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Department for Community Based Services
Standards of Practice Online Manual
Chapters
1
2
3
4
9
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31
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Chapter 1-Fundamentals of Practice
Fundamentals of Practice
1.1 Ethical Practice
1.2 Reasonable Efforts
1.3 Worker Safety
1.4 Documentation
1.5 Supervision and Consultation
1.6 Engaging the Family
1.7 Family Team Meetings (FTM)
1.8 Prevention Planning
1.9 Working With Service Providers
1.10 Targeted Case Management: TCM Contacts with a Family
1.11 CQI Case Review System
1.13 Debriefing of Protection and Permanency Staff-Reaction and Emotional Responses to Trauma
1.14 Limited English Proficiency (LEP)
1.15-Not Yet Utilized
Confidentiality
1.16 Confidentiality and Safeguards Regarding Client, DPP Office, Program and Facility Information
1.17 Informed Consent and Release of Information
1.18 HIV/AIDS
Chapter 2-Child Protective Services (CPS) Intake and Investigation
Intake
2.1 Receiving the Report
2.2 Receiving a Specialized Investigation Report
2.3 Acceptance Criteria
2.4 Court Requested CPS Activity
2.5 Criteria for Reports that are Not Accepted
2.6 Completing the CPS Intake
2.7 through 2.9-Not Yet Utilized
Conducting the Investigation or Family in Need of Services Assessment
2.10 Initiating the Report
2.11 Investigation Protocol
2.12 Completing the Continuous Quality Assessment (CQA) and Making a Finding
2.13 Case Disposition-Determination Whether to Open a Case
2.14 Child Fatality or Near Fatality
2.15 Specialized Investigations
2.15.1 Investigations of Foster or Adoptive Homes (DCBS or Private Child Placing (PCP) Agencies)
2.15.2 Investigations of Licensed Private Child Caring Facilities
2.15.3 Investigations of Licensed Child Care Centers
2.15.4 Investigations of Registered (Subsidized) Family Child Care Providers
2.15.5 Investigations of School Personnel
2.15.6 Investigations of Supports for Community Living (SCL) and Community Mental Health/Mental Retardation Center (CMHC)
2.15.7 Investigations of Psychiatric Residential Treatment Facilities (PRTF), Crisis Stabilization Units or Psychiatric Hospitals
2.15.8 Investigations Involving DCBS Employees
2.16 through 2.22-Not Yet Utilized
Consultations and Staffing Requirements
2.23 Pediatric Forensic Medicine Consult
2.24 Child Emotional Abuse Investigations and Emotional Injury Evaluations
2.25 Staffing with FSOS and High Risk Protocol
2.26 Utilization Review if Removal of a Child from Home
2.27 through 2.29-Not Yet Utilized
Chapter 3-In Home Child Protective Services (CPS) Case
Opening an In Home Case
3.1 Engaging the Family and Opening the Case
3.2 Timeframes and Ongoing Service Requirements for All In Home Services Cases
3.3 Tools for Case Planning (Prevention Plans and Genograms)
3.4 Initial In Home Case Planning Conference
3.5 Participants and Notification for All In Home Cases
3.6 Negotiating Objectives and Tasks
3.7 through 3.9-Not Yet Utilized
Ongoing Assessment, Case PLanning and Service Provision
3.10 Onsite Provision of Services
3.11 Working with Incarcerated Parents
3.12 Ongoing Assessment (CQA)
3.13 Ongoing Case Planning
3.14 through 3.17-Not Yet Utilized
Case Closure
3.18 Assessing the Case for Closure
3.19 Aftercare Planning
Chapter 4-Out of Home Care Services (OOHC)
Initial Considerations Prior to Removal
4.1 Native American Child/Maintaining Cultural Connections
4.2 Consideration of Race or Ethnicity
4.3 Relative and Absent Parent Search
4.4 Not Yet Utilized
4.5 Relative Evaluation and Placement
4.5.1 Kinship Care Regional Logs
4.5.2 Eligibility Criteria for Kinship Care Benefits
4.5.3 Kinship Care Benefits Approvals
4.5.4 Background Checks for Kinship Care Providers or Relative Caregivers
4.5.5 Not Yet Utilized
4.5.6 Permanency for the Child
4.5.7 Start-Up Costs for Kinship Care
4.5.8 Discontinuance of Kinship Care
4.5.9 Redetermination and Reapplication for Kinship Care
4.5.10 Service Appeals for Kinship Care Providers
4.6 through 4.9-Not Yet Utilized
Foster Care Placement Administrative Section
4.9 Initial Placement Considerations
4.10 Placement in a DCBS Resource Home
4.10.1 DCBS Care Plus
4.10.2 DCBS Medically Fragile Placement
4.10.3 Emergency Shelter Resource Home
4.10.4 Relative Foster Home
4.11 Private Child Placing (PCP) or Child Caring (PCC) Agency
4.11.1 Level of Care Assignment
4.11.2 Request for Emergency LOC Assignment
4.11.3 Reviews of LOC Assignment
4.11.4 Change in LOC Assignment
4.12 through 4.13-Not Yet Utilized
Opening a Foster Care Case and Developing an Initial Case Plan
4.14 Timeframes for All OOHC Cases
4.15 Family Attachment and Involvement
4.16 Participants and Notification for All OOHC Cases
4.17 Preparation for and Five (5) Day Conference
4.18 Ongoing Case Planning
4.19 Visitation Agreement
4.20 Not Yet Utilized
4.21 Safe Infants Act
4.22 through 4.23-Not Yet Utilized
Ongoing OOHC Service Provision
4.24 SSW's Ongoing Contact with the Birth Family and Child, Including the Medically Fragile Child
4.25 Ongoing Contact Between Parents and Children in Out of Home Care
4.26 Meeting Basic Health Care Needs
4.26.1 Medical Passport
4.26.2 Authorization for Medical Services
4.26.3 Immunizations Including Human Papillomavirus Vaccine
4.26.4 Passport Health Plan
4.26.5 Early Periodic Screening, Diagnosis and Treatment (EPSDT)
4.27 Meeting Medically Fragile Health Care Needs
4.27.1 Individual Health Plan for the Medically Fragile Child
4.27.2 Extraordinary Medical Care/Medical Expenses of a Medically Fragile Child
4.27.3 Serious Injury of a Child in Foster Care
4.27.4 Life Support Systems
4.27.5 Ending Use of Life Support Systems
4.28 Meeting Educational Needs
4.28.1 Educational Assessment
4.28.2 Providing Educational Services Under the Individuals with Disabilities Act (IDEA)
4.28.3 Educational Passport
4.28.4 Higher Education Assistance
4.28.5 Educational Training Voucher for Aged Out Youth
4.29 Independent Living
4.29.1 Independent Living Services
4.29.2 Transition Planning for OOHC Youth
4.30 through 4.33-Not Yet Utilized
Ongoing Assessment, Case Planning and Case Closure
4.34 Assessing Family Progress and Collateral Contacts
4.35 Reunification, Including Extended Visitation, Case Planning and Transitional Supports to Families
4.36 Case Closure and Aftercare Planning
4.37 through 4.44-Not Yet Utilized
OOHC Administrative Standards of Practice
4.45 Movement from a Home Placement
4.46 Movement from a DCBS Resource Home
4.47 Movement from One PCC Placement to Another
4.48 Discharge from a PCP or PCC Placement
4.49 Discharge Planning Prior to Leaving a Hospital or Treatment Facility
4.50 Discharge Planning Prior to Placement Changes Against Medical Advice
4.51 Out of State Placement
4.52 Personal Care Home/Family Care Home
4.53 Bed Hold-Private Residential or Foster Care Placement
4.54 Transportation and Out of State Travel with a Child in the Custody of the Cabinet
4.55 Sex Education
4.55.1 Pregnant Youth
4.55.2 Family Planning for Pregnant Youth
4.56 Use of Tobacco Products
4.57 Photography, Videotaping or Audio Taping of a Child in OOHC
4.58 Mail to Child in OOHC
4.59 Change of Surname for a Youth in OOHC
4.60 Driver's License for Youth in OOHC
4.61 Employment for a Youth in OOHC
4.62 Household Work and Operation of Machinery
4.63 Athletic Program Participation
4.64 Census Count for a Youth in OOHC
4.65 Credit Reports for Youth in Foster Care
4.66 Critical Situations
Chapter 9-Status Offender Services
Introduction
9.1 Introduction to Status Offender Services
9.2 Compliance with Interstate Compact on Juveniles
9.3 Coordination of Efforts with the Department of Juvenile Justice
9.4 Detention of Status Offenders
9.5 Diversion Options for Status Offenders
9.6-Not Yet Utilized
Intake and Service Provision
9.7 Intake and Investigation, Including Interviews
9.8 Dispositional Report for Status Offenders
9.9 Assessment
9.10 In Home Case Planning
9.11 In Home Service Provision
9.12 Case Planning for Status Offenders
9.13 Placement for Status Offenders
9.14 through 9.17-Not Yet Utilized
General Ongoing Services for Status Offenders
9.18 Ongoing Services
9.19 Case Closure and Aftercare Planning
Chapter 10-Interstate Compact on the Placement of Children
ICPC Home Evaluations
10.1 Introduction to ICPC Home Evaluations
10.2 Request to Another State for Interstate Parental or Relative Home Evaluation
10.3 Request to Another State for Interstate Home Evaluation-Court Jurisdiction Only Cases
10.4 Request to Another State for Interstate Foster Care or Adoptive Home Study
10.5 Request from Another State for Interstate Parental or Relative Home Study
10.6 Request from Another State for Interstate Foster Care or Adoptive Home Study
10.7 Approved Interstate Parental, Relative, Foster Care or Adoptive Home Study to Another State
10.8 Approved Interstate Parental, Relative, Foster Care or Adoptive Home Study From Another State
10.9 Denied Interstate Parental, Relative, Foster Care or Adoptive Home Study to Another State
10.10 through 10.12-Not Yet Utilized
Compliance with Interstate Compact on Juveniles
10.13 Introduction to Compliance with Interstate Compact on Juveniles
10.14 Status Offender Referrals and Return of Runaways
10.15 Child Protective Services (CPS) Referrals and CPS Alerts
10.16 Child Protective Services (CPS) Records Requests
10.17 Custody Investigations
10.18 Travel
10.19 through 10.22-Not Yet Utilized
Making Adoptive Interstate Placements
10.23 Introduction to Making Adoptive Interstate Placements
10.24 Requirements for Out of State Adoptive Families
10.25 Obtaining an Out of State Home Study
10.26 Request for ICPC Approval of Out of State Visitation and Placement
10.27 Travel Expenses for the Out of State Family
10.28 Out of State Travel for DCBS Staff
10.29 Services Required After Out of State Placement
10.30 SSW's Responsibility for the Child After Out of State Placement
10.31 Out of State Petitions for Finalization of Adoption
10.32 Kentucky Families Adopting Through Out of State or Out of Country Adoption Agencies
Chapter 11-CPS Court
CPS Court Administrative SOP
11.1 Preparation for Court
11.2 Subpoenas and Confidentiality
11.3 Attorney-Client Privileged Information
11.4 Regional Attorney and Office of Legal Services
11.5 Appointment of Guardian Ad Litem
11.6 Overview of Notifications to the Court
11.7 Motion to Redocket
11.8 Judicial Determination of Reasonable Efforts and Aggravated Circumstances
11.9 Educational Assessment of a Child in Placement
11.10 through 11.12-Not Yet Utilized
How a Case Moves through Court
11.13 How to File a Petition
11.14 When to File a Petition
11.15 Temporary Removal Hearing
11.16 Temporary Custody
11.17 Expiration of Temporary Custody Order to the Cabinet
11.18 Voluntary Commitment
11.19 Release from Voluntary Commitment
11.20 Emergency Custody Order (ECO)
11.21 Medical Consent for Child in Emergency or Temporary Custody
11.22 Non-Custodial Parent and Financial Support
11.23 Procedures When the Court Orders Specific Placement
11.24 Completing and Filing Subpoenas
11.25 Adjudication Hearing
11.26 Admissions and Agreements
11.27 Dispositional Reports
11.28 Dispositional Hearing
11.29 Dispositional Alternatives
11.30 Permanency Hearings
11.31 Determining Who has Legal Right to the Child
11.32 through 11.34-Not Yet Utilized
Termination of Parental Rights Process
11.35 Voluntary Termination of Parental Rights (TPR)
11.35.1 Voluntary TPR Petition/Drafting
11.35.2 Voluntary TPR Hearing and Order of Judgment
11.36 Involuntary Termination of Parental Rights (TPR)
11.36.1 Pre-Permanency Planning Conference
11.36.2 Initiating the Request for Involuntary TPR
11.36.3 Attorneys Involved in the TPR Action
11.36.4 Notice to OLS of Filing the Involuntary TPR Petition
11.36.5 Witness Conference and TPR Subpoenas
11.36.6 Involuntary TPR Hearing and Order of Judgment
11.37 Appearance Waiver and Consent to Adopt
11.38 Services to the Family During an Appeal
11.39 through 11.41-Not Yet Utilized
Child Custody and Commitment
11.42 Return of a Committed Child to Care
11.43 Release from Custody/Commitment
11.43.1 Release of Commitment of a Child Committed as Dependent, Neglected or Abused
11.43.2 Release of Commitment of Status Offenders
11.43.3 Discharge Involving Interstate Compact
11.43.4 Disabled Youth
11.44 Court Ordered or Requested Child Custody Investigations
Chapter 12-Resource Family Recruitment, Certification and Reimbursement
Recruitment and Certification of DCBS Resource Homes
12.1 Introduction to Recruitment and Certification of DCBS Resource Homes
12.2 Diligent Recruitment of Resource Home Parents
12.2.1 Region Budget for Recruitment
12.2.2 Printing of Recruitment Material
12.2.3 Recruitment Bonus
12.3 Resource Home Approval Process
12.3.1 Resource/Respite Home Parent Applicants-Employee or Former Employees
12.4 Background Checks for Resource Parents
12.4.1 Child Abuse/Neglect Central Registry and Fingerprint Checks for Resource Parents
12.4.2 Child Abuse/Neglect Central Registry Requests from Another State
12.5 Pre-Service Family Preparation Training
12.6 Resource Home Parents Approved by Other States or Licensed Child Placing Agencies
12.7 Approval and Denial
12.8 through 12.9-Not Yet Utilized
General Provisions of Resource Homes
12.10 Rights/Responsibilities of DCBS Resource Home Parents
12.11 Number of Children in Resource Home
12.11.1 Placement Exception Requests
12.12 Respite Care
12.13 Home Environment Prerequisites
12.14 Resource Home Adoption
12.15 Ongoing Training
12.16 Annual Re-Evaluation
12.17 Resource Home Reviews
12.18 Specialized Foster Care Services
12.18.1 Advanced Resource Home Approval
12.18.2 Emergency Shelter Home
12.18.3 Medically Fragile Home
12.18.4 Specialized Medically Fragile Home
12.18.5 Care Plus Resource Home
12.19 Closure of a Resource Home and Reopening
12.20 111-A Resource Home Contract Supplement
12.21 through 12.23-Not Yet Utilized
Resource Home Per Diems, Expenses and Reimbursements
12.24 Per Diem Rates (Including Specialized Foster Care)
12.25 Clothing Expenses
12.26 Medical Expenses
12.27 Transportation Expenses
12.28 Respite Expenses
12.29 Other Expenses
12.30 Supplemental Services Expenses
12.31 Property Damage
12.32 Special Expense Reimbursement for PCC or PCP Agency
Chapter 13-Adoption Services
General Provisions
13.1 Introduction to Adoption Services
13.2 Child Freed for Adoption Procedure
13.3 Swift Adoption
13.4 Matching an Adoptive Family with a Waiting Child
13.5-Not Yet Utilized
Preparing for Adoption
13.6 Preparing the Child for Adoption
13.7 Foster Parent's and Other Caregivers Role in Preparing Child for Adoption
13.8 "Goodbye" Visit
13.9 Sibling Relationship Decisions
13.10 Preparing the Presentation Summary Packet
13.10.1 Updating the Presentation Summary
13.11 through 13.12-Not Yet Utilized
Making the Placement and Service Provision
13.13 Placement Resources
13.13.1 DCBS Foster Parent Adoption
13.13.2 Private Child Placing (PCP) Foster Parent Adoption
13.13.3 Foster Parent Adoption Not Recommended
13.13.4 Employee Adoption or Former Employee Adoption
13.14 Referral of a Child to the Special Needs Adoption Program (SNAP)
13.15 Adoptive Placement of a Newborn Directly from the Hospital
13.16 Resource Home Placement
13.17 Planning the Placement/Pre-Placement Conference
13.18 Pre-Placement Visits
13.19 Making the Adoptive Placement
13.20 Post Placement Services
13.20.1 Withdrawing the Adoptive Referral
13.21 Annual Permanency Reviews
13.22 FTM/Periodic Review for Children in Adoptive Placement
13.23 through 13.24-Not Yet Utilized
Finalizing the Adoption
13.25 Petition for Adoption
13.26 Assisting the Adoptive Family's Attorney in Finalizing the Adoption of a DCBS Child
13.27 Court Report
13.28 Adoption Judgment
13.29 Sealing Closed Adoption Records
13.30 Confidentiality of Closed Adoption Records
13.30.1 Requesting Non-Identifying Information About Biological Relatives from Closed Adoption Records
13.30.2 Request for Inspection of Adoption Records for Identifying Information and Contact with the Birth Family
13.30.3 Mutual Requests from Pre-Adoptive Siblings
13.30.4 Request for Information from a Biological Parent
13.30.5 Updating Health Information
13.31 through 13.33-Not Yet Utilized
Adoption Disruption
13.34 Adoption Disruption
13.35 Working with the Family During Disruption
13.36 Alternative Placements When Disruption Becomes the Plan
13.37 through 13.38-Not Yet Utilized
Adoption Assistance
13.39 Adoption Assistance
13.40 Approval of Adoption Assistance
13.41 Denial of Adoption Assistance
13.42 Annual Contact with the Adoptive Family
13.43 Adoption Assistance Renegotiation
13.44 Discontinuance of Adoption Assistance
13.45 Post Finalization Adoption Assistance Requests
13.45.1 State Funded Post Finalization Adoption Assistance Request
13.45.2 Federal Title IV-E Post Adoption Finalization Adoption Assistance Request
13.45.3 Post Adoptive Placement Stabilization Services (PAPSS)
13.45.4 Post Adoption Child Support
13.46 Continuation of Adoption Assistance After Age 18
13.46.1 Continuation of Title IV-E Adoption Assistance After Age 18
13.47 through 13.49-Not Yet Utilized
Independent Adoption
13.50 Relative and Non-Independent Adoptions
13.51 Obtaining Relative Health Histories
13.52 Independent Adoption Application
13.53 Interstate Independent Adoption
13.54 Planning for the Child Following Withdrawal of Independent Adoption Applications
13.55 Court Report for Independent Adoption
13.56 Court Action
Chapter 19-Adult Protective Services (APS) Intake
19.1 APS Introduction
19.2 Receiving the Report
19.3 Acceptance Criteria
19.3.1 Adult Physical or Sexual Abuse
19.3.2 Adult Mental Injury
19.3.3 Adult Self Neglect
19.3.4 Caretaker Neglect
19.3.5 Adult Exploitation
19.3.6 Spouse/Partner Physical and Sexual Abuse
19.3.7 Spouse/Partner Abuse Mental Injury
19.3.8 Spouse/Partner Neglect
19.3.9 Death of an Adult as a Result of Adult Abuse/Neglect or Spouse/Partner Abuse
19.3.10 Investigations of Resident to Resident Allegations in Alternate Care Settings
19.4 Completion of the DPP-115 Reporting Form
19.5 Criteria for Reports that are Not Accepted
Chapter 20-APS Investigations and Assessment
20.1 Introduction to APS Investigation and Assessment
20.2 General Interviewing Guidelines
20.3 Failure to Gain Entry
20.4 Adult Fatality Investigation and Review
20.5 Investigations in State Operated Facilities
20.6 Investigations in Alternate Care Facilities
20.7 Investigations in a Licensed Health Care Facility
20.8 Investigations Involving the Department for Aging and Independent Living (DAIL) Division of Guardianship Employees
20.9 Determining the Findings of an Adult Abuse/Neglect/Exploitation Investigation
20.10 Determining the Findings of an Alternate Care Investigation
20.11 Completion and Distribution of the Notification of Protective Services and Investigative Findings Report Form
20.12 Conducting Initial and Semi-Annual Assessment of Family Care Homes and Personal Care Homes
Chapter 21-Report of Domestic Violence / Spouse / Partner Abuse or Neglect
21.1 Introduction to Report of Domestic Violence/Spouse/Partner Abuse or Neglect
21.2 Domestic Violence Spouse/Partner Abuse or Neglect Investigations
21.3 Determining the Findings of a Spouse/Partner Abuse or Neglect Investigation
21.4 Referral to Spouse Abuse Center
Chapter 23-APS Ongoing Services and Case Planning
23.1 Ongoing Case Planning
23.2 Prevention Planning
23.3 Individualized Adult Safety Planning Utilizing the Prevention Plan
23.4 Adult Personal Development Plan
Chapter 24-APS Placement and Movement of Adults
24.1 Alternate Care Placement
24.2 Alternate Care Facility Closure
Chapter 25-APS Court
25.1 Introduction to APS Court
25.2 Involuntary Protective Services
25.3 Adult Guardianship/Conservatorship
25.4 Mental Health Hospitalization
25.5 Referrals for Civil Protective Orders (KRS Chapter 403)
25.6 Enforcement of "Foreign Protective Orders"
Chapter 26-APS Case Closure/Aftercare
26.1 APS Case Closure/Aftercare
Chapter 27-General Adult Services
27.1 Introduction to General Adult Services
27.2 Intake and Acceptance Criteria
27.3 Assessment, Documentation and Timeframes
27.4 Case Planning
27.5 Ongoing Services
27.6 Case Closure and Aftercare Planning
Chapter 30-Quality Assurance and Organizational Integrity
Quality Assurance Systems
30.1 Service Appeals
30.2 CAPTA Appeals
30.3 Service Complaints
30.4 Citizen's Review Panels
30.5 Citizen's Foster Care Review Board and Interested Party Review
30.6 through 30.7-Not Yet Utilized
Case Management
30.8 Case File Format
30.9 Case Transfer
30.10 Case Transfers Not Accepted
30.10 CPS Open Records Request and Disclosure of Information
30.11 APS Open Records and Confidentiality
30.12 Request from the Public for CA/N Checks and Central Registry Checks
30.13 Archiving Closed Case File Records
30.14 through 30.18-Not Yet Utilized
Services and Supports
30.19 Child Care Assistance-Introduction
30.19.1 Preventive Child Care Assistance
30.19.2 Protective Child Care Assistance
30.19.3 Redetermination of Preventive and Protective Child Care Assistance
30.19.4 Child Care Assistance for a Kinship Care Provider
30.19.5 Closure of a Child Care Facility or Home that Provides Preventive/Protective Child Care Assistance
30.20 Drug Testing
30.21 KASPER Reports
30.22 Family Preservation
30.23 Grant Services and Eligibility-Social Services Block Grant (SSBG)
30.24 Regional Interagency Council (RIAC)
30.25 Safety Net
30.26 Community Action Agencies
30.27 Medical Support Section
30.28 Commission for Children With Special Health Care Needs
30.29 Court Appointed Special Advocates (CASA)
30.30 Student Interns and Volunteer Programs
Chapter 31-Standards of Practice Regarding Title IV-E, Medicaid and Other Applicable Benefits
31.1 Title IV-E Determination
31.2 Title IV-E Eligibility and Reimbursability
31.3 Required IV-E Judicial Determination
31.4 Reimbursability and Annual Redetermination Under Title IV-E Foster Care
31.5 Legal Responsibility
31.6 Reasonable Efforts in Determining Title IV-E Eligibility
31.7 Best Interest Determination for a Voluntary Commitment Agreement
31.8 Concurrent Receipt of Title IV-E and SSI
31.9 Child Support and Title IV-E
31.10 Title IV-E Adoption Assistance
31.11 SSI Benefits During a Trial Home Visitation
Forms Browser
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Unnumbered Forms
Absent Parent Search Form
Adoption Assistance Coversheet
Adoption Assistance Request
Adoption Assistance Yearly Contact Form
Adoption Assitance Renegotiation Request
Adoption Court Report Outline
Adult Fatality Review Form
Agreement for Planned Permanent Living Arrangement
APS Supervisory Consultation Quarterly Review
Biological Parent Search Results
Case Transfer Summary Form
CHFS Out of Home Care Service Plan for Physical Health
Child Behavior Checklist for Ages 1.5-5
Child Behavior Checklist for Ages 6-18
Concurrent CPS-DV Abbreviated APS CQA Tip Sheet
Concurrent Planning Screening Matrix
DCBS Checklist and Inquiry-Investigation or FINSA (Out of Home Placement)
DCBS Individual Health Care Plan-Part 2
DCBS Individual Health Plan-Part 1
Division of Printing Order Form
Do Not Resuscitate Checklist for Worker
Do Not Resuscitate Confirmation Notice
Do Not Resuscitate Form
Do Not Resuscitate Form and Guidelines
Do Not Resuscitate-Termination of Life Support Worksheet
Domestic Violence Determination
Educational Passport
Emotional Abuse Assessment Referral Form
Extension-Reinstatement of Commitment Agreement (Sample Outline for Regions to Utilize-Customize as Appropriate)
FAP-TRIS Foster-Adoptive Parent Informational Form
FAP-TRIS Foster-Adoptive Parent Intake Form
FAP-TRIS Foster-Adoptive Parent Update
FAP-TRIS Foster-Adoptive Parent Withdrawal
FAP-TRIS New Foster-Adoptive Parent Verification
FAP-TRIS1 Foster-Adoptive Parent Training Documentation
FAP-TRIS1 Foster-Adoptive Parent Training Documentation Continuation Form
Fatality/Near Fatality 60 Day Internal Review Template
ICPC Cover Letter Statement of Family Case Manager
ICWA Non Indian Affidavit Form
Independent Living Referral Form
Instructions for Completing Form ICPC-100A Interstate Compact on the Placement of Children Request
Instructions for Completion of the KIM-78KC
Investigators Checklist for Kinship Care
Kinship Care Checklist
Memo of Justification Supplement Service Per Diem (Sample)
Non-Recurring Adoption Expenses Application
Notice of Adult Fatality
Notice of Amendment to Adoption Assistance Agreement
Notice of Child Fatality-Near Fatality
Notice of Privacy Practices Acknowledgement Cover Sheet
Notice of Protective Services Investigative Findings-Adult Abuse, Neglect or Exploitation
Ongoing Workers Checklist for Kinship Care
PCC Adoption Invoice
Physical and Behavioral Health Service Plan
Post-Legal Adoption Assistance
Prevention Plan
Prevention Plan (Incorporated)
Privacy and Security of Protected Health Information, Confidential and Other Sensitive Information
Private Child Placing Transportation Log
Provide Supervisory Consultation Quarterly Review
Region Log for Kinship Care Respite
Region Log for Kinship Care Start Up
Region Log for Out of State Criminal Checks
Relative Resource Information Sheet
Release of Information Letter for Adult Protective Services (HIPAA)
Release of Information Letter for Child Protective Services (HIPAA)
Request for Approval as Medically Fragile (Child Designation)
Request for Approval of Special Expense
Request for Bed Hold
Request for Conviction Records-Adoptions and Foster Homes
Sample Letter to Reimburse Attorneys Directly (for Adoption Expenses)
Standardized Spouse-Partner Abuse Letter
Standardized Spouse-Partner Abuse Letter - Spanish
Statement of After-Placement Services
Sub-Fund Monthly Reconciliation Statement
Supplemental Services Daily Log
Support for Community Living Program Visit-Review of Records and Facility Form
TWIST Account Request for EPO-DVO
Universal Referral Form for Services
Form Number: CFC-301
CFC-301 Request for Client's Access to Protected Health Information
CFC-301 Request for Client's Access to Protected Health Information (PHI) - Spanish
Form Number: CFC-302
CFC-302 Request for Amendment of Protected Health Information (PHI)
CFC-302 Request for Amendment of Protected Health Information(PHI) - Spanish
Form Number: CFC-303
CFC-303 Request to Restrict Protected Health Information - Spanish
CFC-303 Request to Restrict Protected Health Information (PHI)
Form Number: CFC-304
CFC-304 Request for Accounting Disclosures of Client's Protected Health Information (PHI) - Spanish
CFC-304 Request for Accounting of Disclosures of Client's Protected Health Information (PHI)
Form Number: CFC-306
CFC-306 Revocation of Authorization for Release, Use or Disclosure of Health Information
CFC-306 Revocation of Authorization for Release, Use or Disclosure of Health Information - Spanish
Form Number: CFC-307
CFC-307 Record of Verbal Agreement Concerning Protected Health Information - Spanish
CFC-307 Record of Verbal Agreement Concerning Protected Health Information (PHI)
Form Number: CFC-308
CFC-308 Complaint Form for HIPAA Compliance of Protected Health Information (PHI)
CFC-308 Complaint Form for HIPAA Compliance of Protected Health Information (PHI) - Spanish
Form Number: CFC-309
CFC-309 Accounting of Disclosure Tracking Log
Form Number: CHFS-005
CHFS-005 Request for Authorization of Out of State Travel
Form Number: CHFS-96
CHFS-96 Purchase Requisition Completion Instructions
Form Number: CHFS-219
CHFS-219 Employee Privacy and Security of Protected Health, Confidential and Sensitive Information Agreement
Form Number: CHFS-300
CHFS-300 Notice of Privacy Practices
CHFS-300 Notice of Privacy Practices - Spanish
Form Number: CHFS-305
CHFS-305 Authorization for Disclosure of Protected Health Information (PHI)
CHFS-305 Authorization for Disclosure of Protected Health Information (PHI) - Spanish
Form Number: CHFS-305A
CHFS-305A Authorization for Disclosure of Psychotherapy Information
CHFS-305A Authorization for Disclosure of Psychotherapy Information - Spanish
Form Number: CHR-101
CHR-101 Receiving Report and Authorization for Payment
Form Number: CHR-156
CHR-156 Request for Purchase
Form Number: CRP-001
CRP-001 Residential Application for Level of Care Payment
Form Number: CRP-002
CRP-002 Notice of Level of Care Payment Authorization
Form Number: CRP-003
CRP-003 Foster Care Application for Level of Care Payment
Form Number: CRP-004
CRP-004 Notice of Level of Care Redetermination
Form Number: CRP-005
CRP-005 DCBS Foster Care Utilization Review Notice of Level Assignment
Form Number: CRP-006
CRP-006 Private Child Care Notice of Level of Care Payment Authorization Reassignment
Form Number: CRP-QA-100
CRP-QA-100 Fax Notice Coversheet for Suspected Maltreatment or Harm to Self or Others
Form Number: CRP-QA-101
CRP-QA-101 Exit Interview DCBS Staff Fax Memorandum
Form Number: CRP-QA-102
CRP-QA-102 Report of Suspected Maltreatment
Form Number: CRP-QA-103
CRP-QA-103 Report of Harm to Self or Others
Form Number: CRP-QA-200
CRP-QA-200 Out of Home Care CPS Investigation-FINSA Review Scoring Criteria
Form Number: CRP-QA-350E
CRP-QA-350E Special Request for Youth to be Exit Interviewed by Children's Review Program
Form Number: DCBS-1
DCBS-1 Informed Consent and Release of Information and Records
DCBS-1 Informed Consent and Release of Information and Records
DCBS-1 Informed Consent and Release of Information and Records - Spanish
Form Number: DCBS-1A
DCBS-1A Informed Consent and Release of Information and Records Supplement
DCBS-1A Informed Consent and Release of Information and Records Supplement
Form Number: DCBS-1B
DCBS-1B Application for Services
Form Number: DCBS-2
DCBS-2 Release of Information for Photography, Videotaping or Audiotaping
Form Number: DCBS-83
DCBS-83 Acceptance Scale for Adoption Matching
Form Number: DCBS-84
DCBS-84 Child's Profile for Adoption Matching
Form Number: DCBS-173
DCBS-173 Benefits Change Notice
Form Number: DCC-85
DCC-85 Approval for Child Care Assistance
Form Number: DCC-86
DCC-86 Referral for Low Income Child Care Assistance
Form Number: DCC-87
DCC-87 Change Report for Child Care Assistance
Form Number: DCC-88
DCC-88 Child Care Service Appeal
Form Number: DCC-91B
DCC-91B DCBS Client Fact Sheet
Form Number: DCC-108
DCC-108 Notice of Adverse Action for Child Care Providers and Early Care and Education Professionals
Form Number: DCC-112
DCC-112 Selecting Quality Child Care for my Child
Form Number: DCC-113
DCC-113 Child Care Assistance Program (CCAP) Information for Workers
Form Number: DCC-300
DCC-300 Kentucky Child Care Maximum Payment Rate Chart
Form Number: DPP-010
DPP-010 Open Records Request -
Form Number: DPP-20
DPP-20 Utilization Review Consult Form
Form Number: DPP-33
DPP-33 Education Assistance Authorization Form
Form Number: DPP-098
DPP-098 Student Intern and Volunteer Application
Form Number: DPP-103
DPP-103 Application for Tuition Assistance for Youth Committed to CHFS-DCBS
Form Number: DPP-104A
DPP-104A Request for Approval as Medically Fragile
Form Number: DPP-104B
DPP-104B DCBS-Individual Health Plan
Form Number: DPP-104C
DPP-104C Medically Fragile Monthly Report
Form Number: DPP-105
DPP-105 Medical Information on Child's Birth
Form Number: DPP-106A
DPP-106A Authorization for Medical Treatment
DPP-106A Authorization for Medical Treatment - Spanish
Form Number: DPP-106B
DPP-106B Initial Health History Interview with Family
DPP-106B Initial Health History Interview with Family - Spanish
Form Number: DPP-106C
DPP-106C Child Medical History and Annual Physical Exam
DPP-106C Medical History and Annual Phsyical Exam - Spanish
Form Number: DPP-106D
DPP-106D Medical Appointment
Form Number: DPP-106E
DPP-106E Dental Care
Form Number: DPP-106F
DPP-106F Visual Screening
Form Number: DPP-106G
DPP-106G Mental Health Services
Form Number: DPP-106H
DPP-106H Medication Administration Form
Form Number: DPP-106I
DPP-106I Methamphetamine Exposure Medical Evaluation and Follow-Up Form
Form Number: DPP-107
DPP-107 Health Information Required for Resource Home Applicants or Adult Household Members
DPP-107 Health Information Required for Resource Home Applicants or Adult Household Members - Spanish
Form Number: DPP-108
DPP-108 Health Information Required for Resource Home Applicants Regarding Dependent Children
Form Number: DPP-108A
DPP-108A Health Information Required for Proposed Adoptive Parents Regarding Dependent Children
Form Number: DPP-109
DPP-109 DEPPB Investigative Report Request
Form Number: DPP-110
DPP-110 90 Day Concurrent Planning Family Assessment
Form Number: DPP-111
DPP-111 Foster Home Contract
DPP-111 Foster Home Contract
Form Number: DPP-111A
DPP-111A Foster Home Contract Supplement -
Form Number: DPP-111B
DPP-111B Service Supplement Assessment
DPP-111B Service Supplement Assessment Daily Log
DPP-111B Service Supplement Assessment Memorandum of Justification
Form Number: DPP-112A
DPP-112A Placement Exception Request
Form Number: DPP-112B
DPP-112B Placement Exception Plan
Form Number: DPP-112C
DPP-112C Adoption Placement Exception Request
Form Number: DPP-114
DPP-114 Private Child Caring and Child Placing Level of Care Schedule
Form Number: DPP-115
DPP-115 Confidential Suspected Abuse-Neglect, Dependency or Exploitation Reporting Form
Form Number: DPP-117
DPP-117 Verification Request Marriage and Divorce
Form Number: DPP-125
DPP-125 Consent for Voluntary Random Drug Testing
Form Number: DPP-130
DPP-130 DPP-130 Care Plus Daily Record of Events
Form Number: DPP-152
DPP-152 Child Protective Services (CPS) Substantiated Investigation Notification Letter
Form Number: DPP-152A
DPP-152A Child Protective Service (CPS) Unsubstantiated Investigation Notification Letter - Spanish
DPP-152A Child Protective Service Unsubstantiated Investigation Notification Letter
Form Number: DPP-152B
DPP-152B Child Protective Service Substantiated Investigation Notification Letter
Form Number: DPP-153
DPP-153 Child Protective Services Family in Need of Services Assessment Notification Letter
Form Number: DPP-153A
DPP-153A Child Protective Service (CPS) Family Not in Need of Services Assessment Notification Letter (Arabic) - Arabic
DPP-153A Child Protective Service Family Not in Need of Services Assessment Notification
DPP-153A Child Protective Services (CPS) Family Not in Need of Services Assessment Notification Letter - Spanish
Form Number: DPP-154
DPP-154 Protection and Permanency Service Appeal
DPP-154 Protection and Permanency Service Appeal - Spanish
Form Number: DPP-154A
DPP-154A Notice of Intended Action
Form Number: DPP-155
DPP-155 Request for Appeal of Child Abuse or Neglect Investigative Finding
DPP-155 Request for Appeal of Child Abuse or Neglect Investigative Finding - Spanish
Form Number: DPP-156
DPP-156 Central Registry Check
DPP-156 Central Registry Check - Spanish
Form Number: DPP-157
DPP-157 Background Checks for Applicants or Foster/Adoptive Parents
Form Number: DPP-159
DPP-159 Background Checks for Caretaker Relatives or Kinship Caregivers
Form Number: DPP-165
DPP-165 Permanency Hearing Notification
Form Number: DPP-167
DPP-167 Consent to Voluntary Commitment
Form Number: DPP-170
DPP-170 Financial Statement-Resource Parent Applicant
Form Number: DPP-171
DPP-171 Notice of Confidentiality Requirements Acknowledgement Cover Sheet
Form Number: DPP-187
DPP-187 Independent Adoption Application
Form Number: DPP-188
DPP-188 Application for Registration of Foreign Adoption
Form Number: DPP-189
DPP-189 Biological Parents Identifying Information
Form Number: DPP-190
DPP-190 Information to be Obtained from the Proposed Adoptive Parents
Form Number: DPP-190A
DPP-190A Supplemental Information to be Obtained from the Proposed Adoptive Parents
Form Number: DPP-191
DPP-191 Information to be Obtained from the Placing Parent
DPP-191 Information to be Obtained from the Placing Parent - Spanish
Form Number: DPP-191A
DPP-191A Information to be Obtained from Placing Parents for Independent Adoptions
DPP-191A Information to be Obtained from Placing Parents for Independent Adoptions - Spanish
Form Number: DPP-192
DPP-192 Biological Parent Consent Form
DPP-192 Biological Parent Consent Form - Spanish
Form Number: DPP-193
DPP-193 Adoptive Review Committee Comments
Form Number: DPP-195
DPP-195 Adoptive Placement Agreement
Form Number: DPP-196
DPP-196 Special Needs Adoption Program Referral
Form Number: DPP-196A
DPP-196A Individualized Recruitment Plan
Form Number: DPP-196B
DPP-196B Update to Special Needs Adoption Program Referral
Form Number: DPP-196C
DPP-196C SNAP Withdrawn Form
Form Number: DPP-197
DPP-197 Adult Child Interview
Form Number: DPP-198
DPP-198 Foster Parents Statement of Intent to Adopt
Form Number: DPP-199
DPP-199 Independent Adoption Home Study Outline
Form Number: DPP-201
DPP-201 Planned Permanent Living Arrangement (PPLA) Worksheet
Form Number: DPP-215
DPP-215 Consent to Adoption
Form Number: DPP-250
DPP-250 Verified Petition for the Provision of Emergency Protective Services -
Form Number: DPP-251
DPP-251 Emergency Protective Services Order
Form Number: DPP-252
DPP-252 Emergency Protective Order Ex Parte
Form Number: DPP-277
DPP-277 Family Care Home Semi-Annual Assessment
Form Number: DPP-277A
DPP-277A Personal Care Home Semi-Annual Assessment
Form Number: DPP-278
DPP-278 Profile of Family Care Home
Form Number: DPP-293
DPP-293 Adult Personal Development Plan
Form Number: DPP-330
DPP-330 Educational Advocacy Request Form
Form Number: DPP-333
DPP-333 Tuition Waiver for Foster and Adopted Children
Form Number: DPP-334
DPP-334 Request for Educational and Training Voucher Funds
Form Number: DPP-335
DPP-335 Monthly Academic Standing and Enrollment Verification
Form Number: DPP-601
DPP-601 Referral for Determination of Disability to Continue IV-E Funded Adoption Assistance
Form Number: DPP-886
DPP-886 Private Child Care Inter-Agency Referral Form
Form Number: DPP-886A
DPP-886A Application for Referral and Needs Assessment
Form Number: DPP-888
DPP-888 Annual Audited Cost Report and Time Study (AACRTS)
DPP-888 Annual Audited Cost Report and Time Study (AACRTS) Instructions for Completion
DPP-888 Annual Audited Cost Report and Time Study Codes and Definitions
Form Number: DPP-1020
DPP-1020 Safety Net Assessment
Form Number: DPP-1021
DPP-1021 Safety Net Verification Form
Form Number: DPP-1022
DPP-1022 Safety Net Report
DPP-1022 Safety Net Report Example
Form Number: DPP-1258
DPP-1258 Adoption Assistance Agreement
Form Number: DPP-1258A
DPP-1258A Adoption Assistance Agreement Non-Recurring Adoption Expenses
Form Number: DPP-1258B
DPP-1258B Adoption Assistance Annual Contact Form
Form Number: DPP-1268
DPP-1268 Medical Information for Newborn Infants
DPP-1268 Medical Information for Newborn Infants - Spanish
Form Number: DPP-1275
DPP-1275 Relative Exploration Form
DPP-1275 Relative Exploration Form - Spanish
Form Number: DPP-1275A
DPP-1275A Notice to Relative of Removal of a Child
DPP-1275A Notice to Relative of Removal of a Child - Spanish
Form Number: DPP-1276
DPP-1276 Relative Home Evaluation
Form Number: DPP-1281
DPP-1281 Family Case Plan
Form Number: DPP-1285
DPP-1285 Out of State Psychiatric Hospital-Residential Program Services Agreement
Form Number: DPP-1288
DPP-1288 Resource Home Annual Re-Evaluation Child Abuse or Neglect Check
Form Number: DPP-1289
DPP-1289 Annual Strengths-Needs Assessment for Resource Families
Form Number: DPP-1290
DPP-1290 Family Profile Coversheet
Form Number: DPP-1291
DPP-1291 Resource Home Discipline Policy
Form Number: DPP-1292
DPP-1292 Information for OOHC Placements
Form Number: DPP-1293
DPP-1293 Rehabilitative Services Plan of Care Approval Form
Form Number: DPP-1294
DPP-1294 Rehabilitative Services Monthly Progress Report
Form Number: DPP-1299
DPP-1299 Referral for Emergency Weatherization Program
Form Number: DPP-1300
DPP-1300 SRA Service Complaint Monthly Report
Form Number: DPP-1301
DPP-1301 Validation Summary-3rd Level Reviews
Form Number: DPP-AC-1
DPP-AC-1 Transmittal Memorandum for Presentation Summary
Form Number: DSS-110
DSS-110 Imprest Cash Voucher
Form Number: DSS-158
DSS-158 Petition for Voluntary Termination of Parental Rights
Form Number: DSS-160
DSS-160 Statement of Representatives of the Cabinet for Families and Children
Form Number: DSS-161
DSS-161 Request for Involuntary Termination of Parental Rights
Form Number: DSS-177
DSS-177 Report of Filing of Petition for Involuntary Termination of Parental Rights
Form Number: DSS-194
DSS-194 Adoption Visitation Agreement
Form Number: DSS-284
DSS-284 Complaint Report
Form Number: DSS-892
DSS-892 Daily Routine for a Preschool Child (0-5 Years of Age)
Form Number: DSS-893
DSS-893 Daily Routine for a School-Age Child
Form Number: DSS-1251A
DSS-1251A Child Placement History Log
Form Number: DSS-1259
DSS-1259 Benefits Action Transmittal
Form Number: DSS-1260
DSS-1260 Title IV-E Child Support Referral
Form Number: DSS-1263
DSS-1263 Title IV-E Child Support and Change of Status
Form Number: DSS-1266
DSS-1266 Affidavit of Reasonable Efforts
Form Number: DSS-1291
DSS-1291 Family Profile Coversheet
Form Number: F-001
F-001 CCSHCN Nurse Consultant Referral Form
Form Number: ICPC-100A
ICPC-100A Interstate Compact on the Placement of Children Request
Form Number: ICPC-100B
ICPC-100B Interstate Compact Report on Child's Placement Status
Form Number: KC-01
KC-01 Kinship Care Program Statement of Rights and Responsibilities
KC-01 Kinship Care Program Statement of Rights and Responsibilities - Spanish
Form Number: KC-02
KC-02 Kinship Care Respite Request Form
Form Number: KC-02A
KC-02A Kinship Care Respite Services Receipt Form
Form Number: KIM-78KC
KIM-78KC Kinship Care Financial Assistance Application
KIM-78KC Kinship Care Financial Assistance Application - Spanish
Form Number: M-001
M-001 CCSHCN Verbal Release of Information
Form Number: M-002
M-002 CCSHCN Medically Fragile Referral Form
Form Number: MAP-620
MAP-620 Application for SCL Waiver and ICF-MR Services
Form Number: MRT-15
MRT-15 Authorization to Disclose Information to Cabinet for Health and Family Services
MRT-15 Procedural Instructions
Form Number: PAFS-628
PAFS-628 Exchange of Information (Safety Net)
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Incorporated
(29)
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