CASE REVIEW CHECKLIST   MONTH UNDER REVIEW				

Case Name: ____________________		Social Worker: ________              ______
Date of Custody: _________________		Date of Review: ___	_    _________
Date Assigned: __________________		Current Case Plan:			_______

STATE STANDARDS:
Case Record:	Yes  No  	N/A 
•	Life book created & maintained (#62):				
•	Photograph of child yearly in record (#62):	 			
•	Documentation current w/in 7 days (#97):				
•	Information is filed and easily retrievable:	 			
•	Placement Module updated with moves/court hearings/FSARs (#63):				

Contacts:	Yes   No    N/A
•	F2F w/child & provider w/in 7 days of placement & subsequent placements (#64):				
•	F2F w/ child monthly (#77):	 			
•	F2F w/ removal caretakers monthly (when reunification is plan )(#78):				
•	Efforts for F2F w/absent pr uninvolved parent (when reunification is the plan) (item #17)				
•	Minimum of 2 collateral contacts monthly (#79):				
•	Monthly contact w/placement provider / complete form 5295/5296(#80):	 			
•	Shared parenting experiences facilitated and documented				
•	Quarterly F2F w/child when other county DSS involved (#81):	 			
•	Sibling visitation agreement within 7 days if children not placed together (#68)	 			
•	Sibling visitation if children are not placed together (#61)				

Well Being:	Yes   No	N/A 
•	Child referred for physical w/in 7 days of initial placement/form given to caretaker (#65):				
•	Child referred for dental/developmental/psychological/education as needed (#66):	 			
•	Parent(s) referred for services (item #17)				
•	Diligent efforts for one single stable living arrangement/same community (#60):	 			
•	Efforts to include parent in child’s appointments	 			
•	Siblings placed together whenever possible/efforts documented (#62):				
•	Services offered to caretaker(s) (item #17)				

Forms:	Yes   No	N/A
•	Health Components completed w/in 7 days of placement, every 6 months & given to placement provider if placement moves(#69)				
•	Education Components completed w/in 7 days of placement, every 6 months & given to placement provider if placement moves(#70)	 			
•	Comprehensive Kinship Care Assessment completed w/in 30 days of placement (#59)				
•	Written notice given to parents w/in 14 days of placement moves (#73)	 			
•	Visitation plan completed w/in 7 days of placement and given to parent/documented quality of visit/visitation consistent with risk rating (#67)				
•	Kinship Exploration Form completed w/in 60 days of transfer	 			
•	WIRM data current for this case				

FSA & FSARs & Services	Yes  No	N/A 
•	FSA developed w/in 30 days of custody & concurrent plan is documented/FSA developed with absent parent/documented barriers/efforts to achieve goals #72 & #71)				
•	ICWA documented on case plan/updated every 6 months (item 14)				
•	FSA updated every 6 months and with case plan change  (#90)				
•	FSA and FSAR signed by youth and parent or written justification why not signed/documentation of engaging youth /parent in FSA development				

FSA & FSARs & Services (continued)	Yes  No	N/A 
•	FSA w/in 30 days of Court changing plan from reunification & updated every 6 months /module updated (#90)	 			
•	FSARs held 60/90/every 6 months (#75):				
•	Notice of FSAR’s given to child/parent/caretakers/GAL (#76):	 			
•	Family Reunification Assessment completed @ FSARs/prior to trial visits or returning home/30 days prior to Court (#74):				
•	Strengths & Needs completed w/FSARs/prior to trial visits or returning home/30 days prior to         
   Court (#23):	

	
•	Child & Family Team Meetings held w/in 30 days of custody	 			
•	Child & Family Team Meetings held prior to any case plan change/significant changes	 			

Youth 16 years old and above:	Yes  No	N/A
•	Casey Life Skills Assessment completed w/in 30 days of youth turning 16 (#102):				
•	Case Life Skills Assessment addresses education, job skills, basic living skills, personal, social & emotional development (#102)	 			
•	Transitional living plan completed				
•	Youth offered LINKS; refusal is documented; offered every 6 months thereafter(#104)	 			
•	LINKS data/survey current for case				
•	CARS agreement reviewed every 6 months, if applicable				

Case Plan of Adoption:	Yes  No	N/A
•	TPR packet to Legal Dept. w/in 10 days if case plan change/update TPR list:				
•	W/in 30 days of case plan change, develop a specific written strategy for recruitment of an adoptive home w/in the FSA (#93):				
•	Child listed on the Adoption Resource Exchange w/in 30 days of being legally free (#94) if not in a pre-adoptive home::	 			
•	Priority given to child’s placement provider (#96):				
•	W/in 30 days of being legally free for adoption, assess child for Adoption Assistance (#95)				
•	Signed Adoption Assistance agreement between the agency and adoptive parents prior to entry of final decree (#115):	 			
•	F2F w/in first 7 days of placement & monthly w/child and adoptive parents until finalization of adoption (#116) 				
•	Documentation in record describes adjustment of child/family and service needs (#117)	 			

Court: 	Yes  No 	 N/A 
•	All appropriate parties notified of Court reviews (#82):				
•	Court report prepared for each hearing according to standards (#83):	 			
•	Court reviews held w/in 90 days of initial disposition & every 6 months (#85):				
•	Permanency Planning hearing: 30 days after case plan change OR w/in 12 months of custody (#86):	 			
•	Request made to cease reunification efforts of absent/uninvolved parent  (item #11)	 			
•	If child placed out of home for 12 of most recent 22 months, TPR initiated or documented why not (#88): 				
•	Exception” language used in court report if TPR not pursued (item # 7)	 			
•	If relinquishment is received on child, Court reviews held every 6 months (#91):				

Comments:
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