Concurrent Planning

Date of Removal to 30 Days

Names of Parents:

Date of Removal:

Names and Dates of Birth of Children:

Social Worker:
Full Disclosure
1. In the last 22 months, how long has each
child been in foster care?

Date of Review:
Notes
________________________________
________________________________

2. Which family members have received full

disclosure regarding ASFA timeframes?
Mother
All fathers
Maternal
Paternal
Grandparents
Grandparents
Mothers siblings
Fathers siblings
Child(ren)
Other family
Other (specify)
supports

________________________________
________________________________
________________________________
________________________________
________________________________

3. How has full disclosure been documented?

1. Have the following fathers been identified for

each child?
Man listed on the birth certificate
Man listed on the Putative Father
registry
Man who acknowledges paternity
Man adjudicated as the biological father
Man living with the birth mother who
identifies himself as the father
Spouse of the birth mother at the time of the
conception and/or birth of the child
Father identified in a child support order
Man identified by the mother as the childs
father

________________________________
________________________________

4. Have all resource parents received adequate

information to keep each child safe and meet his
or her needs?
Yes
No

Paternity

________________________________

2. Has a referral been made to the Parent

Locator Service for absent parents?
Yes
No
N/A (no absent parents)

________________________________
________________________________

Family Engagement/Case Planning

1. Was Family Group Decision Making
utilized?
Yes
No

Notes
________________________________
________________________________

Relatives
1. Has a genogram been completed with the
family?
Yes
No

________________________________
Contacts/Visitation
________________________________
1. Has an adequate visitation schedule been
established with all parents (see standard for
minimums)?
Yes
No

________________________________
________________________________
________________________________

2. Has visitation been arranged with maternal

and paternal relatives?
Yes
No

2. Has an ecomap been completed with the

family?
Yes
No
3. Which maternal and paternal relatives and
fictive kin have been contacted about their
willingness to be a resource for placement or
other support?

________________________________
________________________________

4. Does a Parent Locater Service referral need

to be made to locate relatives?
Yes
No

3. Has visitation been arranged between siblings

who are not placed together?
Yes
No
N/A

________________________________
________________________________

Assessment/Services

A. If no, explain why.

________________________________

1. What poor prognosis and strength indicators

have been identified for the family?

________________________________
________________________________
________________________________
________________________________

2. Has the Child and Family Social and Medical

Information Form been completed for each
child?
Yes
No
3. What reasonable efforts have been made to
prevent removal?

________________________________
4. How have these efforts been documented?
________________________________
________________________________

Placement

Notes
________________________________

1. Where is each child placed?

Relative foster home with potential for
permanency
Non-relative foster home with potential
for permanency
Relative, temporary foster home
Non-relative, temporary foster
home
Other (specify)

________________________________
________________________________
________________________________
________________________________
________________________________

2. Which siblings are placed together?

________________________________

3. If all siblings are not placed together, what

efforts are being made to place them together?

________________________________
________________________________

4. Has an ICPC been initiated for prospective

relative placements?
Yes

No

N/A

5. Has an ICPC Regulation 7 been considered?

Yes
No

________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________

Date of Removal to 30 Days

Names of Parents:

Date of Removal:

Names and Dates of Birth of Children:

Social Worker:
ICWA
1. Have inquiries been made to all parents and
extended family members to ascertain if there is
Indian ancestry for the child(ren)?
Yes
No

Date of Review:
Notes
________________________________

D. Has response been received from all tribes

and/or BIA with tribal membership status?
Yes
No

________________________________
________________________________

3. If the child(ren) is Indian, are they placed

according to ICWA placement preferences?
Yes
No

________________________________
2. Does the child(ren) have Indian ancestry?
Yes
No
If yes, have the following tasks been
completed?

________________________________

4. If the child(ren) is Indian, did an expert

witness testify at the adjudicatory hearing?
Yes
No

________________________________
________________________________

A. Biological parent(s) or family member

completed the Indian Status Information form.
Yes
No

________________________________
________________________________

B. Biological parent(s) or family member

completed the Ancestry form
Yes
No

________________________________
________________________________

C. Tribal membership inquiry sent to all tribes

and/or BIA
Yes
No

________________________________
________________________________
________________________________

Concurrent Planning Additional Notes

Date of Removal to 30 Days
_

Concurrent Planning
1 to 3 Months
Names of Parents:

Date of Removal:

Names and Dates of Birth of Children:

Social Worker:

Date of Review:

Have all prior concurrent planning action

steps been resolved?
Yes
No

Notes
________________________________

Full Disclosure

________________________________

1. Have the parents, relatives and child(ren)

been informed of both the primary and
secondary permanent plans?
Yes
No

________________________________
________________________________
________________________________

2. Have all resources parents received adequate

information to make an informed decision in
supporting each child in his or her permanency
plan?
Yes
No

Family Engagement/Case Planning

1. Which family members were engaged in the
development of the familys case plan?
Mother
All fathers
Maternal
Paternal
Grandparents
Grandparents
Mothers siblings
Fathers siblings
Child(ren)
Other family
Tribe
supports
Other (specify)

________________________________
________________________________
________________________________

2. Is the case plan written in measurable terms

so it is evident when safety threats have been
reduced?
Yes
No

________________________________
Paternity

________________________________

1. Have all absent parents been located?

Yes
No

________________________________
________________________________

Contacts/Visitation
1. Has the social worker had adequate contact
with the parents to support them in moving
forward with their case plan?
Yes
No

Notes
________________________________
________________________________

Relatives
1. Have diligent and continuous efforts been
made to locate relatives?
Yes
No

________________________________
2. How have these efforts been documented?
2. Are those contacts adequately documented in
FOCUS?
Yes
No

________________________________
________________________________

3. Have any additional relatives been identified?

Yes
No

________________________________
3. Has the social worker had monthly face to
face contact with each child?
Yes
No

________________________________
________________________________

4. Are those contacts adequately documented in

FOCUS?
Yes
No

________________________________
Assessment/Services
________________________________
________________________________

5. Is visitation between the mother and the

child(ren) occurring per the standard?
Yes
No

________________________________

8. Are any changes to the visitation plan

needed?
Yes
No

2. Have the needs of each child been assessed

and referrals made for services?
Yes
No

________________________________
________________________________

7. Do any barriers to visitation exist?

Yes
No

1. Have the needs for all parents been assessed

and referrals made for services?
Yes
No

________________________________
________________________________

6. Is visitation between the father(s) and the

child(ren) occurring per the standard?
Yes
No

4. Has an ICPC been initiated for out of state

relatives?
Yes
No

3. What has been started for each childs Life

Book?

________________________________
________________________________
________________________________

Placement
1. Mark each childs primary permanency plan
with a 1 and secondary plan with a 2:
Return Home
Permanent placement with other parent
Adoption by Relative
Adoption by Non-Relative
Guardianship with Relative
Guardianship with Non-Relative
Other Planned Permanent Living
Arrangement

Notes
________________________________
________________________________

Court
1. If there was a judicial finding of aggravated
circumstances, did a permanency hearing take
place within 30 days?
Yes
No

________________________________
________________________________
________________________________
________________________________

2. Are these the same permanency goals

contained in FOCUS and on the most recent
Alternate Care Plan?
Yes
No

________________________________
________________________________
________________________________

3. Is each child in a potentially permanent

placement?
Yes
No

________________________________
________________________________
________________________________

A. If no, what needs to happen in order for each

child to be in a concurrent planning placement?

________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________

1 to 3 Months
Names of Parents:

Date of Removal:

Names and Dates of Birth of Children:

Social Worker:
ICWA
1. If the child(ren) is Indian, has the tribe been
invited to participate in case planning and kept
apprised of what is happening in the case?
Yes
No
N/A

Date of Review:
Notes
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________

Concurrent Planning Additional Notes

1 to 3 Months

10

Concurrent Planning
3 to 6 Months
Names of Parents:

Date of Removal:

Names and Dates of Birth of Children:

Social Worker:

Date of Review:

Have all prior concurrent planning action

steps been resolved?
Yes
No

Notes
________________________________

Full Disclosure

________________________________

1. Have case plan progress and permanent

placement options been discussed with all of the
following:
Mother
Father(s)
Child(ren)
Relatives
Resource families

________________________________
________________________________
________________________________
________________________________

2. Have all resources parents received adequate

information to make an informed decision in
supporting each child in his or her permanency
plan?
Yes
No

________________________________
________________________________
________________________________

Paternity

________________________________

1. Have all paternity issues been resolved?

Yes
No

________________________________
________________________________

Family Engagement/Case Planning

1. Have the original safety issues been reduced
to a sufficient level so it is probable each child
can be safe with the parent or caregiver?
2. Have the parents made adequate progress on
their case plan to retain reunification as the
primary permanency goal?
Yes
No
A. If no, has voluntary relinquishment of
parental rights been discussed with the parents?
Yes
No
3. Will the parents be able to achieve
reunification by 12 months?
Yes
No
A. If no, what are the barriers to success?
4. Does the case plan need to be revised before
the next court review?
Yes
No
5. What additional safety issues been identified
since the case has been opened?

11

Contacts/Visitation
1. Has the social worker had adequate contact
with the parents to support them in moving
forward with their case plan?
Yes
No

Notes
________________________________

1. Have any additional relatives been identified?

Yes
No

________________________________
________________________________

2. Are those contacts adequately documented in

FOCUS?
Yes
No

Relatives

________________________________
________________________________

2. If ICPC home study results have not been

received, has assistance been requested from the
Idaho ICPC Administrator to access home study
results and placement recommendations?
Yes
No

________________________________
3. Has the social worker had monthly face to
face contact with each child?
Yes
No

________________________________
________________________________

4. Are those contacts adequately documented in

FOCUS?
Yes
No

________________________________

3. ICPC placement authorizations remain valid

for six months. Has a request for renewal or
assistance been made through Idahos ICPC
Administrator to make sure all ICPC placement
authorizations remain current?
Yes
No
N/A (no ICPC renewals needed)

________________________________
________________________________

5. Is visitation between the mother and the

child(ren) occurring per the standard?
Yes
No

________________________________
________________________________

6. Is visitation between the father(s) and the

child(ren) occurring per the standard?
Yes
No

________________________________
________________________________

7. Do any barriers to visitation exist?

Yes
No
8. Are any changes to the visitation plan
needed?
Yes
No

________________________________
________________________________
________________________________

12

Assessment/Services
1. Has information been collected from all
service providers regarding the familys
progress toward achieving case plan goals?
Yes
No

Notes
________________________________
________________________________

Placement
1. Is each child in a potential permanent
placement?
Yes
No

________________________________
2. Have services been appropriate or helpful to
the family in achieving their case plan
objectives?
Yes
No

________________________________
________________________________

A. If yes, has the family been referred for an

updated PRIDE study which includes an
adoption recommendation or an adoptive home
study?
Yes
No

________________________________
3. Has the Social and Medical Information
Form been updated with additional background
and social history information?
Yes
No

________________________________
________________________________
________________________________

4. For youth age 15 or older, has an AnsellCasey Assessment been completed?

Yes
No

B. If no, what steps are being taken to ensure

each child is moved to a permanent placement?

________________________________

C. If no, does each child have contact and

visitation with a potential permanent caregiver?
Yes
No

________________________________
________________________________

5. For youth age 15 or older, has an

Independent Living Plan been developed and
services put into place?
Yes
No
6. Have the needs of each child been assessed
and relevant services been provided?
Yes
No

________________________________
________________________________
________________________________
________________________________
________________________________
________________________________

13

3 to 6 Months
Names of Parents:

Date of Removal:

Names and Dates of Birth of Children:

Social Worker:

Date of Review:

ICWA
Notes
1. If the child(ren) is Indian, has the tribe(s)
and/or BIA responded to tribal membership
inquiries?
Yes
No
2. Is the child(ren)s tribe participating in case
planning and kept apprised of what is
happening?
Yes
No

_______________________________

5. If the child(ren) is Indian, is their current

placement in accordance with ICWA placement
requirements?
Yes
No

________________________________
________________________________
________________________________
________________________________

3. Has there been tribal (or BIA) notification of

all court hearings?
Yes
No

________________________________
________________________________

4. If the child(ren) is Indian, is their identified

permanent placement in accordance with ICWA
placement requirements?
Yes
No

________________________________
________________________________
________________________________
________________________________
________________________________

14

Concurrent Planning Additional Notes

3 to 6 Months

15

Concurrent Planning
6 to 9 Months
Names of Parents:

Date of Removal:

Names and Dates of Birth of Children:

Social Worker:
Have all prior concurrent planning action
steps been resolved?
Yes
No

Date of Review:
Family Engagement/Case Planning
Notes
________________________________

Full Disclosure

1. Is progress on the case plan sufficient to

reunify at or before the permanency hearing?
Yes
No

________________________________
1. Have case plan progress and each childs
identified concurrent plan goals been discussed
with all of the following:
Mother
Father(s)
Child(ren)
Relatives
Resource families
2. Have all resources parents received adequate
information to make an informed decision in
supporting each child in his or her permanency
plan?
Yes
No

________________________________
________________________________
________________________________
________________________________

2. Does the primary permanency goal need to

be changed or updated on the Alternate Care
Plan and/or FOCUS?
Yes
No
3. Has the case been staffed with the
Permanency Committee to confirm or select
each childs permanency goal and placement?
Yes
No

________________________________
________________________________
________________________________

4. If the permanency goal is Other Planned

Permanent Living Arrangement (OPPLA), have
all other permanency options been exhausted?
Yes
No

Paternity
________________________________
1. Have all paternity issues been resolved?
Yes
No

________________________________
________________________________

16

Contact/Visitation

Notes

Assessment/Services

1. Have the parents maintained frequent

consistent and quality visitation?
Yes
No

________________________________

2. Do there need to be any changes to the

visitation plan?
Yes
No

________________________________

3. Have ongoing visits occurred between

siblings not living together?
Yes
No

________________________________

4. Has each childs other connections been

maintained (i.e. relatives, friends, cultural)?
Yes
No

________________________________
________________________________

Placement

5. Has the social worker had adequate contact

with the parents to support them in moving
forward with their case plan?
Yes
No

________________________________

1. For each child in a permanent placement,

does the family have a current home study with
a recommendation for adoption?
Yes
No
N/A (no child is in a permanent placement or
the concurrent plan does not include adoption)

________________________________

________________________________

________________________________

________________________________
________________________________

6. Are those contacts adequately documented in

FOCUS?
Yes
No

1. Have adequate services been provided to all

parents to support successful reunification?
Yes
No
A. If not, what barriers exist, services are
needed and what reasonable or active efforts
have been made to overcome those barriers?
2. For each child who is not likely to return
home, has the social history been started?
Yes
No
N/A (each child likely to return home)

________________________________
________________________________

7. Has the social worker had monthly face to

face contact with each child?
Yes
No

________________________________
________________________________

8. During those visits, has the social worker

discussed permanency, safety and well-being
goals with each child?
Yes
No
9. Are those contacts adequately documented in
FOCUS?
Yes
No

________________________________
________________________________
________________________________
________________________________

17

6 to 9 Months
Names of Parents:

Date of Removal:

Names and Dates of Birth of Children:

Social Worker:
ICWA
1. If the child(ren) is Indian, is the tribe
participating in case planning and kept apprised
of what is happening?
Yes
No

Date of Review:
Notes
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________

18

Concurrent Planning Additional Notes

6 to 9 Months

19

Concurrent Planning
9 to 12 Months
Names of Parents:

Date of Removal:

Names and Dates of Birth of Children:

Social Worker:

Date of Review:
Notes

Have all prior concurrent planning action

steps been resolved?
Yes
No

Family Engagement/Case Planning

________________________________
________________________________

Full Disclosure

1. Is progress on the case plan sufficient to

reunify at or before the permanency hearing?
Yes
No

________________________________
1. Have case plan progress and each childs
identified concurrent plan goals been discussed
with all of the following:
Mother
Father(s)
Child(ren)
Relatives
Resource families

________________________________
________________________________
________________________________

2. Have all resources parents received adequate

information to make an informed decision in
supporting each child in his or her permanency
plan?
Yes
No

________________________________

3. What is each childs understanding of the

permanent plan?

________________________________

2. Does the primary permanency goal need to

be changed or updated on the Alternate Care
Plan and/or FOCUS?
Yes
No
3. Has the case been staffed with the
Permanency Committee to confirm or select
each childs permanency goal and placement?
Yes
No

________________________________
________________________________

4. If the permanency goal is Other Planned

Permanent Living Arrangement (OPPLA), have
all other permanency options been exhausted?
Yes
No

________________________________
________________________________

20

Contact/Visitation

Notes

1. Have parents maintained frequent consistent

and quality visitation?
Yes
No

________________________________

2. Do there need to be any changes to the

visitation plan?
Yes
No

________________________________

3. Have ongoing visits occurred between

siblings not living together?
Yes
No

________________________________

4. Has each childs other connections been

maintained (i.e. relatives, friends, cultural)?
Yes
No

________________________________

5. Has the social worker had adequate contact

with the parents to support them in moving
forward with their case plan?
Yes
No

________________________________

________________________________

________________________________

________________________________

________________________________

________________________________
________________________________

6. Are those contacts adequately documented in

FOCUS?
Yes
No
7. Has the social worker had monthly face to
face contact with each child?
Yes
No

9. Are those contacts adequately documented in

FOCUS?
Yes
No

1. Have adequate services been provided to all

parents to support successful reunification?
Yes
No
2. Has each child received options counseling to
make an informed decision about his or her
permanent plan?
Yes
No
3. Has each childs social history been
completed?
Yes
No
4. Has each childs Child and Family Social and
Medical Information Form been updated?
Yes
No
5. Is each childs Life Book up to date?
Yes
No
6. Reasonable efforts to finalize a permanent
plan have OR have not been made.

________________________________
________________________________

Placement

________________________________

1. If a permanent placement has disrupted or

has not been identified, have child-specific
recruitment efforts been started?
Yes
No

________________________________
8. During those visits, has the social worker
discussed permanency, safety and well-being
goals with each child?
Yes
No

Assessment/Services

________________________________
________________________________
________________________________

2. Does judicial consent to utilize media

recruitment efforts need to be requested at the
permanency hearing?
Yes
No

________________________________

21

9 to 12 Months
Names of Parents:

Date of Removal:

Names and Dates of Birth of Children:

Social Worker:

ICWA
1. If the child(ren) is Indian, is the tribe
participating in case planning and kept apprised
of what is happening?
Yes
No

Date of Review:

Notes
________________________________
________________________________
________________________________

2. If the child(ren) is Indian, has the tribe and/or

BIA been notified of the permanency hearing in
accordance with ICWA notification
requirements?
Yes
No

________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________

22

23

Concurrent Planning Additional Notes

9 to 12 Months

24

Concurrent Planning
12 to 15 Months
Names of Parents:

Date of Removal:

Names and Dates of Birth of Children:

Social Worker:

Date of Review:

Have all prior concurrent planning action

steps been resolved?
Yes
No

Notes
________________________________

Full Disclosure

________________________________

4. Have the birth parents been given the

opportunity to sign the release of their
identifying information to the adoptive parents?
Yes
No
N/A (the permanency plan is not adoption)

1. Have case plan progress and each childs

identified concurrent plan goals been discussed
with all of the following:
Mother
Father(s)
Child(ren)
Relatives
Resource families

________________________________

Family Engagement/Case Planning

________________________________

1. Is progress on the case plan sufficient to

reunify at or before the permanency hearing?
Yes
No

________________________________
________________________________

2. Have all resources parents received adequate

information to make an informed decision in
supporting each child in his or her permanency
plan?
Yes
No

________________________________
________________________________
________________________________

3. Is each child prepared for his or her alternate

permanency plan?
Yes
No

________________________________
________________________________
________________________________

2. Does the primary permanency goal need to

be changed or updated on the Alternate Care
Plan and/or FOCUS?
Yes
No
3. Has the case been staffed with the
Permanency Committee to confirm or select
each childs permanency goal and placement?
Yes
No
4. If the permanency goal is Other Planned
Permanent Living Arrangement (OPPLA), have
all other permanency options been exhausted?
Yes
No

25

Contact/Visitation

Notes

Assessment/Services

1. Have the parents maintained frequent

consistent and quality visitation?
Yes
No

________________________________

2. Do there need to be any changes to the

visitation plan?
Yes
No

________________________________

3. Have ongoing visits occurred between

siblings not living together?
Yes
No

________________________________
________________________________

Placement

4. Has each childs other connections been

maintained (i.e. relatives, friends, cultural)?
Yes
No

________________________________

5. Has the social worker had adequate contact

with the parents to support them in moving
forward with their case plan?
Yes
No

________________________________

1. If the identified permanent placement has

disrupted, or has not yet been identified, which
ongoing child-specific recruitment efforts are
being made?
Re-contacting relatives, previous foster
parents and other connections
Internet adoption exchanges (Wednesdays
Child, NW Adoption Exchange, AdoptUSKids)
Televised Wednesdays Child production
Wednesdays Child newspaper feature
Other

________________________________

________________________________

________________________________

________________________________
________________________________

6. Are those contacts adequately documented in

FOCUS?
Yes
No

________________________________
________________________________

7. Has the social worker had monthly face to

face contact with each child?
Yes
No

________________________________

1. Have adequate services been provided to all

parents to support successful reunification?
Yes
No
2. Has each child received options counseling to
make an informed decision about his or her
permanent plan?
Yes
No

2. If the permanent plan is OPPLA, has the

foster parent signed a Declaration of
Commitment?
Yes
No

________________________________
8. During those visits, has the social worker
discussed permanency, safety and well-being
goals with each child?
Yes
No
9. Are those contacts adequately documented in
FOCUS?
Yes
No

________________________________
________________________________
________________________________
________________________________

26

Court
1. Has the termination report to the court been
written?
Yes
No
N/A (permanent plan is not adoption)

Notes
________________________________
________________________________
________________________________

2. Has a petition for termination of parental

rights been filed?
Yes
No
N/A (permanent plan is not adoption)

________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________

27

12 to 15 Months
Names of Parents:

Date of Removal:

Names and Dates of Birth of Children:

Social Worker:

ICWA
1. If the child(ren) is Indian, is the tribe
participating in case planning and kept apprised
of what is happening?
Yes
No

Date of Review:

Notes
________________________________
________________________________
________________________________

2. If the child(ren) is Indian, has the tribe and/or

BIA been notified of the permanency hearing in
accordance with ICWA notification
requirements?
Yes
No

________________________________
________________________________
________________________________

3. If the child(ren) is Indian, has the tribe and/or

BIA been notified of the hearing to terminate
parental rights in accordance with ICWA
notification requirements?
Yes
No

________________________________
________________________________
________________________________

4. If the child(ren) is Indian and the permanency

plan is adoption, is an expert witness scheduled
to testify at the termination hearing?
Yes
No

________________________________
________________________________
________________________________
________________________________

28

29

Concurrent Planning Additional Notes

12 to 15 Months

30

Concurrent Planning
15 to 22 Months
Names of Parents:

Date of Removal:

Names and Dates of Birth of Children:

Social Worker:

Date of Review:
Notes

Have all prior concurrent planning action

steps been resolved?
Yes
No

Family Engagement/Case Planning

________________________________
________________________________

Full Disclosure
________________________________
1. Is each child prepared for his or her
permanency plan?
Yes
No

1. If termination of parental rights has not

occurred, does the case plan continue to address
the parents?
Yes
No

________________________________
________________________________

2. Has full disclosure of each childs Child and

Family Social and Medical Information Form,
social history, educational, medical and mental
health records been made to the adoptive
family?
Yes
No
N/A (permanent plan is not adoption)

________________________________
________________________________
________________________________
________________________________

3. If yes, have records disclosed been

documented on the Adoption Information
Disclosure form?
Yes
No

________________________________
________________________________
_______________________________
________________________________

31

Contact/Visitation
1. If termination of parental rights has not
occurred, have the parents maintained frequent
contact and quality visitation?
Yes
No

Notes
________________________________
________________________________

Assessment/Services
1. Are supports and/or services for each child
and their resource family in place to ensure a
stable and successful placement?
Yes
No

________________________________
2. Have ongoing visits occurred between
siblings not living together?
Yes
No

________________________________
________________________________

3. Has each childs other connections been

maintained (i.e. relatives, friends, cultural)?
Yes
No

________________________________
________________________________

4. Has the social worker had monthly face to

face contact with each child?
Yes
No

________________________________
________________________________

5. During those visits, has the social worker

discussed permanency, safety and well-being
goals with each child?
Yes
No
6. Are those contacts adequately documented in
FOCUS?
Yes
No

2. Have the needs of each child been addressed

to prepare him or her for adoption?
Yes
No
N/A (permanent plan is not adoption)
3. For youth age 15 or older, is the Independent
Living Plan current?
Yes
No
A. Are the current Independent Living services
meeting the needs of each youth?
Yes
No

________________________________
________________________________

Placement

________________________________

1. Has the Adoptive Placement Agreement (or

Legal Risk Adoptive Placement Agreement)
been signed?
Yes
No
N/A (permanent plan is not adoption)

________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________

32

Adoption/Guardianship Assistance
1. Which parts of the adoption or guardianship
assistance application have been completed?
Part 1
Part 2
N/A (permanent plan is not adoption or
guardianship after termination of parental rights)

Notes
________________________________
________________________________
________________________________
________________________________

2. Has an Adoption Assistance Agreement or

Guardianship Assistance Agreement been
signed?
Yes
No
N/A (permanent plan is not adoption or
guardianship after termination of parental rights)

________________________________
________________________________
________________________________
________________________________
________________________________

Court
1. Copies of which documents necessary to
finalize each childs adoption have been
received?
Three certified copies of all orders
terminating parental rights
Certified birth certificate for each child
Certified death certificate for each deceased
parent
Current (within three years ) criminal history
clearances for the adoptive parents and any adult
residing in their home
Hospital birth records for each child
N/A (permanent plan is not adoption)
2. Has the Adoption Report to the Court been
written?
Yes
No
N/A (permanent plan is not adoption)

________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________

33

15 to 22 Months
Names of Parents:

Date of Removal:

Names and Dates of Birth of Children:

Social Worker:
ICWA
1. If the child(ren) is Indian, has the tribe been
notified of adoption or guardianship proceedings
in accordance with ICWA notification
requirements?
Yes
No

Date of Review:
Notes
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________

34

35

Concurrent Planning Additional Notes

15 to 22 Months

36

Concurrent Planning Summary

Names of Children:
Names of Parents:

Date of Removal:

Social Worker:
Full Disclosure
Date of
Removal to 30
Days

15 to 22 Months
Date of Review

Action Needed

1 to 3 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

3 to 6 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

6 to 9 Months

____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________

9 to 12 Months

____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________

____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________

____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________

12 to 15
Months

Completed/Date

37

____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________

Paternity
Date of
Removal to 30
Days

1 to 3 Months

3 to 6 Months

6 to 9 Months

9 to 12 Months

12 to 15
Months

15 to 22 Months
Date of Review

Action Needed

Completed/Date

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________

38

____________

____________
____________

__________________________________________________________________
__________________________________________________________________

____________
____________

_____________
_____________
_____________
_____________
_____________
_
____________
____________

_____________
_____________
_____________
_____________
_____________
_
____________
____________

_____________
_____________
_____________
_____________
_____________
_
____________

39

Family Engagement/Case Planning

Date of
Removal to 30
Days

Date of Review

Action Needed

Completed/Date

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

1 to 3 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

3 to 6 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

6 to 9 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

9 to 12 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

12 to 15
Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

15 to 22
Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

40

Contact/Visitation
Date of
Removal to 30
Days

Date of Review

Action Needed

Completed/Date

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

1 to 3 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

3 to 6 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

6 to 9 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

9 to 12 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

12 to 15
Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

15 to 22
Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

41

Relatives
Date of Review

Action Needed

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

3 to 6 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

6 to 9 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

9 to 12 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

12 to 15
Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

15 to 22
Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

Date of
Removal to 30
Days

1 to 3 Months

Completed/Date

42

Assessment/Services
Date of
Removal to 30
Days

Date of Review

Action Needed

Completed/Date

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

1 to 3 Months

3 to 6 Months

6 to 9 Months

9 to 12 Months

12 to 15
Months

15 to 22
Months

43

Placement
Date of
Removal to 30
Days

Date of Review

Action Needed

Completed/Date

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

1 to 3 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

3 to 6 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

6 to 9 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

9 to 12 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

12 to 15
Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

15 to 22
Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

44

Adoption/Guardianship Assistance
Date of
Removal to 30
Days

Date of Review

Action Needed

Completed/Date

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

1 to 3 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

3 to 6 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

6 to 9 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

9 to 12 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

12 to 15
Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

15 to 22
Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

45

Court
Date of
Removal to 30
Days

Date of Review

Action Needed

Completed/Date

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

1 to 3 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

3 to 6 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

6 to 9 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

9 to 12 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

12 to 15
Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

15 to 22
Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

46

ICWA
Date of
Removal to 30
Days

Date of Review

Action Needed

Completed/Date

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

1 to 3 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

3 to 6 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

6 to 9 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

9 to 12 Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

12 to 15
Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

15 to 22
Months

____________
____________
____________
____________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

____________
____________
____________
____________

47