within 24 months of his/her most recent entry into foster care? Since this item measures achievement of the permanency goal within 24 months of the child’s most recent entry into foster care, reviewers should consider barriers outside the period under review if the child was already in foster care at the onset of the period under review.
B.	If the child has been in foster care less than 24 months since the most recent entry into foster care, are steps in place to finalize the adoption within the 24-month timeframe?
	B1.	If the response to question B is yes, describe the steps.
	B2.	If the response to question B is no, what are the barriers to finalizing the adoption?
Exploratory Questions What length of time has/was the child been in foster care since the most recent entry into foster care? What is/was the status of planning/efforts to finalize the child’s adoption? Is the child legally free for adoption? What are/were the efforts to identify an adoptive family or to legally free the child for adoption? What are/were the barriers to placing the child for adoption? What are/were the barriers to freeing the child for adoption?
Rating for this indicator: (Check one)				Strength		Area Needing Improvement				Not Applicable
(Continued)

Instructions for Item 9: Adoption

This item focuses on the achievement of a child’s goal of adoption.

This item applies only to children in foster care.

Achievement of an adoption goal means finalization of the adoption.

Reviewers should document the reasons for delays in the adoption process and the agency’s efforts to address the delays.

If the response to question A is no, reviewers must provide substantial documentation of agency efforts to finalize the adoption within 24 months in order to rate this item a strength.

Provide documentation that supports the rating for item 9

This item is rated as a(n) _____________________________________ because:

Outcome P1: Children have permanency and stability in their living situations.

Item 10.

Permanency Goal of Other Planned Permanent Living Arrangement – Complete only for children with a current or most recent permanency goal of emancipation or a planned permanent living arrangement other than adoption, guardianship, or return to family (Case Record, Interviews With Caseworker, Foster Parent(s), Child, and Parent(s))

Core Questions

Emancipation

Other Planned Living Arrangement (Specify)

A.

What is the child’s permanency goal?

Yes

No

B.

Has/was the goal been achieved? Reviewers need to identify whether the most recent permanency goal has been achieved. For example, if the goal is emancipation and steps have been taken toward the goal (for example, referral to an independent living program) but the child remains in foster care, then the goal has not been achieved.

B1.

If the response to question B is no, what are the barriers to achieving the goal? Reviewers need to identify whether the goal has been addressed appropriately and if not, document the reasons.

Yes

No

C.

Are/were services being provided to help the child achieve the goal of another planned living arrangement (including independent living services, if appropriate)?

Exploratory Questions What factors were considered in determining the goal? What were the reasons this goal was selected rather than legal guardianship or adoption? How does/did the agency review the goal for continued appropriateness since the goal was initially established? What factors are/were affecting or delaying goal achievement? What are/were the agency’s efforts to achieve the permanency goal?

Rating for this indicator: (Check one)

Strength

Area Needing Improvement

Not Applicable

Instructions for Item 10: Permanency Goal of Other Planned Permanent Living Arrangement This item focuses on the achievement of a child’s permanency goal of “other planned living arrangement” and includes children with a goal of emancipation for whom independent living services are appropriate. This item should be completed only for children in foster care with a permanency goal of a planned living arrangement other than adoption, guardianship, or return to family.

(Instructions continue on the next page)

Reviewers should complete this item for children in foster care whose goal is continued placement with relatives with the agency retaining placement and care responsibility.

This item applies only to children in foster care.

This item is used, in part, to determine whether the State agency is in substantial conformity with Adoption and Safe Families Act (ASFA) requirements that services be provided to assist children to attain permanency in their living arrangements.

Reviewers should review for and note any delays in the child’s achievement of the permanency goal and the reasons for those delays.

Reviewers should consider for a child with a goal of emancipation whether independent living services are being provided.

If the child does not have a permanency goal of other planned living arrangement, this item should be rated as not applicable.

Provide documentation that supports the rating for item 10

This item is rated as a(n) _______________________________________ because:

DISCUSSION OF PERMANENCY OUTCOME #1
Outcome P1: Children have permanency and stability in their living situations.
Check the level of outcome achievement that best describes the extent to which this outcome is being or has been achieved, based on the case record reviews and interviews. In the box, provide documentation that supports the level of outcome achievement selected for each item.
Level of Outcome Achievement
	Substantially Achieved:	Item 7 and the relevant item (8, 9, or 10) rated for this case must be rated as strengths, and no more than one of either items 5 and 6 (if applicable) may be rated as an area needing improvement (disregard items rated as not applicable). If the State is using concurrent planning for the case being reviewed and, therefore, the reviewer rated two of the relevant items (8 and 9, 8 and 10, or 9 and 10), then both must be rated as strengths.
	Partially Achieved:	Item 7 and the relevant item (8, 9, or 10) are rated as strengths, but both items 5 and 6 (if applicable) are rated as areas needing improvement, or either item 7 or the relevant item (8, 9, or 10) is rated as an area needing improvement (disregard items rated as not applicable).
	Not Achieved:	All of the applicable items are rated as areas needing improvement (disregard items rated as not applicable).
	Not Applicable:	All of the items are rated as not applicable.
Instructions for Permanency Outcome #1: Children have permanency and stability in their living situations.
Reviewers should clearly record the link between their ratings and all items in this outcome section (5–10). For example, “Permanency Outcome #1 was substantially achieved because the agency filed a termination of parental rights within 15 months of the child coming into care. The last foster placement was stable, despite the child experiencing four previous foster care re-entries. The child’s permanency goal is appropriately matched to his needs, and his adoption goal was achieved within 24 months of coming into care.”
Provide a summary of the documentation that supports the rating for items 5, 6, 7, 8, 9, and 10 Permanency Outcome #1 is rated as _____________________________ because:

Outcome P2: The continuity of family relationships and connections is preserved for children.

Item 11. Proximity of Foster Care Placement (Case Records, Interviews With Caseworker, Parent(s))

Core Questions

Same Community

Same County

Out of County

Out of State

Not Applicable

A.

What is/was the proximity of the child’s current or most recent placement to their parents? Reviewers should check not applicable when (1) the parents’ whereabouts are unknown despite agency efforts to locate them, (2) the parents are deceased, or (3) parental rights are terminated with no planned involvement of the parents in case planning or case goals. If the child is in a pre-adoptive home, the response to question A is based on proximity to the birth parents.

Yes

No

Not Applicable

B.

For children placed outside of the community, county, or State of their parents’ residence, is/was the reason for the location of the placement clearly related to helping the child achieve his/her case plan goals? Reviewers should check not applicable if the child is not placed outside the community, county, or State of their parents’ residence. Reviewers should consider all placement settings during the period under review. Reviewers should check no if a placement outside the community is/was made because there were no existing placement resources in the community. However, reviewers may check yes if the placement is/was made outside the community in order to provide a temporary specialized service/environment for the child where it is unreasonable to expect that such specialized services would be offered in the child’s community. If a child is in an adoptive or pre-adoptive placement outside of the community or county of his/her parent’s residence and the location of the placement relates to achievement of the adoption goal, then reviewers should check yes.

C.

For children placed outside the State during the period under review, is/was the child visited at least every 12 months by a caseworker of the supervising agency and a report filed with the agency holding custody? Reviewers should check not applicable if the child is/was not placed outside the State. Reviewers should note that this question addresses the Federal visitation requirement that when a child is placed outside the State, the sending State should inquire about the supervision of the placement by the receiving State.

Exploratory Questions What is/was the location of the child’s placement? Which parent is/was working with the agency and most likely to be reunified with child? What are/were the reasons for the child’s placement settings? How does/did the placement location support or inhibit achieving the child’s case plan goals? What is/was the impact of placement location on maintaining important family and community connections?

Rating for this indicator: (Check one)

Strength

Area Needing Improvement

Not Applicable

Instructions for Item 11: Proximity of Foster Care Placement This item focuses on the proximity of a child’s placement to the community in which the child’s parent(s) reside.

(Instructions continue on the next page)

This item pertains to all children in foster care, including those whose parents’ rights have been terminated and children who are in adoptive placements.

Reviewers should respond to question A in this item using the child’s current placement setting or the most recent foster care placement if the child has been discharged from foster care, and respond to questions B and C based on all placement settings during the period under review.

If the child’s parents are/were living separately, reviewers must determine which parent is/was the most involved in case planning and is/was most likely to be reunified with the child and then base decisions on the location of that parent’s residence.

Reviewers will need to determine whether the child is/was placed in the same community or outside the community in which the primary parent (as determined above) resides. In making this determination, reviewers should consider the following:
(1) identifiable neighborhoods, (2) school districts, (3) the actual distance between the parent’s home and the placement, and (4) the general accessibility of the child in placement to family and other social institutions familiar to the child.

Reviewers should document when a child is placed outside the community for specific purposes, such as meeting the individualized needs of the child or keeping the child in closer contact with the family than a same-community placement would allow.

Reviewers should rate this item as not applicable when (1) the parents’ whereabouts are unknown despite agency efforts to locate them, (2) the parents are deceased, or (3) parental rights are terminated with no planned involvement of the parents in case planning or case goals.

Provide documentation that supports the rating for item 11

This item is rated as a(n) _______________________________________ because:

Outcome P2: The continuity of family relationships and connections is preserved for children.
Item 12. Placement With Siblings (Case Records and Interviews With Caseworker, Parent(s), Foster Parents)
Core Questions				Placed With All Siblings Who Are in Foster Care			Placed With One or More Siblings Who Are in Foster Care	Placed Apart From All Siblings Who Are in Foster Care			Not Applicable
A.	Is/was the child placed with siblings who also are/were in foster care? Reviewers should check not applicable if there are/were no siblings in foster care.
							Yes	No			Not Applicable
B.	If the child is/was not placed with all of his/her siblings who are/were in foster care, is there clear evidence that separation is/was necessary to meet the needs of the children? Reviewers should check not applicable if there are no siblings in foster care.
Exploratory Questions What efforts did the agency make to place siblings together? What are/were the reasons siblings are/were not placed together, if applicable? What is/was the history of siblings’ placement together, including reasons for separations?
Rating for this indicator: (Check one)			Strength			Area Needing Improvement				Not Applicable
Instructions for Item 12: Placement With Siblings This item focuses on a child’s placement in foster care with sibling(s) who also are placed in foster care. This item applies only to children in foster care. This item attempts to distinguish the extent to which siblings are separated because of factors such as the availability of resources or disrupted placements rather than circumstances in which siblings’ individual needs can be met only in separate placements. Reviewers should look at siblings who also are in foster care and with whom the child lived prior to foster care placement or with whom the child would be expected to live if the child was not in foster care. Reviewers should rate this item for the period under review. Reviewers may rate this item as a strength when siblings are not placed together to ensure the best interests of the child(ren). Examples include (1) when there is/was a large sibling group divided between two different placements and they maintain close, regular contact; (2) when one child is/was in an alternative placement to receive needed therapeutic services, with the plan to return that child to the placement with siblings; or (3) when one sibling is/was perpetrating abuse on another. Reviewers should rate this item as an area needing improvement if siblings are/were placed separately due to the lack of placement resources. If a brief separation is/was necessary to meet the needs of one sibling, reviewers should consider the efforts of the agency to reunite the siblings as appropriate. Reviewers should rate this item as not applicable if there are/were no siblings in foster care.
(Continued)

Provide documentation that supports the rating for item 12

This item is rated as a(n) ______________________________________ because:

Outcome P2: The continuity of family relationships and connections is preserved for children.

Item 13. Visiting With Parents and Siblings in Foster Care (Case Records, Interviews With Caseworker, Parent(s))

Core Questions

Weekly

Bi-weekly

Monthly

Less Than Monthly

No Visits

Not Applicable

A.

What is/was the most typical pattern of visitation between the child and parents? Reviewers should check not applicable if contact with parents has been/was determined to be contrary to the child’s safety or best interests.

Mother:

Father:

B.

What is/was the most typical pattern of visitation between the child and siblings placed separately in foster care? Reviewers should check not applicable if no siblings are/were placed separately.

Yes

No

Not Applicable

C.

Are/were there other forms of contact between the child and parents? Reviewers should check not applicable if contact is/was contrary to the child’s safety or best interests.

D.

Are/were there other forms of contact between the child and siblings? Reviewers should check not applicable if contact is/was contrary to the child’s safety or best interests.

E.

Is/was the frequency of and arrangements for visitation in accordance with State policy? Reviewers should check not applicable if contact is/was contrary to the child’s permanency goal.

F.

Describe any efforts made by the agency to promote and support visitation (for example, developing visitation plans, arranging transportation, actively encouraging visits, arranging for flexible meeting locations). Efforts with the mother: Efforts with the father: Efforts with siblings who are placed separately:

Exploratory Questions What are/were the reasons for restrictions or prohibitions on visits? What are/were the reasons for visiting less frequently than weekly? What are/were the agency services/supports to encourage more frequent visiting? What is/was the custody status of the child, including termination of parental rights?

Rating for this indicator: (Check one)

Strength

Area Needing Improvement

Not Applicable

Instructions for Item 13: Visiting With Parents and Siblings in Foster Care This item focuses on the child’s visitation with parents or siblings placed separately in foster care. (Instructions continue on the next page)

Reviewers should rate this item for the period under review based on the individual needs of the child and family, rather than on the State’s visiting policy.

This item applies only to children in foster care.

Reviewers should determine the most typical visitation pattern in responding to questions in this item. Reviewers also should determine whether other forms of contact are/were occurring, such as by telephone or mail, and note that visitation patterns may vary over time.

When reviewers note that visits occur infrequently, they should use the Exploratory Questions to determine whether there are/were barriers to more frequent visiting.

For this item, it is important that reviewers explore the reasons for visitation restrictions.

Reviewers should explain the circumstances under which visiting is/was contrary to the child’s safety or best interests: (1) visiting would present an unmanageable risk of harm to the child, (2) the child is to be adopted and continued contact with parents is impossible or would be harmful to the child, or (3) the parents’ whereabouts are unknown despite diligent agency efforts to locate and engage the parents. If the parents’ whereabouts are/were unknown, reviewers should document the agency’s efforts to locate them.

Reviewers should note that visitation with parents may still be appropriate following a termination of parental rights (for example, in cases of an open adoption, or placement with relatives).

Reviewers should note that the intent of this item is to assess the child’s visitation with his/her siblings who are/were placed separately while in foster care. Visitation and contact with siblings not in foster care placement should be documented under Preserving Connections (item 14).

If reviewers rate this item as not applicable because parental rights have been terminated, this information should be documented.

Provide documentation that supports the rating for item 13

This item is rated as a(n) ______________________________________ because:

Outcome P2: The continuity of family relationships and connections is preserved for children.
Item 14. Preserving Connections (Interviews With Caseworker, Parent(s), Foster Parent(s), Child)
Core Questions							Significantly	Partially			Not at All
A.	Are/were the primary connections and characteristics of the child being preserved in the foster care placement? Reviewers need to make a professional judgment about the child’s primary connections and then explore whether those connections have been/were preserved through case planning and service delivery.
							Yes	No			Not Applicable
B.	If the child is Native American, are/were his/her interests being addressed through
	–	Timely notification of the tribe?
	–	Placement with the child’s extended family or tribe?
	Reviewers should check not applicable if the child is not a member of, or eligible for membership in, a federally recognized Indian tribe in accordance with the Indian Child Welfare Act (ICWA).
Exploratory Questions What are/were the primary connections of the child to his/her neighborhood, community, faith, family, and friends? What are/were the unique characteristics of the family and child, including language, religion, values and beliefs, traditions, and background? How are/were the primary connections addressed in the agency’s work with the family and child? How does/did the foster care provider support the child’s connections? Is the child Native American? Did the agency determine whether a child who is Native American is a member of, or eligible for membership in, a federally recognized Indian tribe? How did the agency work with the tribe regarding ICWA issues if the child is a member of, or eligible for membership in, a federally recognized tribe?
Rating for this indicator: (Check one)				Strength		Area Needing Improvement				Not Applicable
Instructions for Item 14: Preserving Connections This item focuses on the preservation of the child’s primary connections, including their relationship with previous foster families, schools, friends, communities, tribes/tribal customs, and religion/religious observances. This item applies only to children in foster care. Reviewers should note the following definitions when responding to this item: “Connections” refer to ties with family members and other related or nonrelated individuals with whom the child in foster care has/had a significant, positive relationship before entering foster care. “Characteristics” of the child refer to positive aspects of the values, beliefs, religion, language, traditions, and other factors that distinguish the identity of the child and the child’s family.
(Instructions continue on the next page)

Reviewers should determine whether the child’s primary connections are/were preserved during the foster care placement(s) for the entire period under review. Reviewers should document the barriers to preserving connections for the child. For example, are the foster parents facilitating the child’s connection to a previously established religious affiliation?

If reviewers answer Core Question A as “partially,” they must document the agency’s efforts to preserve the child’s connections and identify and document the additional efforts needed.

Reviewers should note that ICWA requires that (1) in the absence of good cause, the State give placement preference to members

of the Native American child’s extended family; and (2) the State provide Indian tribes with timely notice of a Native American child’s involvement in an involuntary court proceeding.

Provide documentation that supports the rating for item 14

This item is rated as a(n) _______________________________________ because:

Outcome P2: The continuity of family relationships and connections is preserved for children.
Item 15. Relative Placement (Case Record, Interviews With Caseworker, Child’s Caretaker, Parent(s))
Core Questions							Yes		No		Not Applicable
A.	Is/was the child in foster care placed with relatives?
	A1.	If the response to question A is no, state the reason:
							Yes		No		Not Applicable
B.	For children not placed with relatives, were relatives considered for placement of the child? Reviewers must focus on the title IV-E provision that requires States to consider giving preference to placing the child with relatives, and determine whether the State considered such a placement and how (for example, seeking out and evaluating the child’s relatives). Relatives include non-custodial parents, such as fathers not in the home, if applicable to the case. Reviewers should check not applicable if the child is placed with relatives. Reviewers must determine the extent to which the agency identified relatives who had some reasonable degree of relationship with the child and with whom the child might reside. There does not need to be in the case record a formal evaluation of relatives with whom the child might reside, but for reviewers to answer yes evidence must exist, through either the case documentation or the case interviews, that relatives were evaluated and considered.
							Yes		No		Not Applicable
	B1.	Were both maternal and paternal relatives identified and considered as placement resources? Reviewers should check not applicable if relatives were unable to be identified despite the agency’s diligent efforts to do so, or in situations such as abandonment where the identity of the parents and relatives remains unknown despite efforts to identify them.
Exploratory Questions Was the agency timely in identifying and evaluating relatives? Was the non-custodial parent considered as a placement resource before considering other relatives? Were maternal and paternal relatives sought out and evaluated? Did relatives continue to be assessed as placement resources throughout the life of the case? What were the reasons relatives were not evaluated, if applicable? What were the reasons relatives were not used for placement, if applicable?
Rating for this indicator: (Check one)				Strength		Area Needing Improvement				Not Applicable
Instructions for Item 15: Relative Placement This item focuses on placement of children with relatives, when possible. This item applies only to children in foster care.
(Instructions continue on the next page)

Reviewers should answer yes to Core Question B if relatives were identified and evaluated before the period under review, for example when the child entered foster care, or during the period under review.

Reviewers should determine whether relatives were identified and considered as a placement resource for the child. They also should document the reason(s) for the child not being placed with a relative who was considered.

Reviewers may rate this item as a strength if (1) the agency assessed the child’s needs and determined that he/she required special services and (2) the agency assessed potential relative placements and determined that the relative placements did not have the capacity to meet the child’s needs.

Reviewers may rate this item as not applicable: (1) if the agency determined upon the child’s initial entry into care that his/her needs required residential treatment services and a relative placement would be inappropriate, or (2) if relatives were unable to be identified despite the agency’s diligent efforts to do so, or in situations such as abandonment in which the identity of the parents and relatives remains unknown despite efforts to identify them.

Provide documentation that supports the rating for item 15

This item is rated as a(n) ______________________________________ because:

Outcome P2: The continuity of family relationships and connections is preserved for children.
Item 16. Relationship of Child in Care With Parents (Interviews With Child, Parent(s), Foster Parent(s), Service Provider)
Core Questions							Yes		No		Not Applicable
A.	Is/was there evidence of a strong, emotionally supportive relationship between the child in foster care and the child’s parent(s) during the period under review? Reviewers should check not applicable if such a relationship is/was contrary to the child’s safety or best interests.					Mother:
						Father:
B.	Where appropriate, has the agency made efforts to promote or maintain a strong, emotionally supportive relationship between the child in foster care and the child’s parent(s)? Reviewers should check not applicable if such efforts are/were not appropriate based on the child’s safety or best interests, for example, serious, indicated abuse. Reviewers should not assume, however, that an emotionally supportive relationship between the parent(s) and child is inappropriate simply because the child is in foster care and/or was maltreated by the parent(s). If reviewers check yes, they must document below the specific information showing how the State is/was supporting positive relationships between the child and parent(s).					Mother:
						Father:
C.	Were visits and other contacts between the child and his/her parents/family members planned and carried out in a manner that supports the parent/family/child relationship?
D.	If the response to question A, B, or C is no, specify the reason(s):
Exploratory Questions What is/was the nature of the child’s relationship with his/her mother? What is/was the nature of the child’s relationship with his/her father? What is/was the nature of the current relationship from the child’s and parents’ perspectives? What are/were the factors affecting the child/parent relationship? What are/were the agency’s efforts to support parental participation in activities with the child, for example, school functions and special occasions? What are/were the agency’s efforts to support the parents’ involvement in decisionmaking regarding the child’s needs and activities? What are/were the agency’s efforts to support a positive relationship between the child and parents? What is/was the quality of visits between the child and parents?
Rating for this indicator: (Check one)			Strength		Area Needing Improvement					Not Applicable
(Continued)

Instructions for Item 16: Relationship of Child in Care With Parents

This item focuses on the nature of the parent-child relationship during the period under review and requires that reviewers make professional qualitative judgments. Reviewers can best make those judgments by considering the following when evaluating the parent-child relationship: (1) the child’s and parents’ expressed feelings toward each other, (2) evidence of sustained attachment between the parents and child throughout the placement, (3) the level of ongoing involvement of the parent(s) in the child’s life during the placement, (4) the level of support the parent(s) are/were able to give the child in care, and (5) the extent to which the integrity of the parent-child relationship is/was maintained. Reviewers should focus on how the agency is/was promoting parental involvement with the child in foster care (not just visitation). This might include, for example, facilitating parental involvement in medical or mental health appointments or other activities through which parents can enhance their ability to connect to and parent the child.

This item applies only to children in foster care.

Reviewers should consider what has occurred in the case during the period under review, while noting the circumstances during the life of a case. For example, if the relationship between the child and parent(s) currently is contrary to the child’s safety or best interests, reviewers should answer Core Question A as not applicable; they could, however, still check yes for Core Question B because the agency previously made appropriate efforts to promote a supportive relationship between the child and parents.

If there is/was no evidence of a supportive parent-child relationship, reviewers should explore and note in the documentation section below the reasons, for example, “parents’ whereabouts unknown.”

Reviewers should note that a supportive parent-child relationship may still be appropriate following a termination of parental rights (for example, open adoption or placement with relatives).

Reviewers should rate this item as not applicable if a relationship with the child’s parent(s) is contrary to the child’s safety or best interests.

Provide documentation that supports the rating for item 16

This item is rated as a(n) ______________________________________ because:

DISCUSSION OF PERMANENCY OUTCOME #2
Outcome P2: The continuity of family relationships and connections is preserved for children.
Check the level of outcome achievement that best describes the extent to which this outcome is being or has been achieved, based on the case record reviews and interviews. In the box below, provide documentation that supports the level of outcome achievement selected for each item.
Level of Outcome Achievement
	Substantially Achieved:	No more than one of the applicable items for this outcome is rated as an area needing improvement (disregard items rated as not applicable).
	Partially Achieved:	Two or more (but not all) of the applicable items are rated as areas needing improvement (disregard items rated as not applicable).
	Not Achieved:	All of the applicable items for this outcome are rated as areas needing improvement (disregard items rated as not applicable).
	Not Applicable:	All of the items are rated as not applicable.
Instructions for Permanency Outcome #2: The continuity of family relationships and connections is preserved for children. Reviewers should clearly record the link between their ratings and items 11–16 by providing supporting information. For example: “Permanency Outcome #2 is substantially achieved because the child is placed in close proximity to his parents, extended family, and neighborhood. Regular visitation with his parents and sibling has been facilitated by the agency. Relatives were assessed for placement, but not approved.”
Provide a summary of the documentation that supports the rating for items 11, 12, 13, 14, 15, and 16 Permanency Outcome #2 is rated as _____________________________ because:

SECTION III: CHILD AND FAMILY WELL-BEING
Outcome WB1: Families have enhanced capacity to provide for their children’s needs.
Item 17. Needs and Services of Child, Parents, Foster Parents (Case Record, Interviews With Caseworker, Child, Parent(s), Foster Parent(s), Services Providers)
Core Questions			Yes	No	Not Applicable
A.	Assessment of Needs: Indicate in questions A1–A3 below whether the needs of the child(ren), parents, and foster parents, related to safety, permanency, and well-being, were adequately assessed and identified (provide details in the chart on the next page). Reviewers should view assessment as an ongoing process. It is reasonable to expect that an initial assessment occurred before the period under review, with ongoing assessments occurring throughout the period under review.
	A1.	The child(ren).
	A2.	The child(ren)’s parents. If the child is in a pre-adoptive home and termination of parental rights or relinquishment for adoption has been achieved, reviewers should consider the adoptive parents as the parents. If the child is placed with a relative or legal guardian with whom he/she will remain, the caretaker should be considered as the parent. Reviewers should check not applicable if service(s) to the parent(s) are/were contrary to the child’s safety or best interests (for example, if the parent(s) are no longer involved in case planning, when the parents’ rights have been terminated, and when the agency has made a decision not to work with the parents).
	A3.	The child’s foster parents. Reviewers should check not applicable if the child(ren) is/was not in foster care.
	A4.	Describe the process the agency used to assess the needs of the child(ren), parents, and foster parents. The needs of foster parents refer to what they need to provide appropriate care and supervision to the child in their home.
	A5.	List in the chart below (under “unidentified needs”) any needs related to safety, permanency, and well-being in this case that were not identified during the assessment process but became apparent during the case record review or in case-related interviews.
			Yes	No	Not Applicable
B.	Provision of Services: Indicate in questions B1–B3 below whether the identified needs of the child(ren), parents, and foster parents were addressed through appropriate services, including community-based family support services, family preservation services, time-limited family reunification services, and adoption promotion and support services, as appropriate (provide details in the chart on the next page).
	B1.	The child(ren) (for example, independent living services for children in foster care who are 16 years and older).
	B2.	The child(ren)’s parents. Reviewers should check not applicable if services to parents are/were contrary to the child(ren)’s safety or best interests (for example, if the parents are/were no longer involved in case planning, such as when the parents’ rights have been terminated and the agency has made a decision not to work with the parents). If the child is
			(Continued)

Yes

No

Not Applicable

in a pre-adoptive home, and termination of parental rights or relinquishment for adoption has been achieved, reviewers should consider the adoptive parents as the parents. If the child is placed with a relative or legal guardian with whom he/she will remain, the caretaker should be considered as the parent.

B3.

The child’s foster parents. Reviewers should check not applicable if the child(ren) is/was not in foster care. The needs of foster parents refer to what they need to provide appropriate care and supervision to the child in their home.

B4.

List in the chart below (under “services needed/not provided”) any services that were not provided for which a need was identified in questions A1, A2, and A3, or services that were not provided relevant to needs identified in item A5.

Exploratory Questions What type of assessment process was used to identify needs (for example, a psychological evaluation and/or discussions with relevant parties)? How adequate was the assessment in covering all relevant areas and in identifying needs? What are/were the underlying needs associated with more obvious needs or presenting problems? What services have been/are being provided in relation to current needs? How appropriate are/were the services provided in relation to the identified needs? How accessible and available are/were services (for example, location, schedule, cost)? To what degree are/were the services provided meeting the identified needs? How accessible to foster parents is/was the caseworker? How appropriate is/was the child’s placement setting (for example, family-like and suited to the child’s needs)? What types of independent living and transitional living services are/were provided for children age 16 years and older?

Rating for this indicator: (Check one)

Strength

Area Needing Improvement

Not Applicable

Assessment of Needs/Provision of Services Chart

Identified Needs (A1-3)

Services Provided (B1-3)

Services Needed/ Not Provided (B-4)

Unidentified Needs (A-5)

Child(ren):

Mother:

(Continued)

	Identified Needs (A1-3)	Services Provided (B1-3)	Services Needed/ Not Provided (B-4)	Unidentified Needs (A-5)
Father:
Foster Parents:
Instructions for Item 17: Needs and Services of Child, Parents, Foster Parents This item focuses on the needs and services of the child, parents, and foster parents. If the child is in foster care, item 17 applies to that specific child only. If the instrument is being completed for a family receiving inhome services, then item 17 applies to all children in the family who are receiving agency services or are/were residing within the family. Reviewers should use the chart above as a work space for recording needs and services for Items A1, A2, A3, A5, and B4.
Reviewers should examine whether the needs and services are/were addressed for some of the children in the family but not others and consider this information when rating this item. Reviewers should consider which members of the family are/were in the identified service unit and whether it is/was reasonable to expect that they receive services. Reviewers should rate this item for the period under review, although in responding to questions A1–A5, reviewers should consider initial assessments of needs that were conducted outside the period under review, and ongoing assessments during the period under review. Reviewers must determine whether the agency identified the individual needs of the child(ren) and family in relation to the case goals or the agency’s involvement with them. Assessment of needs may take different forms (for example, a psychosocial evaluation conducted by another agency or by contract purchase). Reviewers also may find evidence during interviews with caseworkers or service providers that identifiable efforts were made to assess needs through the case planning process (using a process other than formal assessment) and the caseworker has an indepth understanding of the needs of the child and family upon which to base the case plan. Reviewers should document whether the services provided are/were appropriately matched to the identified needs. For example, if the agency identified the need to address parental substance abuse, reviewers should explore whether substance abuse assessment, prevention, education, or treatment services are/were provided. Reviewers also should document the reason why services were not provided when a need had been identified.
(Instructions continue on the next page)

Reviewers should document in particular whether the following services are/were needed and provided: (1) community-based family support services, (2) family preservation services, (3) time-limited family reunification services, and (4) adoption promotion and support services.

Reviewers also should explore the accessibility and availability of services being provided (for example, location and schedule).

Reviewers should rate item 17 as a strength if (1) a needs assessment was conducted for the child(ren), parents, and foster parents, and (2) appropriate services were provided in relation to the identified needs of the target child in foster care cases, or for all children in inhome cases. Reviewers should note that education and physical or mental health services to the target child are not rated for this item (these are rated in items 21, 22, and 23). Reviewers should, however, document whether these services were provided to parents.

Provide documentation that supports the rating for item 17

This item is rated as a(n) ______________________________________ because:

Outcome WB1: Families have enhanced capacity to provide for their children’s needs.
Item 18. Child and Family Involvement in Case Planning (Interviews With Caseworker, Parent(s), Child, Service Providers)
Core Questions			Yes	No	Not Applicable
A.	Indicate in questions A1–A3 below whether the agency actively involved the parent(s) or guardian and child(ren) in the case planning activities relevant to the current case plan. To determine the level of participation by parents and children, reviewers should identify the specific activities in which they have input or involvement. These might include, for example: (1) identifying strengths and needs, (2) requesting services and service providers, (3) establishing goals in case plans, (4) evaluating progress toward goals, and (5) attending case planning meetings. Reviewers also should identify barriers to child and parent participation in the case planning process. Reviewers should thoroughly explore specific case planning activities open to child and parent participation and not assume that a parent’s signature on a case plan signifies involvement. Moreover, reviewers should explore how the agency engaged the child and parent and in what specific activities.
	A1.	Child(ren). Reviewers should check not applicable if the child(ren) is/was not old enough or is/was incapacitated. Reviewers will need to determine the ability of the child(ren) to participate actively in case planning activities. This capacity will vary among children; however, most school-age children can be expected to participate to some extent if they are verbal and understand most of the events occurring in their lives.
	A2.	Mother. Reviewers should check not applicable if the mother’s involvement was determined to be contrary to the child(ren)’s safety or best interests, and document the reasons. Reviewers should check not applicable if the mother was absent, and the agency tried to locate her but was unable to do so, and document the agency’s efforts. Reviewers should check no if the mother is absent, and the State did not try to locate her, and document the reasons why the State did not do so. Reviewers should consider pre-adoptive parents or permanent relative or guardian caretakers as “parents.”
	A3.	Father. Reviewers should check not applicable if the father’s involvement was determined to be contrary to the child(ren)’s safety or best interests, and document the reasons. Reviewers should check not applicable if the father was absent, and the agency tried to locate him but was unable to do so, and document the agency’s efforts. Reviewers should check no if the father is absent, and the State did not try to locate him, and document the reasons why the State did not do so. Reviewers should consider pre-adoptive parents or permanent relative or guardian caretakers as “parents.”
			(Continued)

A4.

Describe the family’s and child(ren)’s involvement in case planning. Child(ren): Mother: Father:

Yes

No

Not Applicable

B.

Was the input of the family and child(ren) actively considered in the development of the case plan?

C.

Are/were procedural safeguards in place with respect to parental rights pertaining to the removal of children from home, changes in placements, and visiting privileges? Reviewers should check not applicable if the child is/was not placed in foster care.

Exploratory Questions Is/was a current case plan on file for the family/child? Was the input of the family/child considered and addressed in case plans? What is/was the family/child involvement in identifying needs and services, establishing goals, and evaluating progress? What are/were the reasons for their noninvolvement, if applicable? What efforts were made to locate, and then involve, absent parents, if applicable? Are/were parents notified when a child is moved or changes are made in visiting plans or case plans?

Rating for this indicator: (Check one)

Strength

Area Needing Improvement

Not Applicable

Instructions for Item 18: Child and Family Involvement in Case Planning This item focuses on the agency’s efforts to involve the child(ren), parent(s), and permanent caregivers (for example, pre-adoptive parents and guardians) in case planning activities. If the child is/was in foster care, item 18 applies to that specific child only. If the instrument is being completed for a family receiving inhome services, then item 18 applies to all children in the family who are/were receiving agency services or are/were residing within the family. For inhome cases, reviewers should assess whether the primary service recipients in the family have been/were involved in the case plan development. Reviewers should note that State policies regarding requirements for case plans for inhome service cases may vary and there may not be a requirement to have an identifiable written case plan in the record. In those instances, reviewers should determine the extent to which the appropriate family members have been/were involved in determining the following: (1) their strengths and needs, (2) the type and level of services needed, and (3) their goals and their progress toward meeting them. If the original case plan was developed before the period under review and the goals remain the same, reviewers should consider the agency’s attempts to involve the parent(s) in developing that case plan and also in the ongoing case planning activities that occurred during the period under review, such as updating and evaluating case plans or developing new plans. Reviewers should rate this item as an area needing improvement if a case plan was not completed. Reviewers should rate this item as not applicable if (1) the child(ren) is/was not old enough or is/was incapacitated and (2) the father and mother’s involvement was determined to be contrary to the child(ren)’s safety or best interests or the father and mother were absent, and the agency tried to locate them but was unable to do so.

(Continued)

Provide documentation that supports the rating for item 18

This item is rated as a(n) _____________________________________ because:

Outcome WB1: Families have enhanced capacity to provide for their children’s needs.
Item 19. Worker Visits With Child (Case Record, Interviews With Caseworker, Child, Foster Parent(s))
Core Questions						Weekly	Bi-weekly	Monthly			Less Than Monthly
A.	What has been/was the most typical pattern of visitation between the caseworker or other responsible party and the child(ren) during the period under review (other responsible party refers to contracted service providers who maintain total responsibility for case planning and case management)?
							Yes	No			Not Applicable
B.	When visits are/were occurring less frequently than monthly, is/was the frequency of visits consistent with the needs of the child(ren)? Reviewers should check not applicable when visits are/were occurring at least monthly.
C.	Do/did the visits between the caseworker or other responsible party and the child(ren) focus on issues pertinent to case planning, service delivery, and goal attainment?
Exploratory Questions What is/was the child’s need for contacts with the worker? Who is/was the party responsible for maintaining visits? What are/were the quality and substance of visits (for example, duration, activities, nature of discussions, planned vs. unplanned visits)? What is/was the location of visits? What is/was the frequency and consistency of visits? What are/were the factors affecting frequency of visits? What are/were the reasons for infrequent visiting, if applicable?
Rating for this indicator: (Check one)			Strength		Area Needing Improvement					Not Applicable
Instructions for Item 19: Worker Visits With Child This item focuses on worker visits with the child. Visits are defined as face-to-face contacts between the worker and child. If the child is/was in foster care, item 19 applies to that specific child only. If the instrument is being completed for a family receiving inhome services, then item 19 applies to all children in the family who are/were receiving agency services or are/were residing within the family. Reviewers should determine the most typical pattern of visiting during the period under review since the actual frequency may vary for different time periods. When reviewers note that visits occur infrequently, they should use the Exploratory Questions to determine the barriers to more frequent visiting. Reviewers should rate this item based on the child(ren)’s need for contact with the caseworker, not the agency’s policy on caseworker visits. For example, reviewers should rate this item as an area needing improvement if there is/was less frequent visiting than needed by the child(ren). If visits were less frequent than monthly, reviewers must provide substantial documentation in order to rate this item as a strength. (Continued)

Provide documentation that supports the rating for item 19

This item is rated as a(n) ______________________________________ because:

Outcome WB1: Families have enhanced capacity to provide for their children’s needs.

Item 20. Worker Visits With Parent(s) (Case Record, Interviews With Caseworker, Parent(s), Foster Parent(s))

Core Questions

Weekly

Bi-weekly

Monthly

Less Than Monthly

Not Applicable

A.

What is/was the most typical pattern of visitation between the caseworker or other responsible party and the parent(s) during the period under review (other responsible party refers to contracted service providers who maintain total responsibility for case planning and case management)? Reviewers should check not applicable if visiting with parents is contrary to the child(ren)’s safety or best interests and document the reasons below.

Mother:

Father:

Yes

No

Not Applicable

B.

When visits are/were occurring less frequently than monthly, is/was the frequency of visits consistent with the needs of the child(ren)? Reviewers should check not applicable if visits are occurring at least monthly.

C.

Do/did the visits between the caseworker or other responsible party and the parents focus on issues pertinent to case planning, service delivery, and goal attainment?

Exploratory Questions What are/were the parents’ needs for contacts with the caseworker? Who is/was the party responsible for maintaining visits? What is/was the location of visits? What are/were the frequency and consistency of visits? What are/were the factors affecting frequency of visits? What are/were the reasons for infrequent visiting, if applicable? What are/were the quality and substance of visits (for example, duration, activities, nature of discussions, planned vs. unplanned visits)?

Rating for this indicator: (Check one)

Strength

Area Needing Improvement

Not Applicable

Instructions for Item 20: Worker Visits With Parent(s) This item focuses on worker visits with the parent(s) and permanent caregivers (for example, pre-adoptive parents and guardians). Visits are defined as face-to-face contacts between the worker and the parent(s). If the child is/was in foster care, item 20 applies to that specific child only. If the instrument is being completed for a family receiving inhome services, then item 20 applies to all children in the family who are/were receiving agency services or are/were residing within the family.

(Instructions continue on the next page)

Reviewers should determine the most typical pattern of visiting during the period under review since the actual frequency may vary for different time periods.

When reviewers note that visits occur infrequently, they should use the Exploratory Questions to determine the barriers to more frequent visiting.

Reviewers should rate this item based on the parent(s)’ need for contact with the caseworker, not the agency’s policy on caseworker visits. For example, reviewers should rate this item as an area needing improvement if there is/was less frequent visiting than needed by the parent(s).

If visits were less frequent than monthly, reviewers must provide substantial documentation in order to rate this item as a strength.

Provide documentation that supports the rating for item 20

This item is rated as a(n) ________________________________________ because:

DISCUSSION OF CHILD AND FAMILY WELL-BEING OUTCOME #1
Outcome WB1: Families have enhanced capacity to provide for their children’s needs.
Check the level of outcome achievement that best describes the extent to which this outcome is being or has been achieved, based on the case record reviews and interviews. In the box, provide documentation that supports the level of outcome achievement selected for each item.
Level of Outcome Achievement
	Substantially Achieved:	Item 17 must be rated as a strength, plus no more than one of the remaining applicable items may be rated as an area needing improvement (disregard items rated as not applicable).
	Partially Achieved:	Item 17 is rated as an area needing improvement, or two or more (but not all) of the applicable items are rated as areas needing improvement (disregard items rated as not applicable).
	Not Achieved:	All of the applicable items are rated as areas needing improvement (disregard items rated as not applicable).
	Not Applicable:	All of the items are rated as not applicable.
Instructions for Child and Family Well-Being Outcome #1: Families have enhanced capacity to provide for their children’s needs. Reviewers should clearly record the link between their rating and items 17–20 by providing supporting information. For example, “Well-Being Outcome #1 was partially achieved because the agency involved the child and parents in case planning; however, the child’s need to develop the skills to manage her behavior was not met through appropriate services, and the worker contact with the child and parents was sporadic.”
Provide a summary of the documentation that supports the rating for items 17, 18, 19, and 20 Well-Being Outcome #1 is rated as ______________________________ because:

Outcome WB2: Children receive appropriate services to meet their educational needs.
Item 21. Educational Needs of the Child (Case Record, Interviews With Caseworker, Child, Foster Parent(s), Parent(s))
Core Questions			Yes	No	Not Applicable
A.	If the child is/was in foster care, is/was the child enrolled in multiple schools as the result of being placed in foster care? Reviewers should check not applicable if the child is/was not of school age or is/was not in foster care. Only those changes in schools resulting from the child’s placement in foster care should be recorded in this item; normal changes, such as the transition from elementary to middle school, should not be noted.
B.	Indicate below whether the child(ren)’s educational needs are/were being addressed.
	B1.	Special education classes. Reviewers should check not applicable if there are/were no identified special education needs or the child is/was not school age.
	B2.	Services for identified educational needs. Reviewers should check not applicable if no unusual educational needs are/were noted.
	B3.	Early intervention for preschool children. Reviewers should check not applicable if early intervention is/was not needed or the child is/was not school age. Early intervention refers to early intervention programs operated by the State’s education system for preschool children, infants, and toddlers who have developmental delays.
	B4.	Inclusion of school records in the case file. Reviewers should check not applicable if the child is/was not school age or not in foster care.
	B5.	Advocacy with the education/school system. Reviewers should check not applicable if there are/were no identified needs or the child is/was not school age. Advocacy refers to efforts by the agency to obtain educational services for the child. This might include, for example, arranging for priority testing for special education or other special placement classes or meeting with school personnel to address the child’s performance. This question is applicable whether or not the child is/was in special education.
	B6.	Attention to education in case planning. Reviewers should check not applicable if there are/were no identified needs (for inhome cases only) or the child is/was not school age. Reviewers should check no if the child is/was of school age and in foster care and education was not addressed in case planning.
	B7.	Providing education records to foster parents. Reviewers should check not applicable if the child is/was not in foster care or the child is/was not school age.
Exploratory Questions What are/were the identified educational needs of the child(ren)? What services are/were being provided to address the child(ren)’s educational needs? What are/were the reasons for changes of school placement, if applicable? What testing/evaluation was performed to determine the educational needs of the child(ren)? What is/was the child(ren)’s functioning in school? What is/was the appropriateness of services provided related to identified needs, such as those stemming from developmental delays or learning disabilities? What activities are/were performed to address the child(ren)’s educational needs? (Continued)

Rating for this indicator: (Check one)		Strength		Area Needing Improvement		Not Applicable
Instructions for Item 21: Educational Needs of the Child
This item focuses on the educational needs of the child. If the child is/was in foster care, item 21 applies to that specific child only and reviewers should respond to Core Questions A and B. If the instrument is being completed for a family receiving inhome services, reviewers should apply item 21 to all children in the family who are/were residing with, and included in services to, the family and respond to Core Question B only. When addressing educational issues for families receiving inhome services, reviewers should consider whether the educational needs are/were relevant to the reason why the agency is/was involved with the family, and whether the need to address educational issues is/was a reasonable expectation given the circumstances of the agency’s involvement with the family. (If not, reviewers should rate this item as not applicable.) For example, if a child became known to the agency and was determined to be in need of inhome services, and the alleged abuse or neglect was affecting the child’s school performance or attendance, then it is reasonable to expect the agency to provide services to ensure that the child receives the appropriate educational assessment and services. Reviewers may rate this item as a strength if the agency made extensive efforts to address the child’s educational needs and the school system was unresponsive, especially if the problems are with a local school or jurisdiction. Reviewers should rate this item as a strength if the child(ren)’s educational needs were assessed and addressed, including cases where the educational records are not maintained in the case record. In these instances, reviewers should, however, document that the educational records are missing and the reasons why. Reviewers should rate this item as a strength if the agency conducted an assessment of educational issues and determined that there were no problems in that area, nor any need for educational services.
Provide documentation that supports the rating for item 21 This item is rated as a(n) _____________________________________ because:

DISCUSSION OF CHILD AND FAMILY WELL-BEING OUTCOME #2
Outcome WB2: Children receive appropriate services to meet their educational needs.
Check the level of outcome achievement that best describes the extent to which this outcome is being or has been achieved, based on the case record reviews and interviews. In the box, provide documentation that supports the level of outcome achievement selected for each item.
Level of Outcome Achievement
	Substantially Achieved:	Item 21 is rated as a strength.
	Partially Achieved:	Item 21 is rated as an area needing improvement, although some components of item 21 are being addressed in a satisfactory manner.
	Not Achieved:	Item 21 is rated as an area needing improvement and none of the components of item 21 are being addressed in a satisfactory manner.
	Not Applicable:	Item 21 is rated as not applicable.
Instructions for Child and Family Well-Being Outcome #2: Children receive appropriate services to meet their educational needs. Reviewers should clearly record the link between their ratings and item 21, providing supporting information. For example: “Well-Being Outcome #2 is substantially achieved because during the educational case planning, the child was assessed as needing special education services, and has been enrolled in the appropriate classes. The foster parents are maintaining the child’s educational records.”
Provide a summary of the documentation that supports the rating for item 21 Well-Being Outcome #2 is rated as _______________________________ because:

Outcome WB3: Children receive adequate services to meet their physical and mental health needs.
Item 22. Physical Health of the Child (Case Record, Interviews With Caseworker, Child, Foster Parent(s))
Core Questions								Yes	No		Not Applicable
A.	If the child is/was in foster care, was an initial health screening (or other medical examination) provided upon the most recent entry into foster care? Reviewers should check not applicable if the child is/was not in foster care. Health care screening refers to the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) or other comprehensive medical examinations.
	A1.	If the response to question A is yes, was the initial health screening provided in accordance with the timeframe specified in the State’s guidelines? Reviewers should check not applicable if the child is/was not in foster care or the State does not have guidelines.
							Significantly	Partially	Not at All		Not Applicable
B.	Indicate below whether the child’s physical health needs (including follow-up services) were being addressed in the following ways during the period under review. Reviewers should document what those needs are/were and how they are/were being met.
	B1.	Preventive health care. Preventive health care refers to both the initial and periodic age-appropriate examinations and maintenance procedures designed to avoid, detect, and treat health problems.
	B2.	Preventive dental care. Preventive dental care refers to both the initial and periodic age-appropriate examinations and maintenance procedures designed to avoid, detect, and treat dental problems.
	B3.	Immunizations.
	B4.	Treatment for identified health needs. Reviewers should check not applicable if the initial or subsequent health screens did not identify needs requiring treatment.
	B5.	Treatment for identified dental needs. Reviewers should check not applicable if there are/were no identified needs.
	B6.	Providing health records to foster parents. Reviewers should check not applicable if the child is/was not in foster care.
Exploratory Questions What are the State’s guidelines for the timing of initial health examinations for children entering foster care? How are/were comprehensive medical examinations managed (beyond initial screenings)? What type of initial screening was received by the child in foster care? How recent are/were immunizations? What has been/were the frequency of subsequent health screenings and preventive dental care? (Continued)
What is/was the appropriateness of services provided related to the identified needs, such as those stemming from developmental delays or learning disabilities? What is/was the treatment of identified health and dental needs? What is/has been the agency’s method for tracking the medical needs and services of the child(ren)? Do/did foster parents (provider) have copies of the child’s health records?
Rating for this indicator: (Check one)				Strength		Area Needing Improvement				Not Applicable
Instructions for Item 22: Physical Health of the Child This item focuses on the physical health of the child. If the child is/was in foster care, reviewers should apply item 22 to that specific child only and reviewers should respond to Core Questions A and B. If the instrument is being completed for a family receiving inhome services, reviewers should apply item 22 to all children in the family who are/were residing with, and included in services to, the family and respond to Core Question B only. Reviewers must determine whether the child has/had any identified health needs. The primary criteria for rating this item is whether the child’s health needs were identified in a timely manner and treated appropriately, if applicable. Reviewers should answer Core Questions A and A1 based on the most recent entry into foster care, even if it occurred before the period under review, and answer Core Question B for the period under review.
When addressing health issues for families receiving inhome services, reviewers should consider whether the physical health needs are/were relevant to the reason why the agency is/was involved with the family and whether the need to address physical health issues is/was a reasonable expectation given the circumstances of the agency’s involvement with the family. (If not, reviewers should rate this item as not applicable.) For example, if a child became known to the agency and was determined to be in need of inhome services at least partly as a result of physical abuse or sexual abuse, then it is reasonable to expect the agency to provide services to ensure that the child receives the appropriate physical health services. Reviewers should rate this item as a strength if the agency conducted an assessment of physical health and determined that there were no problems in that area, nor any need for physical health services.
Provide documentation that supports the rating for item 22 This item is rated as a(n) ______________________________________ because:

Outcome WB3: Children receive adequate services to meet their physical and mental health needs.

Item 23. Mental Health of the Child (Interviews With Caseworker, Parent(s), Foster Parent(s), Service Providers)

Core Questions

Yes

No

Not Applicable

A.

If the child is/was in foster care, was an initial formal mental health screening or assessment provided upon the most recent entry into foster care (or within the timeframe specified in the State’s guidelines, if applicable)? Reviewers should check not applicable if the child is not in foster care or if the State has no guidelines and there were no indications that a screening or assessment was needed.

Not Applicable

B.

Indicate the assessment or screening method used (for example, a comprehensive mental health evaluation or psychological evaluation). Reviewers should check not applicable if no assessment or screening was done and there were no indications that a screening or assessment was needed, or if the response to question A is not applicable.

Significantly

Partially

Not at All

Not Applicable

C.

Indicate below whether the agency has addressed the child’s mental health needs in the following ways during the period under review. Reviewers should determine whether the child has/had specific mental health needs and, if so, whether services are/were being provided that appropriately address the identified needs.

C1.

Formal assessment or screening (initial and ongoing, as needed).

C2.

Ongoing treatment for identified needs. Reviewers should check not applicable if the assessment did not identify needs.

Exploratory Questions How were mental health needs assessed at initial agency involvement or upon the child’s entering foster care? How are/were mental health needs assessed on an ongoing basis? What are the current mental health needs? What services have been provided for mental health needs, including any followup care identified? What is/was the appropriateness of services provided related to the child’s identified needs, such as those stemming from developmental delays or learning disabilities?

Rating for this indicator: (Check one)

Strength

Area Needing Improvement

Not Applicable

Instructions for Item 23: Mental Health of the Child This item focuses on the mental health of the child.

(Instructions continue on the next page)

If the child is/was in foster care, reviewers should apply item 23 to that specific child only and respond to Core Questions A, B, and C. If the instrument is being completed for a family receiving inhome services, reviewers should apply item 23 to all children in the family who are/were residing with, and included in services to, the family and respond to Core Question C only.

Reviewers should focus on all of the child’s mental health needs, as would be identified by reading the case notes or through case- related interviews, not only those that have been diagnosed by a mental health professional.

The primary criteria for rating item 23 is whether the child’s mental health needs were identified in a timely manner and treated appropriately, if applicable. Reviewers should answer Core Questions A and B based on the most recent entry into foster care, even if it occurred before the period under review and should answer Core Question C for the period under review.

When addressing mental health issues for families receiving inhome services, reviewers should consider whether the mental health needs are/were relevant to the reason why the agency is/was involved with the family and whether the need to address mental health issues is/was a reasonable expectation given the circumstances of the agency’s involvement with the family. (If not, reviewers should rate this item not applicable.) For example, if a child became known to the agency and was determined to be in need of inhome services at least partly as a result of the child experiencing recurrent episodes of severe depression as a result of some form of maltreatment for which it is reasonable to expect that mental health issues would be involved (such as sexual abuse), then it is reasonable to expect the agency to provide services to ensure that the child receives the appropriate mental health services.

Reviewers should rate this item as a strength if the agency conducted an assessment of the child’s mental health and determined that there were no problems in that area, nor any need for mental health services.

Provide documentation that supports the rating for item 23

This item is rated as a(n) _______________________________________ because:

DISCUSSION OF CHILD AND FAMILY WELL-BEING OUTCOME #3
Outcome WB3: Children receive adequate services to meet their physical and mental health needs.
Check the level of outcome achievement that best describes the extent to which this outcome is being or has been achieved, based on the case record reviews and interviews. In the box, provide documentation that supports the level of outcome achievement selected for each item.
Level of Outcome Achievement
	Substantially Achieved:	All applicable items are rated as strengths (disregard items rated as not applicable).
	Partially Achieved:	One of the applicable items is rated as an area needing improvement and one is rated as a strength (disregard items rated as not applicable).
	Not Achieved:	All applicable items are rated as areas needing improvement (disregard items rated as not applicable).
	Not Applicable:	Both of the items are rated as not applicable.
Instructions for Child and Family Well-Being Outcome #3: Children receive adequate services to meet their physical and mental health needs. Reviewers should clearly record the link between their ratings and items 22 and 23, providing supporting information. For example, “Well-Being Outcome #3 is partially achieved because the child has unmet treatment needs in the areas of health and dental care. The child needs to see a specialist for asthma and requires specialized orthodontic work, and the foster parents cannot find a local provider who accepts Medicaid, so treatment has been delayed. The child’s need to deal with separation from family is being met through counseling services at the local mental health clinic.”
Provide a summary of the documentation that supports the rating for items 22 and 23 Well-Being Outcome #3 is rated as ________________________________ because:

Case Rating Summary Reviewers should check the nonshaded box for each performance item and outcome that corresponds to the rating assigned.
Performance Item or Outcome		Perf. Item Ratings			Outcome Ratings
		Strength	Area Needing Improve-ment	N/A*	Substan- tially Achieved	Partially Achieved	Not Achieved	N/A*
Outcome S1: Children are, first and foremost, protected from abuse and neglect.
Item 1:	Timeliness of initiating investigations of reports of child maltreatment
Item 2:	Repeat maltreatment
Outcome S2: Children are safely maintained in their homes whenever possible and appropriate.
Item 3:	Services to family to protect child(ren) in home and prevent removal
Item 4:	Risk of harm to child(ren)
Outcome P1: Children have permanency and stability in their living situations.
Item 5:	Foster care re-entries
Item 6:	Stability of foster care placement
Item 7:	Permanency goal for child
Item 8:	Reunification, guardianship, or permanent placement with relatives
Item 9:	Adoption
Item 10:	Permanency goal of other planned permanent living arrangement
Outcome P2: The continuity of family relationships and connections is preserved for children.
Item 11:	Proximity of foster care placement
Item 12:	Placement with siblings
Item 13:	Visiting with parents and siblings in foster care
Item 14:	Preserving connections
Item 15:	Relative placement
Item 16:	Relationship of child in care with parents
Outcome WB1: Families have enhanced capacity to provide for their children’s needs.
Item 17:	Needs and services of child, parents, foster parents
Item 18:	Child and family involvement in case planning
Item 19:	Worker visits with child
Item 20:	Worker visits with parent(s)
Outcome WB2: Children receive appropriate services to meet their educational needs.
Item 21:	Educational needs of the child
Outcome WB3: Children receive adequate services to meet their physical and mental health needs.
Item 22:	Physical health of the child
Item 23:	Mental health of the child