Center for Tribes Demographic Survey

Evaluation of the Child Welfare Capacity Building Collaborative

07 Center for Tribes demographic survey

Center for Tribes Demographic Survey

OMB: 0970-0484

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Capacity Building Center for Tribes

Tribal Demographic Survey

OMB Control No.: 0970-0484

Expiration Date: XX/XX/XXXX



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THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) Public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, 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.




Official Tribe Name:

Date:

Contact Information

Program Name _____________________________________________________________

Contact ___________________________________________________________________

Title ______________________________________________________________________

Address ___________________________________________________________________

__________________________________________________________________________

Phone ___________________________________________

Email ____________________________________________

Website __________________________________________





Tribal Population and Location

# enrolled tribal members



# or % of enrolled tribal members living on-reservation or within tribal boundaries


# or % of tribal population under age 18



Approximate size (e.g., acres) of reservation or tribal communities


State(s) in which reservation/tribal communities are located


Children’s Bureau Region



BIA Region



Law Enforcement, Tribal Court, and Judiciary

Which agencies provide law enforcement for the tribe? (circle all that apply)

Tribe

BIA

State

County

FBI

Other (name):

Which law enforcement agency/agencies most often assists with child welfare matters? (circle all that apply)

Tribe

BIA

State

County

FBI

Other (name):

Does the tribe have an independent judiciary?

Yes

No






Does the tribe have its own court that makes determinations in child welfare cases?

Yes

No

Part of an

intertribal court





Additional Comments:





Child Welfare Program Services


Yes

No

Does the tribe currently operate a child welfare program?

If the tribe does not currently operate a child welfare program, please skip to Page 5-Child Welfare Staffing.



If the tribe operates a child welfare program, please check Yes or No for each service area below. If yes, also indicate whether policies and procedures are in place for that service.


Yes

No

If yes, check if policies

& procedures for this service are in place

Child protection investigations




Permanency planning




Case management




Family preservation




Child abuse & neglect prevention




ICWA




Foster/kinship care/resource family recruitment




Foster/kinship care/resource family placements




Foster care/resource family licensing by tribe




Transitional or independent living services for youth




Other services for youth (please indicate)

_____________________________________

_____________________________________

_____________________________________





Kinship guardianships




Adoptions




Customary adoptions




Cultural programs




Other: _________________________________





Other: _________________________________





Other: _________________________________








Yes

No


In addition to the tribal program, do any outside/non-tribal agencies provide child welfare services for the tribe?



If yes, which agencies provide child welfare services for the tribe (circle all that apply)

BIA

State

County

Other (name)

Service(s) provided by other agencies:

______________________________________

______________________________________

______________________________________

______________________________________








Additional Comments:









Child Welfare Staffing

Instructions for this section: Please write in the staff positions of the child welfare program and indicate the number of staff currently working in each position, the number of position vacancies, and the required educational level for the position (if any).

Staff Position

# staff currently in position

# positions vacant

Required educational level










































Additional Comments:













Data Management & Child Welfare Program Statistics


Yes

No

Does the child welfare program have an electronic data management system?



If yes, what is the name of this system?


_________________________________________________





If No, how does the program track and manage data?

_____________________________________________

_____________________________________________

_____________________________________________




Yes

No

If the program does not currently have an electronic data management system, is it considering obtaining one in the near future?



If yes, name of system(s) under consideration:

_____________________________________________

_____________________________________________

_____________________________________________



Estimated number of children currently served by the tribal child welfare program __________


Estimated number of children currently in out-of-home placements __________

__________ Tribal

__________ State or other

Current number of tribal foster/kinship/resource homes

__________

Of these:

# licensed by tribe __________

# licensed by state __________

Estimated number of ICWA cases in which the tribal child welfare program is actively involved __________


Estimated number of ICWA notifications received monthly

__________




Additional Comments:





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