Department for Community Based Services

Standards of Practice Online Manual

4.18 Ongoing Case Planning

Cabinet for Health and Family Services

Department for Community Based Services
Division of Protection and Permanency
Standards of Practice Online Manual
Chapter:
Chapter 4-Out of Home Care Services (OOHC)
Effective:
8/15/2018
Section:
4.18 Ongoing Case Planning
Version:
16

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Legal Authority/Introduction

LEGAL AUTHORITY:

Following a child’s entrance into OOHC, federal law requires that the department conduct periodic case reviews to ensure appropriate service provision and evaluation of the family’s progress.  Periodic reviews are held every six months from the date the child entered out of home care. 

A well executed periodic review should include a review of the needs and strengths from prior case conferences, a current assessment of whether or not the family has a continued need for department intervention, and whether or not a safety issue necessitates the child’s continued placement in OOHC.  OOHC case plans are also expected to make appropriate plans to ensure the child’s mental health, educational stability, physical health, the establishment and support of a stable placement for the duration of their time in OOHC.  Additionally, for a child in OOHC the SSW and the department are responsible for creating a plan that demonstrates reasonable efforts to obtain a safe, permanent placement that permits the child to exit foster care in a reasonable timeframe.  The components of a well-designed case plan include documentation around all these efforts. 

Key strategies for the achievement of an appropriate case plan include the engagement of family members and use of a family team meeting model when appropriate, appropriate implementation of concurrent case plan goals when appropriate, and the development of the key family level and individual level objectives that identify key benchmarks for the evaluation of the family’s progress. 

Procedure

Prior to all periodic reviews the SSW: 

  1. Reviews the case history, circumstances and investigative information to determine if the case meets concurrent planning criteria for the initial case plan;
  2. Completes the Waiver of Reasonable Efforts Checklist and consults with the FSOS.  Refers to SOP 11.8 Judicial Determination of Reasonable Efforts and Aggravated Circumstances, if the case meets for waiver of reasonable efforts;
  3. Compiles current assessment information from collateral sources, including updated information from the most recent assessment;
  4. Engages the family to solicit and encourage their approval for community partner involvement in developing the case plan;
  5. Makes attempts to identify and include both parents and relatives in the case conference/team meeting; 1  2
  6. Includes the child or children, when age appropriate in case planning efforts;
  7. Empowers children age fourteen (14) and older in the development of their own case plan and transition planning for a successful adulthood;
  8. Permits a child who has attained fourteen (14) years to designate up to two (2) additional people to participate in the case planning conference, one of whom may be designated as the child’s advisor, and when necessary, to advocate with respect to the application of the reasonable and prudent parent standard, as outlined in SOP 4.30 Normalcy for Children and Youth in Out of Home Care (Section 475 (1) (B) of the Social Security Act);  3
  9. Ensures full disclosure by respectful, candid discussion from the outset with all parties involved in the case planning and service provision of the following:
    1. Negative impact of foster care on children;
    2. Clarity about the birth parent’s rights and responsibilities;
    3. Services DCBS will provide;
    4. Permanency options;
    5. Concurrent Planning; and
    6. Consequences for not following the case plan.

Six (6) Month Periodic Reviews

The FSOS: 

  1. Chairs the periodic review and provides input into case plan development;
  2. Reviews and approves the case plan by signature and date prior to distribution.

The SSW:

  1. Holds case planning conference periodic reviews as appropriate or as needed, but is required to hold one within six (6) months of a child’s temporary removal hearing and/or order of temporary custody or placement date of a voluntary commitment;
  2. Holds subsequent periodic reviews within six (6) months of the previous review when the child remains in OOHC;
  3. Converts the case to concurrent planning at the first periodic review, unless one of the following situations occurs:
    1. An AFSA exemption has been granted by the court;
    2. The case is a status case; or
    3. The goal for the case is planned permanent living arrangement, legal guardianship or emancipation;
  4. Determines the permanency goal or goals that are in the best interest of the child;
  5. Establishes a target date for achievement of the permanency goal or goals;
  6. Ensures that the immediate safety needs of the child and the risk of future abuse and/or neglect should guide the selection of goals, objectives and tasks;
  7. Ensures that there are specific tasks developed related to the individual's high risk behaviors;
  8. Ensures that the goals, objectives and tasks outlined in the case plan support the permanency plan;
  9. Specifies the activities or tasks to be undertaken, the person(s) responsible for each task and the time frames for achieving the goals, objectives and tasks;
  10. Develops the child/youth action plan as described in the Case Planning Objectives-Out of Home Care (OOHC) Tip Sheet;
  11. Ensures that the periodic review includes the following:
    1. A discussion of ASFA guidelines, including the cabinet’s obligation to make reasonable efforts to finalize a permanent placement and the cabinet’s obligation to file for a termination of parental rights once the child has been care for 15 months under federal law: (475 (5)(E) and 45 CFR 1356.21 (i)(1)(i));
    2. A discussion of the problems that are barriers to the child’s safe return home or other permanent placement and the progress of the family and child to overcoming each barrier;
    3. A review of the appropriateness of services, including assessment and recommendations from community partners, whether services are being provided according to schedule and whether the parties, including identified fathers as outlined in SOP 4.14 Family Attachment and Involvement with expectations set for them are complying with those expectations;
    4. A review of any plan of safe care developed for a substance affected infant as required by CAPTA 106(b)(2)(B)(ii)and (iii) (referenced in SOP 1.15);
    5. A review of the quality and appropriateness of visits between parents and children, and between siblings;
    6. A review of the child’s health, including mental health and educational history and current status are reviewed and the plan for meeting the child’s needs is reviewed;
    7. A review of the steps the agency is taking to ensure that the child’s foster family home or child caring institution is following the reasonable and prudent parent standard, and to ascertain whether the child has regular, ongoing opportunities to engage in age or developmentally appropriate activities; (Section 475 (5)(B))
    8. A discussion of any goal of a planned permanent living arrangement (PPLA) to ensure documentation of intensive, ongoing, and as of the date of the review, unsuccessful efforts to return the child home or secure a placement for the child with a fit and willing relative (including adult siblings), a legal guardian, or an adoptive parent, including efforts that utilize search technology (including social media) to find biological family members for the children; (Section 475A)
    9. A decision, based on (a) and (b) above, about whether the child may be returned home immediately and safely maintained in the home (Sec 475(5)(B));
  12. Ensures that the following components are always documented on the case plan documentation includes (in accordance with provisions of Title IV-E of Social Security Act):
    1. Permanency goal(s);
    2. Appropriate services to the parents that will constitute reasonable efforts towards reunification;
    3. Services that will be provided to achieve the least restrictive (most family like) placement that is in the closest proximity to the parents’ home (Sec 475 and 42 USC 675);
    4. A schedule for visitation between the child and parents, ensuring that visits are occurring no less than once every two weeks, unless there is a documented reasons regarding why this is not in the child's best interest.  Visits are designed to enhance and support the relationship (refer to OOHC Visitation Tip Sheet for information regarding frequency and duration of visits);
    5. A schedule for visitation between separated siblings, as appropriate to the case circumstances, designed to enhance and support the relationship;
    6. Documentation of the child specific efforts being taken to finalize a permanent placement for the child, including efforts to identify, recruit, process or approve a qualified family for (475(1)(E) and (5)(E)):
      1. Relative placement;
      2. Adoption;
      3. Legal guardianship placement;
    7. Documentation of the reasons permitted under federal law for not initiating TPR when the child has been care for fifteen (15) of the last forty eight (48) twenty-two (22) months, one of which must be met for an ASFA exception:
      1. The child is being cared for by a relative; or
      2. A compelling reason why filing for termination would not be in the best interest of the child; or
      3. Failure to provide, consistent with the time period in the case plan, services deemed necessary for the safe return of the child to the home, when reasonable efforts are required (45 CFR 1356.21 (i)(2));
    8. Documentation of justification for the selection of “another planned permanent living arrangement,” when selected as the goal for the child (45 CFR 1356.21(h)(3));
    9. A plan for assuring that services are provided to the child and placement provider as necessary to support the placement and  meet needs of the child while in foster care (Sec 475(1)(b)).  Such a plan should incorporate the following documentation pertaining to health and education records (Sec 475(1)(c)):  
      1. The names and addresses of the child's health and educational providers;
      2. The child's grade level performance;
      3. The child's school record; 
      4. A record of the child's immunizations;
      5. The child's known medical problems;
      6. The child's medications;
    10. Objectives, tasks or other notes that constitute a plan for the child’s educational stability (reference SOP 4.28 Meeting Educational Needs) as required by Sec 475 (1)(g) and Sec 471 (a)(30) of the Social Security Act, including:
      1. Assurances that each placement takes into account the appropriateness of the child’s current school setting, as well as the proximity of the placement to the child’s current school at the time of placement;
      2. Assurances that the cabinet coordinated with the local education agency to insure the child is able to attend the same school where enrolled at the time of each placement; and
      3. Assurances that, when a change of schools is necessary, the child will be immediately enrolled in an appropriate school, with all of the educational records of the child provided to the new school;
      4. Verification that a child, who has attained the minimum age for compulsory school attendance, is attending school in accordance with state law; or
      5. Regularly updated medical documentation that verifies that a child is incapable of attending school; 4
    11. Information describing the safety and appropriateness of the child’s current placement, and any consideration being given to change in placement is presented to conference participants (U.S. Code 42 USC Section 675 (1)(A); 5
    12. A description of the programs and services which will assist youth in preparing for the transition to adulthood as outlined in SOP 4.29.1 Independent Living Services (Sec 475(5)(C)(i));
    13. A transition plan, for youth 17 and over, updated as appropriate during the periodic review (Sec 475(5)(H));
    14. Signatures of the periodic review participants, including an objective 3rd party as required by federal law (Sec 475(6));
  13. Ensures an out of home care child who has attained fourteen (14) years of age is provided a copy of their rights included with the DPP-1281 Family Case Plan, and files the child’s signed acknowledgement of receipt with the agency’s copy of the case plan;  (475a of the Social Security Act)
  14. Ensures that the parent/guardian is informed of their right and responsibility to make health care decisions about their child, as well as the expectation that they will participate in these decisions;
  15. Ensures that a signed DPP-106A is maintained in the child’s file; 
  16. Enters the case plan information and submits it to the FSOS who approves it within ten (10) days from the case planning conference date;
  17. Submits the case plan to the FSOS with or without the parents’ signatures and documents in the comment section of the DPP-1281 Family Case Plan why the parents did not sign;
  18. Ensures that all required signatures are obtained on the approved case plan including, but not limited to the following:
    1. Parent, guardian or custodian (including non-custodial parent);
    2. Child (if age and developmentally appropriate);
    3. Foster and adoptive parent;
    4. Court Appointed Special Advocate (CASA);
    5. Guardian ad litem (GAL);
    6. Private child placing or private child caring agency worker;
    7. SSW; and
    8. FSOS;
  19. Dockets a placement court review no later than six (6) months after the child is removed from the home, regardless of placement or custody, when the child is sixteen (16) or younger at the time of removal in accordance with Family Court Civil Rule 34;
  20. Files, for the purpose of the six (6) month review, a dispositional report with the court at least three (3) days prior to the hearing (Family Court Civil Rule 28);
  21. Submits a copy of every case plan, visitation agreement, and prevention plans to the court (45 CFR 1356.21 (i)(2) and Family Court Civil Rule 29); 6
  22. Mails or distributes a copy of the family plan portion of the DPP-1281 Family Case Plan to:
    1. Parent, guardian or custodian (including identified fathers);
    2. Any person or agency providing services to the family; and
    3. Administrative Office of the Courts Citizen Foster Care Review Board Program at the following address:

      Dependent Children’s Services
      Administrative Office of the Courts
      100 Millcreek Park
      Frankfort, KY 40601
  23. Distributes the out of home child/youth portion of the DPP-1281 to the following:
    1. Family, including identified fathers as outlined in SOP 4.14;
    2. Caregiver (foster parents, PCC provider, relative, etc.);
    3. Case planning participants in attendance (with the consent of the parents or court order);
    4. Parent’s attorney, if applicable;
    5. Court Appointed Special Advocate (CASA), if applicable (the CASA worker receives all information pertaining to the child’s case plan and may have case plan information pertaining to the parents with their consent or court order);
    6. Administrative Office of the Courts Citizen Foster Care Review Board Program for the five (5) day initial case planning only;
    7. Any community partners assigned a task at parent’s request in the case plan, (with parent consent);and
    8. Child’s attorney, Guardian Ad Litem;
  24. Mails a copy of the approved DPP-1281 Family Case Plan, DPP-154 Protection and Permanency Service Appeal and other approved documents, by certified mail, to all biological and legal parents if the parent or guardian did not attend the case plan meeting;
  25. Documents the following in TWIST:
    1. Efforts to involve both parents, the child’s guardian or custodian in the case planning process;
    2. Contents of the dispositional report; and
    3. Court hearings and any court orders.

Annual Periodic Reviews and Permanency Hearings

The SSW: 

  1. Prepares for the second periodic review, approximate to the child’s twelfth (12th) month in care, prior to the permanency hearing;
  2. Determines, in consultation with supervisor staff and other professionals involved in the case, whether or not to pursue either a termination of parental rights or an exemption to ASFA requirements at the next annual permanency hearing when the goal, or one of the concurrent goals, is adoption.
  3. Considers the length of time the child has been in care;
  4. Considers whether or not services provided to the parent have been adequate for reunification, and whether or not additional services are likely to facilitate a safe reunification;
  5. Holds the case conference as required;
  6. Completes the case plan document as required;
  7. Documents case conference activities;
  8. Requests the annual permanency hearing be scheduled within thirty (30) days of the development of the case plan using the DPP-165 Permanency Hearing Notification within sixty (60) days of the required due date:
    1. No later than twelve (12) months from the date the child entered OOHC, and
    2. Every twelve (12) months thereafter for as long as the child remains in OOHC;
  9. Files a dispositional report, case plan, visitation agreement, and any prevention plans at least three (3) days prior to any annual review in accordance with Family Court Rules 28 and 29;  
  10. Ensures the dispositional report includes sufficient documentation of the information discussed and reviewed during the periodic review to include:
    1. The discussion of ASFA guidelines, including the cabinet’s obligation to make reasonable efforts to finalize a permanent placement and the cabinet’s obligation to file for a termination of parental rights once the child has been care for 15 months under federal law: (475 (5)(E) and 45 CFR 1356.21 (i)(1)(i));
    2. The problems that are barriers to the child’s safe return home or other permanent placement and the progress of the family and child to overcoming each barrier;
    3. The appropriateness of services, including assessment and recommendations from community partners, whether services are being provided according to schedule and whether the parties, including identified fathers as outlined in SOP 4.14 Family Attachment and Involvement with expectations set for them are complying with those expectations;
    4. The quality and appropriateness of visits between parents and children, and between siblings;
    5. The child’s health, including mental health and educational history and current status are reviewed and the plan for meeting the child’s needs is reviewed;
    6. The steps the agency is taking to ensure that the child’s foster family home or child caring institution is following the reasonable and prudent parent standard, and information about whether the child has regular, ongoing opportunities to engage in age or developmentally appropriate activities (Section 475 (5)(B));
    7. Documentation of (only for a child who has attained 16 years of age) a compelling reason for the selection of the goal of APPLA (Section 475 (5)(B));
    8. Documentation, for children with a goal of APPLA, of intensive, ongoing, and as of the date of the court hearing, unsuccessful efforts to return the child home or secure a placement for the child with a fit and willing relative (including adult siblings), a legal guardian, or an adoptive parent, including efforts that utilize search technology (including social media) to find biological family members for the children (Section 475A);
    9. Documentation regarding ongoing searches for relatives at a minimum of every six (6) months during case planning conferences;
    10. A decision, based on (a) and (b), about whether the child may be returned home immediately and safely maintained in the home (Sec 475(5)(B));
  11. Ensures the contents of the dispositional report are reflected in TWIST;
  12. Obtains the judicial determination regarding the appropriateness of the permanency goal; 
  13. Obtains a judicial determination regarding the appropriateness of the agency’s efforts to finalize the permanency plan;
  14. Convenes another periodic review, to change the goal per court order if the court does not approve the permanency goal; and
  15. Documents the hearing and any court orders in TWIST, noting the court’s agreement with or deviation from the dispositional report.

Practice Guidance

  • It is important to ensure the case plan is realistically related to the underlying needs of the family;
  • In cases where domestic violence has been identified, the SSW consults with the FSOS to determine how to best plan for the safety of the non-offending parent and children.
  • Recognizing the importance of both formal and informal community supports to the family is an important aspect of case plan development.
  • The SSW may convene a family team meeting, when appropriate, for the development of the case plan and may include any or all of the following community partners:
    • Parent, guardian, or custodian (including noncustodial parent);
    • Child (if age appropriate and developmental level);
    • Foster and adoptive parent(s);
    • Court Appointed Special Advocate;
    • Guardian Ad Litem;
    • Private child placing agency (PCP) or private child care agency (PCC);
    • Formal and informal supports; and
    • SSW and Supervisor.
  • The SSW will not involve the parent in the case planning process if parental rights have been terminated, unless the FSOS or designee determine it is in the child's best interest.
  • While the participation of the child’s parents is important, the review is required within six (6) months of the child’s temporary removal hearing/placement or the last periodic review, even when the parents do not attend.
  • When the child cannot return home immediately or be safely maintained in the home, alternative permanency goals will be considered.  The SSW, for example, may choose “Return to Parent” as a permanency goal and at the same time, have an alternate permanency objective and tasks in the OOHC section of the case plan. 
  • The SSW MAY NOT choose a goal of PPLA for a child less than sixteen (16) years of age.  (Section 475 (5)(C)(i) of the Social Security Act)
  • The SSW assesses the progress of the family in meeting the family and individual objectives as part of ongoing assessment and service delivery.
  • Any revisions or updates to the plan must be developed in consultation with the child and up to two (2) members of the case planning team designated by the child. (Section 475 (1) (B) of the Social Security Act)
  • Federal language around “compelling reasons” for an ASFA exception is broad.  Such reasons may include, but are not limited to, a determination that adoption isn’t an appropriate goal—perhaps due to the parents’ progress, or that there are international legal obligations that preclude termination.  The worker, in consultation with the FSOS as appropriate, may exercise some discretion on whether or not “compelling reasons” exist. 
  • Child specific recruitment efforts to find a permanent placement may include such efforts as tribal, state, regional and national adoption exchanges, and electronic exchange systems in order to facilitate orderly and timely in state and interstate placements (when the child’s goal is adoption).
  • Public Law 96-272 (IV-E) requires the participation of one objective third party in the periodic review, who is not:
    • The case manager;
    • In the line of supervision for the case; or
    • Involved in the delivery of services to either the child or the parents.
  • Examples of acceptable objective third party participants include the following: 
    • Permanency specialist;
    • An SSW or FSOS who is not directly involved with the case; or
    • Regional office staff.
  • It is preferred that the objective third party is protection and permanency employee.
  • Periodic reviews are scheduled on a day and time when primary participants can attend.
  • Participants are encouraged to attend, in part by convenience of schedule and sufficient notice.
  • The permanency hearing is required no later than twelve (12) months from the date the child entered OOHC by order of temporary custody following the temporary removal hearing or placement as a result of voluntary commitment and every twelve (12) months thereafter if custody and out of home placement continues (Sec 475(5)(c)). 
 

Footnotes

  1. Absent parent and relative searches must be conducted, on all identified fathers and relatives, within 30 calendar days of the child’s entrance into OOHC and documented in TWIST to generate an Absent Parent Form (TWIST form) and continue at a minimum of every six (6) months during case planning conferences.
  2. In voluntary TPR situations, if the worker has obtained a waiver of efforts based on the parents intention to voluntary TPR, a case planning meeting is held, but plans to reunite parent and child are not required.
  3. The  SSW, in consultation with the FSOS, may at any time reject a person selected by the child if the worker has good cause to believe the individual would not act in the best interests of the child. (Section 475 (1)(B) of the Social Security Act)
  4. If a child is not enrolled in school as required by state law, the child becomes ineligible for IV-E benefits.  The SSW notifies the CBW accordingly of changes to the child’s enrollment status as they pertain to IV-E eligibility. (Sec 471 (a)(30)).
  5. The SSW ensures the correct placement information is entered in TWIST.
  6. This includes both the family and out of home care youth portions of the case plan. 

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