Form 1 cfsr r3 onsite review instructions

Child and Family
Services Reviews
Onsite Review Instrument and
Instructions
July 2014

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Table of Contents
Face Sheet ....................................................................................................................................................... 2
SAFETY OUTCOME 1: CHILDREN ARE, FIRST AND FOREMOST, PROTECTED FROM ABUSE AND
NEGLECT. .................................................................................................................................................. 7
Item 1: Timeliness of Initiating Investigations of Reports of Child Maltreatment ................................................. 7
SAFETY OUTCOME 2: CHILDREN ARE SAFELY MAINTAINED IN THEIR HOMES WHENEVER POSSIBLE
AND APPROPRIATE. ................................................................................................................................ 11
Item 2: Services to Family to Protect Child(ren) in the Home and Prevent Removal or Re-Entry Into Foster
Care........................................................................................................................................................... 11
Item 3: Risk and Safety Assessment and Management ................................................................................... 14
PERMANENCY OUTCOME 1: CHILDREN HAVE PERMANENCY AND STABILITY IN THEIR LIVING
SITUATIONS. ............................................................................................................................................ 20
Item 4: Stability of Foster Care Placement ....................................................................................................... 20
Item 5: Permanency Goal for Child .................................................................................................................. 25
Item 6: Achieving Reunification, Guardianship, Adoption, or Other Planned Permanent Living Arrangement .. 31
PERMANENCY OUTCOME 2: THE CONTINUITY OF FAMILY RELATIONSHIPS AND CONNECTIONS IS
PRESERVED FOR CHILDREN. ................................................................................................................ 37
Item 7: Placement With Siblings ...................................................................................................................... 37
Item 8: Visiting With Parents and Siblings in Foster Care ................................................................................ 39
Item 9: Preserving Connections ....................................................................................................................... 44
Item 10: Relative Placement ............................................................................................................................ 47
Item 11: Relationship of Child in Care With Parents ........................................................................................ 50
WELL-BEING OUTCOME 1: FAMILIES HAVE ENHANCED CAPACITY TO PROVIDE FOR THEIR
CHILDREN’S NEEDS................................................................................................................................ 54
Item 12: Needs and Services of Child, Parents, and Foster Parents ................................................................ 54
Item 13: Child and Family Involvement in Case Planning ................................................................................ 62
Item 14: Caseworker Visits With Child ............................................................................................................. 66
Item 15: Caseworker Visits With Parents ......................................................................................................... 69
WELL-BEING OUTCOME 2: CHILDREN RECEIVE APPROPRIATE SERVICES TO MEET THEIR
EDUCATIONAL NEEDS. .......................................................................................................................... 74
Item 16: Educational Needs of the Child .......................................................................................................... 74
WELL-BEING OUTCOME 3: CHILDREN RECEIVE ADEQUATE SERVICES TO MEET THEIR PHYSICAL
AND MENTAL HEALTH NEEDS............................................................................................................... 78
Item 17: Physical Health of the Child ............................................................................................................... 78
Item 18: Mental/Behavioral Health of the Child ................................................................................................ 82

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OMB Control Number: 0970-0214
Expiration Date: 1/31/2015

Children's Bureau
Child and Family Services Reviews
Onsite Review Instrument and Instructions
General Instructions
The Onsite Review Instrument and Instructions is used to review both foster care and in-home
services cases during the onsite review component of the Child and Family Services Reviews.
In completing the instrument, reviewers conduct case file 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, reviewers
collect information on a number of “items” related to that outcome.
Although reviewers use the instrument to review both foster care and in-home services cases,
they should complete the permanency section only if the case under review is a foster care
case. If reviewing an in-home services case, reviewers should select Not Applicable as the
rating for the permanency items.
For children in foster care, reviewers should consider the safety items (1 through 3) for all
children in the family, but complete the permanency items (4 through 11) and the child and
family well-being items (12 through 18) only as they apply to the specific child whose case is
under review. For children receiving in-home services, reviewers should consider the safety
items (1 through 3) for all children in the family home and complete the well-being items (12
through 18) for all children in the family unless reviewers determine that only specific children
should be receiving services and, based on case circumstances, the other children in the family
home do not need to be considered in these items.

Reviewing the Case
Reviewers must respond to all the questions for each applicable item. Reviewers should use
their professional judgment to determine how best to gather all the relevant information needed
to respond to questions. The instrument provides some instructions on where to find
information, such as the case record or court orders. Information gathered through case-related
interviews should be considered when responding to questions.
Reviewers must indicate the case participants who have been included in the assessment of
certain items, in order to identify which children in an in-home services case were included in
the assessment of various items and in order to determine who was being considered as
“mother” and “father” in various items. Participants should be selected from the case
participants listed in the child and case participant tables in the face sheet.
Further instructions for answering the questions relating to the individual items, along with
definitions for key terms, are provided below the relevant question. Reviewers should read all
instructions and definitions carefully before responding to questions.

Child and Family Services Reviews Onsite Review Instrument

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Onsite Review Instrument: Face Sheet

CHILD AND FAMILY SERVICES REVIEWS
ONSITE REVIEW INSTRUMENT

Face Sheet
Case Information
Definition and Instructions for Questions A through E below:
•
•
•

For the local area, use the name that is used by the state for the review. This may be a region rather
than a county, or may be multiple counties.
Enter the case name that is the official name on the case file.
The period under review is the time frame used for making decisions about the case. It begins with the
sampling period start date and ends with the date the case review was completed.

A.

Name of state and county (or local area):

B.

Case name:

C.

Period under review begins on:

D.

Reviewer name(s):
QA completed by (name(s)):

E.

Date case review was completed:

F.

What is the type of case reviewed? Select one type only:

Foster Care 

In-Home Services 

In-Home Services—Differential/Alternative Response 

Question F Instructions:
•

•
•

2

The case is a foster care case if the target child was in foster care at any time during the period under
review. A child is considered to be in foster care if the state child welfare agency or another public
agency with whom the agency has a title IV-E agreement (hereafter “the agency”) has placement and
care responsibility for the child. This includes a child who is placed by the agency with relatives or in
other kin-type placements, but the agency maintains placement and care responsibility. It does not
include a child who is living with relatives (or caregivers other than parents) but who is not under the
placement and care responsibility of the agency.
The case is an in-home services case if no child in the family was in foster care at any time during the
period under review, and the case was open for at least 45 days.
The case is an in-home services differential/alternative response case if the state has some form of
differential/alternative response program during the period under review and the in-home services
case was served through that program.

Child and Family Services Reviews Onsite Review Instrument

Onsite Review Instrument: Face Sheet

G1.

Child Table

Target
Child

Child’s Name

Race(s)

Ethnicity

Date of Birth
(MM/DD/YYYY)

Gender

Interviewed
(Yes/No)

Table G1 Instructions:
•

•

•
•

•

For both foster care cases and in-home services cases, enter the first and last names (first name first) of
all children in the family as identified in the case file. If the case is a foster care case, indicate “Yes” in
the first column of the table next to the name of the target child. It is essential that the target child be
clearly identified for all foster care cases.
Enter the race and ethnicity information as provided in the case file. If the child is of two or more races,
list all that are provided in the case file (for example, White and Asian, or White and American Indian). If
you learn during the course of the interviews that a child is of a different race or ethnicity than is noted in
the file or is of two or more races and only one is noted in the file (for example, Non-Hispanic instead of
Hispanic, or both White and Native American), please change the race or ethnicity identification
information presented to reflect the accurate information.
Select from the following options for ethnicity: “Not Hispanic or Latino” or “Hispanic or Latino”
Select from the following options for race:
- American Indian or Alaska Native
- Asian
- Black or African American
- Native Hawaiian or Other Pacific Islander
- White
- Unknown or Unable to Determine
Provide the date of birth for every child in the family, even if this is a foster care case.

Child and Family Services Reviews Onsite Review Instrument

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Onsite Review Instrument: Face Sheet

G2.

Case Participant Table
Name

Role

Relationship to Child

Interviewed
(Yes/No)

Table G2 Instructions:
•

In the Name column, for both foster care and in-home services cases, enter the first and last names
(first name first) of the key case participants whose participation in this case will be assessed in the
instrument and other persons who were interviewed to provide relevant information.

•

In the Role column, list one of the following options for each participant listed: Mother, Father,
Caregiver, Foster Parent, Caseworker, Caseworker’s Supervisor, Other. The same role may be
indicated for more than one person (for example, a biological father may have the role of Father, and a
stepfather may have the role of Father).

•

In the Relationship to Child column, indicate how the person is involved in the case and/or related to the
child. Indicate whether the person is/was living with the child and/or in a caregiving role. For example:
boyfriend of (child name)’s mother, lives in the home; biological mother of (children’s names) not living
in the home, not a caregiver; legal father of (child’s name), not living in the home.

•

In the Interviewed column, note whether the person has been interviewed regarding the case.

H.

Was this case opened for reasons other than child abuse and neglect?

Yes 

No 

Question H Instruction:
Examples of cases opened for reasons other than child abuse or neglect include: (1) cases opened because
of the child’s behavior, including juvenile delinquency, substance abuse, or “child in need of supervision,”
and there were no maltreatment concerns in the family; or (2) cases opened because parents requested
mental/behavioral health services for their child(ren).

I.

What is the date of the first case opening, of the cases open for services during the period under review?

------/-------/----------------

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Child and Family Services Reviews Onsite Review Instrument

Onsite Review Instrument: Face Sheet
Question I Instructions:
•

•
•

J.

Using the MM/DD/YYYY format, enter the date on which the case was actually opened within the
agency. Consider all cases that were open for services during the period under review, if there were
multiple case openings. If the first case that was open during the period under review was opened
before the period under review began, include it as the first case opening date for the period.
If a child was on a trial home visit and returned to a foster care placement, the return to foster care is
not considered a “case opening” unless the trial home visit was longer than 6 months and there was
no court order extending the trial home visit beyond 6 months.
If the family received in-home services before the removal of a child and placement of the child in
foster care, and the case was not closed before placement, enter the date on which the case was
opened for in-home services. The date of the child’s removal from home will be captured in the next
question.
What is the date of the child’s most recent entry into foster care?

------/-------/----------------

NA 

Question J Definition:
“Entry into foster care” refers to a child’s removal from his or her normal place of residence and
placement in a substitute care setting under the placement and care responsibility of the state or local title
IV-B/IV-E agency. Children are considered to have entered foster care if the child has been in substitute
care for 24 hours or more.
Question J Instructions:
•
•
•

K.

Using the MM/DD/YYYY format, enter the date of the child’s most recent entry into foster care.
If a child was on a trial home visit and returned to a foster care placement, the return is not
considered an “entry into foster care” unless the trial home visit was longer than 6 months and there
was no court order extending the trial home visit beyond 6 months.
If the case is an in-home services case, J is Not Applicable.
What is the date of discharge from foster care for the most recent foster care episode?

------/-------/----------------

NA 

Not Yet Discharged 

Question K Definition:
“Discharge from foster care” is defined as the point when the child is no longer in foster care under the
placement and care responsibility or supervision of the agency.
Question K Instructions:
•

•

Using the MM/DD/YYYY format, enter the date of discharge from foster care for the most recent
foster care episode.
If a child returns home on a trial home visit and the agency retains responsibility or supervision of the
child, the child should be considered discharged from foster care only if the trial home visit was
longer than 6 months, and there was no court order extending the trial home visit beyond 6 months.
If the child is in foster care but has not yet been discharged, select Not Yet Discharged.

•

If the case is an in-home services case, K is Not Applicable.

•

Child and Family Services Reviews Onsite Review Instrument

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Onsite Review Instrument: Face Sheet

L.

What is the date of the most recent case closure during the period under review?

------/-------/----------------

Case not closed by time of review 

Question L Instructions:
•
•
•

M.

Using the MM/DD/YYYY format, enter the date on which the agency officially closed the case. For
foster care cases, this may or may not be the same as the discharge date.
If there were multiple case openings and closures during the period under review, indicate the date of
the last case closure that occurred during the period.
If the case is still open at the time of review, select “Case not closed by time of review.

Why was/were the case(s) opened for services?

 Physical abuse
 Sexual abuse
 Emotional maltreatment
 Neglect (not including medical
neglect)
 Medical neglect

 Abandonment
 Mental/physical health of parent
 Mental/physical health of child
 Substance abuse by parent(s)
 Child’s behavior
 Substance abuse by child

 Domestic violence in child’s
home
 Child in juvenile justice system
 Other (specify)

Question M Instructions:
Indicate the reason(s) for case opening(s) by selecting all that apply. Consider all cases open during the
period under review.

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.

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Child and Family Services Reviews Onsite Review Instrument

Section I: Safety Outcome 1

SECTION I: SAFETY
SAFETY OUTCOME 1: CHILDREN ARE, FIRST AND FOREMOST,
PROTECTED FROM ABUSE AND NEGLECT.
Item 1: Timeliness of Initiating Investigations of Reports of Child Maltreatment
Purpose of Assessment: To determine whether responses to all accepted child maltreatment reports
received during the period under review were initiated, and face-to-face contact with the child(ren)
made, within the time frames established by agency policies or state statutes.
Item 1 Applicable Cases:
•

•

Cases are applicable for an assessment of this item if an accepted child maltreatment report on any
child in the family was received during the period under review. “Accepted” means that the report
was assigned to the agency to conduct an assessment or investigation. This includes reports
assigned for an “alternative response” assessment. Reports that are screened out are not
considered “accepted.” “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.
Cases are Not Applicable for an assessment of this item if, during the period under review, there were
no accepted child maltreatment reports on any child in the family that were referred for an
assessment or investigation.

Is this case applicable?
Select the appropriate response below. If the response is No, rate the case as Not Applicable in the ratings
section and continue to item 2.
Yes 

No 

Child and Family Services Reviews Onsite Review Instrument

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Section I: Safety Outcome 1

A1. Reports Table
Report
Date

First
Name of
Child

Allegation

Priority
Level (if
applicable)

Assessment
or
Investigation

Date
Assigned for
an
Investigation
or
Assessment

Date
Investigation
or
Assessment
Initiated

Date of
Face-to-Face
Contact With
Child

Relationship
of Alleged
Perpetrator
to Child

Disposition

Table 1A1 Instructions:
•
•
•
•

Complete the table for all accepted reports received during the period under review.
If the state has policies outlining different priority levels for reports, indicate the priority level that was assigned.
Indicate whether the report was assigned for an investigation or referred for an assessment.
The date assigned for an investigation or assessment is the date the report is assigned to a specific worker to conduct the investigation
or assessment.
• The date the investigation or assessment was initiated is the date on which the agency made the first attempt to contact the family.
• In the last column, report the disposition of the case. If the case was investigated, indicate whether the report was “Substantiated” or
“Not Substantiated” (this may be documented in the record as “founded” or “unfounded,” or “indicated” or “not indicated”). If the
investigation has not been completed as of the time of review, indicate “Investigation Pending.” If the case was referred for an
assessment, indicate whether it was “opened for services” or “not opened for services.” If the assessment has not yet been completed,
indicate “Assessment Still Pending.”

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Child and Family Services Reviews Onsite Review Instrument

Section I: Safety Outcome 1

A. In how many of the reports listed in the table was the investigation or assessment NOT initiated
in accordance with the state’s time frames and requirements for a report of that priority?
____________

B. In how many of the reports in the table was face-to-face contact with the child(ren) who is (are)
the subject of the report NOT made in accordance with the state’s time frames and requirements for a
report of that priority?
_____________

C. For all reports identified in A and B, were the reasons for the delays due to circumstances
beyond the control of the agency?
Yes 

No 

NA 

Explain the reason for any delays related to reports identified in A and B in the narrative field below.

Question 1C Instructions:
• If the answers to both questions A and B are zero, the answer to question C should be Not
Applicable.
• Delays in services provided by organizations or agencies under contract with the agency would
not be considered to be beyond the control of the agency. However, where services are provided
by another public state or local agency, such as law enforcement, the actions of these agencies
may be beyond the control of the child welfare agency.
Item 1 Rating Criteria:
Item 1 should be rated as a Strength if either of the following applies:
• The answers to A and B are zero.
• The answers to A or B are greater than zero, but the answer to C is Yes.
Item 1 should be rated as an Area Needing Improvement if the following applies:
•

The answer to A or B is greater than zero, and the answer to C is No.

Item 1 should be rated as Not Applicable if the response to the question of applicability is No.
Item 1 Rating (select one):
Strength 

Area Needing Improvement 

NA 

Provide any additional comments that highlight strengths or challenges related to specific practices,
systemic issues, or resources that affected this item in the narrative field below:

Child and Family Services Reviews Onsite Review Instrument

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Section I: Safety Outcome 1

RATING SAFETY OUTCOME 1
SAFETY OUTCOME 1: CHILDREN ARE, FIRST AND FOREMOST,
PROTECTED FROM ABUSE AND NEGLECT.
What is the level of outcome achievement that best describes the extent to which this outcome is being or has
been achieved, based on the rating for item 1?

Instructions:
Safety Outcome 1 should be rated as Substantially Achieved if the following applies:
• Item 1 is rated as a Strength.
Safety Outcome 1 should be rated as Not Achieved if the following applies:
• Item 1 is rated as an Area Needing Improvement.
Safety Outcome 1 should be rated as Not Applicable if the following applies:
• Item 1 is rated as Not Applicable.
Select the appropriate response:
Substantially Achieved 

10

Not Achieved 

NA 

Child and Family Services Reviews Onsite Review Instrument

Section I: Safety Outcome 2

SAFETY OUTCOME 2: CHILDREN ARE SAFELY MAINTAINED IN THEIR HOMES
WHENEVER POSSIBLE AND APPROPRIATE.
Item 2: Services to Family to Protect Child(ren) in the Home and Prevent Removal or
Re-Entry Into Foster Care
Purpose of Assessment: To determine whether, during the period under review, the agency made concerted
efforts to provide services to the family to prevent children’s entry into foster care or re-entry after a
reunification.
Item 2 Applicable Cases: In the list of criteria below, check Yes for any that apply and No for any that do not
apply. A case is applicable for an assessment of this item if it meets at least one of the following criteria:
•
•
•
•
•

It is an in-home services case and the reviewer determines that there are concerns regarding the safety of
at least one child in the family during the period under review. Yes  No 
It is an in-home services case and services were provided for children at risk of foster care placement to
remain safely in their homes. Yes  No 
It is a foster care case and the child entered foster care during the period under review due to safety
concerns. Yes  No 
It is a foster care case and the child was reunified during the period under review or was returned home on
a trial basis, and the reviewer determines that there are concerns regarding the safety of that child in the
home. Yes  No 
It is a foster care case, and although the target child entered foster care before the period under review
and remained in care for the entire period under review, there are other children in the home and the
reviewer determines that there are concerns regarding the safety of those children during the period under
review. Yes  No 

However, a case is not applicable for an assessment of this item if it meets the following criterion, even if the
case is applicable based on the criteria above:
•

Only a safety plan was needed to ensure the child(ren)’s safety and no safety-related services were
necessary based on the circumstances of the case. (In this situation, item 2 would be Not Applicable and
the safety plan would be assessed in item 3.) Yes  No 

Is this case applicable?
Select the appropriate response below. If the response is No, rate the case as Not Applicable in the ratings
section and continue to item 3.
Yes 

No 

A.

For the period under review, did the agency make concerted efforts to provide or arrange for appropriate
services for the family to protect the children and prevent their entry into foster care or re-entry into foster care
after a reunification? (Be sure to assess the entire period under review.)
Yes 

No 

If No, explain any concerns in the narrative field below.

Child and Family Services Reviews Onsite Review Instrument

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Section I: Safety Outcome 2

Question 2A Definitions:
“Appropriate services,” for the purposes of item 2, are those that are provided to, or arranged for, the family
with the explicit goal of ensuring the child’s safety. Examples include: (1) if there are safety issues in the
home due to environmental hazards, homemaking services could be an appropriate safety-related service;
(2) if there are safety concerns related to the parent’s ability to manage specific child needs or child
behaviors, intensive in-home services could be an appropriate safety-related service; (3) child care services
could be a safety-related service in cases where the child was being cared for in an unsafe setting or by an
inappropriate caregiver; and (4) if there are safety concerns related to parental substance abuse, substance
abuse treatment could be an appropriate safety-related service. In most cases a child’s need for mental
health services, education-related services, or services to address health issues, would not be considered
relevant to the child’s safety if the child remained in the home. The agency’s efforts to meet those service
needs are assessed in other items.
“Concerted efforts,” for the purposes of item 2, refers to facilitating a family’s access to needed services and
working to engage the family in those services.
Question 2A Instructions:
• In answering question A, focus only on whether the agency made concerted efforts to provide
appropriate and relevant services to the family to address the safety issues in the family so that the child
could remain safely in the home or would not re-enter foster care after reunification. Concerns about
monitoring service participation and safety planning and assessment of progress made will be captured
in item 3.
• If the agency removed the child from the home without making concerted efforts to provide services, the
answer to question A should be No, even if the agency determined that it was necessary to remove the
child for safety reasons. This issue will be addressed in question B.

B.

If, during the period under review, any child was removed from the home without providing or arranging
for services, was this action necessary to ensure the child’s safety?
Yes 

No 

NA 

If No, explain any concerns in the narrative field below.

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Child and Family Services Reviews Onsite Review Instrument

Section I: Safety Outcome 2

Question 2B Instructions:
•
•
•

•

If the answer to question A is Yes, but, after making efforts to provide services, the child was removed
from the home during the period under review due to unmanageable safety concerns, the answer to
question B should be Not Applicable.
If the child was not removed from the home during the period under review, the answer to question B
should be Not Applicable.
Focus on whether the circumstances of the case and of the removal suggest that services would not
have been able to ensure the child’s safety if the child remained in the home. If the information
indicates that it was necessary to remove the child immediately to ensure the child’s safety, the answer
to question B should be Yes. If the information indicates that services could have been provided to
prevent removal but the child was removed without providing those services, this question should be
answered No.
If services should have been offered to protect the child, but were not because those services were not
available in the community, the answer to question B should be No.

Item 2 Rating Criteria:
This item should be rated as a Strength if either of the following applies:
• The answer to question A is Yes, and the answer to question B is Not Applicable.
• The answer to question A is No, and the answer to question B is Yes.
This item should be rated as an Area Needing Improvement if either of the following applies:
• The answer to question A is No, and the answer to question B is No.
• The answer to question A is No, and the answer to question B is Not Applicable.
Item 2 should be rated as Not Applicable if the response to the question of applicability is No.
Item 2 Rating (select one):
Strength 

Area Needing Improvement 

NA 

Provide any additional comments that highlight strengths or challenges related to specific practices, systemic
issues, or resources that affected this item in the narrative field below:

Child and Family Services Reviews Onsite Review Instrument

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Section I: Safety Outcome 2

SAFETY OUTCOME 2: CHILDREN ARE SAFELY MAINTAINED IN THEIR HOMES
WHENEVER POSSIBLE AND APPROPRIATE.
Item 3: Risk and Safety Assessment and Management
Purpose of Assessment: To determine whether, during the period under review, the agency made concerted
efforts to assess and address the risk and safety concerns relating to the child(ren) in their own homes or
while in foster care.
Item 3 Applicable Cases: All cases are applicable for an assessment of this item.

A1.
•

Did any of the following concerns exist during the period under review?

There were maltreatment allegations about the family but they were never formally reported or formally
investigated/assessed. Yes  No 
There were maltreatment allegations that were not substantiated despite evidence that would support
No 
substantiation. Yes 

•

A.

If the case was opened during the period under review, did the agency conduct an initial assessment that
accurately assessed all risk and safety concerns for the target child in foster care and/or any child(ren) in the
family remaining in the home?
Yes 

No 

NA 

If No, explain any concerns in the narrative field below.

Questions 3A and 3B Definitions:
• “Risk” is defined as the likelihood that a child will be maltreated in the future.
•

An assessment of safety is made to determine whether a child is in a safe environment. A safe
environment is one in which there are no threats that pose a danger or, if there are threats, there is a
responsible adult in a caregiving role who demonstrates sufficient capacity to protect the child.

•

“Target child” is defined as the child in a foster care case who is the subject of the case.

Questions 3A and 3B Instructions:
•
•
•
•

For foster care cases, questions A and B should be answered for the target child in foster care and any
children remaining in the home.
For in-home services cases, questions A and B should be answered for all children in the home.
In responding to questions A and B, consider any concerns selected in 3A1.
Question A should be answered Not Applicable if the case was opened before the period under review.

B.

During the period under review, did the agency conduct ongoing assessments that accurately assessed
all of the risk and safety concerns for the target child in foster care and/or any child(ren) in the family remaining
in the home?
Yes 

14

No 

NA 

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Section I: Safety Outcome 2
If No, explain any concerns in the narrative field below.

Question 3B Instructions:
• In responding to question B, determine whether ongoing assessments (formal or informal) were
conducted during the period under review. If the agency conducted an initial assessment of risk and
safety at the onset of the case, but did not assess for risk and safety concerns on an ongoing basis and
at critical times in the case (for example, when there were new allegations of abuse or neglect,
changing family conditions, new people coming into the family home or having access to the children,
changes to visitation, upon reunification, or at case closure) then the answer to question B should be
No.
• Note that in some cases that were opened during the period under review, the issue of ongoing
assessments may not be relevant because the case was opened for a very short period of time (for
example, if the case was opened shortly before the end of the period under review and during the initial
assessment the agency determined that there were no risk or safety concerns, then it may be
reasonable to conclude that the agency would not have conducted a second risk and safety
assessment during the period under review). If the case was opened during the period under review
and you believe that ongoing assessments were not necessary given the time frame and circumstances
of the case, question B may be answered Not Applicable.
• If a case was closed during the period under review, determine whether the agency conducted a risk
and safety assessment before closing the case. If not, the answer to question B should be No.

C. During the period under review, if safety concerns were present, did the agency: (1) develop an
appropriate safety plan with the family and (2) continually monitor and update the safety plan as needed,
including monitoring family engagement in any safety-related services?
Yes 

No 

NA 

If No, explain any concerns in the narrative field below.

Questions 3C and 3D Definition:
“Safety plan” refers to a plan that describes strategies developed by the agency and family to ensure that
the child(ren) is (are) safe. Safety plans should address (1) safety threats and how those will be managed
and addressed by the caregiver, (2) caregiver capacity to implement the plan and report safety issues to
the agency, and (3) family involvement in implementation of the plan. Safety plans may be separate from
or integrated into the case plan.
Questions 3C and 3D Instructions:
•
•

Questions C and D are applicable to all in-home services cases and to foster care cases in which there
are other children remaining in the family home, and/or the target child in foster care returned home
during the period under review.
Questions C and D should be answered Not Applicable if the reviewer determines that during the
period under review there were no apparent safety concerns for any child in the family home.

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Section I: Safety Outcome 2

D1.

Indicate whether any safety-related incidents occurred during the period under review. Select all that
apply:
 Recurring maltreatment: There was at least one substantiated or indicated maltreatment report on any
child in the family during the period under review AND there was another substantiated report within a
6-month period before or after that report that involved the same or similar circumstances. In
determining the similarity of the circumstances, consider the perpetrator of the maltreatment and other
individuals involved in the incident.
 Recurring safety concerns: There was at least one maltreatment report involving any child in the family
during the period under review that was handled by an alternative response and resulted in opening the
case for services to address safety concerns (this decision may have been made by the agency or by a
private provider under contract with the agency) AND there was at least one additional maltreatment report
within a 6-month period before or after that report that was handled by an alternative response and resulted
in a decision to open the case for services to address the same or similar safety concerns (the case
may have been opened for services by the agency or by a private provider under contract with the agency).
In determining the similarity of the concerns, consider the perpetrator of the maltreatment, other individuals
involved in the incident, and the type of safety issues that existed.
 The case was closed while significant safety concerns that were not adequately addressed still existed in
the home.
 Other (describe any other safety-related incidents that were not adequately addressed by the agency):
___________________________________________________________________________________.
 No safety-related incidents occurred that were not adequately addressed by the agency.
 NA (no safety issues were present during the period under review).

D.

During the period under review, were there safety concerns pertaining to any child(ren) in the family
remaining in the home that were not adequately or appropriately addressed by the agency?
Yes 

No 

NA 

Question 3D Instruction:
•
•
•

Answer Yes if any safety-related incidents in D1 are selected.
Answer No if no safety-related incidents occurred that were not adequately addressed by the agency.
Answer NA if no safety issues were present during the period under review.

E1.

For foster care cases only, indicate whether any safety concerns related to visitation were present during
the period under review. Select all that apply:
 NA (this is an in-home services case, or the target child did not have any visitation).
 Sufficient monitoring of visitation by parents/caretakers or other family members was not ensured.
 Unsupervised visitation was allowed when it was not appropriate.
 Visitation was court-ordered despite safety concerns that could not be controlled with supervision.
 Other (describe the safety concerns that existed with visitation):___________________________
 No safety concerns related to visitation were present

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Section I: Safety Outcome 2

E.

During the period under review, was there a safety concern related to the target child in foster care
during visitation with parents/caretakers or other family members?

Yes 

No 

NA 

Question 3E Instructions:
• Select Not Applicable if this is not a foster care case.
• Answer Yes if any safety concerns in E1 are selected.
• If no safety concerns were identified in E1, answer No.
• If the child does not have visits with parents/caretakers or with other family members, select Not
Applicable.

F1. For foster care cases only, indicate whether any concerns existed for the child in at least one foster care
placement during the period under review. Select all that apply:
 NA (this is an in-home services case).
 There was a substantiated allegation of maltreatment of the child by a foster parent (including a relative
foster parent) or facility staff member that could have been prevented if the agency had taken appropriate
actions.
 There was a critical incident report or other major issue relevant to noncompliance by foster parents or
facility staff that could potentially make the child unsafe, and the agency could have prevented it or did not
provide an adequate response after it occurred.
 The child’s placement during the period under review presented other risks to the child that are not being
addressed, even though no allegation was made and no critical incident reports were filed.
 You discover that there are safety concerns related to the child in the foster home of which the agency is
unaware because of inadequate monitoring.
 Other (describe any other safety concerns that existed with the child’s foster
placement):__________________
 No concerns existed for the target child while in foster care placement that were not adequately
addressed.
Questions 3F1 and 3F Definition:
Foster parents are defined as related or non-related caregivers who have been given responsibility for
care of the child by the agency while the child is under the placement and care responsibility and
supervision of the agency. This includes pre-adoptive parents if the adoption has not been finalized.

F.

For foster care cases only, during the period under review, was there a concern for the target child’s
safety related to the foster parents, members of the foster parents’ family, other children in the foster home or
facility, or facility staff members, that was not adequately or appropriately addressed by the agency?
Yes 

No 

NA 

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Section I: Safety Outcome 2

Question 3F Instructions:
•
•
•

Answer Not Applicable if this is not a foster care case.
Answer No if no unaddressed concerns were noted in F1.
Answer Yes if you determine that, during the period under review, the child was in at least one foster
care placement in which he or she was unsafe, and appropriate action was not taken (such as
providing closer monitoring of the placement, placing fewer children in the home, providing services
to address potential problems or existing problems, or finding a more appropriate placement). If any
concerns are selected in F1, question F should be answered Yes.

Item 3 Rating Criteria
Item 3 should be rated as a Strength if the following applies:
• Questions A and B are both answered Yes, or
• The answer to either A or B is Yes and the other is Not Applicable, and
• The answer to question C is either Yes or Not Applicable, and
• The answers to questions D, E, and F are either No or Not Applicable.
Item 3 should be rated as an Area Needing Improvement if the following applies:
• The answer to any one of questions A, B, or C is No, and/or
• The answer to any one of questions D, E, or F is Yes.
There are no circumstances under which item 3 could be rated as Not Applicable.
Item 3 Rating (select one):
Strength 

Area Needing Improvement 

Provide any additional comments that highlight strengths or challenges related to specific practices, systemic
issues, or resources that affected this item in the narrative field below:

18

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Section I: Safety Outcome 2

RATING SAFETY OUTCOME 2
SAFETY OUTCOME 2: CHILDREN ARE SAFELY MAINTAINED IN THEIR HOMES
WHENEVER POSSIBLE AND APPROPRIATE.
What is the level of outcome achievement that best describes the extent to which this outcome is being or has
been achieved, based on the ratings for items 2 and 3?

Instructions:
Safety Outcome 2 should be rated as Substantially Achieved if either of the following applies:
• Items 2 and 3 are rated as Strengths.
• Item 2 is rated as Not Applicable and Item 3 is rated as a Strength.
Safety Outcome 2 should be rated as Partially Achieved if the following applies:
• One of the two items is rated as a Strength and the other as an Area Needing Improvement.
Safety Outcome 2 should be rated as Not Achieved if either of the following applies:
• Items 2 and 3 are rated as Areas Needing Improvement.
• Item 2 is rated as Not Applicable and Item 3 is rated as an Area Needing Improvement.
Select the appropriate response:
Substantially Achieved 

Partially Achieved 

Child and Family Services Reviews Onsite Review Instrument

Not Achieved 

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Section II: Permanency Outcome 1

SECTION II: PERMANENCY
PERMANENCY OUTCOME 1: CHILDREN HAVE PERMANENCY AND STABILITY
IN THEIR LIVING SITUATIONS.
Item 4: Stability of Foster Care Placement
Purpose of Assessment: To determine whether the child in foster care is in a stable placement at the time of
the onsite review and that any changes in placement that occurred during the period under review were in the
best interests of the child and consistent with achieving the child’s permanency goal(s).
Item 4 Applicable Cases: All foster care cases are applicable for an assessment of this item.

A1. Placement Table
Placement
Date

20

Placement Type

Reason for Change in Placement Setting

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Section II: Permanency Outcome 1

Table 4A1 Definitions and Instructions:
Complete the placement table. Begin with the child’s placement setting at the onset of the period under
review, or if the child entered foster care during the period under review, begin with the first placement
setting at entry into foster care. If there was only one placement setting, complete only the first two
columns of the first row.
Select from the following options for placement type. Definitions for each placement type are provided:
•
•
•
•
•

•

Pre-Adoptive Home—A home in which the family intends to adopt the child. The family may or may not
be receiving a foster care payment or an adoption subsidy on behalf of the child.
Foster Family Home (Relative)—A licensed or unlicensed home of the child's relatives regarded by the
title IV-E agency as a foster care living arrangement for the child.
Foster Family Home (Non-Relative)—A licensed foster family home regarded by the title IV-E agency as
a foster care living arrangement.
Group Home—A licensed or approved home providing 24-hour care for children in a small group setting
that generally has from seven to twelve children.
Institution—A child care facility operated by a public or private agency and providing 24-hour care
and/or treatment for children who require separation from their own homes and group living experience.
These facilities may include child care institutions, residential treatment facilities, maternity homes, etc.
Supervised Independent Living—An alternative transitional living arrangement where the child is under
the supervision of the agency but without 24-hour adult supervision, is receiving financial support from
the child welfare agency, and is in a setting that provides the opportunity for increased responsibility for
self-care.

Select from the following options for reason for change in placement setting:
•
•
•
•
•
•
•
•

Move to an adoptive or permanent guardian’s home
Move from a more restrictive to a less restrictive placement
Move from a less restrictive to a more restrictive placement
Move to a relative placement
Move that brings the child closer to family or other important connections
Move to a temporary placement while awaiting a more appropriate placement
Move due to foster parent’s request
Other (describe)________________________

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Section II: Permanency Outcome 1

A.

How many placement settings did the child experience during the period under review?

________________
Question 4A Definitions:
•

•

•

“Placement setting” refers to a physical setting in which a child resides while in foster care under the
placement and care responsibility of the agency. A new placement setting would result, for example,
when a child moves from one foster family home to another or to a group home or institution. If,
however, a foster family with whom a child is placed moves and the child moves with them, this does
not constitute a change in placement.
“Entry into foster care” refers to a child’s removal from his or her normal place of residence and
placement in a substitute care setting under the placement and care responsibility of the state or local
title IV-B/IV-E agency. Children are considered to have entered foster care if the child has been in
substitute care for 24 hours or more.
“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 or her normal place of residence, resulting in his or her placement in a
foster care setting and ending upon the child’s discharge from foster care.

Question 4A Instructions:
•

•

If there were multiple episodes of foster care during the period under review, add up the placement
settings within each episode. If there is a re-entry into foster care and the child is placed in a different
placement setting at the time of re-entry, then it would count as a new placement setting. If the child
returns to the placement setting he or she was in before the return home, then it would not count as a
new placement setting.
Do not consider the following as placement settings: (1) a trial home visit; (2) a runaway episode; (3)
temporary absences 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); (4) hospitalization for medical treatment, acute psychiatric episodes, or
diagnosis; (5) respite care; (6) day or summer camps; and (7) locked facilities (for example, when a
youth is held in detention).

B. Were all placement changes during the period under review planned by the agency in an effort to
achieve the child’s case goals or to meet the needs of the child?
Yes 

22

No 

NA 

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Section II: Permanency Outcome 1
Question 4B Instructions:
•

If the response to question A is one (1), then the response to question B should be Not Applicable. If
the single placement is not stable, that information will be collected in question C.
Placement changes that reflect agency efforts to achieve case goals include moves from a foster home
to an adoptive home, moves from a more restrictive to a less restrictive placement, moves from nonrelative foster care to relative foster care, and moves that bring the child closer to family or community.
Placement changes that do not reflect agency efforts to achieve case goals include moves due to
unexpected and undesired placement disruptions; moves due to placing the child in an inappropriate
placement (that is, moves based on mere availability rather than on appropriateness); moves to more
restrictive placements when this is not essential to achieving a child’s permanency goal or meeting a
child’s needs; temporary placements while awaiting a more appropriate placement; and practices of
routinely placing children in a particular placement type, such as shelter care, upon initial entry into
foster care regardless of individual needs.
If ALL placement changes during the period under review reflect planned agency efforts to achieve the
child’s case goals or meet the needs of the child, then the answer to question B should be Yes.
If any single placement change that occurred during the period under review was for a reason other
than agency efforts to achieve case goals or to meet the child’s needs, the answer to question B should
be No.
Placement changes that occur as a result of unexpected circumstances that are out of the control of the
agency (such as the death of a foster parent or foster parents moving to another state) can be
considered similar to those that reflect agency efforts to achieve case goals for purposes of question B.

•
•

•
•
•

C1.

Indicate whether any of the circumstances below apply to the child’s current placement. Select all that
apply:

 The child’s current placement is in a temporary shelter or other temporary setting.
 There is information indicating that the child’s current substitute care provider may not be able to





continue to care for the child.
There are problems in the current placement threatening its stability that the agency is not addressing.
The child has run away from this placement more than once in the past, or is in runaway status at the
time of the review.
Other (describe reasons why the current placement is not stable): _____________________________
None apply, placement is stable.

C. Is the child’s current placement setting (or most recent placement if the child is no longer in foster care)
stable?
Yes 

No 

Question 4C Instruction:
If any of the circumstances in C1 apply to the child’s current placement, the answer to question C should be
No.

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Section II: Permanency Outcome 1
Item 4 Rating Criteria:
Item 4 should be rated as a Strength if either of the following applies:
•

The answer to question A is one (1), the answer to question B is Not Applicable, and the answer to
question C is Yes.

•

The answer to question A is greater than one (1), but the answers to questions B and C are Yes.

Item 4 should be rated as an Area Needing Improvement if either of the following applies:
•

The answer to question A is one (1), but the answer to question C is No.

•

The answer to question A is greater than one (1), and the answer to question B and/or C is No.

Item 4 Rating (select one):
Strength 

Area Needing Improvement 

Provide any additional comments that highlight strengths or challenges related to specific practices, systemic
issues, or resources that affected this item in the narrative field below:

24

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Section II: Permanency Outcome 1

PERMANENCY OUTCOME 1: CHILDREN HAVE PERMANENCY AND STABILITY
IN THEIR LIVING SITUATIONS.
Item 5: Permanency Goal for Child
Purpose of Assessment: To determine whether appropriate permanency goals were established for the child
in a timely manner.
Item 5 Applicable Cases: All foster care cases are applicable for assessment of this item, unless the child has
not been in foster care long enough (at least 60 days) for the agency to have developed a case plan and
established a permanency goal. If the child has been in foster care for less than 60 days, but a permanency
goal has been established, the case is applicable for assessment.
Is this case applicable?
Select the appropriate response. If the response is No, rate the item as Not Applicable in the rating section
and continue to item 6.
Yes 

No 

A1. Permanency Goal Table

Permanency Goal

Date
Established

Time in Foster
Care Before
Goal
Established

Date
Goal
Changed

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Reason for Goal Change

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Section II: Permanency Outcome 1

Table 5A1 Definitions:
Permanency goals are defined as follows:
•
•

•
•

A goal of reunification is defined as a plan for the child to be discharged from foster care to his or her
parents or primary caretaker.
A goal of guardianship is defined as a plan for the child to be discharged from foster care to a legally
established custody arrangement with an individual that is intended to be permanent. This could include
permanent placement with a relative.
A goal of adoption is defined as a plan for the child to be discharged from foster care to the care and
custody of adoptive parents through a legal adoption.
A goal of other planned permanent living arrangement refers to a situation in which the agency
maintains placement and care responsibility for, and supervision of, the child, and places the child in a
setting in which the child is expected to remain until adulthood. Examples of these “permanent” living
arrangements include situations where foster parents have made a formal commitment to care for the
child until adulthood, the child is with relatives who plan to care for the child until adulthood, the child is
in a long-term care facility to meet special needs and will be transferred to an adult facility at the
appropriate time, the child is an older adolescent in a stable group home and both the group home
directors and the child have agreed that it will be the child’s placement until adulthood, or the child is in
agency-supervised transitional living.

Table 5A1 Instructions:
Complete the table for each of the permanency goals in place during the period under review. Begin with
the child’s first permanency goal in place during the period under review, and end with the current or latest
permanency goal or goals. If no permanency goal is specified in the case file, but the caseworker indicates
that a permanency goal has been established reviewers should consider that goal. If two concurrent
permanency goals have been established and are identified in the case plan, identify both goals in the
table.

A2.

What is (are) the child’s current permanency goal(s)? (If concurrent permanency goals have been
established in the case plan, identify both goals.) Or, if the case was closed during the period under review,
what was the permanency goal before the case was closed?
Permanency Goal 1: ____________________
Permanency Goal 2 (if applicable): _______________________

A3.

Is (are) the child’s permanency goal(s) specified in the case file?

Yes 

No 

NA 

Question 5A3 Instructions:
•
•

26

If the child has been in foster care less than 60 days and the goal is not specified in the case file, A3
should be answered NA.
If the permanency goal(s) is (are) not specified anywhere in the case file, such as in the case plan or in
a court order, then the answer to question A3 should be No.

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Section II: Permanency Outcome 1

B.

Were all the permanency goals that were in effect during the period under review established in a timely
manner?
Yes 

No 

NA 

If No, explain any concerns in the narrative field below.

Question 5B Instructions:
•
•

•

If the child has been in foster care less than 60 days, question B should be answered NA.
Answer this question based on your professional judgment regarding the timeliness of establishing the
goal, particularly with regard to changing a goal. For children who recently entered care, expect the
first permanency goal to have been established no later than 60 days from the date of the child’s entry
into foster care, consistent with the federal requirement. For children whose goal was changed from
reunification to adoption, consider the guidelines established by the federal Adoption and Safe
Families Act regarding seeking termination of parental rights, which might affect the timeliness of
changing a goal from reunification to adoption.
Answer this question for all permanency goals in effect during the period under review. If there are
concurrent goals, the answer should apply to both goals. For example, if there are concurrent goals of
reunification and adoption, and you believe that the reunification goal was established in a timely
manner, but the adoption goal was not, the answer to question B should be No.

C.

Were all permanency goals in effect during the period under review appropriate to the child’s needs for
permanency and to the circumstances of the case?
Yes 

No 

If No, explain any concerns in the narrative field below.

Question 5C Instructions:
•
•
•

Answer this question based on your professional judgment regarding the appropriateness of the
permanency goal.
Consider the factors that the agency considered in deciding on the permanency goal and whether all of
the relevant factors were evaluated.
If one of the goals is other planned permanent living arrangement and the reviewer determines that the
goal was established without a thorough consideration of other permanency goals, then the answer to
question C should be No.

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Section II: Permanency Outcome 1

D.

Has the child been in foster care for at least 15 of the most recent 22 months?

Yes 

No 

Question 5D Instruction:
•

E.

In answering question D, begin the “count” with the date of the judicial finding of child abuse and
neglect (usually the adjudicatory hearing) or 60 days after the child’s entry into foster care, whichever
is earlier. If the child had multiple episodes in care over the past 22 months, the determination of
whether the child had been in care for at least 15 months should be calculated cumulatively over the
episodes in foster care during the past 22 months from the review date.
Does the child meet other Adoption and Safe Families Act criteria for termination of parental rights?

Yes 

No 

NA 

Question 5E Definitions:
The Adoption and Safe Families Act requires an agency to seek termination of parental rights when the
child has been in care for at least 15 of the most recent 22 months, or a court of competent jurisdiction
has determined that:
• The child is an abandoned infant, or
• The child’s parents have been convicted of one of the felonies designated in Section 475(5)(E) of the
Social Security Act: (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
resulted in serious bodily injury to the child or another child of the parent.
Question 5E Instructions:
•
•
•

If the answer to question D is Yes, the answer to question E should be Not Applicable.
Question E must be answered if the answer to question D is No.
If any of the conditions noted above apply to the case under review, question E should be answered
Yes.

F. Did the agency file or join a termination of parental rights petition before the period under review or in a
timely manner during the period under review?
Yes 

No 

NA 

Question 5F Instructions:
•

If the answers to both questions D and E are No, the answer to question F should be Not Applicable.

•

Review the case file for evidence of petitioning for termination of parental rights. If there is no evidence
of this in the file, then ask the caseworker for documentation regarding petitioning for termination of
parental rights. If there is no evidence in the file or other documentation, then question F should be
answered No.

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Section II: Permanency Outcome 1

G1.

Indicate whether any of the following exceptions to the termination of parental rights requirement apply.
NA 
(1) At the option of the state, the child is being cared for by a relative at the 15/22-month time frame.
Yes 
No
(2) The agency documented in the case plan a compelling reason for determining that termination of
parental rights would not be in the best interests of the child.
Yes 
No
(3) The state has not provided to the family the services that the state deemed necessary for the safe return
of the child to the child’s home.
Yes 
No

Question 5G1 Instruction:
If the answer to question F is Yes or Not Applicable, then question G1 should be answered Not
Applicable.

G.

Did an exception to the requirement to file or join a termination of parental rights petition exist?

Yes 

No 

NA 

Question 5G Instructions:
•
•
•

If the answer to question F is Yes or Not Applicable, then question G should be answered Not
Applicable.
If any answers to G1 are yes, question G should be answered Yes.
If, during an interview, the caseworker provides a compelling reason for not seeking termination of
parental rights, but cannot provide any documentation, then question G should be answered No.

Item 5 Rating Criteria:
Item 5 should be rated as a Strength if any one of the following criteria apply:
• The answers to questions A3, B, and C are Yes or NA, and the answers to questions D and E are No.
• The answers to questions A3, B, and C are Yes or NA, and D and F are Yes.
• The answers to questions A3, B, and C are Yes or NA, the answer to question D is No, and the
answers to questions E and F are Yes.
• The answers to questions A3, B, and C are Yes or NA, the answer to question D or E is Yes, the
answer to question F is No, and the answer to question G is Yes.
Item 5 should be rated as an Area Needing Improvement if any of the following apply:
• The answer to question A3, B, or C is No.
• The answers to questions A3, B, and C are Yes or NA, but the answer to question D or E is Yes, and
the answers to questions F and G are No.
Item 5 should be rated as Not Applicable if the response to the question of applicability is No.

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Section II: Permanency Outcome 1
Item 5 Rating (select one):
Strength 

Area Needing Improvement 

NA 

Provide any additional comments that highlight strengths or challenges related to specific practices, systemic
issues, or resources that affected this item in the narrative field below:

30

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Section II: Permanency Outcome 1

PERMANENCY OUTCOME 1: CHILDREN HAVE PERMANENCY AND STABILITY
IN THEIR LIVING SITUATIONS.
Item 6: Achieving Reunification, Guardianship, Adoption, or Other Planned Permanent
Living Arrangement
Purpose of Assessment: To determine whether concerted efforts were made, or are being made, during the
period under review to achieve reunification, guardianship, adoption, or other planned permanent living
arrangement.
Item 6 Applicable Cases: All foster care cases are applicable for this item.

A1.

What is the date of the child’s most recent entry into foster care?

------/-------/---------------Question 6A1 Definition and Instruction:
•

•

“Entry into foster care” refers to a child’s removal from his or her normal place of residence and
placement in a substitute care setting under the placement and care responsibility of the state or local
title IV-B/IV-E agency. Children are considered to have entered foster care if the child has been in
substitute care for 24 hours or more.
Using the MM/DD/YYYY format, enter the date of the child’s most recent entry into foster care. This
date should be the same as the date provided in section J on the Face Sheet.

A2.

What is the time in care (in months) at the time of the onsite review?

Question 6A2 Instruction:
Enter the number of months that the child was in foster care, from (1) the date of the most recent entry
into foster care to the date the case is being reviewed, or (2) from the date of the most recent entry into
foster care to the time of discharge.

A3.
 NA

What is the date the child discharged from foster care?
------/-------/----------------

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Question 6A3 Definition and Instruction:
•

“Discharge from foster care” is defined as the point when the child is no longer in foster care under the
placement and care responsibility or supervision of the agency. If a child returns home on a trial home
visit and the agency retains responsibility or supervision of the child, the child is not considered
discharged from foster care unless the trial home visit is longer than 6 months and there was no court
order extending the trial home visit beyond 6 months.

•

Using the MM/DD/YYYY format, enter the date the child discharged from foster care. This date should
be the same as the date provided in section K on the Face Sheet. If the child was not discharged,
select Not Applicable.

A4. What is (are) the child’s current permanency goal(s)?

(If concurrent permanency goals have been
established in the case plan, identify both goals.) Or, if the case was closed during the period under review,
what was the permanency goal before the case was closed?

Reunification 

Guardianship 

Adoption 

Other planned permanent living arrangement 

Question 6A4 Instruction:
If item 5 was completed, select the same goal or goals identified in question 5A2. If item 5 was not
applicable, refer to the definitions and instructions provided for the table in item 5 A1 in order to determine
the child’s permanency goal(s). For cases in which the child has been in foster care less than 60 days and
no goal is documented, inquire with the caseworker about what the goal is (in most cases it should be
reunification).

B.

During the period under review, did the agency and court make concerted efforts to achieve permanency
in a timely manner?
Yes 

No 

NA 

If No, explain any concerns in the narrative field below:

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Section II: Permanency Outcome 1
Question 6B and 6C Instructions:
•
•

•

If concurrent goals are in place and one of the goals has been, or will likely be, achieved in a timely
manner, answer question B OR C based on the goal that has been or will be achieved.
If concurrent goals are in place (neither of which is other planned permanent living arrangement) but
permanency will not be achieved in a timely manner, answer question B No and indicate in the
documentation specific barriers to implementing concurrent planning.
If concurrent goals are in place and one of the goals is other planned permanent living arrangement but
permanency will not be achieved in a timely manner, answer questions B and C No and indicate in the
documentation specific barriers to implementing concurrent planning.

Question 6B Instructions:
•

If the only goal for the child during the period under review was other planned permanent living
arrangement, select Not Applicable.
• In determining a response to question B, consider the time the child has been in foster care as well as
agency and court efforts. The following time frames for achievement should be considered for each
goal:
─ Reunification: 12 months
─ Guardianship: 18 months
─ Adoption: 24 months
• If the child has been in foster care for more than the suggested time frame (12, 18, or 24 months,
depending on the goal) and the goal has not yet been achieved, then the answer to question B should
be No, unless there are particular circumstances that justify the delay. For example:
─ The permanency goal of reunification has been in place for longer than 12 months, but the child was
physically returned to the parents during or before the 12th month and remained at home on a trial
home visit beyond the 12th month. If you determine that the length of time that the child spent in outof-home care and on the trial home visit was reasonable given the child and family circumstances,
then the item may be rated as a Strength even though the child was not discharged from foster care
until after the 12th month.
─ The permanency goal of adoption has been in place for longer than 24 months but there is evidence
that the agency has made concerted efforts to find an adoptive home for a child with special needs
although an appropriate family has not yet been found, or a pre-adoptive placement disrupted despite
concerted efforts on the part of the agency to support it.
• If you determine that the agency and court could have achieved the permanency goal before the
suggested time frame, but there was a delay due to lack of concerted efforts on the part of the agency or
court during the period under review, then the answer to question B should be No even if the child
achieved the goal within the suggested time frame.

C1. If the child’s current (or most recent) permanency goal is (was) other planned permanent living
arrangement, what is (was) the child’s permanent living arrangement?
 NA
 Placement with a non-relative foster parent until age of majority or extended age
 Placement with a specified relative in foster care until age of majority or extended age
 Placement in a longer-term facility until transition to an adult care facility
 Placement in an independent living program/supervised independent living until age of majority or
extended age
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 Other ____________________________________________________________________
Question 6C1 Instructions:
•
•
•
•
•

If the child’s current (or most recent) permanency goal was not other planned permanent living
arrangement, select Not Applicable.
If the child’s current (or most recent) permanency plan is other planned permanent living arrangement,
select the response that describes the permanent living arrangement for the child.
If the child does not have a permanent living arrangement specified, indicate that in “Other.”
If the child has an arrangement that does not fit any of the options noted in C1, describe it in “Other.”
If the goal for the child is noted as “emancipation/independent living” without a permanent placement
specified, indicate that in “Other.”

C2.

For a child with a goal of other planned permanent living arrangement during the period under review,
what is the date of documentation regarding “permanency” of the child’s living arrangements?

NA 

No Date 

------/-------/----------------

Question 6C2 Definition and Instructions:
•
•
•
•

If the child’s permanency goal is not other planned permanent living arrangement, select Not Applicable.
The date of documentation regarding “permanency” is the date on which there was a court order, signed
agreement, or other method to formalize that the caretaker or a particular facility would provide care for
this child until the child reaches adulthood.
If there is no documentation regarding “permanency” of the child’s living arrangement, select “No Date”.
Using the MM/DD/YYYY format, enter the date of documentation regarding “permanency.”

C.

For a child with a goal of other planned permanent living arrangement during the period under review, did
the agency and court make concerted efforts to place the child in a living arrangement that can be considered
permanent until discharge from foster care?
Yes 

No 

NA 

If No, explain any concerns in the narrative field below:

Question 6C Instructions:
•
•
•

•

34

If the child’s only goal during the period under review was reunification, guardianship, or adoption, select
Not Applicable.
Consider the child’s current living arrangement and whether formal steps were completed to make this
arrangement permanent.
This might include the agency asking foster parents or relatives to agree to and sign a long-term care
commitment, or ensuring that a child who is in a long-term care facility to meet special needs will be
transferred to an adult facility at the appropriate time.
If the child is no longer in foster care, then the answer to question C should be based on the child’s last
placement before leaving foster care.
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Section II: Permanency Outcome 1
Item 6 Item Rating Criteria:
Item 6 should be rated as a Strength if the answer to either question B or C is Yes.
Item 6 should be rated as an Area Needing Improvement if the answer to question B and/or C is No.
Item 6 Rating (select one):
Strength 

Area Needing Improvement 

Provide any additional comments that highlight strengths or challenges related to specific practices, systemic
issues, or resources that affected this item in the narrative field below:

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Section II: Permanency Outcome 1

RATING PERMANENCY OUTCOME 1
PERMANENCY OUTCOME 1: CHILDREN HAVE PERMANENCY AND STABILITY
IN THEIR LIVING SITUATIONS.
What is the level of outcome achievement that best describes the extent to which this outcome is being or has
been achieved, based on the ratings for items 4, 5, and 6?

Instructions:
Permanency Outcome 1 should be rated as Substantially Achieved if either of the following applies:
• Items 4, 5, and 6 are rated as Strengths
• Items 4 and 6 are rated as Strengths and Item 5 is rated as Not Applicable
Permanency Outcome 1 should be rated as Partially Achieved if the following applies:
• At least one of items 4, 5, or 6 is rated as a Strength.
Permanency Outcome 1 should be rated as Not Achieved if either of the following applies:
• All of items 4, 5, and 6 are rated as Areas Needing Improvement.
• Items 4 and 6 are rated as Areas Needing Improvement and Item 5 is rated as Not Applicable.
Select the appropriate response:
Substantially Achieved 

36

Partially Achieved 

Not Achieved 

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Section II: Permanency Outcome 2

PERMANENCY OUTCOME 2: THE CONTINUITY OF FAMILY RELATIONSHIPS AND
CONNECTIONS IS PRESERVED FOR CHILDREN.
Item 7: Placement With Siblings
Purpose of Assessment: To determine whether, during the period under review, concerted efforts were made
to ensure that siblings in foster care are placed together unless a separation was necessary to meet the needs
of one of the siblings.
Item 7 Applicable Cases
Cases applicable for an assessment of this item include all foster care cases in which the child has one or
more siblings who are (or were) also in foster care during the period under review. If the child has no siblings
in foster care during the period under review, the case is Not Applicable for an assessment of this item. For
example, if the child in foster care has an older sibling who was in foster care at one time, but not during the
period under review, this case would be Not Applicable.
Is this case applicable?
Select the appropriate response. If the response is No, rate the item as Not Applicable in the ratings section
and continue to item 8.
Yes 

A.

No 

During the entire period under review, was the child placed with all siblings who also were in foster care?

Yes 

No 

Question 7A Definition and Instruction:
•
•

B.

Siblings are children who have one or more parents in common either biologically, through adoption, or
through the marriage of their parents, and with whom the child lived before his or her foster care
placement, or with whom the child would be expected to live if the child were not in foster care.
In answering question A, consider only the location of each of the siblings, not the reason for their
location. If the child was placed with siblings for a portion of the period under review, or if the child was
placed with one but not all siblings during the period under review, answer question A No.

If the answer to question A is No, was there a valid reason for the child’s separation from the siblings?

Yes 

No 

NA 

If No, explain any concerns in the narrative field below:

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Question 7B Instructions:
•
•

•
•

If question A was answered Yes, then question B is NA.
Consider the circumstances of the placement of siblings, focusing on whether separation was
necessary to meet the child’s needs. For example, were siblings separated temporarily because one
sibling needed a specialized treatment or to be in a treatment foster home, or because one sibling was
abusive to the other, or because siblings with different biological parents were placed with different
relatives?
If the separation of siblings is attributed by the agency to a lack of foster homes willing to take sibling
groups, question B should be answered No.
If siblings were separated for a valid reason, consider the entire period under review and determine
whether that valid reason existed during the whole period of separation. For example, the siblings were
separated because one sibling needed temporary treatment services. However, during the period
under review, the sibling’s treatment services ended. In this situation, determine whether concerted
efforts were made to reunite the siblings after the treatment service was completed. If the need for
separation no longer existed and no efforts were made to reunite the siblings, then the answer to
question B should be No.

Item 7 Rating Criteria:
Item 7 should be rated as a Strength if either of the following applies:
• The answer to question A is Yes.
• The answer to question A is No, but the answer to question B is Yes.
Item 7 should be rated as an Area Needing Improvement if the answers to questions A and B are No.
Item 7 should be rated as Not Applicable if the response to the question of applicability is No.
Item 7 Rating (select one):
Strength 

Area Needing Improvement 

NA 

Provide any additional comments that highlight strengths or challenges related to specific practices, systemic
issues, or resources that affected this item in the narrative field below:

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Section II: Permanency Outcome 2

PERMANENCY OUTCOME 2: THE CONTINUITY OF FAMILY RELATIONSHIPS AND
CONNECTIONS IS PRESERVED FOR CHILDREN.
Item 8: Visiting With Parents and Siblings in Foster Care
Purpose of Assessment: To determine whether, during the period under review, concerted efforts were made
to ensure that visitation between a child in foster care and his or her mother, father, and siblings is of sufficient
frequency and quality to promote continuity in the child’s relationship with these close family members.
Definitions:
•
•

“Mother” and “Father” in items 8 and 11 are typically defined as the parents/caregivers from whom the
child was removed and with whom the agency is working toward reunification.
Because the focus of item 8 is to promote continuity in the child’s relationships, do not include in this
item a parent who did not have a relationship with the child prior to the child’s entry in foster care, even
if the goal is to reunify with that parent. Visitation for a parent in that circumstance may be assessed
as a service need in item 12 (see item 12 instructions).

Indicate the case participants who are included in this item as Mother and Father:

Item 8 Applicable Cases: Cases are applicable for an assessment of this item if either of the following
applies:
• The child has at least one sibling in foster care who is in a different placement setting. Yes  No 
• The whereabouts of the child’s parents are known and there is no documented information in the case file
indicating that contact between the child and the parents is not in the child’s best interests. Yes  No 
Cases are Not Applicable for assessment if the child has no siblings placed separately in foster care, AND any
of the following apply (check Yes for any that apply and No for any that do not apply):
•
•
•
•

There is documentation in the case file indicating that contact between the child and both of his or her
parents is not in the child’s best interests. Yes 
No 
The whereabouts of both parents are unknown despite documented concerted agency efforts to locate the
parents. Yes 
No 
Both parents were deceased during the entire period under review. Yes 
No 
The parental rights of both parents remained terminated during the entire period under review.
Yes 
No 

Is this case applicable?
Select the appropriate response. If the response is No, rate the case as Not Applicable in the ratings section
and continue to item 9.
Yes 

No 

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A1. What was the usual frequency of visits between the mother and the child during the period under review?
Select the box next to the statement that best describes the typical frequency of visits during the period under
review.
 NA
 More than once a week
 Once a week
 Less than once a week, but at least twice a month
 Less than twice a month, but at least once a month
 Less than once a month
 Never
A. During the period under review, were concerted efforts made to ensure that visitation (or other forms of
contact if visitation was not possible) between the child and his or her mother was of sufficient frequency to
maintain or promote the continuity of the relationship?
Yes 

No 

NA 

Question 8A1 and 8B1 Instruction:
Answer Not Applicable if (1) contact between the child and the mother or father was not in the child’s best
interests and this was documented in the case file or court order, (2) the whereabouts of the mother or
father was not known during the entire period under review, despite documented concerted efforts to
locate her or him, (3) the mother’s or father’s parental rights remained terminated during the entire period
under review, or (4) the mother or father was deceased during the entire period under review.

B1.

What was the usual frequency of visits between the father and the child during the period under review?
Select the box next to the statement that best describes the typical frequency of visits during the period under
review.
 NA
 More than once a week
 Once a week
 Less than once a week, but at least twice a month
 Less than twice a month, but at least once a month
 Less than once a month
 Never

B. During the period under review, were concerted efforts made to ensure that visitation (or other forms of
contact if visitation was not possible) between the child and his or her father was of sufficient frequency to
maintain or promote the continuity of the relationship?
Yes 

40

No 

NA 

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Section II: Permanency Outcome 2

Questions 8A and 8B Instructions:
•
•
•

•

•

If A1 is NA, question A is answered Not Applicable.
If B1 is NA, question B is answered Not Applicable.
Determine whether the frequency of visitation during the period under review was sufficient to maintain
the continuity of the relationship between the child and the mother or father, depending on the
circumstances of the case. For example, frequency may need to be greater for infants and young
children who are still forming attachments. Frequency also may need to be greater if reunification is
imminent. Visitation should be as frequent as possible, unless safety concerns cannot be appropriately
managed with supervision. The opportunity for visitation should not be used as a consequence or
reward for parents or for children.
If, during the period under review, frequent visitation with the mother or father was not possible (for
example, due to incarceration in a facility where visitation is not feasible, or if the parent lives in another
state), determine whether there are documented concerted efforts to promote other forms of contact
between the child and the mother or father, such as telephone calls or letters, in addition to facilitating
visits when possible and appropriate.
Address the question of appropriate frequency based on the circumstances of the child and the family,
rather than on state policy.

C. During the period under review, were concerted efforts made to ensure that the quality of visitation
between the child and the mother was sufficient to maintain or promote the continuity of the relationship?
Yes 

No 

NA 

Questions 8C and 8D Instructions:
•
•
•

If A1 is NA or Never, question C is answered NA
If B1 is NA or Never, question D is answered NA.
Determine whether concerted efforts were made to ensure that the quality of parent-child visitation was
sufficient to maintain the continuity of the relationship. For example, did visits take place in a
comfortable atmosphere and were they of an appropriate length? Did visitation allow for sufficient
interaction between mother or father and child? If siblings were involved, did visits allow mother or
father to interact with each child individually? If appropriate, were unsupervised visits and visits in the
mother’s or father’s home in preparation for reunification allowed?

D. During the period under review, were concerted efforts made to ensure that the quality of visitation
between the child and the father was sufficient to maintain or promote the continuity of the relationship?
Yes 

No 

NA 

E1.

What was the usual frequency of visits between the child and his or her siblings during the period under
review? Select the box next to the statement that best describes the usual frequency of visits between the
siblings and the child during the period under review.
 NA
 More than once a week
 Once a week

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Section II: Permanency Outcome 2





Less than once a week, but at least twice a month
Less than twice a month, but at least once a month
Less than once a month
Never

Question 8E1 Instruction:
Answer E1 Not Applicable if the child has no siblings in foster care or if contact with all siblings who are in
foster care was not considered to be in the best interests of the child for the entire period under review
(for example, one sibling is a physical threat to the other sibling or has a history of physical or sexual
abuse of the other sibling and this concern remained throughout the period under review).

E. During the period under review, were concerted efforts made to ensure that visitation (or other forms of
contact if visitation was not possible) between the child and his or her sibling(s) was of sufficient frequency to
maintain or promote the continuity of the relationship?
Yes 

No 

NA 

Question 8E Instructions:
•
•
•

If E1 is NA, E should be answered NA.
If E1 is Never, E should be answered No.
Consider whether the frequency of visits during the period under review was sufficient to maintain the
continuity of the sibling relationships.

F. During the period under review, were concerted efforts made to ensure that the quality of visitation
between the child and his or her sibling(s) was sufficient to promote the continuity of their relationships?
Yes 

No 

NA 

Question 8F Instructions:
•
•

42

If E is NA or Never, question F should be answered NA.
Determine whether concerted efforts were made to ensure that the quality of sibling visitation was
sufficient to maintain the continuity of the relationship. For example, were visits long enough to permit
quality interaction? Did sibling contacts only occur in the context of parent visitations? Did visits occur
in a comfortable atmosphere?

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Section II: Permanency Outcome 2
Item 8 Rating Criteria:
Item 8 should be rated as a Strength if at least one of the questions A through F is answered Yes and
the other questions are answered Not Applicable.
Item 8 should be rated as an Area Needing Improvement if any one of the questions A through F is
answered No.
Item 8 should be rated as Not Applicable if the response to the question of applicability is No.
Item 8 Rating (select one):
Strength 

Area Needing Improvement 

NA 

Provide any additional comments that highlight strengths or challenges related to specific practices, systemic
issues, or resources that affected this item in the narrative field below:

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Section II: Permanency Outcome 2

PERMANENCY OUTCOME 2: THE CONTINUITY OF FAMILY RELATIONSHIPS AND
CONNECTIONS IS PRESERVED FOR CHILDREN.
Item 9: Preserving Connections
Purpose of Assessment: To determine whether, during the period under review, concerted efforts were made
to maintain the child’s connections to his or her neighborhood, community, faith, extended family, Tribe,
school, and friends.
Item 9 Applicable Cases:
Almost all foster care cases are applicable for an assessment of this item. A possible exception may be the
situation of an abandoned infant where the agency has no information about the child’s extended family or
connections.
Is this case applicable?
Select the appropriate response. If the response is No, rate the item as Not Applicable in the ratings section
and continue to item 10.
Yes 

No 

A.

During the period under review, were concerted efforts made to maintain the child’s important
connections (for example, neighborhood, community, faith, language, extended family members including
siblings who are not in foster care, Tribe, school, and/or friends)?

Yes 

No 

Question 9A Instructions:
•

Determine what the important connections were for the child prior to their placement in foster care and
then determine whether concerted efforts were made to maintain those connections during the period
under review.

•

For a child enrolled in school, consider whether efforts were made to maintain the child in the same
school the child was in before placement in foster care, if remaining in the same school was in the
child’s best interests.

•

Do not rate this item based on connections to parents/caregivers from whom the child was removed
and/or with whom the child will be reunified, or to siblings who are in foster care. Information about
sustaining those connections is captured in other items. However, this item may be rated based on
connections with siblings who are not in foster care and other extended family members, such as
grandparents, uncles, aunts, or cousins.

•

Connections to caregivers from whom the child was removed may also be included in this item if the
goal is not to reunify the child with those caregivers and it is in the child’s best interest to preserve
those relationships.

• If, prior to placement in foster care, the child had a relationship with a biological parent who was not the
caregiver the child was removed from or that they are being reunified with (the parent is not part of the
case plan), that connection may be included in this item if it is in the child’s best interest to preserve that
relationship.

B. Was a sufficient inquiry conducted with the parent, child, custodian, or other interested party to determine
whether the child may be a member of, or eligible for membership in, a federally recognized Indian Tribe?
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Section II: Permanency Outcome 2
Yes 

No 

Question 9B Instructions:
•
•

•

•

This question is for data collection purposes only and does not affect the rating for this item.
If there is no information in the case file that indicates the child is a member of, or eligible for
membership in, an Indian Tribe, but you learn through interviews that the child has Native American
heritage and no apparent efforts were made to determine this, then the answer to question B is No.
If the child entered foster care during the period under review, determine whether timely and
appropriate action was taken to determine whether the child is a member of, or eligible for membership
in, an Indian Tribe. This may include exploring this with the parents and/or other persons with a
relationship to the child, contacting Tribes, and contacting the Bureau of Indian Affairs.
If the child entered foster care before the period under review, the answer to question B can be Yes if
by the beginning of the period under review an informed determination was made about the child’s
membership, or eligibility for membership, in an Indian Tribe and all appropriate steps were taken to
determine whether the child is Native American.

C.

If the child may be a member of, or eligible for membership in, a federally recognized Indian Tribe, during
the period under review, was the Tribe provided timely notification of its right to intervene in any state court
proceedings seeking an involuntary foster care placement or termination of parental rights?
Yes 

No 

NA 

Question 9C Instructions:
•
•

•

If the child is not a member of, or eligible for membership in, an Indian Tribe, the answer to question C
is Not Applicable.
If the child entered care during the period under review or had a termination of parental rights hearing
during the period under review, determine whether timely notice was provided to the Tribe. Timely
notice is notice that was received no later than 10 days before the proceeding. If timely notice was not
provided, the answer to question C is No.
If the child entered care before the period under review and did not have a termination of parental rights
hearing during the period under review, the answer to question C is Yes, if, by the beginning of the
period under review, all appropriate steps were taken to notify the Tribe.

D. If the child is a member of, or eligible for membership in, a federally recognized Indian Tribe, was the
child placed in foster care in accordance with Indian Child Welfare Act placement preferences or were
concerted efforts made to place the child in accordance with the Act’s placement preferences?
Yes 

No 

NA 

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Question 9D Instructions:
•
•

•

If the child is not Native American, then the answer to question D is Not Applicable.
Determine whether, during the period under review, the child was placed (1) with a member of the
child’s extended family, (2) in a foster home licensed, approved, or specified by the Native American
child’s Tribe, (3) in another Native American foster home placement, or (4) in an institution approved by
a Tribe or operated by a Native American organization. Placement preference is in this order unless
another order is specified by Tribal resolution.
If the child’s placement was not made in accordance with Indian Child Welfare Act placement
preferences, determine whether, during the period under review, there were documented concerted
efforts to meet the Act’s placement preferences.

Item 9 Rating Criteria:
Item 9 should be rated as a Strength if the answer to question A is Yes and the answers to questions C
and D are either Yes or Not Applicable.
Item 9 should be rated as an Area Needing Improvement if either of the following applies:
• The answer to question A is Yes, but the answer to question C and/or D is No.
• The answer to question A is No, regardless of the answers to questions C and D.
The answer to question B is not considered in rating this item.
Item 9 should be rated as Not Applicable if the response to the question of applicability is No.
Item 9 Rating (select one):
Strength 

Area Needing Improvement 

NA 

Provide any additional comments that highlight strengths or challenges related to specific practices, systemic
issues, or resources that affected this item in the narrative field below:

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PERMANENCY OUTCOME 2: THE CONTINUITY OF FAMILY RELATIONSHIPS
AND CONNECTIONS IS PRESERVED FOR CHILDREN.
Item 10: Relative Placement
Purpose of Assessment: To determine whether, during the period under review, concerted efforts were made
to place the child with relatives when appropriate.
Item 10 Applicable Cases:
All foster care cases are applicable for assessment of this item except those in which (1) the agency
determined upon the child’s initial entry into care that his or her needs required a specialized placement (such
as residential treatment services) and that they will continue to require such specialized treatment the entire
time the child is in care and a relative placement would be inappropriate, or (2) situations such as
abandonment in which the identity of both parents and all relatives remains unknown despite documented
concerted efforts to identify them.
Is this case applicable?
Select the appropriate response. If the response is No, rate the case as Not Applicable in the ratings section
and continue to item 11.
Yes 

A1.

No 

During the period under review, was the child’s current or most recent placement with a relative?

Yes 

No 

A2. If the child’s current or most recent placement is with a relative, is (or was) this placement stable and
appropriate to the child’s needs?
Yes 

No 

NA 

Questions 10A1 and 10A2 Definition:
“Relative” is defined as a person related to the child by blood, marriage, or adoption.
Questions 10A1 and 10A12 Instructions:
•
•

If the answer to question A1 is No, the answer to question A2 should be Not Applicable.
If the answer to question A2 is Yes, you may rate the item as a Strength, and answer Not Applicable to
the remaining questions for the item.

•

If the answer to question A1 or A2 is No, answer the remaining questions for this item.

B. Did the agency, during the period under review, make concerted efforts to identify, locate, inform, and
evaluate maternal relatives as potential placements for the child, with the result that maternal relatives were
ruled out as placement resources (due to fit, relative’s unwillingness, or child's best interests) during the period
under review?
Yes 

No 

NA 

If No, specify the area in which concerns existed:

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Section II: Permanency Outcome 2
Identify 

Locate 

Inform 

Evaluate 

Questions 10B and 10C Instructions:
•
•

•

•

The answers to questions B and C are NA if the answers to both questions A1 and A2 are Yes.
If a child entered foster care during the period under review, determine whether the state followed the
requirements of 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, identifying, seeking out, and informing and evaluating the child’s relatives).
If the parent’s whereabouts were not known during the entire period under review despite agency efforts
to locate the parent, and as a result relatives could not be identified, the answer to question B and/or C
should be NA.
If a child entered foster care before the period under review and the answer to either question A1 or A2
is No, determine whether, during the period under review, the agency made concerted efforts to search
for and assess relatives as placement resources, if appropriate. If all maternal and/or paternal relatives
had already been appropriately considered and permanently ruled out before the period under review,
the answer to question B and/or C can be Not Applicable. If, however, you determine that, during the
period under review, the agency should have reconsidered relatives who had previously been ruled out
and they did not, the answer to question B and/or C should be No.

C. Did the agency, during the period under review, make concerted efforts to identify, locate, inform, and
evaluate paternal relatives as potential placements for the child, with the result that paternal relatives were
ruled out as placement resources (due to fit, relative’s unwillingness, or child's best interests) during the period
under review?
Yes 

No 

NA 

If No, specify the area in which concerns existed:
Identify 

Locate 

Inform 

Evaluate 

Item 10 Rating Criteria:
Item 10 should be rated as a Strength if either of the following applies:
• The answers to both questions A1 and A2 are Yes.
• The answer to either question A1 or A2 is No, but the answers to questions B and/or C are Yes or
Not Applicable.
Item 10 should be rated as an Area Needing Improvement if both of the following apply:
• The answer to either question A1 or A2 is No.
• The answer to question B and/or C is No.
Item 10 should be rated as Not Applicable if the response to the question of applicability is No.
Item 10 Rating (select one):
Strength 

48

Area Needing Improvement 

NA 

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Provide any additional comments that highlight strengths or challenges related to specific practices, systemic
issues, or resources that affected this item in the narrative field below:

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Section II: Permanency Outcome 2

PERMANENCY OUTCOME 2: THE CONTINUITY OF FAMILY RELATIONSHIPS
AND CONNECTIONS IS PRESERVED FOR CHILDREN.
Item 11: Relationship of Child in Care With Parents
Purpose of Assessment: To determine whether, during the period under review, concerted efforts were made
to promote, support, and/or maintain positive relationships between the child in foster care and his or her
mother and father or other primary caregiver(s) from whom the child had been removed through activities other
than just arranging for visitation.
Item 11 Definitions:
•
•

“Mother” and “Father” in items 8 and 11 are typically defined as the parents/caregivers from whom the
child was removed and with whom the agency is working toward reunification.
Because the focus of item 11 is to promote, support, and maintain the child’s relationships with the
parents/caregivers from whom the child was removed, do not include in this item a parent who did not
have a relationship with the child prior to the child’s entry into foster care, even if the goal is to reunify
with that parent. Services to support a parent in developing a new relationship with a child may be
assessed as a service need in item 12 (see item 12 instructions).

Indicate the case participants who are included in this item as Mother and Father:

Item 11 Applicable Cases: All foster care cases are applicable for assessment of this item unless any of the
following apply (check Yes for any that apply and No for any that do not apply):
•
•
•
•
•

The parental rights for both parents remained terminated during the entire period under review.
Yes  No 
The child was abandoned and neither parent could be located. Yes  No 
The whereabouts of both parents were not known during the entire period under review despite
documented concerted agency efforts to locate both parents. Yes  No 
Contact with both parents was considered to be not in the child’s best interests and this is documented in
the case record. Yes  No 
During the entire period under review, both parents were deceased. Yes  No 

Is this case applicable?
Select the appropriate response. If the response is No, rate the item as Not Applicable in the ratings section,
and continue to the section on rating Permanency Outcome 2.
Yes 

No 

A. During the period under review, were concerted efforts made to promote, support, and otherwise
maintain a positive and nurturing relationship between the child in foster care and his or her mother?
Yes 

50

No 

NA 

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Section II: Permanency Outcome 2

Questions 11A and 11B Instructions
•

Question A or B should be answered Not Applicable if (1) contact between the child and the mother or
father was not in the child’s best interests and this was documented in the case file or court order, (2)
the whereabouts of the mother or father was not known during the entire period under review, despite
documented concerted efforts to locate her or him, (3) the mother’s or father’s parental rights remained
terminated during the entire period under review, or (4) the mother or father was deceased during the
entire period under review.
Foster parents’ activities are considered for purposes of this question. For example, if the foster parent
provided transportation so that the mother or father could attend the child’s school event or medical
appointment, that would be considered as contributing toward concerted efforts.
Do not answer this question based on efforts (or lack of efforts) to ensure the frequency or quality of
visitation between the mother or father and the child. That information is captured under item 8. This
question pertains to additional activities to help support, strengthen, or maintain the parent-child
relationship.

•
•

A1.

What concerted efforts were made to support or strengthen the mother-child relationship?

Select all that apply if question A is Yes.
 NA
 Encouraged the mother’s participation in school activities and case conferences, attendance at doctors’
appointments with the child, or engagement in the child’s after-school or sports activities?
 Provided or arranged for transportation or provided funds for transportation so that the mother could
attend the child’s special activities and doctors’ appointments?
 Provided opportunities for therapeutic situations to help the mother and child strengthen their
relationship?
 Encouraged the foster parents to provide mentoring or serve as role models to the mother to assist her
in appropriate parenting?
 Encouraged and facilitated contact with a mother not living in close proximity to the child?
 Other (describe other concerted efforts made)_____________________________________

Question 11A1 Instructions:
•
•

Select NA if the answer to question A is NA.
Select NA if the answer to question A is No.

B. During the period under review, were concerted efforts made to promote, support, and otherwise
maintain a positive and nurturing relationship between the child in foster care and his or her father?
Yes 

B1.

No 

NA 

What concerted efforts were made to support or strengthen the father-child relationship?

Select all that apply if question B is Yes.
 NA
 Encouraged the father’s participation in school activities and case conferences, attendance at doctors’
appointments with the child, or engagement in the child’s after-school or sports activities?

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Section II: Permanency Outcome 2
 Provided or arranged for transportation or provided funds for transportation so that the father could
attend the child’s special activities and doctors’ appointments?
 Provided opportunities for therapeutic situations to help the father and child strengthen their relationship?
 Encouraged the foster parents to provide mentoring or serve as role models to the father to assist him in
appropriate parenting?
 Encouraged and facilitated contact with a father not living in close proximity to the child?
 Other (describe other concerted efforts made)_____________________________________

Question 11B1 Instructions:
•
•

Select NA if the answer to question B is NA.
Select NA if the answer to question B is No.

Item 11 Rating Criteria:
Item 11 should be rated as a Strength if either of the following applies:
• The answers to both questions A and B are Yes.
• The answer to either question A or B is Yes and the answer to the other question is Not Applicable.
Item 11 should be rated as an Area Needing Improvement if the answer to question A and/or B is No.
Item 11 should be rated as Not Applicable if the response to the question of applicability is No.
Item 11 Rating (select one):
Strength 

Area Needing Improvement 

NA 

Provide any additional comments that highlight strengths or challenges related to specific practices, systemic
issues, or resources that affected this item in the narrative field below:

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RATING PERMANENCY OUTCOME 2
PERMANENCY OUTCOME 2: THE CONTINUITY OF FAMILY RELATIONSHIPS
AND CONNECTIONS IS PRESERVED FOR CHILDREN.
What is the level of outcome achievement that best describes the extent to which this outcome is being or has
been achieved, based on the ratings for items 7 through 11?

Instructions:
Permanency Outcome 2 should be rated as Substantially Achieved if both of the following apply:
• Not more than one of items 7 through 11 is rated as an Area Needing Improvement.
• At least one item is rated as a Strength.
Permanency Outcome 2 should be rated as Partially Achieved if both of the following apply:
• At least two items, but fewer than all five items, are rated as an Area Needing Improvement.
• At least one item is rated as a Strength.
Permanency Outcome 2 should be rated as Not Achieved if both of the following apply:
• No item is rated as a Strength.
• At least one item is rated as an Area Needing Improvement.
Permanency Outcome 2 should be rated as Not Applicable if the following applies:
• All of items 7 through 11 items are rated as Not Applicable.
Select the appropriate response:
Substantially Achieved 

Partially Achieved 

Not Achieved 

Child and Family Services Reviews Onsite Review Instrument

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Section III: Child and Family Well-Being Outcome 1

SECTION III: CHILD AND FAMILY WELL-BEING
WELL-BEING OUTCOME 1: FAMILIES HAVE ENHANCED CAPACITY TO PROVIDE
FOR THEIR CHILDREN’S NEEDS.
Item 12: Needs and Services of Child, Parents, and Foster Parents
Item 12 is divided into three sub-items: 12A: Needs assessment and services to children, 12B: Needs
assessment and services to parents, and 12C: Needs assessment and services to foster parents.
Purpose of Assessment: To determine whether, during the period under review, the agency (1) made
concerted efforts to assess the needs of children, parents, and foster parents (both initially, if the child entered
foster care or the case was opened during the period under review, and on an ongoing basis) to identify the
services necessary to achieve case goals and adequately address the issues relevant to the agency’s
involvement with the family, and (2) provided the appropriate services.
Item 12 Applicable Cases: All cases are applicable for an assessment of this item because sub-item 12A is
always applicable to all cases. Sub-items 12B and 12C may not be applicable to all cases, and instructions for
applicability are provided before each sub-item.

Sub-Item 12A: Needs Assessment and Services to Children
Sub-Item 12A Instructions:
•

If the case is a foster care case, determine whether the agency assessed the needs of, and provided
services for, the target child in the case, even if there are other children in the family in foster care or in
the home.

•

If the case is an in-home services case, determine whether the agency assessed the needs of, and
provided services for, all children in the family unless you determine that based on case circumstances
only specific children in the home should be assessed and provided with services.

For in-home services cases, indicate the names of the children who were included in the assessment of item
12A:

A1.

During the period under review, did the agency conduct a formal or informal initial and/or ongoing
comprehensive assessment that accurately assessed the children’s needs?
Yes 

No 

If No, explain any concerns in the narrative field below:

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Section III: Child and Family Well-Being Outcome 1

Question 12A1 Instructions:
•
•
•

•

If the case was opened during the period under review, focus on whether the agency conducted an
initial comprehensive assessment as a basis for developing a case plan, and whether ongoing
assessment was conducted as appropriate.
If the case was opened before the period under review, focus on whether the agency conducted
periodic comprehensive needs assessments (as appropriate) during the period under review to update
information relevant to ongoing case planning.
Assessment of needs may take different forms. For example, needs may be assessed through a
formal evaluation conducted by another agency or by a contracted provider or through a more informal
case planning process involving intensive interviews with the child, family, and service providers.
Answer question A1 based on a determination of whether the agency made concerted efforts to
achieve an in-depth understanding of the needs of the child, regardless of whether the needs were
assessed in a formal or informal manner. Consequently, the evaluation of the assessment should
focus on its adequacy in accurately assessing the child’s needs in addition to whether one was
conducted.
Answer this question with regard to an assessment of needs other than those related to children’s
education, physical health, and mental/behavioral health (including substance abuse). The
assessment of the child’s needs related to these issues is addressed in later items. Needs that should
be assessed in this item include those related to social/emotional development that are not connected
to other physical health or mental health issues. These may include social competencies, attachment
and caregiver relationships, social relationships and connections, social skills, self-esteem, and coping
skills. If the case is a foster care case, and the child is an adolescent, determine whether the child’s
needs for independent living services are being assessed on an ongoing basis as part of the child’s
independent living plan. In making this determination, consider the following:
– Did the agency assess for independent living skills?
– Is there an independent living plan in the file? (This is required for all youth age 16 and older.)

A2. During the period under review, were appropriate services provided to meet the children’s identified
needs?
Yes 

No 

NA 

If No, explain any concerns in the narrative field below:

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Question 12A2 Instructions:
•

•
•

•
•

•

If the answer to question A1 is Yes, but the result of the assessment was that no service needs were
identified other than those related to education, physical health, and mental/behavioral health (including
substance abuse), and therefore no services were provided other than services to address those needs,
the answer to question A2 should be Not Applicable.
Focus on the agency’s provision of services during the period under review. If services were provided
before the period under review, and an assessment conducted during the period under review indicated
no further service needs, then the answer to question A2 should be Not Applicable.
Answer this question with regard to provision of services other than those related to education, physical
health, or mental/behavioral health (including substance abuse). The assessment of service provision
related to these issues is addressed in later items. Item 2 should address all the safety-related services
provided to the family. Do not capture those services in this item.
Determine whether the services provided matched identified needs. For example, were the services
provided simply because those were the services available or were they provided because the
assessment revealed a particular need for a particular type of service?
If the case is a foster care case, independent living services should be provided to all youth age 16 and
older and to children of any age with a goal of emancipation/independence or “other planned permanent
living arrangement” who are expected to eventually exit foster care to independence. Consider whether
concerted efforts were made to provide the child with services to adequately prepare the child for
independent living when the child leaves foster care, such as post-high school planning, life skills
classes, employment training, financial planning skills training, and transitional services.
Examples of services that are assessed under this item include child care services that are not required
for the child’s safety (those services would be covered under item 2), mentoring programs that are not
related to the child’s education, recreational services, teen parenting education, preparation for adoption
and other permanency goals, services that address family relationships that are not mental health in
nature (for example, services to assist children in reestablishing or maintaining family ties), and services
to assist the child that are recommended by a therapist or other provider but are not mental healthrelated (such as enrollment in an activity to assist with social skills or to boost self-esteem).

Sub-Item 12A Rating Criteria:
Sub-item 12A should be rated as a Strength if either of the following applies:
• The answers to both questions A1 and A2 are Yes.
• The answer to question A1 is Yes, and the answer to question A2 is Not Applicable.
Sub-item 12A should be rated as an Area Needing Improvement if the answer to question A1 and/or A2
is No.
There are no circumstances under which sub-item 12A could be rated as Not Applicable.
Sub-Item 12A Rating (select one):
Strength 

56

Area Needing Improvement 

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Section III: Child and Family Well-Being Outcome 1

Sub-Item 12B: Needs Assessment and Services to Parents
Sub-Item 12B Definitions:
In-home services cases:
•

•

“Mother” and “Father” in items 12, 13, and 15, are typically defined as the parents/caregivers with whom
the children were living when the agency became involved with the family and with whom the children
will remain (for example, biological parents, relatives, guardians, adoptive parents).
If a biological parent does not fall into any of the categories above, determine whether that parent should
be included in this item based on the circumstances of the case. Some things to consider in this
determination are: the reason for the agency’s involvement and the identified perpetrators in the case,
the status of the children’s relationship with the parent, the nature of the case (court supervised or
voluntary) and the length of case opening. If a biological parent indicates a desire during the period
under review to be involved with the child and it is in the child’s best interests to do so, they should be
assessed in this item.

Foster care cases:
•
•
•

“Mother” and “Father” in items 12, 13, and 15 are typically defined as the parents/caregivers from whom
the child was removed and with whom the agency is working toward reunification.
“Mother” and “Father” in items 12, 13, and 15 include biological parents who were not the parents from
whom the child was removed.
“Mother and “Father” include adoptive parents if the adoption has been finalized during the period under
review.

Indicate the case participants who are included in this item as Mother and Father:

Sub-Item 12B Applicable Cases:
• Because multiple case participants can be assessed in these questions, consider applicability for all
appropriate case participants before determining that the rating should be Not Applicable.
• Questions in sub-item B for either parent should be answered Not Applicable if any of the following applies
to either the mother or the father being assessed in this item (check Yes for any that apply and No for any
that do not apply):
– Parental rights remained terminated during the entire period under review Yes 
No 
– Parent’s whereabouts were not known during the entire period under review despite agency efforts to
locate the parent Yes 
No 
– Parent was deceased during the entire period under review Yes 
No 
– During the entire period under review it was documented in the case file that it was not in the child’s best
interests to involve the parent in case planning Yes 
No 
– During the entire period under review the parent has indicated he/she does not want to be involved in the
child’s life and this was documented in the case file Yes 
No 
Is sub-item 12 B applicable for Mother?
Yes 

No 

If No, answer questions B1 and B3 Not Applicable.
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Section III: Child and Family Well-Being Outcome 1
Is sub-item 12 B applicable for Father?
Yes 

No 

If No, answer questions B2 and B4 Not Applicable.
If both parents are not applicable for this item, go to sub-item 12B rating criteria, select Not Applicable and
continue to sub-item 12C.

B1. During the period under review, did the agency conduct a formal or informal initial and/or ongoing
comprehensive assessment that accurately assessed the mother’s needs?
Yes 

No 

NA 

If No, explain any concerns in the narrative field below:

Questions 12B1 and 12B2 Instructions:
•
•
•

•

If the case was opened during the period under review, focus on whether the agency conducted an
initial comprehensive assessment as a basis for developing a case plan, and whether ongoing
assessment was conducted as appropriate.
If the case was opened before the period under review, focus on whether the agency conducted
periodic comprehensive needs assessments (as appropriate) during the period under review to update
information relevant to ongoing case planning.
Determine whether the agency has made concerted efforts to ensure that case planning is based on an
in-depth understanding of the needs of the mother and father, regardless of whether the needs were
assessed in a formal or informal manner. (Assessment of needs may take different forms. For
example, needs may be assessed through a formal psychosocial evaluation conducted by another
agency or by a contracted provider or through a more informal case planning process involving
intensive interviews with the child, family, and service providers.)
Assessment of mother’s and father’s needs refers to a determination of what the mother or father needs
to provide appropriate care and supervision and to ensure the well-being of his/her children. This could
include mental and physical health needs (as later items do not address these concerns for the
parents), if those needs impact the parent’s capacity to care for the children. This could also include an
assessment of needs related to supporting a biological parent’s relationship with the child if they did not
have an established relationship prior to the child’s entry into foster care.

B2. During the period under review, did the agency conduct a formal or informal initial and/or ongoing
comprehensive assessment that accurately assessed the father’s needs?
Yes 

No 

NA 

If No, explain any concerns in the narrative field below:

B3.

During the period under review, did the agency provide appropriate services to the mother to meet
identified needs?

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Section III: Child and Family Well-Being Outcome 1
Yes 

No 

NA 

If No is selected, explain any concerns in the following narrative field:

Question 12B3 and 12B4 Instructions:
•
•

If an assessment was conducted but no service needs were identified, this question can be
answered Not Applicable.
Appropriate services are those that enhance the mother’s or father’s ability to provide care and
supervision and support the well-being of his or her child(ren); for example, substance abuse
treatment, parenting skills classes, or visitation and/or family counseling services for a biological
parent who is establishing a new relationship with the child. Item 2 should address all the safetyrelated services provided to the family. Do not capture those services in this item. Visitation
services would only be included for a biological parent in this item if the parent was not included in
item 8.

B4.

During the period under review, did the agency provide appropriate services to the father to address
identified needs?
Yes 

No 

NA 

If No is selected, explain any concerns in the following narrative section:

Sub-Item 12B Rating Criteria:
Sub-item 12B should be rated as a Strength if either of the following applies:
• The answers to B1, B2, B3, and B4 are Yes.
• The answer to at least one question is Yes, and the answer to the other questions is Not Applicable.
Sub-item 12B should be rated as an Area Needing Improvement if the answer to any one of the
questions is No.
Sub-item 12B should be rated as Not Applicable if the answer to the questions of applicability for both
Mother and Father is No.
Sub-Item 12B Rating (select one):
Strength 

Area Needing Improvement 

NA 

Sub-Item 12C: Needs Assessment and Services to Foster Parents
Sub-Item 12C Applicable Cases:
• In-home cases are not applicable for an assessment of this sub-item.
• All foster care cases are applicable for assessment of this sub-item unless, during the entire period under
review, the child was in out-of-home care in a residential facility or similar placement, but does not have
foster parents.

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Section III: Child and Family Well-Being Outcome 1
Is sub-item 12C applicable?
Yes 

No 

If No, go to sub-item 12C rating criteria and select Not Applicable.
Item 12C Definition:
Foster parents are defined as related or non-related caregivers who have been given responsibility for care
of the child by the agency while the child is under the placement and care responsibility and supervision of
the agency. This includes pre-adoptive parents if the adoption has not been finalized.

C1. During the period under review, did the agency adequately assess the needs of the foster or preadoptive parents on an ongoing basis (with respect to services they need to in order to provide appropriate
care and supervision to ensure the safety and well-being of the children in their care)?
Yes 

No 

If No is selected, explain any concerns in the following narrative section:

Question 12C1 Instructions:
•
•

•

All foster parents who cared for the child during the period under review are included in this
assessment.
Determine whether an assessment was conducted to identify what the foster parents needed to
enhance their capacity to provide appropriate care and supervision to the child in their home, such as
respite care, assistance with transportation, or counseling to address the child’s behavior problems.
Determine whether assessment of foster parent needs is done on an ongoing basis. If there is no
evidence in the case file that the agency assessed the needs of the foster parents at any time during
the period under review, and the foster parents (if available for interview) indicate that they have not
been assessed, then the answer to question C1 should be No.

C2. During the period under review, were the foster or pre-adoptive parents provided with appropriate
services to address identified needs that pertained to their capacity to provide appropriate care and
supervision of the children in their care?
Yes 

No 

NA 

If No is selected, explain any concerns in the following narrative section:

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Section III: Child and Family Well-Being Outcome 1

Question 12C2 Instructions:
•

The answer to question C2 should be Not Applicable if needs were assessed but no service needs
were identified.

•

All foster parents who cared for the child during the period under review are included in this
assessment.

Sub-Item 12C Rating Criteria:
Sub-item 12C should be rated as a Strength if either of the following applies:
• The answers to both questions C1 and C2 are Yes.
• The answer to question C1 is Yes, and the answer to question C2 is Not Applicable.
Sub-item 12C should be rated as an Area Needing Improvement if the answer to question C1 and/or C2
is No.
Sub-item 12C should be rated as Not Applicable if the response to the question of applicability is No.
Item 12C Rating (select one):
Strength 

Area Needing Improvement 

NA 

Item 12 Rating Criteria:
Item 12 should be rated as a Strength if sections A, B, and C are all rated Strength OR at least one of
the sections is rated as a Strength and the others are Not Applicable.
Item 12 should be rated as an Area Needing Improvement if any one of sections A, B, or C is rated as
an Area Needing Improvement.
There are no circumstances under which item 12 could be rated as Not Applicable.
Item 12 Rating (select one):
Strength 

Area Needing Improvement 

Provide any additional comments that highlight strengths or challenges related to specific practices, systemic
issues, or resources that affected this item in the narrative field below:

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Section III: Child and Family Well-Being Outcome 1

WELL-BEING OUTCOME 1: FAMILIES HAVE ENHANCED CAPACITY TO PROVIDE
FOR THEIR CHILDREN’S NEEDS.
Item 13: Child and Family Involvement in Case Planning
Purpose of Assessment: To determine whether, during the period under review, concerted efforts were
made (or are being made) to involve parents and children (if developmentally appropriate) in the case
planning process on an ongoing basis.
Item 13 Definitions:
In-home services cases:
•

•

“Mother” and “Father” in items 12, 13, and 15, are typically defined as the parents/caregivers with
whom the children were living when the agency became involved with the family and with whom the
children will remain (for example, biological parents, relatives, guardians, adoptive parents).
If a biological parent does not fall into any of the categories above, determine whether that parent
should be included in this item based on the circumstances of the case. Some things to consider in
this determination are: the reason for the agency’s involvement and the identified perpetrators in the
case, the status of the children’s relationship with the parent, the nature of the case (court supervised
or voluntary) and the length of case opening. If a biological parent indicates a desire during the period
under review to be involved with the child and it is in the child’s best interests to do so, they should be
assessed in this item.

Foster care cases:
•
•
•

“Mother” and “Father” in items 12, 13, and 15 are typically defined as the parents/caregivers from
whom the child was removed and with whom the agency is working toward reunification.
“Mother” and “Father” in items 12, 13, and 15 include biological parents who were not the parents from
whom the child was removed.
“Mother and “Father” include adoptive parents if the adoption has been finalized during the period
under review.

Indicate the case participants who are included in this item as Mother and Father:

Item 13 Applicable Cases:
Because multiple case participants can be assessed in these questions, consider applicability for all
appropriate case participants before determining that the rating should be Not Applicable. All cases are
applicable for an assessment of this item except as determined below (check Yes for criteria that apply and No
for those that do not).
• Cases involving children for whom participating in planning is not developmentally appropriate
Yes 
No 
AND:
• Cases in which all parents being assessed as Mother or Father meet any of these criteria:
– Parental rights remained terminated during the entire period under review Yes 
No 
– Parent’s whereabouts were not known during the entire period under review despite agency efforts to
locate the parent Yes 
No 
– Parent was deceased during the entire period under review Yes 
No 
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– During the entire period under review it was documented in the case file that it was not in the child’s best
interests to involve the parent in case planning Yes 
No 
– During the entire period under review the parent has indicated he/she does not want to be involved in the
child’s life and this was documented in the case file Yes 
No 
• In-home services cases are applicable even in states that do not require a formal case plan to be developed
for in-home services cases. Therefore, the case is applicable even if there is no state requirement for a
case plan and there is no case plan in the file.
Is this case applicable?
Select the appropriate response. If the response is No, rate the case as Not Applicable in the ratings section
and continue to item 14.
Yes 

No 

A.

During the period under review, did the agency make concerted efforts to actively involve the child in the
case planning process?
Yes 

No 

NA 

If No, explain any concerns in the narrative field below:

For in-home services cases, indicate the names of the children who are included in the assessment of item 13:

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Section III: Child and Family Well-Being Outcome 1

Question 13A Definition:
“Actively involved” means that the agency consulted with the child (as developmentally appropriate)
regarding the child’s goals and services, explained the plan and terms used in the plan in language that the
child can understand, and included the child in periodic case planning meetings, particularly if any changes
are being considered in the plan.
Question 13A Instructions:
•

Select Not Applicable if the child is not old enough to participate in case planning or is incapacitated.
Although the capacity to participate actively in case planning will need to be decided on a case-by-case
basis, as a guideline, most children who are elementary school-aged or older may be expected to
participate to some extent.

•

If the case is a foster care case, item 13 applies to the target child only. If the case is an in-home
services case, item 13 applies to all children in the family home unless you determine that based on
case circumstances only specific children in the home should be engaged in case planning (for
example, only children receiving services from the agency).

•

If the case is a foster care case, answer No to this question if there is no case plan in the case file.

•

If the case is an in-home services case, and there is no case plan in the file (some states require that
an identifiable written case plan be included in the file for in-home services cases), identify the extent to
which the children (if developmentally appropriate) were involved in determining: (1) their strengths and
needs, (2) the type and level of services needed, and (3) their goals and progress toward meeting
them. Determine whether this information was documented in the case file in any way.

•

Do not assume that a child’s knowledge about his or her case plan is an indicator of active involvement.

•

If the initial case plan was developed before the period under review, focus on the children’s
involvement during the period under review in the ongoing case planning process, particularly with
regard to evaluating progress and making changes in the type and level of services needed as well as
understanding changes made to their permanency goal (in foster care cases).

B. During the period under review, did the agency make concerted efforts to actively involve the mother in
the case planning process?
Yes 

No 

NA 

If No, explain any concerns in the narrative field below:

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Section III: Child and Family Well-Being Outcome 1

Questions 13B and 13C Definition:
“Actively involved” means that the agency involved the mother or father in (1) identifying strengths and
needs, (2) identifying services and service providers, (3) establishing goals in case plans, (4) evaluating
progress toward goals, and (5) discussing the case plan.
Questions 13B and 13C Instructions:
•
•
•

Select Not Applicable if all case participants being assessed as Mother in 13B or as Father in 13C meet
the criteria for Not Applicable in the item 13 rating criteria.
If the initial case plan was developed before the period under review, focus on the mother’s or father’s
involvement during the period under review in the ongoing case planning process, particularly with
regard to evaluating progress and making changes in the plan.
Select No if the agency did not make concerted efforts to locate a mother or father whose whereabouts
were unknown.

C. During the period under review, did the agency make concerted efforts to actively involve the father in
the case planning process?
Yes 

No 

NA 

If No, explain any concerns in the narrative field below:

Item 13 Rating Criteria:
Item 13 should be rated as a Strength if either of the following applies:
• The answers to A, B, and C are Yes.
• The answer to at least one question is Yes, and the answer to the other questions is Not Applicable.
Item 13 should be rated as an Area Needing Improvement if the answer to any one of questions A, B, or
C is No.
Item 13 should be rated as Not Applicable if the response to the question of applicability is No.
Item 13 Rating (select one):
Strength 

Area Needing Improvement 

NA 

Provide any additional comments that highlight strengths or challenges related to specific practices, systemic
issues, or resources that affected this item in the narrative field below:

Child and Family Services Reviews Onsite Review Instrument

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Section III: Child and Family Well-Being Outcome 1

WELL-BEING OUTCOME 1: FAMILIES HAVE ENHANCED CAPACITY TO PROVIDE
FOR THEIR CHILDREN’S NEEDS.
Item 14: Caseworker Visits With Child
Purpose of Assessment: To determine whether the frequency and quality of visits between caseworkers and
the child(ren) in the case are sufficient to ensure the safety, permanency, and well-being of the child(ren) and
promote achievement of case goals.
Item 14 Applicable Cases: All cases are applicable for an assessment of this item.

A1. During the period under review, what was the most typical pattern of visitation between the caseworker
or other responsible party and the child(ren) in the case? Select the box that describes the usual pattern of
visitation.
 More than once a week
 Once a week
 Less than once a week, but at least twice a month
 Less than twice a month, but at least once a month
 Less than once a month
 Never
Questions 14A1 and 14A Definitions:
• “Other responsible party” refers to contracted service providers who have full responsibility for case
planning and case management (for example, fully or partially privatized child welfare systems where
full case management responsibilities are delegated to contract agencies). It does not refer to
contracted service providers that provide services while the agency maintains decision-making and
case management responsibilities regarding the case or the child.
• A “visit” is defined as a face-to-face contact between the caseworker or other responsible party and the
child.
Question 14A1 Instructions:
•
•
•
•
•

If the case is an in-home services case, question A1 should be answered for all children in the family
home.
If the case is a foster care case, question A1 should be answered only for the target child in the case.
Consider only the pattern of visits during the period under review and not over the life of the case.
Focus on the visitation frequency of the agency caseworker (or other responsible party) responsible for
the case and not on other service providers who may be visiting the children.
Determine the most typical pattern of visitation during the period under review because the actual
frequency may vary in specific time periods.

A. During the period under review, was the frequency of the visits between the caseworker (or other
responsible party) and the child(ren) sufficient to address issues pertaining to the safety, permanency, and
well-being of the child and promote achievement of case goals?
Yes 

66

No 

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Section III: Child and Family Well-Being Outcome 1

Question 14A Instructions:
•
•
•

•
•
•

If A1 is Never, question A is No.
In responding to question A, consider the frequency of visits selected in question A1.
Base your determination on the frequency necessary to ensure the child’s safety, permanency, and
well-being and not on compliance with state policy requirements regarding caseworker contacts or visits
with the child. For example, if state policy is that the caseworker should visit the child at least once a
month and they complied with that, but you determine that given the circumstances of the case (for
example, there are safety concerns), the caseworker should visit more frequently, then the answer to
question A should be No.
If the child is in a placement in another state, you should determine whether a caseworker from the
jurisdiction in which the child is placed, or a caseworker from the jurisdiction from which the child was
placed, visits with the child in the placement on a schedule that is consistent with the child’s needs.
If the typical pattern of visits is less than once a month, the answer to question A should be No unless
you determine that there is a substantial justification for a Yes answer.
For an in-home services case, any children in the home who were assessed in item 12 should be
visited at least monthly unless there is substantial justification for less than monthly visits. Frequency of
visitation with other children in the family home should be determined based on the circumstances of
the case, such as any risk and safety concerns present during the period under review, the age and
vulnerability of the children, the reason for the agency’s involvement with the family, etc.

B.

During the period under review, was the quality of the visits between the caseworker and the child(ren)
sufficient to address issues pertaining to the safety, permanency, and well-being of the child and promote
achievement of case goals (for example, 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 achievement)?
Yes 

No 

NA 

If No, explain any concerns in the narrative field below:

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Section III: Child and Family Well-Being Outcome 1

Question 14B Instructions:
•
•

•

•

If A1 is Never, question B is Not Applicable.
Consider both the length of the visit (for example, was it of sufficient duration to address key issues with
the child, or was it just a brief visit) and the location of the visit (for example, was it in a place conducive
to open and honest conversation, such as a private home, or was it in a more formal or public
environment, such as a court house or restaurant?).
Consider whether the caseworker (or other responsible party) saw the child alone or whether the parent
or foster parent was usually present during the caseworker’s visits with the child. If the child was older
than an infant, and the caseworker did not see the child alone for at least part of each visit, then the
answer to question B should be No.
Also consider the topics that were discussed during the visits, if that information is available in the case
file or through interviews. For the answer to question B to be Yes, there must be some evidence that
the caseworker and the child addressed issues pertaining to the child’s needs, services, and case goals
during the visits.

Item 14 Rating Criteria:
Item 14 should be rated as a Strength if the answers to both questions A and B are Yes.
Item 14 should be rated as an Area Needing Improvement if the answer to question A and/or B is No.
There are no circumstances under which item 14 could be rated as Not Applicable.
Item 14 Rating (select one):
Strength 

Area Needing Improvement 

Provide any additional comments that highlight strengths or challenges related to specific practices, systemic
issues, or resources that affected this item in the narrative field below:

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Section III: Child and Family Well-Being Outcome 1

WELL-BEING OUTCOME 1: FAMILIES HAVE ENHANCED CAPACITY TO PROVIDE
FOR THEIR CHILDREN’S NEEDS.
Item 15: Caseworker Visits With Parents
Purpose of Assessment: To determine whether, during the period under review, the frequency and quality of
visits between caseworkers and the mothers and fathers of the child(ren) are sufficient to ensure the safety,
permanency, and well-being of the child(ren) and promote achievement of case goals.
Item 15 Definitions:
In-home services cases:
•
•

“Mother” and “Father” in items 12, 13, and 15, are typically defined as the parents/caregivers with
whom the children were living when the agency became involved with the family and with whom the
children will remain (for example, biological parents, relatives, guardians, adoptive parents).
If a biological parent does not fall into any of the categories above, determine whether that parent
should be included in this item based on the circumstances of the case. Some things to consider in this
determination are: the reason for the agency’s involvement and the identified perpetrators in the case,
the status of the children’s relationship with the parent, the nature of the case (court supervised or
voluntary) and the length of case opening. If a biological parent indicates a desire during the period
under review to be involved with the child and it is in the child’s best interests to do so, they should be
assessed in this item.

Foster care cases:
•
•
•

“Mother” and “Father” in items 12, 13, and 15 are typically defined as the parents/caregivers from
whom the child was removed and with whom the agency is working toward reunification.
“Mother” and “Father” in items 12, 13, and 15 include biological parents who were not the parents from
whom the child was removed.
“Mother and “Father” include adoptive parents if the adoption has been finalized during the period
under review.

Indicate the case participants who are included in this item as Mother and Father:

Item 15 Applicable Cases:
Because multiple case participants can be assessed in these questions, consider applicability for all
appropriate case participants before determining that the rating should be Not Applicable. All cases are
applicable for an assessment of this item except cases in which all parents being assessed as Mother and
Father meet any of the following criteria (check Yes for any that apply and No for those that do not):
• Parental rights remained terminated during the entire period under review Yes 
No 
• Parent’s whereabouts were not known during the entire period under review despite agency efforts to locate
the parent Yes 
No 
• Parent was deceased during the entire period under review Yes 
No 
• During the entire period under review it was documented in the case file that it was not in the child’s best
interests to involve the parent in case planning Yes 
No 
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Section III: Child and Family Well-Being Outcome 1
• During the entire period under review the parent has indicated he/she does not want to be involved in the
child’s life and this was documented in the case file Yes 
No 
Is this case applicable?
Select the appropriate response. If the response is No, select Not Applicable in the ratings section and
continue to item 16.
Yes 

No 

A1. During the period under review, what was the most typical pattern of visitation between the caseworker
(or other responsible party) and the mother of the child(ren)? Select the appropriate response:
 More than once a week
 Once a week
 Less than once a week, but at least twice a month
 Less than twice a month, but at least once a month
 Less than once a month
 Never
 NA
Questions 15A1, 15A2, 15B1 and 15B2 Definitions:
•

•

“Other responsible party” refers to contracted service providers who have full responsibility for case
planning and case management (for example, fully or partially privatized child welfare systems where
full case management responsibilities are delegated to contract agencies). It does not refer to
contracted service providers who provide services while the agency maintains decision-making and
case management responsibilities regarding the case or the child.
A “visit” is defined as a face-to-face contact between the caseworker or other responsible party and the
parent.

Questions 15A1 and 15B1 Instructions:
•
•
•

Select Not Applicable if all case participants being assessed as Mother in 15A1 or as Father in 15B1
meet the criteria for Not Applicable in the item 15 rating criteria above. Consider only the pattern of
visits during the period under review and not over the life of the case.
Determine the most typical pattern of visitation during the period under review because the actual
frequency may vary in specific time periods.
Select Never for questions A1 and B1 if the agency reported that the whereabouts of the mother or
father was unknown, but there was no evidence that the agency made concerted efforts to locate either
the mother or the father.

A2.

During the period under review, was the frequency of the visits between the caseworker (or other
responsible party) and the mother sufficient to (1) address issues pertaining to the safety, permanency, and
well-being of the child and (2) promote achievement of case goals?
Yes 

70

No 

NA 

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Section III: Child and Family Well-Being Outcome 1

Questions 15A2 and 15B2 Instructions:
•
•
•

If the answer to question A1 or B1 is Not Applicable, the answer to question A2 or B2 for that parent
also should be Not Applicable.
Consider the frequency of visits that is necessary to effectively address: (1) the child’s safety,
permanency, and well-being, and (2) achievement of case goals. Do not answer the question based
on the caseworker visit requirements that may be established by state policy.
The answers to questions A2 and B2 should be No if the typical pattern of contact is less than once a
month, unless you have a substantial justification for answering either question as Yes.

B1. During the period under review, what was the most typical pattern of visitation between the caseworker
(or other responsible party) and the father of the child(ren)? Select the appropriate response:
 More than once a week
 Once a week
 Less than once a week, but at least twice a month
 Less than twice a month, but at least once a month
 Less than once a month
 Never
 NA
B2.

During the period under review, was the frequency of the visits between the caseworker (or other
responsible party) and the father sufficient to address issues pertaining to the safety, permanency, and wellbeing of the child and promote achievement of case goals?
Yes 

No 

NA 

C. During the period under review, was the quality of the visits between the caseworker (or other
responsible party) and the mother sufficient to address issues pertaining to the safety, permanency, and wellbeing of the child and promote achievement of case goals?
Yes 

No 

NA 

If No, explain any concerns in the narrative field below:

Questions 15C and 15D Instructions:
•

•
•

Consider both the length of the visit (for example, was it of sufficient duration to address key issues with
the mother/father, or was it just a brief visit?) and the location of the visit (for example, was it in a place
conducive to open and honest conversation, such as a private home, or was it in a formal or public
environment that might be uncomfortable for the parent, such as a court house or restaurant?).
Consider whether the visits between the caseworker or other responsible party and the father/mother
focused on issues pertinent to case planning, service delivery, and goal achievement.
If the answer to question A1 or B1 is Not Applicable or Never, then the answer to the corresponding
question (same parent) C or D should be Not Applicable.

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Section III: Child and Family Well-Being Outcome 1

D. During the period under review, was the quality of the visits between the caseworker (or other
responsible party) and the father sufficient to address issues pertaining to the safety, permanency, and wellbeing of the child and promote achievement of case goals?
Yes 

No 

NA 

If No, explain any concerns in the narrative field below:

Item 15 Rating Criteria:
Item 15 should be rated as a Strength if any of the following apply:
• The answers to A2, B2, C, and D are Yes.
• The answer to A2 and C is Yes and the answer to B2 and D is NA.
• The answer to A2 and C is NA and the answer to B2 and D is Yes.
Item 15 should be rated as an Area Needing Improvement if the answer to any one of questions A2, B2,
C, or D is No.
Item 15 should be rated as Not Applicable if the response to the question of applicability is No.
Item 15 Rating (select one):
Strength 

Area Needing Improvement 

NA 

Provide any additional comments that highlight strengths or challenges related to specific practices, systemic
issues, or resources that affected this item in the narrative field below:

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Section III: Child and Family Well-Being Outcome 1

RATING CHILD AND FAMILY WELL-BEING OUTCOME 1
WELL-BEING OUTCOME 1: FAMILIES HAVE ENHANCED CAPACITY TO PROVIDE
FOR THEIR CHILDREN’S NEEDS.
What is the level of outcome achievement that best describes the extent to which this outcome is being or has
been achieved, based on the ratings for items 12 through 15?

Instructions:
Well-Being Outcome 1 should be rated as Substantially Achieved if both of the following apply:
• Item 12 is rated as a Strength, and
• Only one of items 13, 14, and 15 is rated as an Area Needing Improvement.
Well-Being Outcome 1 should be rated as Partially Achieved if either of the following applies:
• Item 12 is rated as an Area Needing Improvement, but at least one other item is rated as a Strength.
• Item 12 is rated as a Strength, but at least two of items 13, 14, and 15 are rated as Areas Needing
Improvement.
Well-Being Outcome 1 should be rated as Not Achieved if the following applies:
• All applicable items are rated as Areas Needing Improvement.
Select the appropriate rating:
Substantially Achieved 

Partially Achieved 

Child and Family Services Reviews Onsite Review Instrument

Not Achieved 

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Section III: Child and Family Well-Being Outcome 2

WELL-BEING OUTCOME 2: CHILDREN RECEIVE APPROPRIATE SERVICES
TO MEET THEIR EDUCATIONAL NEEDS.
Item 16: Educational Needs of the Child
Purpose of Assessment: To assess whether, during the period under review, the agency made concerted
efforts to assess children’s educational needs at the initial contact with the child (if the case was opened during
the period under review) or on an ongoing basis (if the case was opened before the period under review), and
whether identified needs were appropriately addressed in case planning and case management activities.
Item 16 Applicable Cases:
• All foster care cases involving a school-aged child, including those in pre-school, are applicable for an
assessment of this item. If a child is 2 years old or younger and has been identified as having
developmental delays, the case may be applicable if the developmental delays need to be addressed
through an educational approach rather than through physical therapy or some form of physical health
approach. In these latter cases, the issue of developmental delays would be addressed under item 17.
• Foster care cases are Not Applicable if the child is age 2 or younger and there are no apparent
developmental delays.
• In-home services cases are applicable for an assessment of this item if (1) educational issues are relevant
to the reason for the agency’s involvement with the family, and/or (2) it is reasonable to expect that the
agency would address educational issues given the circumstances of the case. For example, it is
reasonable to expect that the agency would address educational issues in a case in which the child is the
subject of a substantiated maltreatment report and, during the period under review, the maltreatment
appeared to be affecting the child’s school performance.
• In-home services cases are Not Applicable for an assessment of this item if the reviewer determines that,
during the period under review, there is no reason to expect that the agency would address educational
issues for any children in the family, given the reason for agency involvement or the circumstances of the
case. This “non-applicability” applies even if there is evidence in the case file that the agency has learned
that the parent/caregiver has obtained educational services for the children.
Is this case applicable?
Select the appropriate response. If the answer is No, rate the item as Not Applicable in the ratings section and
continue to item 17.
Yes 

No 

A. During the period under review, did the agency make concerted efforts to accurately assess the
children’s educational needs?
Yes 

No 

For in-home services cases, indicate the names of the children who are included in the assessment of item 16:

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Section III: Child and Family Well-Being Outcome 2

Question 16A Instructions:
•

If the case is a foster care case, question A should be answered only for the child in foster care, even if
the child was reunified during the period under review and there are other children in the home.
• If the case is an in-home services case, question A should be answered for all children in the home
who meet the case applicability requirements.
• Question A should be answered Yes if there was evidence of an educational assessment in the case
file, such as:
- An educational assessment included in the comprehensive needs assessment.
- A separate educational assessment conducted by the school (and made available to the agency) or
by the agency.
- An informal (and documented) educational assessment conducted by the agency.
• Question A should be answered Yes if the reviewer determines through interviews with key individuals
that the agency assessed the children’s educational needs, even if the case file did not include the
documentation identified above.

A1.

Education Table
Educational Needs

Services Provided

Services Needed But Not Provided

Table 16A1 Instruction:
Document in the table the child(ren)’s educational needs, services provided to meet those needs, and
services needed but not provided. Services could include ensuring that children received special
education classes; making provisions for children to receive tutoring or educational mentoring; and
arranging for children to be enrolled in early intervention preschool classes such as Head Start. Foster
care cases could include advocacy on the part of foster parents as well as the caseworker.

B. During the period under review, did the agency engage in concerted efforts to address the children’s
educational needs through appropriate services?
Yes 

No 

NA 

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Section III: Child and Family Well-Being Outcome 2

Question 16B Instructions:
•
•

Question B should be answered Not Applicable if an educational assessment was conducted (i.e.,
question A is answered Yes) but no needs were identified.
Review any “services needed but not provided” noted in table A1 when responding to question B.
Focus on agency efforts, even if these efforts were not fully successful due to factors beyond the
agency’s control. For example, if the agency made concerted efforts to advocate for special education
classes, but the local school continued to resist, you may answer Yes to question B, although the child
did not receive the needed services. Also consider whether the service need was recently identified
during the period under review and the agency has not had a reasonable amount of time to arrange
for/request the service.

Item 16 Rating Criteria:
Item 16 should be rated as a Strength if either of the following applies:
• The answers to questions A and B are Yes.
• The answer to question A is Yes, and the answer to question B is Not Applicable.
Item 16 should be rated as an Area Needing Improvement if the answer to question A and/or B is No.
Item 16 should be rated as Not Applicable if the response to the question of applicability is No.
Item 16 Rating (select one):
Strength 

Area Needing Improvement 

NA 

Provide any additional comments that highlight strengths or challenges related to specific practices, systemic
issues, or resources that affected this item in the narrative field below:

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Child and Family Services Reviews Onsite Review Instrument

Section III: Child and Family Well-Being Outcome 2

RATING CHILD AND FAMILY WELL-BEING OUTCOME 2
WELL-BEING OUTCOME 2: CHILDREN RECEIVE APPROPRIATE SERVICES
TO MEET THEIR EDUCATIONAL NEEDS.
What is the level of outcome achievement that best describes the extent to which this outcome is being or has
been achieved, based on the rating for item 16?

Instructions:
Well-Being Outcome 2 should be rated as Substantially Achieved if the following applies:
• Item 16 is rated as a Strength.
Well-Being Outcome 2 should be rated as Partially Achieved if the following applies:
• Item 16 is rated as an Area Needing Improvement, but question A or B is answered Yes.
Well-Being Outcome 2 should be rated as Not Achieved if the following applies:
• Item 16 is rated as an Area Needing Improvement and both questions A and B were answered No.
Well-Being Outcome 2 should be rated as Not Applicable if the following applies:
• Item 16 is rated as Not Applicable.
Select the appropriate rating:
Substantially Achieved 

Partially Achieved 

Not Achieved 

Child and Family Services Reviews Onsite Review Instrument

NA 

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Section III: Child and Family Well-Being Outcome 3

WELL-BEING OUTCOME 3: CHILDREN RECEIVE ADEQUATE SERVICES
TO MEET THEIR PHYSICAL AND MENTAL HEALTH NEEDS.
Item 17: Physical Health of the Child
Purpose of Assessment: To determine whether, during the period under review, the agency addressed the
physical health needs of the children, including dental health needs.
Item 17 Applicable Cases:
• All foster care cases are applicable for an assessment of this item.
• In-home services cases are applicable for an assessment of this item if (1) physical/dental health issues
were relevant to the reason for the agency’s involvement with the family, and/or (2) it is reasonable to
expect that the agency would address physical/dental health issues given the circumstances of the case.
For example, it is reasonable to expect that the agency would address physical health issues in a case in
which a child is the subject of a substantiated maltreatment report of physical neglect and there is reason to
suspect that, during the period under review, the neglect may have affected the child’s physical health.
• In-home services cases are Not Applicable for an assessment of this item if you determine that there is no
reason to expect that the agency would address physical and dental health issues for any children in the
family, given the reason for agency involvement or the circumstances of the case. This “non-applicability”
applies even if there is evidence in the case file that the agency has learned that the parent is effective in
taking care of the children’s physical and dental health needs.
Is this case applicable?
Select the appropriate response. If the answer is No, rate the case as Not Applicable in the ratings section
and continue to item 18.
Yes 

No 

A1. During the period under review, did the agency accurately assess the children’s physical health care
needs?
Yes 

No 

NA 

For in-home services cases, indicate the names of the children who are included in the assessment of item 17:

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Section III: Child and Family Well-Being Outcome 3

Question 17A1 and 17A2 Instructions:
•

For in-home services cases, A1 and A2 should be answered for all children in the home who meet the
case applicability requirements. A1 or A2 may be Not Applicable if only one of the issues (physical or
dental health) was relevant for assessment in an in-home services case.

•

Determine whether there is evidence that, during the period under review, the agency arranged for
assessment of the child(ren)’s health care needs, including dental care needs, both initially (if the child
entered foster care during the period under review or if an in-home services case was opened during
the period under review), and on an ongoing basis through periodic health and dental screening
services conducted during the period under review.
• The evidence to consider would include, but is not limited to:
- Conducting an initial health care screening, such as EPSDT (Early Periodic Screening, Diagnosis,
and Treatment) or other comprehensive medical examination upon entry into foster care (if the child
entered foster care during the period under review) or when the case first opened (for an in-home
services case that opened during the period under review).
- Ensuring that, during the period under review, the children received ongoing periodic preventive
physical and dental health screenings to identify and avoid potential problems. (Preventive health
care refers to initial and periodic age-appropriate dental or physical health examinations.)
- Including an assessment of physical and dental health needs in the initial comprehensive needs
assessment (if the child entered foster care during the period under review or if the in-home services
case was opened during the period under review), or in ongoing needs assessments conducted to
guide case planning.

A2.

During the period under review, did the agency accurately assess the children’s dental health care
needs?
Yes 

No 

NA 

Question 17A2 Instruction:
If the children are too young for a dental examination, then question A2 should be answered Not
Applicable.

A3.

Physical and Dental Health Table

Identified Physical or Dental
Health Needs

Services Provided

Child and Family Services Reviews Onsite Review Instrument

Services Needed But Not
Provided

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Table 17A3 Instruction:
Document in the table each identified physical or dental health need, the services provided to meet those
needs, and the services needed but not provided related to each identified need. Needed services could
include immunizations, treatment services, and dental services, including orthodontics.

A4.

For foster care cases only, determine whether, during the period under review, there was evidence that
the following case-management criteria required by federal statute were met (select each one that was met).
 NA (this is an in-home services case).
 To the extent available and accessible, the child’s health records are up to date and included in the case
file [Social Security Act § 475(1)(C)].
 The case plan addresses the issue of health and dental care needs [Social Security Act § 475(1)(C)].
 To the extent available and accessible, foster parents or foster care providers are provided with the
child’s health records [Social Security Act § 475(5)(D)].
Health records include the names and addresses of the child’s health care providers, a record of the child’s
immunizations, the child’s known medical problems, the child’s medications, and any other relevant health
information.

B1.

For foster care cases only, during the period under review, did the agency provide appropriate oversight
of prescription medications for physical health issues?
Yes 

No 

NA 

Question 17B1 Definition:
• “Appropriate oversight” includes, but is not limited to, the following:
– Ensuring that a child is seen regularly by a physician to monitor the effectiveness of the
medication, assess any side effects and/or health implications, consider any changes needed to
dosage or medication type and determine whether medication is still necessary and/or if other
treatment options would be more appropriate
– Regularly following up with foster parents/caregivers about administering medications
appropriately and about the child’s experience with the medication(s), including any side effects
– Following any additional state protocols that may be in place related to the appropriate use and
monitoring of medications
Question 17B1 Instructions:
•
•

Select NA if this is not a foster care case.
If the child was not prescribed any medications for physical health issues during the period under
review, select NA.

B2. During the period under review, did the agency ensure that appropriate services were provided to the
children to address all identified physical health needs?
Yes 

80

No 

NA 

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Section III: Child and Family Well-Being Outcome 3

Questions 17B2 and 17B3 Instructions:
•

If the answers to question(s) A1 and/or A2 are Yes and no needs for services or treatment were
identified, then the corresponding question(s) B2, and/or B3 should be answered Not Applicable. If
question A2 is Not Applicable because of the child’s age, then question B3 also should be Not
Applicable.

•

If any “services needed but not provided” are noted in the A3 table, question B2 and/or B3 should be
No, unless the service was recently identified during the period under review and the agency has not
had a reasonable amount of time to arrange for the service. If services were not provided due to
excessive waitlists, service providers not being available in the community, or delays by the agency,
question B2 and/or B3 should be No.

•

Answer No to question B2 or B3 if the case management criteria noted in question A4 were not met and
you determine that had or has a negative impact on the agency’s ability to meet the child’s health and
dental care needs. For example, foster parents were unable to effectively address health care needs
because they had never seen the child’s health records, or the child’s health care needs were not being
met because there were no health records in the case file and the worker was unaware of the child’s
health care needs.

B3. During the period under review, did the agency ensure that appropriate services were provided to the
children to address all identified dental health needs?
Yes 

No 

NA 

Item 17 Rating Criteria:
Item 17 should be rated as a Strength if either of the following applies:
• The answers to questions A1, A2, B1, B2, and B3 are Yes.
• The answer to at least one of questions A1, A2, B1, B2, or B3 is Yes, and the rest are Not
Applicable.
Item 17 should be rated as an Area Needing Improvement if the answer to any question is No.
Item 17 should be rated as Not Applicable if the response to the question of applicability is No.
Item 17 Rating (select one):
Strength 

Area Needing Improvement 

NA 

Provide any additional comments that highlight strengths or challenges related to specific practices, systemic
issues, or resources that affected this item in the narrative field below:

Child and Family Services Reviews Onsite Review Instrument

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Section III: Child and Family Well-Being Outcome 3

WELL-BEING OUTCOME 3: CHILDREN RECEIVE ADEQUATE SERVICES
TO MEET THEIR PHYSICAL AND MENTAL HEALTH NEEDS.
Item 18: Mental/Behavioral Health of the Child
Purpose of Assessment: To determine whether, during the period under review, the agency addressed the
mental/behavioral health needs of the children.
Item 18 Applicable Cases:
• Foster care cases are applicable for an assessment of this item if the reviewer determines that, during the
period under review, the child had existing mental/behavioral health needs, including substance abuse
issues. If the child had mental/behavioral health issues before the period under review that were adequately
addressed and there are no remaining needs during the period under review, the case should be rated as
Not Applicable.
• In-home services cases are applicable for an assessment of this item if (1) mental/behavioral health issues
related to any of the children in the family were relevant to the reason for the agency’s involvement with the
family, and/or (2) it is reasonable to expect that the agency would address mental/behavioral health issues
given the circumstances of the case. For example, it is reasonable to expect that the agency would address
mental health issues in a case in which a child is the subject of a substantiated maltreatment report and
there is reason to suspect that, during the period under review, the maltreatment may have affected the
child’s mental health.
• In-home services cases are Not Applicable for an assessment of this item if the reviewer determines that
there is no reason to expect that, during the period under review, the agency would address
mental/behavioral health issues for any children in the family, given the reason for agency involvement or
the circumstances of the case. This “non-applicability” applies even if there is evidence in the case file that
the agency has learned that the parent is effective in taking care of the children’s mental/behavioral health
needs.
Is this case applicable?
Select the appropriate response. If the answer is No, rate the case as Not Applicable in the rating section.
Yes 

No 

A.

During the period under review, did the agency conduct an accurate assessment of the children’s
mental/behavioral health needs either initially (if the child entered foster care during the period under review or
if the in-home services case was opened during the period under review) and on an ongoing basis to inform
case planning decisions?
Yes 

No 

For in-home services cases, indicate the names of the children who are included in the assessment of item 18:

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Question 18A Definition:
“Behavioral health needs” includes needs related to behavioral problems that are not always specified as
mental health needs, including substance abuse.
Question 18A Instructions:
•

An assessment of mental health should include consideration of any trauma that the children may have
experienced, including exposure to domestic violence.
Determine whether, during the period under review, the agency conducted a formal or informal
mental/behavioral health assessment on the children initially (if the in-home services case was opened
during the period under review) or at entry into foster care (if the child entered foster care during the
period under review), and on an ongoing basis.

•

•

If the case is an in-home services case, question A should be answered for all children in the home
who meet the case applicability requirements.

A1.

Mental/Behavioral Health Table

Identified Mental/Behavioral
Health Needs

Services Provided

Services Needed But Not
Provided

Table 18A1 Instruction:
Identify in the table the identified mental/behavioral health needs, services provided to address those
identified needs, and services needed but not provided. Services may include outpatient treatment,
inpatient mental health treatment, treatment for substance abuse disorders, individual therapy, group
therapy, family therapy, etc.

B.

For foster care cases only, during the period under review, did the agency provide appropriate oversight
of prescription medications for mental/behavioral health issues?

Yes 

No 

NA 

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Section III: Child and Family Well-Being Outcome 3

Question 18B Definition:
• “Appropriate oversight” includes, but is not limited to, the following:
- Ensuring that a child is seen regularly by a physician to monitor the effectiveness of the medication,
assess any side effects and/or health implications, consider any changes needed to dosage or
medication type and determine whether medication is still necessary and/or whether other
treatment options would be more appropriate
- Regularly following up with foster parents/caregivers about administering medications appropriately
and about the child’s experience with the medication(s), including any side effects
- Following any additional state protocols that may be in place related to the appropriate use and
monitoring of medications
Question 18B Instructions:
•

Select NA if this is not a foster care case.

•

If the child was not prescribed any medications for mental/behavioral health issues during the period
under review, select NA.

C.

During the period under review, did the agency provide appropriate services to address the children’s
mental/behavioral health needs?
Yes 

No 

NA 

Question 18C Instructions:
•

If question A is answered Yes, but no mental/behavioral health service needs were identified, then the
answer to question C should be Not Applicable.

•

If you noted any “services needed but not provided” in the A1 table, question C should be No, unless
the service was recently identified during the period under review and the agency has not had a
reasonable amount of time to arrange for the service. If services were not provided due to excessive
waitlists, service providers not being available in the community, or delays by the agency, question C
should be answered No.

Item 18 Rating Criteria:
Item 18 should be rated as a Strength if the answer to question A is Yes, the answer to question B is
Yes or Not Applicable, and the answer to question C is Yes or Not Applicable.
Item 18 should be rated as an Area Needing Improvement if the answer to any question is No.
Item 18 should be rated as Not Applicable if the response to the question of applicability is No.
Item 18 Rating (select one):
Strength 

Area Needing Improvement 

NA 

Provide any additional comments that highlight strengths or challenges related to specific practices, systemic
issues, or resources that affected this item in the narrative field below:

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Child and Family Services Reviews Onsite Review Instrument

Section III: Child and Family Well-Being Outcome 3

RATING CHILD AND FAMILY WELL-BEING OUTCOME 3
WELL-BEING OUTCOME 3: CHILDREN RECEIVE ADEQUATE SERVICES
TO MEET THEIR PHYSICAL AND MENTAL HEALTH NEEDS.
What is the level of outcome achievement that best describes the extent to which this outcome is being or has
been achieved, based on the ratings for items 17 and 18?

Instructions:
Well-Being Outcome 3 should be rated as Substantially Achieved if either of the following applies:
• Items 17 and 18 are both rated as Strengths.
• One item is rated as a Strength and the other item is rated as Not Applicable.
Well-Being Outcome 3 should be rated as Partially Achieved if the following applies:
• One of the two items (17 and 18) is rated as a Strength and the other is rated as an Area Needing
Improvement.
Well-Being Outcome 3 should be rated as Not Achieved if either of the following applies:
• Both items are rated as Areas Needing Improvement.
• One item is rated as an Area Needing Improvement and the other item is rated as Not Applicable.
Well-Being Outcome 3 should be rated as Not Applicable if the following applies:
• Items 17 and 18 are both rated as Not Applicable.
Select the appropriate rating:
Substantially Achieved 

Partially Achieved 

Not Achieved 

Child and Family Services Reviews Onsite Review Instrument

NA 

85