016.15.03 Ark. Code R. § 005 - Act 650 and Title IV-E; DCFS Forms: CFS-25, CFS-304, CFS-409, CFS-413, CFS-420, CFS-425, CFS-426, CFS-427, CFS-428A, CFS-428B, CFS-428C, CFS-429, CFS-431, CFS-432, CFS-433, CFS-434, CFS-467, CFS-468, CFS-470, and CFS-471

State Regulations
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FAMILY SERVICES FORMS MANUAL

TABLE OF CONTENTS

Each form can be accessed based on the letter in parentheses following the form number. "R" means that the form is a report generated by CHRIS. "T" means that the form is a template located in CHRIS Net Templates (a hard copy of the template is also contained in the Forms Manual) . "G" means that the form can be accessed via DHS Gold. An asterisk "*" besides the form number indicates that the form or publication can be ordered from the Supply Catalog. No letter following the form number means that the form is a hard copy located in the Forms Manual to be copied as needed. "P" means a publication is located in CHRIS Net Publications as a PDF file.

FORM NUMBER	TITLE	DATE
CFS-001 (T)	CHAFEE FOSTER CARE INDEPENDENCE GRANT PROGRAM REFERRAL	01 2003
CFS-001A (T)	CHAFEE FOSTER CARE INDEPENDENCE GRANT PROGRAM AFTER-CARE REFERRAL	01 2003
CFS-020 (R)	CHARACTERISTICS OF FOSTER CHILDREN STATEWIDE TOTALS	12 2001
CFS-021 (R)	CLAIMS PAYMENT/ADJUSTMENTS WORKSHEET	12 2001
CFS-025 (T)	CHAFEE FOSTER CARE INDEPENDENCE PROGRAM (BUDGET)	09 2003
CFS-035 (T)	INDEPENDENT LIVING STATISTICAL SUMMARY	01 2003
CFS-304 (T)	JUSTIFICATION FOR SPECIAL BOARD RATE	09 2003
CFS-305	PARENTAL PLACEMENT STATEMENT	08 94
CFS-307 (T)	FOLLOW-UP WITH CHILD MALTREATMENT REPORTER	REV. 05 2002
CFS-308	AMENDMENT OF CHILD MALTREATMENT RECORD	08 91
CFS-310 (T)	NOTICE OF CHILD MALTREATMENT ALLEGATION	REV. 05 2002
CFS-311 (T)	NOTICE TO LEA OF CHILD MALTREATMENT	REV. 05 2002
CFS-312 (T)	CHILD MALTREATMENT ASSESSMENT DETERMINATION NOTIFICATION	REV. 05 2002
CFS-315	CHILD MALTREATMENT INFO. SYSTEM OPER. LOG	12 86
CFS-316 (T)	REQUEST FOR CPS CENTRAL REGISTRY CHECK	REV. 01 2002
CFS-318	NOTIFICATION TO CHILD MALTREATMENT PETITIONER OF AMENDMENT DENIAL	08 91
CFS-319 (T)	NOTIFICATION TO CHILD MALTREATMENT PETITIONER OF AMENDMENT APPROVAL	09 2000
CFS-320* (T)	ADMINISTRATIVE HEARING STATEMENT	REV. 06 92
CFS-321 (T)	REFERRAL FOR INVESTIGATION	REV. 05 2002
Legend: R = Report	T = Template	G = DHS Gold	* = Supply Catalog

CFS-322 (T)	HOMEMAKER REFERRAL	06 80
CFS-323 (T)	PROTECTIVE CUSTODY/PARENTAL NOTIFICATION REV	05 2002
CFS-324 (T)	CHECKLIST OF HOMEMAKER'S ACTIVITIES	06 80
CFS-325 (T)	NOTIFICATION OF COMPLAINT OTHER THAN CHILD MALTREATMENT	09 91
CFS-326 (T)	OUTCOME OF COMPLAINT INVESTIGATION	09 2000
CFS-327 (T)	NOTIFICATION OF NAME REMOVAL FROM CENTRAL REGISTRY	05 2002
CFS-327A*	PHYSICAL DOCUMENTATION-BODY DIAGRAM	06 92
CFS-328 (T)	REQUEST FOR NAME REMOVAL FROM CENTRAL REGISTRY	05 2002
CFS-329 (T)	CHILD DEATH NOTIFICATION	03 2000
CFS-331 (T)	CHANGE IN PLACEMENT REVIEW	07 93
CFS-332 (T)	INCOME ASSISTANCE REQUEST LOG	06 93
CFS-333 (T)	CLIENT INFORMATION SHEET FOR CASH ASSISTANCE	12 97
CFS-334 (T)	FOSTER CARE AUTHORIZATION FOR BILLING	07 96
CFS-336 (T)	EXPIRATION OF PROTECTIVE CUSTODY/PARENTAL NOTIFICATION	05 97
CFS-341	DCFS POLICY EMPLOYER CERTIFICATION	01 2002
CFS-342 (A) (T)	FOSTER CARE CRIMINAL RECORD CHECK	01 2002
CFS-342(B) (T)	STATE ADOPTIONS CRIMINAL RECORD CHECK	01 2002
CFS-343 (T)	NOTIFICATION OF COURT APPEARANCE	05 99
CFS-344 (T)	REQUEST FOR EMPLOYEE/APPLICANT CM CENTRAL REG. CHECK	12 99
CFS-345 (T)	IFS REFERRAL FORM	09 99
CFS-347 (T)	IFS FAMILY COUNSELOR'S TIME RECORD REV	12 97
CFS-350*	FAMILY ASSESSMENT CHECKLIST (CI)	03 89
CFS-351* (T)	INITIAL DENTAL EXAMINATION	08 93
CFS-352 (T)	MEDICAL, DENTAL, VISION, HEARING AND REV. PSYCHOLOGICAL EPISODIC FORM	05 94
CFS-353* (T)	REQUESTED MEDICAL RECORDS LOG	04 93
CFS-354*	CHECKLIST FOR HEALTH NEEDS ASSESSMENT REV.	05 94
CFS-360 (G/T)	REQUEST FOR CONFERENCE/TRAINING	07 95
CFS-362*	MEDI-ALERT TO FOSTER CARE PROVIDER	REV. 08 93
CFS-364*	FAMILY MENTAL HEALTH HISTORY	08 93
CFS-365*	RECEIPT FOR MEDICAL PASSPORT	08 90
CFS-366*	HEALTH SCREENING	REV. 05 94
CFS-368 (T)	CHILD'S HEALTH SERVICES PLAN	REV. 05 94
CFS-370 (T)	INDEPENDENT YOUTH'S RESIDENCE CHECKLIST	09 89
CFS-371 (T)	CONTINUING DEVELOPMENTAL HISTORY SUMMARY	08 93
CFS-372 (T)	RESULTS OF DEVELOPMENTAL EVALUATIONS	REV. 05 94
CFS-373	MEDICAL PASSPORT SUMMARY	05 94
CFS-376 (T)	AUTHORIZATION FOR BILLING AND TRUST FUND ACCOUNT ACTION	10 2001
CFS-377 (T)	FACILITY TRUST ACCOUNT REPORT	10 2001
CFS-378 (T)	CHILD SUPPORT REFERRAL	10 2001
CFS-379 (T)	CLOSE OUT/OVERPAYMENT NOTIFICATION MEMORANDUM	10 2001
CFS-380 (T)	TRUST ACCOUNT INVOICE	10 2001
CFS-381	EMPLOYEE TRAINING RECORD	10 93
CFS-386*	SERVICES FACE SHEET	10 83
CFS-397 (T)	EDUCATIONAL ASSESSMENT	05 94
CFS-398	REQUEST/RELEASE OF INFORMATION	07 87
CFS-400/1	ADOPTION APPLICATION	REV. 07 87
CFS-400/2	APPLICANT'S FINANCIAL STATEMENT	REV. 06 87
CFS-401	ADOPTION FACT SHEET	REV. 06 87
CFS-404	GENERAL MEDICAL FORM-ADOPTIONS	REV. 06 87
CFS-405	FAMILY ASSESSMENT INFORMATION	01 81
CFS-406	HOME STUDY REQUEST/PRELIMINARY INFORMATION FORM FOR ADOPTIVE APPLICANTS OF FOREIGN BORN CHILDREN	08 90
CFS-407	STATEMENT OF FINANCIAL RESPONSIBILITY FOR FOREIGN BORN CHILDREN	08 90
CFS-408 (T)	FEDERAL PARENT LOCATOR SYSTEM INFORMATION	REV. 01 2003
CFS-409 (T)	ADOPTION QUESTIONNAIRE	REV. 05 2003
CFS-410/1,2, 3,4 (T)	WAIVER AND CONSENT TO THE APPOINTMENT OF A GUARDIAN	REV. 05 87
CFS-411 (T)	AFFIDAVIT	05 2002
CFS-412	CHILD'S INFORMATION SHEET	REV. 07 78
CFS-413 (T)	INITIAL CONTACT ADOPTION	REV. 09 2003
CFS-414	CHANGE OF STATUS	01 85
CFS-415	ADOPTION APPLICATION DATA	REV. 05 89
CFS-417	MONTHLY GUARDIANSHIP REPORT	12 87
CFS-418 (T)	NOTICE OF CUSTODY WITH POWER TO CONSENT TO ADOPTION PROCEDURE	REV. 05 2002
CFS-419	AUTHORIZATION-RELEASE FROM LIABILITY	04 79
CFS-420 (T)	LEGAL RISK ADOPTION PLACEMENT AGREEMENT	REV. 09 2003
CFS-421/1 (T)	HOME STUDY/SUPERVISION CLIENT QUESTIONNAIRE	REV. 5 2002
CFS-421/2 (T)	REFERENCE LETTER FOR HOME STUDY	REV. 05 2002
CFS-421/3 (T)	HOME STUDY ATTACHMENT/ADOPTION	REV. 02 2002
CFS-421/4 (T)	HOME STUDY ATTACHMENT/CUSTODY	REV. 02 2002
CFS-421/5 (T)	HOME STUDY ATTACHMENT/PLACEMENT	REV. 02 2002
CFS-421/6 (T)	HOME STUDY ATTACHMENT/YOUTH SERVICES CENTER	REV. 02 2002
CFS-424	BILLING	REV. 06 82
CFS-425 (T)	APPLICATION FOR ADOPTION SUBSIDY	REV. 09 2003
CFS-426 (T)	STATEMENT OF INCOME AND RESOURCES FOR ADOPTION SUBSIDY	REV. 09 2003
CFS-427 (T)	DETERMINATION OF ELIGIBILITY FOR ADOPTION SUBSIDY	REV. 09 2003
CFS-428A (T)	ADOPTION ASSISTANCE - STATE FUNDED SUBSIDY	REV. 09 2003
CFS-428B (T)	ADOPTION ASSISTANCE - FEDERAL IV-E ASSISTANCE	REV. 09 2003
CFS-428C (T)	ADOPTION ASSISTANCE - NON-RECURRING EXPENSE PAYMENT	REV. 09 2003
CFS-429 (T)	SPECIAL ADOPTION SUBSIDY REEVALUATION	REV. 09 2003
CFS-431 (T)	CERTIFICATION OF ADOPTION SUBSIDY ELIGIBILITY	09 2003
CFS-432 (T)	RECOMMENDATION FOR FINALIZATION OF AN ADOPTION	09 2003
CFS-433 (T)	INDIVIDUALIZED ADOPTION RECRUITMENT PLAN	09 2003
CFS-434 (T)	AFFIDAVIT/REGISTRATION FORM (MCVAR)	REV. 09 2003
CFS-435	ADOPTION CASE PLAN	03 87
CFS-436	INTERSTATE COMPACT ON ADOPTION AND MEDICAL ASSISTANCE/NOTICE OF TRANSFER	01 87
CFS-437	INTERSTATE COMPACT ON ADOPTION AND MEDICAL ASSISTANCE/NOTICE OF ACTION	01 87
CFS-438	MEDICAID COVERAGE OF TITLE IV-E CHILDREN/NOTICE OF TRANSFER	01 87
CFS-439	MEDICAID COVERAGE OF TITLE IV-E CHILDREN/NOTICE OF ACTION	01 87
CFS-440	ICU LETTER	06 88
CFS-441	HOME EVALUATION	11 76
CFS-442	REQUEST FOR OUT-OF-STATE HOME EVALUATION	05 99
CFS-443	REQUEST FOR TRAVEL PERMIT AND SUPERVISION	11 76
CFS-444	AFFIDAVIT OF VERIFICATION	11 76
CFS-448	REQUEST/TRANSMITTAL OF INFORMATION	07 86
CFS-449 (T)	REFERENCE LETTER	09 2000
CFS-450 (T)	FAMILY FOSTER HOME STUDY/APPLICATION	REV. 01 2002
CFS-450* ATT.	ATTACHMENT-FAMILY FOSTER HOME STUDY/APPLICATION	05 87
CFS-451*	FAMILY FOSTER PARENT REEVALUATION	05 87
CFS-454	AGREEMENT FOR RESIDENTIAL SERVICES	REV. 10 87
CFS-455*	REQUEST/CONSENT FOR HEALTH DEPARTMENT SERVICE	REV. 02 8 9
CFS-456 (T)	BIOLOGICAL FAMILY BACKGROUND INFORMATION	REV. 05 99
CFS-457	HOSPITAL DATA	REV. 08 82
CFS-460 (T)	PLAN FOR FOSTER CHILD ATTAINING MAJORITY	REV. 01 2003
CFS-462 (T)	INITIAL FAMILY FOSTER HOME AGREEMENT	REV. 01 2002
CFS-462A (T)	FAMILY FOSTER HOME AGREEMENT ADDENDUM	REV. 01 2002
CFS-463	KNOWLEDGE OF PRE-SERVICE TRAINING MATERIAL	REV. 05 87
CFS-464	FAMILY FOSTER PARENT EVALUATION	03 80
CFS-466	VOLUNTARY TEMPORARY FC AGREEMENT	09 79
CFS-467 (T)	ADOPTION RECRUITMENT AGREEMENT	09 2003
CFS-468 (T)	ADOPTION - DATA MATCHING	09 2003
CFS-470 (T)	SELECTION OF ADOPTIVE FAMILY	09 2003
CFS-471 (T)	DISCLOSURE FOR ADOPTION	09 2003
CFS-472	INFORMATION CHECKLIST FOR JUVENILE COURT	07 85
CFS-473	REQUEST LEGAL EXPENSES FC	03 83
CFS-474	PURCHASE APPROVAL FOR FOSTER CHILD	REV. 08 94
CFS-475* (T)	CHECKLIST FOR COMPLIANCE	REV. 01 2002
CFS-476	GRADUATION CERTIFICATE	REV. 02 93
CFS-478	PHYSICIAN'S REPORT	06 80
CFS-479	FAMILY FOSTER HOME REEVALUATION NOTICE	07 81
CFS-480	ALTERNATE COMPLIANCE-WATER	04 87
CFS-481	FAMILY FOSTER HOME APPROVAL CERTIFICATE	REV. 02 93
CFS-485*	FAMILY FOSTER HOME FACE SHEET	04 85
CFS-487	APPLICATION FOR TITLE IV-E PAYMENTS/MEDICAID	01 93
CFS-489 (T)	REQUEST FOR CONSIDERATION TO ADOPT	09 88
CFS-491 (T)	CONSENT FOR USE OF FUNDS AND RESOURCES	REV. 05 2002
CFS-493*	TITLE IV-E/MEDICAID RE-DETERMINATION	01 93
CFS-495 (T)	NOTIFICATION OF CHANGE	REV. 08 93
CFS-496 (T)	ASSESSMENT FOR INCOME ASSISTANCE	06 93
CFS-537	REQUEST FOR DAY CARE (PROTECTIVE/FOSTER CARE)	03 94
CFS-579 (T)	AGREEMENT FOR PROVIDER SERVICES	02 89
CFS-590* (T)	INVITATION TO FAMILY-CENTERED MEETING	08 94
CFS-592 (T)	FINANCIAL/MEDICAL PLAN ICPC	10 2001
CFS-593	ARKANSAS STATE VEHICLE SAFETY PROGRAM	05 2003
CFS-594 (T)	MEAL VOUCHER AUTHORIZATION FOR "FEED THE KIDS"	08 2002
CFS-595 (T)	MEAL VOUCHER AUTHORIZATION LOG FOR "FEED THE KIDS"	08 2002
CFS-4330	CHILD WELFARE STUDENT STIPEND AGREEMENT	10 2001
CFS-4331	EDUCATIONAL LEAVE CONTRACT FULL TIME/PART TIME MSW STUDENT	10 2001
CFS-4332	CHID WELFARE STUDENT STIPEND APPLICATION	10 2001
CFS-6001 (R)	REFERRAL INFORMATION REPORT	12 2001
CFS-6002 (R)	CLIENT INFORMATION	12 2001
CFS-6003 (R/T)	REPORT TO PROSECUTING ATTORNEY	12 2001
CFS-6004 (T)	ELIGIBILITY DETERMINATION	12 2001
CFS-6005 (R)	CLIENT SERVICES	12 2001
CFS-6006 (R)	TREATMENT CONTACTS/VISITS	12 2001
CFS-6007 (R)	PLACEMENT PLAN - PLACEMENT PROVIDER INFORMATION	12 2001
CFS-6008 (R)	PLACEMENT PLAN	12 2001
CFS-6009 (R)	FAMILY STRENGTHS AND NEEDS ASSESSMENT	12 2001
CFS-6010 (R/T)	CASE PLAN REV.	12 2001
CFS-6011 (R/T)	COURT REPORT	12 2001
CFS-6012 (R)	CLIENT MEDICAL AND PSYCHOLOGICAL INFORMATION	12 2001
CFS-6013 (R/T)	APPLICATION FOR EMERGENCY SERVICES	12 2001
CFS-6014 (R/T)	DIFFICULTY OF CARE PAYMENT REQUEST AND NOTIFICATION	12 2001
CFS-6015 (G/R/T)	ADOPTION STAFFING NOTES	12 2001
CFS-6016 (R)	AFFIDAVIT OF INFORMATION DISCLOSURE FOR ADOPTION	12 2001
CFS-6017 (R/T)	ADOPTION SUBSIDY APPLICATION	12 2001
CFS-6018 (R)	CHILD PLACEMENT HISTORY	12 2001
CFS-6019 (R)	PLACEMENT REQUEST FORM	12 2001
CFS-6020 (R/T)	PLACEMENT WORKSHEET	12 2001
CFS-6021 (R)	TREATMENT/COURT INFORMATION	12 2001
CFS-6022 (R)	CASE SUMMARY	12 2001
CFS-6023 (R)	CLIENTS TO BE REGISTERED/CHANGED/CLOSED	12 2001
CFS-6024 (R/T)	PERMANENCY PLANNING COURT REPORT	05 99
CFS-6025 (R)	HEALTH AND SAFETY CHECKLIST	07 99
CFS-6026 (R)	RISK ASSESSMENT	07 99
CFS-6027 (R)	SAFETY RESPONSE	07 99
CFS-6040 (R)	WAITING LIST OF STAFF PERSONS REQUESTING TRAINING	12 2001
CFS-6050 (R)	TICKLER LIST	12 2001
CFS-6051 (R)	WORKLOAD LIST	12 2001
CFS-6052 (R)	REFERRAL ACCEPTANCE SNAPSHOT	12 2001
CFS-6053 (R)	INVESTIGATION CLOSE SNAPSHOT	12 2001
CFS-6054 (R)	CLIENT MERGE SNAPSHOT	12 2001
CFS-6056 (R)	STAFF LIST	12 2001
CFS-6057 (R)	ON-CALL STAFF LIST	12 2001
CFS-6058 (R)	INDIVIDUAL TRAINING RECORD	12 2001
CFS-6059 (R)	INITIAL REFERRAL SNAPSHOT	12 2001
CFS-6060 (R)	CASE CONNECTION SNAPSHOT	12 2001
CFS-6061 (R)	INVESTIGATION EXTENSION REPORT	12 2001
CFS-6063 (R)	COUNTY RESOURCES INFORMATION REPORT	12 2001
CFS-6064 (R)	COUNTY VACANCIES INFORMATION REPORT	12 2001
CFS-6065 (R)	CHILD WELFARE WORKSHOP ROSTER	12 2001
CFS-6086 (R)	AFCARS DATA ELEMENT LIST	12 2001
CFS-6087 (R)	CLAIM ADJUSTMENTS BY RESOURCE	12 2001
CFS-6088 (R)	ESTIMATED CLAIMS BY RESOURCE	12 2001
CFS-6089 (R)	MALTREATMENT SUMMARY REPORT	12 2001
CFS-6090 (R)	NEW FOSTER PARENTS ENTERED BY RESOURCE DURING	12 2001
CFS-7000 (R)	CASE STAFFINGS LOG	12 2001
ICPC-100A (T)	INTERSTATE COMPACT PLACEMENT REQUEST REV.	08 2001
ICPC-100B (T)	INTERSTATE COMPACT REPORT ON CHILD'S PLACEMENT STATUS REV.	08 2001
ICPC-101 (T)	ASSOCIATION OF ADMINISTRATORS OF THE ICPC/SENDING STATE PRIORITY HOME STUDY REQUEST	08 96

Legend: R= Report T = Template G = DHS Gold * = Supply Catalog

JC A	PETITION FOR REQUISITION TO RETURN A RUNAWAY JUVENILE	06 66
JC B	ORDER OF DETENTION	06 66
JC I	REQUISITION FOR RUNAWAY JUVENILE	06 66
JC IA	APPLICATION FOR COMPACT SERVICES	06 66
JC II	REQUISITION FOR ESCAPEE OR ABSCONDER	06 66
JC III	CONSENT FOR VOLUNTARY RETURN BY RUNAWAY, ESCAPEE OR ABSCONDER	06 66
JC IV	PLACEMENT INVESTIGATION AND SUPERVISION REQUEST	06 66
JC V	REPORT OF SENDING STATE UPON PAROLEE OR PROBATIONER BEING SENT TO ANOTHER JURISDICTION	06 66
JC VI	MEMORANDUM OF UNDERSTANDING AND WAIVER-PAROLEE OR PROBATIONER	REV. 11 72
SS-5 (T)	APPLICATION FOR A SOCIAL SECURITY NUMBER CARD	05 88
DCO-22* (G)	REQUEST FOR UNIQUE PSEUDO SSN	REV. 07 01
DCO-75 (G)	CASE REEVALUATION NOTICE	REV. 03 93
DCO-104 (G)	LETTER TO THE ABSENT PARENT	REV. 07 97
DCO-2609	PRIMARY CARE PHYSICIAN SELECTION AND CHANGE FORM	07 96
DCO-2611	LETTER RE: PHYSICIAN CHOICE	08 96
DCO-2613	NOTICE TO MEDICAID APPLICANTS/RECIPIENTS	09 96
EMS-57*	ACES SINGLE MEMBER DATA SHEET	07 93
EMS-92	IV-E TRANSFER OF RESIDENCE AND ASSIGNMENT	08 87
DHS-47	REQUEST FOR ADMINISTRATIVE COPY OF CERTIFICATE OF BIRTH	REV. 03 93
DHS-81 (G/T)	CONSENT FOR RELEASE OF INFORMATION	05 94
DHS-82	CONSENT FOR MEDICAL TREATMENT	REV. 09 79
DHS-91*	DEMS/DCFS REFERRAL/INFORMATION TRANSMITTAL	REV. 03 92
DHS-160* (G)	NOTICE TO ACTION TO APPLICANTS FOR, AND RECIPIENTS OF, TITLE SSBG SERVICES	REV. 02 01
DHS-355	AUTHORIZATION AND BILLING REV.	04 87
DHS-375	VOLUNTEER TRAVEL LETTER REV.	09 93
DHS-484	AUTHORIZATION FOR TRANSPORTATION REV.	09 86
DHS-1200* (G)	APPEAL FOR HEARING	11 99
DHS-1558	PROBATE COURT SUMMONS REV.	04 82
DHS-1910 (G)	INCIDENT REPORT (Go to DHS Gold link to IRIS to complet	e.)
DHS-3100	MEMO, SUPPORT PAYMENT FOR FOSTER CHILD/CHILDREN	05 88
DHS-3101	MEMO, SUPPORT PAYMENTS FOR FOSTER CHILDREN	05 88
DHS-3102	MEMO, TERMINATION OF SUPPORT PAYMENTS FOR FOSTER CHILD/CHILDREN	05 88
DHS-3300*	INFORMATION/REFERRAL INFORMATION/REFERRAL CODING GUIDE	11 86 01 89
AOV-7000	VOLUNTEER RESOURCES INFORMATION	08 86
AOV-7001	REQUEST FOR INFORMATION	07 88
AOV-7002	VOLUNTEER APPLICATION	08 88
AOV-7003	VOLUNTEER INTERVIEW	08 88
AOV-7004	VOLUNTEER AGREEMENT	08 88
AOV-7005	AGENCY EVALUATION REPORT	08 88
AOV-7006	VOLUNTEER MONTHLY HOUR LOG	08 88
AOV-7007	VOLUNTEER SIGN-IN SHEET	08 88
AOV-7008	VOLUNTEER SERVICES ACTIVITY SIGN-IN SHEET	08 88
AOV-7009	GROUP VOLUNTEER REPORT	08 88
AOV-7010	EXIT INTERVIEW	08 88
AOV-7011	VOLUNTEER ATTENDANCE RECORD	08 88
VSP-1	ARKANSAS STATE VEHICLE SAFETY PROGRAM AUTHORIZATION TO OPERATE STATE VEHICLES AND PRIVATE VEHICLES ON STATE BUSINESS REV.	08 2000
VSP-2	ARKANSAS STATE VEHICLE SAFETY PROGRAM AUTHORIZATION TO OBTAIN TRAFFIC VIOLATION RECORD REV.	08 2000
PUB-01*	Day Care Family Homes Min Lie Requirements	10 91
PUB-02*	Minimum Lie Requirement Day Care Centers	07 95
PUB-04 (P)	Min Lie Standards for Child Welfare Agencies	01 2002
PUB-05*	Day Care Family Home Voluntary Registry	11 92
PUB-0 6	Adopting a Foreign Child	08 90
PUB-011*	Your Child and Foster Care	06 90
PUB-013*	Aid To Families With Dependent Children	10 90
PUB-016*	Parent Guide to Registered Family Day Care	10 91
PUB-022*(P)	Standards for Approval of Family Foster Homes	01 2002
PUB-028*	Early Periodic Screen Diag Treat Prog	03 89
PUB-030*(P)	Family Foster Parent Handbook	01 2002
PUB-035*	Child Maltreatment: The Ark Law & Child Protective Services	09 95
PUB-038	Medical Passport	08 90
PUB-040*	Your Guide To Medicaid Services in Arkansas	06 92
PUB-043	Choices - Adoption Is An Option	04 94
PUB-051*	Pre-Service Foster Parenting Training	03 88
PUB-052*(P)	Child Protective Services - A Caretaker's Guide	05 2002
PUB-053	Directory of Residential Therapeutic Child Care Providers	10 2001
PUB-057	After Hours Directory	09 92
PUB-059*	Out-of-Home Protective Services	02 91
PUB-0 69	Summary Licensing Req Day Care Centers	06 90
PUB-07 0	Summary Licensing Req Day Care Family Homes	06 90
PUB-08 0	Intensive Family Services Guidelines	07 90
PUB-102	Parenting in Arkansas	09 90
PUB-112*	Adoption Services in Arkansas	06 88
PUB-113	Mutual Consent Voluntary Adoption Registry	06 88
PUB-116	Sometime Friends Need Help	12 90
PUB-131*	FC Compliance Requirements/A Desk Guide	10 90
PUB-132*	Children with Special Needs and Subsidy	02 90
PUB-141*	If You Need Us	04 95
PUB-151*	Planning a Quality Program For Children	1986
PUB-152*	If you really care... Foster Care!	1987
PUB-169*	Food Stamps	11 92
PUB-17 8	The Homemaker and Your Family	12 88
PUB-252	"What Do You Think?" - Adoption Choices REV	10 2001
PUB-261	Relative/In-Home Day Care Registration	11 92
PUB-2 62	Child Care Assistance for Teen Parents and Low Income	11 92
PUB-267*	Division of Children and Family Services	11 90
PUB-273*	Department of Human Services	07 93
PUB-275	Freedom of Information Act	09 90
PUB-295	Family Day Care Voluntary Registration	07 91
PUB-321	DCFS Eligibility Specialist Handbook	10 92
PUB-333	Health Check-ups for Children in Foster Care-A Pamphlet for Family Foster Parents	09 93
PUB-334	Health Check-ups for Children in Foster Care-A Pamphlet for Medical Providers	09 93
PUB-34 3	Family Assessment Manual	08 94
PUB-357* (P	) Child Maltreatment Assessment Protocol	05 2002
PUB-3 8 4	Local Cash Accounts Guidelines	07 98
PUB-399 (P	) Feed the Kids - Instructions for Utilizing Coupon Books and Purchase Orders	08 2002
PUB-404	Chafee Foster Care Independence Program	01 2003

CHAFEE FOSTER CARE INDEPENDENCE PROGRAM (BUDGET)

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* Only allowable expenses may be used to justify a higher board rate. See Instructions. CFS-0025 (09/2003)

INSTRUCTIONS FOR CFCIP BUDGET FORM (CFS-0025)

PURPOSE

This form is used to calculate a CFCIP/IL client's income (including Pell Grant funds) and his/her financial obligations so that it can be determined if the board rate is inadequate, adequate or excessive to cover school-related expenses.

COMPLETION

At the top of the form, complete the student's name, CHRIS Number, school term dates for which the budget applies and the name of the school.

In the top right box enter the amount of the Pell Grant expected or received for the semester or term. If the Pell Grant has not been received, enter the "Date Applied For" on the line above the "Tuition" box.

Enter the known or expected costs for tuition, books and fees in the boxes next to those headings. Enter the total for tuition, books and fees in the box beside "Total" and subtract that amount from the amount for "Pell Grant" above. That amount is the Pell Grant balance after subtracting costs for tuition, books and fees. It may be a positive or negative balance. If it is a positive amount, it should be used to offset expense items. If it is a negative amount, the CFCIP program will pay the school that balance when a purchase order and correct bill is submitted.

In the "Assets" boxes, fill in and total all of the client's sources of income. The "Current Board Payment" and any "Other Income" should be multiplied by the number of months covered by the Pell Grant to make the timeframes compatible for calculation. For instance, if the Pell Grant covers a semester, then multiply the amounts in the asset categories by the number of months the semester covers to determine total estimated assets for the semester.

In the "Expenses" boxes, fill in all the client's school-related expenses and total them. Monthly expenses should also be multiplied by the number of months covered by the Pell Grant to make the timeframes compatible for calculation.

Subtract the "Total Expenses" from the "Total Income" to determine if there is a positive or negative balance. Use that information to determine if you will ask for an increase, decrease or no change in the current amount of the board rate. If a rate increase is requested, a copy of the budget form should be attached to form CFS-304 as justification for the increase.

The Budget Preparer, Sponsor and Student should sign and date the budget form and it should then be forwarded to the Area Manager to approve or deny the request.

ROUTING

The client and the Sponsor should receive a copy of the completed budget form and the original should be forwarded to the Supervisor. A copy should be placed in the client's file.

* Allowable expenses - Only maintenance costs such as housing, including utilities, food, personal needs, purchase and care of clothing, transportation and non-Medicaid-covered medical costs may be used to justify a higher board rate. Any deviation from this list must be separately justified and signed off by the Assistant Director of Community Services.

Utilities - Utilities are limited to basic utility services and only include water, gas, electricity, and basic telephone service. Any payment for long distance service should be limited and itemized. Cable TV and cell phone expenses are not included as a utility expense.

Food - If the student attends an institution of higher learning with food service, payment for food should be restricted to the purchase of a meal or cafeteria ticket at the institution. If the student chooses not to eat in the cafeteria, no more than $150 per month may be allotted to the purchase of food.

Clothing - Expenses should be limited to no more than $65 per month.

Transportation - Transportation expenses are limited to services provided through a public transportation system or by a volunteer. Funds allotted for transportation are not to be used for the purchase, maintenance, insuring or operation of privately owned vehicles.

Personal Needs - Funds allotted for personal needs should not exceed $35 per month.

Arkansas Department of Human Services Division of Children and Family Services

Justification for Special Board Rate Form

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Justification for Special Board Rate Form

Instructions: First determine the level of care required in each applicable category of need. Refer to the Point Chart to determine the assigned number of points per level and category. Refer to the Rate Chart to determine the dollar amounts corresponding to points assigned. Add the dollar amounts for each applicable category to the basic board rate (standard of age) to obtain the total monthly Special Board Rate.

LEVELS OF REQUIRED CARE

I. Emotional Need Category

Level A. These are children who periodically exhibit excessive dependency, passivity, lack responsiveness and the ability to relate.

Level B. Children at this level require abnormal amounts of attention and affection, have need for a regimental program such as behavior modification. Such children often have school problems, difficulty with peers, moodiness, frequent enuresis. Foster parents often have to provide an abnormal amount of structure (e.g., constant repetition and follow-through on instructions).

Level C. These children exhibit extreme attention-seeking behavior, stealing, drug use, encopresis, destructive behavior, extreme hyperactivity, sexual acting-out, running away, withdrawal, etc.

Level D. These children show extreme, bizarre behavior, may be self-destructive and require exceptional care.

Level E. Children at this level show severely disturbed behavior, such as frequent running away, depression attempted suicide, fantasizing, or inappropriate behavior. They may be dangerous to themselves or others, and cannot be maintained in a normal family setting.

II. Physical Need Category

Level A. These children need some help with putting on braces or prosthetic devices, some help with buttons, laces, etc., but basically self-caring.

Level B. These children need help with dressing, bathing, general toilet needs, as well as some help in ambulation. They exhibit feeding problems such as excessive intake, extremely slow and/or messy requiring help and/or supervision due to retardation or emotional or physical handicap. Need for tube or gavage feeding. Physical therapy, under one hour per day.

Level C. These children need appliances for drainage or ileal conduit, or a colostomy. They might need aspiration, suctioning, mist tent, etc. they are nonambulatory, needing constant attendance, and/or prescribed physical therapy, 1 -2 hours per day, by foster parent.

Level D. These children require custodial care, physical therapy 2-3 hours per day. They have uncontrollable seizures.

Level E. Due to the severity of their physical handicap, these children are unable to tolerate a normal family setting and require on going care. Such children possible need 24 hours supervision.

III. Auxiliary Need Category

Level A. These children require special diets or supplements that require extra expense and are not covered under any other program. Regular but infrequent (less than monthly) trips must be made to physician, psychiatrist, therapist, etc.

Level B. Children require special equipment or a regular and consistent tutoring program at home. There is unusual wear and tear on the home, and need for occasional period of relief by an adult. Therapeutic appointments must be met every 2-4 weeks.

Level C. There is extreme wear and tear on the home, frequent hospitalizations, therapeutic visits every two weeks or oftener.

Level D. These children exhibit either emotional or physical problems of such severity that the foster parents must make extraordinary adjustments in their family life style to accommodate the foster child. Such adjustments may include, but are not be limited to ongoing regular attendance at supportive group meetings physical changes in the home (such as building ramps, installing, lifts, etc.), ongoing consultation with child care professionals. These children require foster parents with skill in adapting family life to the needs of each child.

Level E. The post-secondary board payment for IL students who choose to remain in care, but not in a licensed foster care facility while pursuing their educational goals should be used primarily for the following expenses:

1. Living quarters rent or dorm room charges

2. Food or meal plan charges

3. Clothing needs

4. Personal needs

5. Utilities

6. Deposits (rent/utilities)

POINT CHART

	A	B	C	D	E
Emotional	5	15	30	60	175
Physical	5	15	30	60	175
Auxiliary	5	15	30	60	250

RATE CHART

Points	Monthly	Points	Monthly	Points	Monthly	Points	Monthly
5	$50	70	$180	135	$310	220	$440
10	$60	75	$190	140	$320	230	$450
15	$70	80	$200	145	$330	240	$460
20	$80	85	$210	150	$340	*250	$630 max
25	$90	90	$220	155	$350
30	$100	95	$230	160	$360
35	$110	100	$240	165	$370
40	$120	105	$250	170	$380
45	$130	110	$260	175	$390
50	$140	115	$270	180	$400
55	$150	120	$280	190	$410
60	$160	125	$290	200	$420
65	$170	130	$300	210	$430

* Applies to IL students only. The actual month y amount depends on completion of a CFS-0025 (IL Budget Calculation).

ARKANSAS DEPARTMENT OF HUMAN SERVICES DIVISION OF CHILDREN AND FAMILY SERVICES

ADOPTION QUESTIONNAIRE

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ARKANSAS DEPARTMENT OF HUMAN SERVICES

DIVISION OF CHIDREN AND FAMILY SERVICES

ADOPTION QUESTIONAIRE

CFS-409

PURPOSE

This form documents the characteristics of a child that an adoptive applicant is willing to accept, discuss, or is not willing to accept. The Adoption Specialist will thoroughly review the completed form with the applicant during the preparation and assessment process for adoption and summarize the characteristics that the applicant is willing to accept or discuss in the adoption home study. The Adoption Specialist and Adoption Supervisor will assess the completed form as part of the process to determine the approval or denial of an applicant for adoption. The Adoption Specialist or Adoption Coordinator will enter the characteristics from the completed form into the computerized system that generates a list of approved applicants that will be considered in selecting an adoptive family for a specific child. In relation to a foster parent, kinship foster parent, or relative adoption, characteristics are not entered into the computerized system for the purpose of selecting an adoptive family. If foster parent, kinship foster parent, or relative adoption is not the plan for a child, the Adoption Specialist and Adoption Supervisor will assess the completed form in selecting an appropriate adoptive family for a child.

COMPLETION

The adoptive applicant will complete the form during the assessment and preparation process for adoption. The Adoption Specialist may need to assist the applicant prior to the completion of the form in order that all characteristics are understood. The Adoption Specialist will review the completed form annually with an approved adoptive applicant until a child is placed to determine if revisions are needed.

ROUTING

The adoptive applicant will return the completed form to the Adoption Specialist during the preparation and assessment process for adoption. This form will be placed in the adoptive applicant's file. Revisions to the form will be placed in the applicant's file.

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ARKANSAS DEPARTMENT OF HUMAN SERVICES DIVISION OF CHILDREN AND FAMILY SERVICES

CFS-413 FOSTER/ADOPTION INQUIRY

PURPOSE

The purpose of this form is to document a prospective foster care/adoptive family's initial contact with DHS/DCFS and/or to learn about the foster care/adoption program and/or to express an interest in completing an application to adopt, and/or foster. For adoption, this would include inquiries related to a specific child who is registered with an adoption web site, exchange, or photo-listing album. This form also documents how a prospective foster care/ adoptive family applicant learned about the DCFS programs.

COMPLETION

NOTE: If the inquiry involves interest in both foster care and adoption, follow-up should be coordinated between the Adoption Specialist and the County Supervisor/designee.

An Adoption Specialist, other DCFS employees or DCO employees will complete this form upon receiving an inquiry from a prospective foster care/ adoptive family applicant(s). The following information will be collected:

Name: Enter the name of the prospective foster care/adoption applicant(s).

Date of Inquiry: Enter the date the prospective foster care/adoption applicant(s) made their inquiry.

Address and Phone Numbers: Enter the home address and telephone numbers of the prospective foster care/adoption applicant(s).

Marital Status: Enter information if the prospective foster care/adoption applicant(s) is married (state length of marriage), single, or divorced.

Race: Enter the race of the prospective foster care/adoption applicant(s).

Age: Enter the age of the prospective foster care/adoption applicant(s).

Children in Home: Enter the number and ages of birth/adopted child(ren) living with the prospective foster care/adoption applicant(s).

Preference of Child: Enter information about the prospective adoption applicant's preferences regarding the type of child(ren) desired.

Specific Child (if applicable): Enter information about the prospective foster care/adoption applicant's interest in adopting a specific child registered with an adoption web site/exchange/photo-listing album.

Home Study Completed: Enter "Yes" or "No" to indicate if a prospective foster care/adoption applicant(s) has a completed (approved) home study. If "Yes", state who conducted the home study.

Training Completed: Enter "Yes" or "No" to indicate if the prospective foster care/adoption applicant(s) has completed the Foster Pride/Adopt-Pride training curriculum or a similar training. If "Yes" is entered, who provided the training and the type of training.

What Prompted Inquiry: Enter information that indicates how the prospective foster care/adoption applicant(s) learned about the DCFS foster care/adoption programs.

Comments: Enter comments as needed, including specific information about publications and brochures, which may have prompted the inquiry.

Signature of Person Taking Inquiry, Title, County: The Adoption Specialist, other DCFS employee, or DCO

employee who has the initial contact with the prospective foster care/adoption applicant will complete this part.

Action Taken to Address Inquiry, Signature, Title, Date: The Adoption Specialist will complete this section to document how an inquiry related to adoption has been addressed. The County Supervisor or designee will complete this section for inquiries related to foster care.

The name(s) of those making the inquiry will be transferred to a Foster Parent/Adoptive Parent Recruitment Log (CFS-563) so that evaluation and development of the home can be tracked.

ROUTING

If a DCFS employee (other than the Adoption Specialist) or a DCO employee completes the form, it will be routed to the Adoption Specialist who is assigned to the county where the prospective foster care/adoption applicant(s) resides. The Adoption Specialist will retain the completed form. If it is a foster care inquiry, it should be routed to the county supervisor, where it will be retained.

Arkansas Department of Human Services

Division of Children and Family Services Adoption Services

LEGAL RISK ADOPTION PLACEMENT AGREEMENT

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INSTRUCTIONS

LEGAL RISK ADOPTION PLACEMENT AGREEMENT

CFS-420

Definition

Is the placement of a child, who is not legally free for adoption, with an approved adoptive applicant. This placement may be considered for a newborn that is being relinquished for adoption or for a child whose birth/legal parent has filed an appeal to the termination of parental rights. The prospective adoptive parent must be educated about the risks and challenges inherent in such a placement and they must sign a form prior to placement of the child.

Purpose

To have the prospective adoptive parent(s) acknowledge that they have been told and understand that the children being adopted are not yet legally free for adoption. They also understand that the placement might terminate and the child(ren) be returned to the legal custodian (DHS).

Completion

Insert the name(s) and birthdate(s) of the child(ren) being placed for adoption. Insert the name(s) of the DCFS representative(s) who explained the nature of the legal risk in the adoptive placement. The adoptive parent(s) must print and sign their name(s). The Notary must have observed the adoptive parent(s) signature(s) and must notarize the form in the place provided.

Routing

The original should be given to the Adoption Specialist. One copy should go to the adoptive parent(s).

Arkansas Department of Human Services

Division of Children and Family Services

Adoption Services

Application For Adoption Subsidy

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ARKANSAS DEPARTMENT OF HUMAN SERVICES DIVISION OF CHILDREN AND FAMILY SERVICES

STATEMENT OF INCOME AND RESOURCES FOR ADOPTION SUBSIDY

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Instructions

CFS-426

Purpose

The CFS-426 form shall serve as a basis for determining the adoptive parent's (s¹) financial eligibility for an adoption subsidy. The form shall be utilized for initial or for amending an existing adoption subsidy.

Completion

The Adoption Specialist, after an interpretation of the policies and procedures of the subsidy program, shall give a CFS-426 form to the adoptive parent(s). The adoptive parent(s) shall complete the CFS-426 form in triplicate and attach a copy of the latest IRS form 1040 or 1040A, or other verification of income.

Routing

The Adoption Specialist shall forward a completed CFS-426 form to Adoption Services, Central Office, and attach to it a CFS-425 form and a CFS-427 form. The adoptive parent(s) shall retain a completed CFS-426 form and the Adoption Specialist shall also retain a copy in the case record permanently.

ARKANSAS DEPARTMENT OF HUMAN SERVICES DIVISION OF CHILDREN AND FAMILY SERVICES

DETERMINATION OF ELIGIBILITY FOR ADOPTION SUBSIDY

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INSTRUCTIONS

CFS - 427

Purpose

The CFS-427 form is utilized by the Adoption Specialist to determine a child and family's eligibility for adoption subsidy as well as to make a projection about the type and amount of adoption subsidy for a child. The form must be completed for an initial application or an amendment to an existing subsidy.

Completion

The Adoption Specialist shall complete an original and one copy of the CFS-427 form. The CFS-425 form and CFS-426 form must be utilized to complete the form. If a special subsidy is being requested, the Adoption Specialist must secure and attach to the CFS-427 verification of the child's diagnosis, treatment/service plan, and cost of treatment/service for up to twelve months.

Routing

The Adoption Specialist shall forward a completed CFS-427 to Adoption Services, Central Office, and attach to it a CFS-425 form and a CFS-426 form. The Adoption Specialist shall retain a completed CFS-427 form in the case record permanently.

Arkansas Department of Human Services

Division of Children and Family Services

Adoption Assistance Agreement

For State Funded Subsidy Payments

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Arkansas Department of Human Services

Division of Children and Family Services

ADOPTION ASSISTANCE AGREEMENT

FOR FEDERAL IV-E FUNDED ASSISTANCE

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Arkansas Department of Human Services Division of Children & Family Services

Adoption Assistance Agreement For Non-Recurring Adoption Expense Payment

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Arkansas Department of Human Services Division of Children and Family Services

Special Adoption Subsidy Re-Evaluation

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INSTRUCTIONS

Purpose

The CFS-429 form is utilized annually to verify the child's continued eligibility for a special subsidy and to project the type and amount of special subsidy.

Completion

The Adoption Specialist shall first secure the signature(s) of the adoptive parent(s). The CFS-429 form shall then be forwarded to the provider of the special subsidy. The provider shall return the completed form to the Adoption Specialist.

Routing

The Adoption Specialist shall have a copy made of the CFS-429 form. The original shall be forwarded to Adoption Services, Central Office. The CFS-425 form and CFS-427 form shall accompany the CFS-429. A copy of the CFS-429 shall be retained in the case record permanently.

Arkansas Department of Human Services

Division of Children and Family Services

Central Office Adoptions Unit

P.O. Box 1437, Slot S565 Little Rock, AR 72203-1437

CERTIFICATION OF ADOPTION SUBSIDY ELIGIBILITY

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INSTRUCTIONS

PURPOSE

The CFS-431 provides a place to formally certify and notarize that adoptive children continue to be eligible to receive a subsidy.

COMPLETION

In the top section of the form, the adoptive parent(s) should print the NAME, BIRTHDATE and DATE OF FINALIZATION of each adoption for each child. The adoptive parent(s) should print their own names, read the following statement and check EITHER "Yes" of "No".

In the middle section of the form, the adoptive parents should sign and date the form, BUT only in the presence of a Notary.

The bottom section of the form should be filled out, signed, dated and stamped by the Notary, who observed the adoptive parents sign the form.

ROUTING

The completed and notarized form should be mailed beck to the Central Office Adoption Unit at the address provided at the top of the form.

ARKANSAS DEPARTMENT OF HUMAN SERVICES DIVISION OF CHILDREN AND FAMILY SERVICES

RECOMMENDATION FOR FINALIZATION OF AN ADOPTION

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ARKANSAS DEPARTMENT OF HUMAN SERVICES

DIVISION OF CHILDREN AND FAMILY SERVICES

RECOMMENDATION FOR FINALIZATION OF AN ADOPTION

CFS-432

PURPOSE

This form documents the approval of the Adoption Specialist and Adoption Supervisor for the OCC attorney, or if applicable, an attorney in private practice, to initiate the process to finalize an adoption. It further verifies the information and forms, reports, and documents that are being submitted to initiate the process to finalize an adoption.

COMPLETION

The Adoption Specialist will complete and sign the form to approve that the process to finalize the adoption should be initiated. The following information will be completed:

Child's Birth Name: Enter the complete name of the child as documented on the child's birth certificate.

Child's Date Of Birth: Enter the birth date of the child that is documented on the child's birth certificate.

Child's Race: Enter the child's race.

Child's Place Of Birth: Enter the city and state that are documented on the child's birth certificate.

Termination Date: Enter the date on the court order when the birth/legal parent(s) rights were terminated.

Date Placed In Adoptive Home: Enter the date that the child was placed in the adoptive home.

County Of Placement: Enter the name of the adoptive parent's resident county.

Family's Address: Enter the complete address of the adoptive family.

Length Of Time The Family Has Been At This Address: Enter the length of the time the family has resided at their current address. Adoptive Father's Date Of Birth: Enter the birth date of the adoptive mother that is documented on the mother's birth certificate. Race: Enter the adoptive father's race.

Adoptive Father's Place Of Birth: Enter the city and state where the adoptive father was born. Adoptive Mother's Date Of Birth: Enter the birth date of the adoptive mother that is documented on the mother's birth certificate. Race: Enter the adoptive mother's race.

Adoptive Mother's Place Of Birth: Enter the city and state where the adoptive mother was born. Adoptive Mother's Maiden Name: Enter the maiden name of the adoptive mother. Adoptive Parent's Date Of Marriage: Enter the date of marriage as documented on the marriage license. Adoptive Parent's Place Of Marriage: Enter the place of marriage documented on the marriage license.

Attachments: (1) Change of Status (CFS 414), (2) adoptive parent's adoption home study (including all updates), (3) child's adoption summary, (4) post placement narrative, (5) results of FBI criminal record check if applicable, (6) copy of Adoption Application (CFS-400), (7) copy of the Adoption Subsidy Agreement (CFS-428) if applicable, (8) termination of parental rights court order, (9) child's certified birth certificate, and (10) any other documents that the court may require.

The Adoption Supervisor will sign the form to approve the recommendation to finalize the adoption.

ROUTING

The Adoption Supervisor will forward the original completed form and the attachments to the OCC Attorney, or attorney in private practice (if applicable). The Adoption Specialist will retain a copy of the completed form and the attachments for the child's file.

ARKANSAS DEPARTMENT OF HUMAN SERVICES DIVISION OF CHILDREN AND FAMILY SERVICES

INDIVIDUALIZED ADOPTION RECRUITMENT PLAN

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ARKANSAS DEPARTMENT OF HUMAN SERVICES

DIVISION OF CHILDREN AND FAMILY SERVICES

INDIVIDUALIZED ADOPTION RECRUITMENT PLAN

PURPOSE

This form develops a plan to recruit an adoptive family for a child and to document the progress. It is not required for a child with a plan of foster parent or kinship foster parent adoption.

COMPLETION

The Adoption Specialist will complete the following:

Child's Name: Enter the child's name.

Date of Birth: Enter the child's date of birth.

Resident County: Enter the child's resident county.

Adoption Specialist: Enter the name of the child's Adoption Specialist.

Date Assigned: Enter the date that the child is assigned to the Adoption Specialist

Dates Revised: Enter the dates that the plan is revised.

Strategy: Select the strategies that are to be implemented to recruit an adoptive family.

Name of Contact: Enter the name of the person, who is to be contacted to achieve the strategy.

Deadline: Enter the proposed date that the strategy is to be achieved.

Competed: Enter the date that the strategy is completed.

Results/Comments: Enter results of the strategy to recruit an adoptive family or related comments.

The Adoption Specialist will periodically assess and revise the recruitment plan when appropriate.

ROUTING

The Adoption Specialist will retain the completed recruitment form.

MUTUAL CONSENT VOLUNTARY ADOPTION REGISTRY

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Space for Additional Comments

ARKANSAS DEPARTMENT OF HUMAN SERVICES DIVISION OF CHILDREN AND FAMILY SERVICES

ADOPTION RECRUITMENT AGREEMENT

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ARKANSAS DEPARTMENT OF HUMAN SERVICES

DIVISION OF CHIDREN AND FAMILY SERVICES

CFS-467

ADOPTION RECRUITMENT AGREEMENT

PURPOSE

The purpose of this form is to document a child's permission to use his/her photograph and a brief description in activities to recruit an adoptive family. If it is necessary to recruit an adoptive family for a child, this form is required if the child is ten years of age or older.

COMPLETION

The Adoption Specialist will present and explain the form to the child for completion and signature. If the child is not mentally competent to sign the form, it will be presented and explained to the child's attorney ad litem for completion and signature. It is necessary to secure the signature of a witness to the child signing the form. The Adoption Specialist will help the child understand each activity before the form is completed. The child will check "Yes" or "No" to each activity.

ROUTING

The Adoption Specialist will retain the completed form and send a copy to the child's Family Service Worker for the child's record. The Adoption Specialist will send a copy to the Adoption Coordinator, Adoption Services Unit, in order for information to be registered about the child on an adoption web site or photo listing.

ARKANSAS DEPARTMENT OF HUMAN SERVICES DIVISION OF CHIDREN AND FAMILY SERVICES

ADOPTION - DATA MATCHING

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ARKANSAS DEPARTMENT OF HUMAN SERVICES DIVISION OF CHIDREN AND FAMILY SERVICES

CFS-468

ADOPTION-DATA MATCHING

PURPOSE

This form is included in the process to select an appropriate adoptive family for a child or sibling group. Significant characteristics about a child or sibling group are identified on the form. The characteristics are entered into a computerized data matching system. A list of approved adoptive applicants, who will accept or consider the characteristics, is produced. The home studies and completed forms on the approved adoptive applicants are forwarded to the child's Adoption Specialist to determine if an appropriate adoptive family can be selected.

COMPLETION

The Adoption Specialist for a child will complete the following information on the form:

Date: Enter the date the form is completed.

Adoption Specialist: Enter the name of the Adoption Specialist for the child.

Name and Date of Birth: Enter the child's name and date of birth. Note: The number by the child's name will correspond with number in the column of characteristics about the child.

Characteristics: Enter information about the child's sex and race and identify up to six additional significant characteristics. Enter a "M" or "F" in the column for the sex of the child. Enter the following code in the column for the race of the child: 1-Caucasian, 2-Native American, 3-

Caucasian/Native American, 4-African American, 5-Caucasian/African American, 6-Hispanic, 7-Asian.

ROUTING

The Adoption Specialist will forward the completed form to the Adoption Coordinator, Adoption Services Unit, and Central Office. The Adoption Coordinator will enter the identified characteristics of the child into the data matching system and will forward the list of approved adoptive applicants to the Adoption Specialist. The home studies and completed forms on the approved adoptive applicants will be forwarded with the list.

ARKANSAS DEPARTMENT OF HUMAN SERVICES DIVISION OF CHILDREN AND FAMILY SERVICES

SELECTION OF ADOPTIVE FAMILY

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ARKANSAS DEPARTMENT OF HUMAN SERVICES DIVISION OF CHILDREN AND FAMILY SERVICES

CFS-470

SELECTION OF ADOPTIVE FAMILY

PURPOSE

The purpose of this form is to document the selection of an adoptive family for a child by providing specific information about the child, name of the selected approved adoptive applicant, the reason(s) for the selection of the approved applicant, and information for adoption subsidy eligibility (if applicable). The form is not required for a foster parent, kinship foster parent, or relative adoption.

COMPLETION

The Adoption Specialist for a child will complete the form if an approved adoptive applicant is determined to be an appropriate adoptive family after assessing the adoption home study and completed adoption forms of approved adoptive applicants.

The Adoption Specialist will complete the following information on the form:

Name of Child: Enter the name of the child.

Date of Birth: Enter the date of birth of the child.

Foster Care Category: Enter if the child is in category IV-E, Non-IV-E, IV-E/SSI, or Non-IV-E/SSI.

Special Need Category: Enter the appropriate code to describe if a child is in a special need category for adoption planning: C-Caucasian child nine years of age or older, CC-Child of color two years of age or older, S-Sibling group of three or more children being placed together, M-Severe medical need that requires ongoing rehabilitation or treatment, P-Severe psychological need that requires ongoing rehabilitation or treatment, and/or HR-High risk for the development of a serious medical, mental, or emotional condition. Enter N/A (not applicable) if the child does not qualify for a special need category.

Legal Status: Enter custody if termination of parental rights has not been granted and a legal risk adoption is planned, or enter termination of parental rights if it has been granted.

Selection of Approved Applicant: Enter the name and address of the family that is being recommended as an appropriate adoptive family for a child. Enter the reason(s) for the selection of the approved adoptive applicant.

Subsidy Consideration: Document efforts to select an approved adoptive applicant who does not require an adoption subsidy. Enter N/A (not applicable) if a child does not qualify for a special need category.

Special Comments: Enter information to explain special situations, needs, or facts such as siblings being separated and ongoing contacts are recommended, ongoing contacts with significant others, special resources the child needs, financial resources the child has beyond foster care board payment, etc.

Signature: Enter signature and date of signature.

The Adoption Supervisor will complete the following information on the form: Signature: Enter signature and date of signature and approve or deny the selection.

ROUTING

The Adoption Specialist for the child will retain the completed form. If the selected approved adoptive applicant does not have the same Adoption Specialist, the child's Adoption Specialist will keep a copy of the form and route the original form to the approved applicant's Adoption Specialist with the child's disclosure packet (child's adoption summary and attachments). If an adoption subsidy application is filed for the child, a copy of the completed form will be included with the initial application packet that is forwarded by the Adoption Specialist to the Adoption Subsidy Coordinator, Adoption Services Unit, Central Office.

ARKANSAS DEPARTMENT OF HUMAN SERVICES DIVISION OF CHILDREN AND FAMILY SERVICES

DISCLOSURE FOR ADOPTION

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ARKANSAS DEPARTMENT OF HUMAN SERVICES DIVISION OF CHILDREN AND FAMILY SERVICES CFS-471

DISCLOSURE FOR ADOPTION

PURPOSE

The purpose of this form is to document that specific non-identifying information and reports about a child have been received by a prospective adoptive parent(s). It further documents that the Adoption Specialist has reviewed the information and reports with the prospective adoptive parent(s). It is required for all adoptions.

COMPLETION

The Adoption Specialist for a child will complete the form after the child's adoption summary and packet have been completed and an adoptive family has been selected. In relation to a foster parent or kinship foster parent adoption, the Adoption Specialist will complete the form after the child's adoption summary and packet have been completed and before the assessment/adoption home study is completed.

The line near the left margin of the form must be checked by the Adoption Specialist to verify what is being disclosed and the line to the right must be completed to verify the date of each report that is being disclosed.

ROUTING

The Adoption Specialist for a child will forward the completed form to the Adoption Supervisor, who will sign and date the form, to confirm the adoption summary and packet and the form have been reviewed and are accurate.

The Adoption Specialist for the prospective adoptive parent(s) will present the adoption summary and packet and form to the prospective adoptive parent(s). The Adoption Specialist will sign and date the form to verify when the information is received by the prospective adoptive parent(s). The prospective adoptive parent(s) will sign and date the form to verify when the information is received.

The Adoption Specialist for the family will sign and date the form to verify when the information is reviewed with the prospective adoptive parent(s), who will sign and date the form to verify the information has been reviewed.

The child's adoption summary and packet and the form must be presented to the prospective adoptive parent(s) prior to initiating the pre-placement visits. In relation to a foster parent or kinship foster parent adoption, the child's adoption summary and packet and the form must be presented to the prospective adoptive parent(s) during the assessment/adoption home study process.

The original signed form must be filed in the child's record and a copy must be given to the prospective adoptive parent(s).

ARKANSAS DEPARTMENT OF HUMAN SERVICES

DIVISION

CHILDREN AND FAMILY

SERVICES

FAMILY SERVICES POLICY AND PROCEDURE MANUAL

I. GENERAL PROVISIONS AND DIVISION OVERVIEW

POLICY (l-A): PHILOSOPHY AND MISSION STATEMENT FOR THE DIVISION OF CHILDREN AND FAMILY SERVICES

The Division of Children and Family Services (DCFS) is committed to child protection and family preservation. Every child is entitled to grow up in a permanent family. The primary and preferred way of achieving this goal is to provide families experiencing turmoil with services to prevent the need to place children outside their homes. The Division recognizes that there are a limited number of situations when children can not safely remain at home and must be separated from their family. The Division strives to preserve and strengthen the child's family ties when it is in the best interest of the child, and to protect the child by considering the child's health and safety as the paramount concern in determining whether or not to remove the child from the home. When a child must be separated from the family, DCFS will provide a healthy and safe environment and will make appropriate and timely efforts to provide services to reunite the family. DCFS will provide appropriate homes for children who can not be reunited with their families.

Our mission is to:

* protect children;

* maintain families, if this is appropriate, with the child's health and safety always considered paramount;

* provide quality services within available resources which enable families to maximize their potential and increase their abilities;

* preserve and enhance human dignity and worth;

* prevent or reduce the need for services.

POLICY (l-B): FAMILY SERVICE DELIVERY SYSTEM

The Division of Children and Family Services is in compliance with Titles VI and VII of the Civil Rights Act and operates, manages and delivers services without regard to race, color, religion, sex, age, national origin, mental or physical disability, veteran status, political affiliation or belief. DCFS is the designated state agency to administer and supervise all Child Welfare Services (Titles IV-B and IV-E of the Social Security Act).

The Division purchases services from private and public agencies, universities and individuals, using state and federal funds. Programs and services of other Divisions within the Department of Human Services (DHS) are also available to clients of DCFS. Delivery of services is coordinated with other Divisions administering TEA/TANF Medicaid, Food Stamps, Social Services Block Grant and other federal entitlement programs.

The services are authorized and funded in conjunction with various state and federal laws which govern the operation of the Division. The major federal laws governing service delivery, as amended, are:

Civil Rights Act: Titles 6,7,9

Rehabilitation Act: Sections 503,504

Americans With Disabilities Act: Title II

Social Security Act Titles:

IV-ATemporary Assistance for Needy Families (TANF)

IV-B Child Welfare Services

IV-E Foster Care and Adoptions Assistance

XIX Medical Services

XX Social Services Block Grant Public Laws: 93-207 Child Abuse and Neglect

94-142 Handicapped Children's Act

96-272 Adoption Assistance and Child Welfare Act of 1980

105-89 Adoption and Safe Families Act of 1997

POLICY (l-C): DIVISION'S ORGANIZATIONAL STRUCTURE

The Director of DCFS has management and administrative responsibilities for the Division and has an interactive role with the Child Welfare Agency Review Board and the Child Placement Advisory Committee. The Division has four major offices, each with an Assistant Director: Office of Community Services, Office of Community Support, Office of Finance and Administrative Support, and Office of Legislative Analysis, Research and Planning.

Office of Community Sendees

The Office of Community Services is responsible for the direct and purchased service delivery of child welfare services throughout the state and is administered by the Assistant Director, Office of Community Services. The Division has ten DCFS areas:

AREA I: Benton, Carroll, Madison, Washington

AREA II: Crawford, Franklin, Johnson, Logan, Scott, Sebastian, Yell

AREA HI: Clark, Garland, Hot Springs, Howard, Montgomery, Perry, Pike, Polk, Saline

AREA TV: Columbia, Hempstead, Lafayette, Little River, Miller, Nevada, Ouachita, Sevier, Union

AREA V: Baxter, Boone, Conway, Faulkner, Marion, Newton, Pope, Searcy, Van Buren

AREA VI: Pulaski

AREA VII: Bradley, Calhoun, Cleveland, Dallas, Grant, Jefferson, Lincoln, Lonoke, Prairie

AREA VIJJ: Clay, Craighead, Fulton, Greene, Izard, Lawrence, Mississippi, Randolph, Sharp

AREA TX: Cleburne, Crittenden, Cross, Independence, Jackson, Poinsett, Stone, White, Woodruff

AREA X: Arkansas, Ashley, Chicot, Desha, Drew, Lee, Monroe, Phillips, St. Francis

Each area has an Area Manager and county-based staff. Minimum county office staffing includes at least one Family Service Worker, a supervisor and an aide.

The Office of Community Services includes the following units: Area Managers and County Office Operations.

Office of Community Support

The Office of Community Support is responsible for the provision of administrative and programmatic support for the state's network of children and family services and is administered by the Assistant Director, Office of Community Support.

The Office of Community Support is comprised of two sections: Program Support In-Home Services (Intensive Family Services (IFS), Family Support, Central Registry, and Interstate Compact), and Program Support Out-of-Home Services (Foster Care, Adoptions, Independent Living, Behavioral Treatment Unit, and Promoting Safe and Stable Families Services).

Office of Finance and Administrative Support

The Office of Finance and Administrative Support provides administrative and management support to DCFS through personnel administration, budget monitoring, resource control, and contract administration.

The Office of Finance and Administrative Support includes the following units: Personnel, Contracts, and Financial Resources. In addition, the Foster Care/Medicaid Eligibility Unit determines the eligibility for federal funding under Title IV-E (Foster Care and Adoption) and Title XTX (Medicaid) of all children in the care of the Department who are placed in Out-of-Home Placement or subsidized adoption.

Office of Legislative Analysis, Research and Planning

The Office of Legislative Analysis, Research and Planning is responsible for statewide DCFS policy development, comprehensive short-term and long-term planning initiatives for the delivery of child welfare services, professional development, child welfare agency licensing, and quality assurance monitoring.

The Office of Legislative Analysis, Research and Planning consists of the following units: Policy, Planning, Professional Development, Child Welfare Agency Licensing, and Quality Assurance.

POLICY (l-D): OFFICIAL RECORD KEEPING

The official record of child welfare information for DCFS is maintained through the Children's Reporting Information System (CHRIS). The CHRIS Unit is a part of the Division of Administrative Services, Office of Technology, which is responsible for the enhancement of the CHRIS Application, data monitoring, Help Desk function and some specialized training. CHRIS is fully automated and is a worker based child-welfare information system. The Family Services Policy and Procedure Manual (FSPP) includes the data input instructions for the CHRIS Application.

A hard copy file of case information will be maintained for data not in CHRIS. Hard copy files will be created, if necessary for case review.

POLICY (l-E): COMPLIANCE WITH THE MULTIETHNIC PLACEMENT ACT (MEPA)

The Division must comply with the Multiethnic Placement Act (MEPA) in making foster care and adoptive placements. The act provides for assessment of individual liability to staff for knowingly violating MEPA requirements.

The Multiethnic Placement Act prohibits delaying or denying the placement of a child for adoption or foster care on the basis of race, color or national origin of the adoptive or foster parent or the child involved.

Consideration of race, color, or national origin is permissible only when an individual determination is made that the facts and circumstances of a particular case require the consideration of race, color, or national origin in order to advance the best interests of the child in need of placement. The Division's compliance with the Indian Child Welfare Act of 1978 ( P.L. 95-608 ) does not violate MEPA.

III. SERVICES CASE OPENING

POLICY (lll-A): SERVICES CASE OPENING AND RE-EVALUATION

The Division of Children and Family Services will open cases to ensure safety and promote the best interest of the child and to provide services to strengthen, reunify, and assist families. This will be accomplished through the delivery of Supportive, Protective, Adoptive (See Section VIII for Adoptive Services) or Out-of-Home Placement Services as deemed appropriate by assessment. The purpose of services shall be to provide the child with a continuous and stable living environment, promote family autonomy, strengthen family life where possible and promote the reunification of the child with the parent, guardian or custodian, when applicable.

Families have a right to appeal the decision of the Division regarding service delivery, eligibility for services, Protective Services, or Adoptive services.

The Division will ensure a determination of Title IV-E/ Medicaid eligibility is obtained for each child placed in an out-of-home setting or subsidized adoption. When a child is removed from his home, a judicial determination as to whether reasonable efforts were made or were not required to prevent removal must be made no later than sixty (60) days from the date the child is removed from the home. Eligibility for Title IV-E foster care maintenance payments will be based on the following requirements:

(1) The child was removed from the home of a specified relative pursuant to judicial determination to the effect that:

* Continuation in the residence in the home would be contrary to, or that the placement would be in the best interest, of the child. The contrary to the welfare determination will be made in the first court ruling that sanctions (even temporarily) the removal of a child from the home. If the determination regarding "contrary to the welfare" is not made in the first court ruling pertaining to removal from the home, the child will not be eligible for Title IV-E maintenance subsidy for the duration of that stay in foster care; and

* A finding of or a deeming of reasonable efforts is required. The judicial determination must state that reasonable efforts to prevent a child's removal from home or to reunify the child and family are not required.

(2) The child's placement and care in a foster family home or child care institution is the responsibility of either DHS or any other public agency with whom DHS has an agreement. (Child care institution means a private child care institution, or a public child care institution which accommodates no more than 25 children, and is licensed by the State in which it is situated or has been approved by the agency of such State or tribal licensing authority (with respect to child care institutions on or near Indian reservations) responsible for licensing or approval of institutions of this type as meeting the standards established for such licensing. This definition must not include detention facilities, forestry camps, training schools, or any other facility operated primarily for the detention of children who are determined to be delinquent.) The licensing file must contain documentation that verifies that safety considerations with respect to the staff of the institution have been addressed. And,

(3) The child received aid (for the purposes of the FSPP Manual "aid" is defined as AFDC program requirements in effect 7-16-1996 ) in or for the month in which court proceedings leading to the removal of the child from the home were initiated, or

* would have received aid in or for the month if application for such aid had been made, or

* had been living with a specified relative within six (6) months prior to the month in which court proceedings were initiated, and would have received aid in or for such month if the he/she had been living with such relative and an application had been made for aid under Title IV-A.

In any case where the child is an alien disqualified by the Immigration and Nationality Act from receiving aid in or for the month in which court proceedings leading to the removal of the child from the home were instituted, such child shall be considered to satisfy the requirements with respect to that month, if he or she would have satisfied such requirements but for such disqualification. The Office of Chief Counsel (OCC) will be consulted if the child's immigration status must be addressed in any manner.

(4) The child was living with a specified relative prior to removal from the home and was AFDC eligible (per AFDC requirements in effect 7-16-1996 ) for in that home in the month of the initiation of court proceedings. Or the child had been living with the parent or specified relative within (6) months of the month of the initiation of court and the child would have been AFDC eligible in that month if he or she had still been living in that home.

A child of a parent who is under the age of eighteen (18) years and is in DHS custody is also considered a dependent juvenile and is eligible to receive foster care maintenance payments and is deemed to be a recipient of aid to families with dependent children. Titles XIX and XX services will be available to the child in the state in which the child resides.

The state of Arkansas is not a voluntary placement state nor does it implement constructive removals The removal of a child from his home must occur pursuant to a judicial order placing custody of the child with the Department.

PROCEDURE (III-A1): Protective/Supportive Services Case Opening

The Family Service Worker will:

* Complete the "Application for Emergency Services" (CFS-6013) by keying the fields in the "Summary" screen. In the "Client" section, complete the "Gen. Info" and "Relations" screens; and in the "Finances" section, complete the "Eligibility" and "Income" screens based on the information gathered for the "Strengths and Needs Assessment" (CFS-6009). This information is located in the "Case Plan/Needs Assessment" section on the "Family Screen".

* Sign the CFS-6013 for families needing Protective Services if they are not willing to sign the completed form.

PROCEDURE (III-A2): Out-of-Home Placement Services Case Opening

The Family Service Worker will:

* Complete the CFS-6013 using appropriate CHRIS screens as indicated in Procedure III-A1.

* Complete the "Case Connect" Screen in the Investigation to open a case.

* Key the appropriate information in the open case on the "Removal" screen in the "Removal" section of CHRIS.

* "Key the appropriate information in the "Placement" section of CHRIS and within the "Place" section on "Recommend", "Diff Care", and "Enter/Exit" screens. Entering information in CHRIS on the first placement of a removal episode will generate a message to "Review/Complete Initial Medicaid Application."

* Key the appropriate information on the "Gen. Info" and "Status" screens. Key the appropriate information on the "Employ" and "Education" screens under the "Emp/Educ" heading in the "Client" section.

* Key the appropriate information on the screens under the "Medical" heading in the "Client" section.

* Print the "Client, Medical, and Psychological Information Report" (CFS-6012) upon completion of keying the above information.

* Issue an initial clothing order, if needed, using the "DHS Requisition" (DHS-1914).

* Initiate a request for Medicaid within one (1) working day of the date the child enters DHS custody by completing the following actions:

* Send the "DCO/DCFS/Referral/Information Transmittal" (DHS-91) to the DCO County Supervisor to determine if the child is a member of an active TEA/TANF or Medicaid case or is a member of pending applications for either.

* Receive notice of closure of TEA/TANF or Medicaid case before proceeding.

* Go to the Initial Medicaid Application screen in CHRIS to verify that information contained on the application is correct and complete. After verifying/correcting the information, click the "Send" button to transmit the Initial Medicaid Application to the Eligibility Unit for processing.

Note - If you have been notified that the CHRIS system will be down, and you cannot transmit the Initial Medicaid Application within the one-day time frame, only then will you complete and fax a paper copy of the CFS-487 (Application for Title IV-E Payments/Medicaid) to the Eligibility Unit.

* Route the signed court order to Family Support Specialist (Eligibility Unit).

* Apply for Title IV-E Payments/Medicaid:

* Complete the "Application for Social Security Card" (SS-5) if the child does not already have a Social Security Number or the number is not known:

* Sign the SS-5 as the DCFS representative for the case.

* Route the SS-5 to the Social Security Administration and copy to the Family Support Specialist.

* Enter income, debts and asset information in the Client/Finance Screens in CHRIS for each member of the removal household.

* Enter necessary information on the Medicaid/IV-E Application screen (4 tabs) in CHRIS in order to complete the application and click "Send" to transmit the application to the Eligibility Unit. Send the completed Medicaid/IV-E Application to the Eligibility Unit within seven (7) working days from the date the child entered the out-of-home-placement. Other information needed to_establish Title IV-E/Medicaid eligibility, e.g., birth certificate, Social Security Number, removal order, petition that led to removal, etc., should also be sent to the Eligibility Unit if available at that time.

* Obtain any additional requested information and forward it to the Family Support Specialist within ten (10) working days.

* Within ten (10) working days of any delay, notify the Family Support Specialist of the information which cannot be obtained and the reason.

* Continue the "Strengths and Needs Assessment" (CFS-6009) with family participation.

PROCEDURE (III-A3): Case Re-evaluation

The Family Service Worker will:

* Receive the printout of cases due for re-evaluation from the Foster Care/Medicaid Eligibility Unit.

* Receive CHRIS tickler notification of Medicaid/IV-E case Re-determination.

* Complete the Re-determination screen in CHRIS (3 tabs) and click "Send" to transmit the Redetermination to the Eligibility Unit for processing.

Note: The Eligibility Unit will be notified by an automated process for reporting "Changes" in CHRIS. When changes are made to the case record for the following circumstances: child age 18, child left care, trial visit, runaway, parental rights terminated, child age 16-19/not in school, child placed for adoption, insurance, and placement/address change, the automated notification process will occur. If a child is born to a child in DHS custody, then the Family Service Worker will check "Client Gave Birth" on the changes tab of the Re-determination/Changes screen in CHRIS.

* Mail a "Notice to Applicants for and Recipients of Title XX Services" (DHS-160) at least ten (10) days prior to the change in service, if the family signed the application and service is to be reduced or terminated.

* Complete the "Application for Emergency Family Services" (CFS-6013) taking the appropriate action as directed in Procedure III-A1.

PROCEDURE (III-A4): Out-Of-Home Placement Outside the Initiating County

The Family Service Worker (FSW) Supervisor from the initiating (primary) county office will:

* Notify (telephone, fax, or email) the FSW supervisor in the resident county office prior to moving the child(ren).

* Within 24 hours following the above notification, assign the resident county as secondary on the Assign/Transfer screen in CHRIS.

The Family Service Worker in the initiating (primary) county will:

* Continue providing casework services (e.g. visits) to the birth/legal parents as determined by the case plan.

* Maintain a case file including such non-CHRIS (hard copy) items as legal and medical documents.

* Provide the resident county FSW a copy of the case file with non-CHRIS items.

* Key data (e.g. case plan changes) into the CHRIS file as appropriate.

* Develop and process any needed purchase orders (DHS 1914) for the child.

* Request Medicaid determinations/re-evaluations by the Medicaid Eligibility Unit and submit needed documentation.

* Develop the initial case plan and subsequent changes as per Policy IV-A.

* Arrange staffings as needed and maintain a current case plan.

* Ensure provision of services to facilitate reunification or other permanency arrangements as appropriate.

* Arrange and help provide transportation for parent/child visits.

* Notify the resident county FSW immediately of any changes in plans for care of the child. The Family Services Worker (secondary) in the resident county will:

* Parti cipate in staffings and case plan development.

* Assist the foster home or facility on implementing case plan goals.

* Keep the initiating county FSW informed of all progress, problems and child experiences.

* Obtain a progress report from facility staff every month following a child's placement in a facility and forward a copy to the initiating county FSW.

* Notify the initiating county FSW immediately of any change in the plans for care of the child.

* Notify the initiating county by telephone within 24 hours, and make all other necessary notifications (e.g. foster parents) if an emergency change in placement is necessary.

* Make regular foster home/facility visits to the child/children as per the case plan.

* Assist the initiating county in arranging for the parent/child/sibling visits.

* Complete any necessary incident reports (e.g. disruption) and provide the initiating county a copy.

POLICY (lll-B) COORDINATION WITH THE OFFICE OF CHILD SUPPORT ENFORCEMENT

The Division of Children and Family Services (DCFS) will coordinate with the Office of Child Support Enforcement (OCSE) to ensure that foster care cases are referred so that support can be paid to the Department of Human Services (DHS) while the child remains in DHS custody. Foster care cases in which paternity is an issue will also be identified and referred. A referral for child support will be made for each parent involved in a foster care case meaning the parents the child was removed from, absent parents and putative fathers.

The IV-E/Medicaid Eligibility Unit will refer foster care cases to OCSE by sending copies of the CFS-408 (The Federal Parent Locator System Information) with family identifying information. In addition, the IV-E/Medicaid Eligibility Unit will submit all emergency and/or custody orders to OCSE upon receipt from the Office of Chief Counsel. The Family Service Worker will provide referral information as needed and coordinate with OCSE after an OCSE (IV-D) case is opened. Once an OCSE case is opened, OCSE has responsibility to coordinate with the support payer and for arranging and paying for paternity testing.

Child support monies will be paid to and managed by the Department of Human Services. Child support monies collected will be used to reimburse the state for foster care board payments and other expenses as appropriate.

PROCEDURE (III-B1) DCFS COORDINATION WITH OSCE:

The Family Service Worker will:

* Fill out the CFS-408 (Federal Parent Locator System Information) and submit it to the IV-E/Medicaid Eligibility Unit to refer a foster care case to OCSE as early as possible.

* Be the contact person with authority to advise OCSE on the status of the family and case as casework progresses.

* Receive and act on notices, e.g. requests for information (CFS-408) sent by OCSE.

* Notify OCSE when parental rights have been terminated so the child support case can be closed.

* Advise OCSE when custody changes and the child leaves foster care.

* Provide OCSE with the following information when custody changes:

* Where the child is placed.

* Where child support payments are to be sent.

NOTE:

Child support payers will remit their child support to DHS P. O. Box 8181, Little Rock, AR 72203.

IV. SERVICES CASE PLAN AND STAFFING

POLICY (IV-A): SERVICES CASE PLAN

The case plan is a written document that is a discrete part of the case record between the family and the Division of Children and Family Services that outlines a plan of services. It addresses the family's needs, building on the family's strengths, and outlines the roles and responsibilities of all involved parties.

Case plans will be developed after a thorough assessment of a family's strengths and needs. The family shall be the primary source of information. The case plan shall be developed with the involvement of family, the age-appropriate children, the foster parents and the Attorney ad litem (if there is court involvement), the Family Service Worker and any other involved parties.

Consideration of the health and safety of a child must be included in case planning and case reviews for children in out-of-home placement.

No child in Out-of-Home Placement shall have a case plan goal of reunification for longer than twelve (12) months, unless otherwise ordered by the court.

PROCEDURE (IV-A1): Case Plan

The Family Service Worker will:

* Complete an initial "Case Plan" (CFS-6010) within thirty (30) days of opening a service case or a child entering an Out-of-Home Placement, whichever comes first.

* Complete the "Treatment" portion of the "Case Plan" section of CHRIS based on the assessment in the "Assess" portion of the "Case Plan" section of CHRIS.

The Case Plan will:

* Includes a description of the type of home or institution in which the child is placed.

* Include a description of the services offered and provided to prevent removal of the child from the home and to reunify the family.

* Include a description of the out-of-home placement with regard to the health and safety of the child.

* Include a plan for assuring a child receives safe and proper care.

* Include a discussion of the appropriateness of the services that have been provided to the child.

* Include a plan for assuring services are provided to the child and parent to improve conditions in the parent's home and facilitate return of the child or the permanent placement of the child.

* Include a plan for assuring services are provided to the child and foster parents to address the needs of the child while in out-of-home placement.

* Include the visitation rights and obligations of the parents, guardian or custodian and the Division during the period the child is in an out-of-home placement.

* Where appropriate for a child 16 or over, include a written description of the programs and services that will help prepare the child for the transition from foster care to independent living. (See Policy VIII-A.)

* Include documentation of the steps taken to (a) find an adoptive family or other permanent living arrangement for the child, (b) place the child with an adoptive family, a fit and willing relative, a legal guardian, or in another planned permanent living arrangement, and (c) finalize the adoption or legal guardianship. At a minimum, documentation shall include child specific recruitment efforts such as the use of state, regional, and national adoption exchanges including electronic exchange systems. This applies in the case of a child for whom the permanency plan is adoption or placement in another permanent home.

* Include a discussion of how the case plan is designed to achieve a safe placement for the child in the least restrictive (most family-like) setting available and in close proximity to the home of the parent(s) when the case plan goal is reunification, and a discussion of how the placement is consistent with the best interests and special needs of the child.

* Set forth the reasons why it is in the best interest of the child if he has been placed in an out-of-home placement that is a substantial distance from the home of the parents, or has been placed out-of-state.

* Includes a discussion of the safety and appropriateness of the placement and how DHS plans to carry out the judicial determination made with respect to the child that:

* Continuance in the home is contrary to the welfare of the child, or that placement would be in the best interest of the child, and

* Reasonable efforts to prevent a child's removal from home or to reunify the child and family are not required.

* If the child has been placed in foster care in a state outside the state in which the child's parent(s) are located, assure that the case worker of either state visits the foster home or institution no less frequently than every twelve (12) months and submits a report on the visit to the state agency of the state where the home of the child's parent(s) is located.

* Incorporate the health and education records of the child to the extent available and accessible, including:

* the names and addresses of the child's health and educational providers;

* the child's grade level performance:

* the child's school record;

* assurances that the child's placement in foster care takes into account the proximity to the school in which the child is enrolled at the time of placement;

* a record of the child's immunizations;

* the child's known medical problems;

* the child's medications; and

* any other relevant health and education information concerning the child determined to be appropriate.

* Print the "Case Plan" (CFS-6010) out of CHRIS under "Reports".

* File the CFS-6010 with the court no later than thirty (30) days after the date the petition was filed or the child was first placed out-of-home, whichever is sooner.

* Review the CFS-6010 and update as needed. The CFS-6010 should be updated at the second staffing held ninety (90) days from the case opening and at subsequent staffing(s) held at a minimum of every three (3) months for out-of-home placement.

POLICY (IV-B): CASE STAFFINGS

A Services Case Staffing is a meeting of all involved parties for the purpose of assessing the current status of the family situation and developing or updating the case plan.

A Services Staffing may be held for various reasons based on the needs of the child and family. Situations which require a staffing include but are not limited to:

* developing the initial "Case Plan" (CFS-6010);

* reviewing progress or making changes in the "Case Plan" (CFS-6010);

* reviewing situations where a child has been in three or more out-of-home placements within a twelve (12) month period;

* reviewing and implementing an Independent Living Plan for a child in out-of-home placement;

* addressing problems that bring a child or family into a state of crisis;

* determining the need for on-going services; and

* reviewing the need for case closure before a case is closed.

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PROCEDURE (IV-B1): Case Staffings

The Family Service Worker will:

* Invite supervisors, parents, or guardian, and if there is court involvement, Court-Appointed Special Advocate (CASA), all parties' attorneys, foster parents, caretaker, age-appropriate child, and any other involved party in the case plan.

* Inform families of their right to have their attorney present.

* Furnish written notice to the child, if of appropriate age (10 years or older).

* Furnish written notice of the staffing "Invitation to Family-Centered Meeting" (CFS-590) (complete with date, time and location) to all participants at least two (2) weeks prior to the staffing.

* File copies of the CFS-590 in the case record. Include documentation of the reason, if the child was not able to attend.

* Document on the CFS-6010 any parent's unwillingness to participate and provide this written documentation to the parent if available.

* Conduct the initial case staffing within thirty (30) days of opening the case or a child's entering an Out-of-Home Placement. The second staffing should occur ninety (90) days from the case opening or a child's entering an Out-of-Home Placement. After the second staffing, subsequent staffings will be held at a minimum of every three (3) months for out-of-home placement.

* Complete the original CFS-6010 at the initial staffing and update the CFS-6010 as needed after subsequent staffings.

* Review the CFS-6010 for compliance by the participants and update as necessary to reflect progress made, new factual circumstances, and new goals.

* Conduct a permanency planning staffing at the 11th month of case opening. Invite the adoption specialist and all other parties involved in the case.

* Conduct a staffing before closing a case to review progress and determine that closure is appropriate.

The Area Manager will:

* Hold a special case staffing within two (2) weeks of the third (3rd) move, whenever a child has been in three or more out-of-home placements within a twelve (12) month period.

* Address the reasons for the frequent moves.

* Determine what steps shall be taken to prevent future placement disruptions.

* Include the Family Service Worker, supervisor, foster parents, and age-appropriate child.

* Conduct a staffing to review the status of a child placed in long-term, out-of-home care.

Some persons will attend the entire staffing, while others will attend only the portion of the staffing relating to the area in which they are involved. Confidentiality prevents sharing information with unauthorized individuals. Information can be shared with treatment providers, Attorneys ad litem and foster parents.

VI. SERVICES TO REUNIFY FAMILIES

POLICY (Vl-A): OUT-OF-HOME PLACEMENT CRITERIA

The state of Arkansas is not a voluntary placement state. The removal of a child from his home must occur pursuant to a judicial order placing custody of the child with the Department. When a child is in the custody of the Department of Human Services, DCFS shall ensure that the out-of-home placement is in the best interest of the child, is the least restrictive possible and is matched to the child's physical and therapeutic needs. A child of a parent who is under the age of eighteen (18) years, and is in DHS custody, is also considered a dependent juvenile and is eligible to receive foster care maintenance payments and is deemed to be a recipient of aid to families with dependent children. Titles XIX and XX services will be available to the child in the state in which the child resides. No child shall be placed in the home of a foster parent where a records check reveals a felony conviction for child abuse or neglect, for spousal abuse, for a crime against children (including child pornography), or a crime involving violence, including rape, sexual assault or homicide. No child shall be placed in the home of a foster parent if the record check reveals a criminal conviction for physical assault, battery, or a drug related offense, if the offense was committed within the past five years. The placement decision shall be based on an individual assessment of the child's needs. All efforts to place a child within Arkansas shall be thoroughly explored and documented before consideration is given to out-of-state placement. Relatives shall be considered for placement first. Placement shall be chosen:

* To ensure the health and safety of a child;

* To ensure that caretakers have the skills and training sufficient to deal with the child's special needs and any disabling condition; and

* To keep the child in close proximity to the family, if possible, to maintain enrollment in the school the child attended before placement.

The Department shall make reasonable efforts to:

* maintain the family unit and prevent the unnecessary removal of a child from his home, as long as the child's safety is assured;

* effect the safe reunification of the child and family (if temporary out-of-home placement is necessary to ensure immediate safety of the child); and

* make and finalize alternate permanency plans in a timely manner when reunification is not appropriate or possible. In determining reasonable efforts to be made with respect to a child and in making such reasonable efforts, the child's health and safety is of paramount concern.

Within 30 days of a child being placed in DHS custody, the Division will provide the parents with literature, verbal information, and referrals to programs for parenting, child abuse, substance abuse, sexual abuse and family planning.

After a child is placed out of the home, reasonable efforts will be made to reunify a family, to make it possible for the child to safely return home. A judicial determination pertaining to reasonable efforts to prevent removal must have been made within 60 days of the child's removal from the home, otherwise the child will not be eligible for Title IV-E foster care maintenance payments for the duration of his stay in foster care. Reasonable efforts to finalize an alternate permanency plan (i.e., place a child for adoption or with a legal guardian or permanent custodian) may be made concurrently with reasonable efforts to reunify a child with his family. Reasonable efforts shall also be made to obtain permanency for a child who has been in an out-of-home placement for more than twelve (12) months, or for fifteen (15) of the previous twenty-two (22) months.

Reasonable efforts to reunite a child with his parent(s) shall not be required in all cases. The court shall conduct and complete a hearing on a "no reunification services" request within fifty (50) days of the date of written notice to the defendants and shall enter an order determining whether or not reunification services shall be provided. Reunification shall not be required if a court of competent jurisdiction, including the juvenile division of circuit court, has determined that the parent has:

(1) Subjected the child to aggravated circumstances; (See Glossary for the definition of aggravated circumstances.)

(2) Committed murder (which would have been an offense under section 1111(a) of Title 18, USC, if the offense had occurred in the special maritime or territorial jurisdiction of the United States) of any child;

(3) Committed voluntary manslaughter (which would have been an offense under section 1112(a) of Title 18, USC, if the offense had occurred in the special maritime or territorial jurisdiction of the United States) of any child;

(4) Aided or abetted, attempted, conspired, or solicited to commit such a murder or such a voluntary manslaughter;

(5) Committed a felony, battery, or assault that results in serious bodily injury to any child; or

(7) Had the parental rights involuntarily terminated as to a sibling of the child; or

(8) Abandoned an infant (not the same as "Voluntary Delivery of an Infant", see Procedure VIII- E2).

If reasonable efforts to reunify are determined by a court to be unnecessary, a permanency hearing must be held within 30 days after the court's determination. If the court determines no reunification services will be provided due to aggravating circumstances or upon recommendation from the Division or Attorney ad litem at adjudication, the Family Service Worker will have case management responsibility until the child is placed in a adoptive home.

If the court recommends that reunification services should not be provided to reunite a child with his family, DHS, the Attorney ad litem or the court shall provide written notice to the defendants. When DHS is the agency requesting that no reunification services be provided, it will send the written notice to the defendants in coordination with OCC. The notice shall be provided to the parties at least fourteen (14) calendar days before the no-reunification hearing, and the notice shall identify in sufficient detail to put the family on notice, the grounds for recommending "no reunification services".

The burden of presenting the case shall be on the requesting party. The court shall conduct and complete a hearing on a "no reunification services" request within fifty (50) days of the date of written notice to the defendants.

PROCEDURE (VI-A1); Out-of-Home Placement Criteria_____________

* The Family Service Worker will:

* Consider placement with appropriate relatives in a Kinship Family Foster Home. (See Policy VTI-A.)

* Select the Out-of-Home Placement that best fits the needs of the child. A child who has been identified as an EXEMPTED FROM FINDING UNDER AGE JUVENILE AGGRESSOR OR SEXUAL OFFENDER must not be placed in a foster home with other children, unless the child's therapist feels that the child is no longer a danger to other children. Proper documentation of this will be contained in the child's hard copy file. If the recommended placement is a facility, the facility must receive information regarding the allegations. This must be documented in the Recommend Placement screen.

* Document placement selection on the "Case Plan" (CFS-6010) by keying the "Plan Goals" and the "Needs/Svc" screens in the "Treatment" portion of the "Case Plan" section of CHRIS.

* Arrange at least one (1) pre-placement visit for the child before the initial placement and before any subsequent changes in placement if possible and appropriate. Contact the OCC Attorney immediately if child is being moved from one Out-of-Home Placement to another. See Procedure VII-D1.

* Contact the OCC Attorney immediately if there is any indication that the child is a member of an Indian tribe.

PROCEDURE (VI-A2): CONCURRENT PLANNING

The Division will ensure timely permanency for children entering Out-of-Home Placement. Concurrent planning includes working towards the goal of returning the child to the parents while concurrently working on alternative permanent placements. Concurrent planning will be done for all out-of-home placement cases except for those cases where the court determines no reasonable efforts to provide reunification services. The level and degree of concurrent planning will be on a case by case basis. The DCFS worker will immediately develop and implement a realistic concurrent plan.

The concurrent planning process will include:

1. The Family Service Worker informing the family of the concurrent planning process. The Family Service Worker must emphasize the importance of family involvement and partnerships in establishing permanency for children in out-of-home placements.

2. The Family Service Worker requesting parental input in identifying relatives and significant others who may be appropriate caregivers and initiate contact and Home Studies. Information on the putative father or any absent parent should be obtained and submitted on the CFS-408 (Federal Parent Locator System Information) to the local OCC Attorney. In considering placements, foster parents should be viewed as a resource.

3. Initiating the completion of the Life Story Book for all children in out-of-home care.

4. The Family Service Worker will complete the initial Case Plan (CFS 6010) within 30 days and document all concurrent planning activities in the appropriate section of the case plan. (See Procedure IV-A1). The CFS-6010 should document tasks that support reunification as well as permanency activities.

5. The Family Service Worker will complete the "Birth Family Background Information" (CFS-456) within 60 days of case opening.

6. At the second staffing (90 days) the Family Service Worker will invite the Adoption Specialist if the court determines reunification services are not required, or the Division is recommending termination of parental rights. The CFS-6010 developed from this staffing should assign tasks and responsibilities to the Family Service Worker and Adoption Specialist.

7. The Adoption Specialist will be invited and participate in the sixth (6th) month, ninth (9th) month and eleventh (11th) month staffing if it appears likely that the child will not return home or if the goal for the child is adoption. The CFS-6010 will assign tasks and responsibilities to the Family Service Worker and Adoption Specialist.

PROCEDURE (VI-A3): PLACEMENT OF INFANTS BORN TO INCARCERATED MOTHERS

The Division of Children and Family Services will accept referrals from the Arkansas Department of Correction (ADC) social worker seeking to find appropriate placements for infants born to incarcerated mothers. If the infant has a legal father, DCFS will not take any action unless the legal father refuses to assume responsibility for the child. The ADC social worker will refer the case to DCFS if the female inmate is unable to identify anyone who meets specific ADC guidelines for the assumption of care for the infant.

After referral by the ADC social worker, the DCFS Family Service Worker will:

* Visit with the mother and discuss possible placements for the child. Options include placement with a family member, a non-family member, or custody placed with DHS.

* If the mother wants to place the infant with a family member the Family Service Worker will discuss whether she wants (1) full custody given to the family member or (2) custody placed with DHS, with the family opened as a relative foster home.

* If the mother wants to place the infant with a non-family member, the Family Service Worker will discuss whether she wants (1) full custody given to the non-family member or (2) custody placed with DHS, with the family opened as a regular foster home.

* Conduct a home study on the requested placements where consideration for custody is with a family or non-family member, but not with DHS.

* If the home study is unfavorable, the Family Service Worker will work with the mother to identify other possible placements, or will petition for custody of the child upon birth.

* If the home study is favorable, when the child is born, DCFS will petition the court for custody to be given to the relative or other person identified by the mother.

* Inform the mother of DCFS licensing requirements if placement consideration is with a family or non family member with custody placed with DHS. Any placement with a family or non-family member, wherein DHS is the custodian, must meet the same child welfare licensing requirements as a regular foster home prior to the child being placed in the home. (See PUB-022 Standards for Approval of Family Foster Homes).

* When the child is born, DCFS will petition the court for custody to be given to DHS for placement in the relative foster home or the person's regular foster home.

The court will assess each case individually and will have a range of options for disposition. One option is to place permanent custody with, or grant guardianship to, a relative or other person and close the case with no DHS involvement. The other end of the spectrum would be for the court to grant custody to DHS and recommend immediate termination of parental rights. If termination of parental rights is granted, the Family Service Worker will follow Policy VIII-C.

* Follow DCFS policy for case opening, placement, and provision of services to the child.

* Contact the ADC social worker to arrange visitation between the child placed in an out-of-home setting and his incarcerated mother as stated in policy VI-B, unless such visitation is prohibited by the court, physician, etc.

POLICY (Vl-B): MAINTAINING FAMILY TIES IN OUT-OF-HOME PLACEMENT

Families and children shall have reasonable opportunities for personal visits, communication by telephone, and involvement in life events such as teacher conferences, school and community events. A plan for visitation shall be developed between a child in out-of-home placement and the family and siblings, whether or not the siblings are in out-of-home placement. The preferred location for the visits is the parents' home or, if that is not possible, in the most homelike setting possible. Office visits are a last resort.

Siblings shall live together in the same foster home. Siblings may be placed separately only upon a written determination by the Administrator designated by the Director that placement of the siblings together would be detrimental to their best interests or is otherwise not possible at the time of initial placement. The Division shall ensure that the reasons for the separation of siblings into different foster homes are regularly reassessed and targeted recruitment efforts continue to reunite the siblings.

PROCEDURE (VI-B1): Maintaining Family Ties in Out-of-Home Placement

The Family Service Worker will:

* Develop a plan for visitation within five (5) working days of placement.

* Arrange for parental visits to occur no less than weekly with the frequency increasing, as the family is prepared for reunification.

* Obtain approval from the County Supervisor for any deviations from required frequency of visitation.

* Request that deviations due to staff shortages be approved by the Area Manager.

* Place siblings together in the same foster home. Separate siblings by placement only upon written determination by a Mental Health Professional that placement of the siblings together would be detrimental to their best interest or is otherwise not possible at the time of initial placement.

* Arrange for sibling visitation to occur no less than every two weeks, when siblings are placed separately.

* Document efforts to reunify siblings placed separately.

The Director's designated Administrator will:

* Receive requests to place siblings separately.

* Approve/disapprove requests.

POLICY (Vl-C): INITIAL HEALTH SERVICES FOR CHILDREN RECEIVING OUT-OF-HOME PLACEMENT SERVICES

The Division of Children and Family Services shall ensure that all necessary medical services are provided to children receiving out-of-home placement services. Foster parents will play an integral role in meeting the child's health needs.

An initial health screening will be held. If the initial screening indicates that treatment or further evaluation is needed, DCFS shall ensure that such treatment or evaluation is promptly provided.

A Medical Passport will be completed for each child in an out-of-home placement. The Medical Passport is a brief, readable, and current summary of the child's health history and current health status for use by present and future caretakers of the child.

PROCEDURE (VI-C1): Initial Health Screening for Children Receiving Out-of-Home Placement Services

The Family Service Worker or Health Services Specialist will:

* Ensure that each child who enters the custody of DHS shall receive an initial health screening, not more than 24 hours after removal from home, if the reason for removal is an allegation of severe child maltreatment under Ark. Code Ann.§ 12-12-503(10), or there is evidence of acute illness or injury.

* Ensure that all other children who enter the custody of DHS receive an initial health screening no more than 72 hours after removal from home.

* Complete the "Medical Passport/Medi-Alert to Substitute Care Provider" (CFS-362) from information obtained from the child's parents.

* Use information obtained from the CFS-362 to complete the "Placement Plan-Placement Provider Information Report" (CFS-6007), by keying the "Gen.Info" screen in the "Client section" of CHRIS and all "Shots" screens in the "Medical" section of CHRIS.

* Complete the "Client Medical and Psychological Information Report" (CFS -6012) by keying all screens found in the "Medical" section of CHRIS from information obtained from the child's parents and the CFS-362.

* Schedule appointments as indicated by the initial screening.

* Ask the Medical Provider to complete the "Health Screening" (CFS-366).

PROCEDURE (VI-C2): Foster Parent Involvement in Health Care for Children Receiving Out-of-Home Placement Services

The Foster Parents will:

* Accompany the child to all medical appointments.

* Inform the Division of any scheduled medical visits or medical problems for the child. The Family Service Worker or Health Services Specialist will:

* Provide necessary support services to enable foster parents to accompany the child to any medical appointment.

PROCEDURE (VI-C3): Gathering and Maintaining Health Records for Children Receiving Out-of-Home Placement Services

The Family Service Worker or Health Services Specialist will:

* Gather each child's health care history from health care providers who have evaluated or treated the child, the child's family, previous caretakers, and from school reports.

* Provide the child's health care history to the physician conducting the Comprehensive Health Assessment.

* Request medical records on the child and document requests on the "Requested Medical Records Log" (CFS-353).

* Record the date of each medical visit, the condition or problem addressed, the diagnosis and treatment (or periodic screening and the results of the screening), and the health care provider's name and telephone number in the "Medical Visits" screen in CHRIS.

* Place all information gathered as to the child's health history, and all records of health screening, assessment and treatment during placement, in the child's case record. This includes the "Medical, Dental, Vision, Hearing and Psychological Episodic" (CFS-352), "Requested Medical Records Log" (CFS-353), "Medical Passport/Medi-Alert to Substitute Provider" (CFS-362), "Health Screening" (CFS-366), "Child's Health Services Plan" (CFS-368), "Placement Plan-Placement Provider Information" (CFS-6007) and the "Client Medical and Psychological Information" (CFS-6012).

PROCEDURE (VI-C4): Medical Passport for Children Receiving Out-of-Home Placement Services

The Family Service Worker or Health Services Specialist will:

* Develop and maintain the Medical Passport. The Medical Passport will consist of the CFS-352, CFS-353, CFS-362, CFS-365, CFS-366, CFS-368, CFS-6007 and CFS-6012.

* Provide the CFS-365 (Receipt for Medical Passport of a Foster Child) to the out-of-home placement provider for completion to verify receipt of the medical passport.

* Provide a copy of the Medical Passport to:

* The out-of-home placement provider and to the child's new caretaker if the child is moved.

* The child (if the child is in an Independent Living Program).

* The child when he or she reaches the age of majority.

* The parents, if the child returns home.

POLICY (Vl-D): COMPREHENSIVE HEALTH ASSESSMENT AND HEALTH PLAN FOR CHILDREN RECEIVING OUT-OF-HOME PLACEMENT SERVICES

A comprehensive health assessment of each child shall be completed. The assessment shall be conducted under the supervision of a physician and a qualified mental health practitioner. Whenever possible, the Family Service Worker, Health Services Specialist, family, and foster parents shall be involved in the assessment to ensure as much information about the child as possible is available to the examining professionals.

A written plan specifying any conditions requiring treatment, the recommended treatment, the schedule for treatment, the names of health care providers responsible for treatment, and the results of treatment as it occurs shall be completed and updated periodically. This plan shall be provided to the child's birth parents and foster parents. The birth parents shall be informed about any medical treatment scheduled for their child and shall be involved in and informed about their child's health care.

PROCEDURE (VI-D1): Comprehensive Health Assessment and Health Plan for Children Receiving Out-of-Home Placement Services

The Family Service Worker or Health Services Specialist will:

* Arrange to have the Comprehensive Health Assessment completed within sixty (60) calendar days of removal from home.

* Complete the "Client, Medical and Psychological Information Report" (CFS-6012) within seven (7) calendar days after completion of the Comprehensive Health Assessment.

* Schedule needed medical appointments for the child as indicated in the "Client, Medical and Psychological Information Report" (CFS-6012) after this form is received from University of Arkansas Medical Sciences.

* Complete the "Child's Health Services Plan" (CFS-368) within fourteen (14) calendar days after completion of the Comprehensive Health Assessment.

* Inform parents of any medical treatment and involve them as appropriate.

* Update the CFS-368 at least every six (6) months.

* Provide copies of updates of the CFS-368 to the child's parents and the out-of-home placement provider.

* Ask the Medical Provider to complete the "Health Screening" (CFS-366).

POLICY (Vl-E): PERIODIC HEALTH REASSESSMENT OF CHILDREN RECEIVING OUT-OF-HOME PLACEMENT SERVICES

Following the initial screening and comprehensive health assessment, the Division shall ensure that periodic medical, dental, mental health, vision, and hearing evaluations are conducted by qualified providers, according to the periodicity schedules adopted by the Arkansas Department of Health.

PROCEDURE (VI-E1): Periodic Health Reassessment of Children Receiving Out-of-Home Placement Services

The Family Service Worker or Health Services Specialist will:

* Refer all children receiving Out-of-Home Placement Services for the Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT) via the EMS-694 "EPSDT" form to the Health Department, or other EPSDT providers after the initial screening and the Comprehensive Health Assessment.

NOTE: If it is the first time the child has seen a health care provider while in the out-of-home placement, a primary care provider must be selected.

* Make an appointment with the Health Department, or other EPSDT providers for the EPSDT screening.

* File a copy of the examination report upon receipt from provider.

* Schedule all subsequent screenings according to established periodicity schedules. (See Appendix III.)

* Ensure all essential treatment is provided and documented in CHRIS in a timely manner.

* Ask the Medical Provider to complete the "Medical, Dental, Vision, Hearing and Psychological Episodic" (CFS-352) at each subsequent examination.

POLICY (Vl-F): CASE REVIEWS JUDICIAL HEARINGS FOR CHILDREN IN OUT-OF-HOME PLACEMENT

Following a probable cause hearing, an adjudication hearing shall be held to determine whether the allegations in a petition are substantiated by a preponderance of the evidence. In dependency-neglect cases, a written adjudication order shall be filed by the court within thirty (30) days of the date of the hearing or prior to the next hearing, whichever is sooner. The Office of Chief Counsel is responsible for drafting and filing court orders. The court can determine the case disposition at the adjudication or at a separate hearing. A disposition determines what actions the agency will take in the case. A judicial determination as to whether reasonable efforts were made or were not required to prevent removal must be made no later than sixty (60) days from the date the child is removed from the home.

The status of each child in out-of-home placement, including children placed out-of-state, shall be reviewed no less than every six months by a judicial review to: (1) determine the safety of the child, the continuing need for and appropriateness of the placement, (2) determine the extent of compliance with the case plan, (3) determine the extent of progress made toward alleviating or mitigating the causes necessitating the placement, and (4) project a likely date by which the child may be returned and safely maintained at home or placed for adoption or legal guardianship. Pertaining to IV-E eligibility requirements, the judicial review is conducted by court review, not an administrative review process. During each six-month review, the court shall make determinations based upon the best interest of the child. The best interest of the child shall be paramount at every stage of the judicial process.

Each child in an out-of-home placement, including children placed out-of-state, shall have a permanency planning hearing within 12 months of the date the child is considered to have entered foster care and not less frequently than every 12 months thereafter during the continuation of foster care. (A child will be considered to have entered foster care on the date the child enters an out-of-home placement.) When the court determines that reasonable efforts to return the child home are not required, the court shall hold a permanency hearing within 30 of the determination in order to enter a new disposition in the case to determine the child's future status. A permanency hearing shall also be held after a child has been in an out-of-home placement for fifteen (15) of the previous twenty-two (22) months, excluding the time spent while the child is on a trial home placement and runaway status. The Permanency Planning Hearing will be conducted by the court, not by an administrative body.

The Division must obtain a judicial determination that reasonable efforts were made to finalize the permanency plan for the child within 12 months of the date the child entered foster care. If a child remains in an out-of-home placement after the initial permanency planning hearing, an annual permanency planning hearing shall be held to reassess the permanency goal selected for the child. If a judicial determination regarding reasonable efforts to finalize a permanency plan is not made, the child will be ineligible under Title IV-E from the end of the 12 month following the date the child is considered to have entered foster care or the end of the 12 month following the month in which the most recent judicial determination of reasonable efforts to finalize a permanency plan was made, and remains ineligible until such a judicial determination is made.

The Permanency Planning Hearing shall determine the permanency goal for the child that includes, listed in order of preference:

(1) Returning the child home at the permanency planning hearing if it is in the best interest of the child and the child's health and safety can be adequately safeguarded if returned home,

(2) Termination of parental rights so the child can be adopted, unless:

* the child is being cared for by a relative and termination of parental rights is not in the best interest of the child;

* the Division has documented in the case plan a compelling reason why filing a termination petition would not be in the best interest of the child and the court approves the compelling reason as documented in the case plan; or

* the Division has not provided services, consistent with the case plan, necessary for the safe return of the child to his home.

At any time during the course of a case, DHS, the Attorney ad litem or the court can request a hearing on whether or not reunification services should be terminated. The requesting party shall provide notice to the parties at least fourteen (14) calendar days before the hearing. The notice shall identify thejlgrounds for recommending termination of reunification services in sufficient detail to put the family onynotice. The court shall determine whether or not reunification services shall be terminated. The burden of presenting the case shall be on the requesting party. The court shall conduct and complete a hearing on a "no reunification services" request within fifty (50) days of the date of written notice to the defendants. The court shall enter an order determining whether or not reunification services shall be provided. If the court determines that reunification services shall be terminated, the court shall hold a permanency planning hearing within thirty (30) days after the determination. If the court determines the permanency goal to be termination of parental rights, the Department shall file a petition to terminate parental rights within thirty (30) days from the date of the entry of the order establishing such goal. The court shall conduct and complete a termination of parental rights hearing within ninety (90) days from the date the petition for termination of parental rights is filed, unless continued for good cause. After an order of termination of parental rights is filed, the court shall review the case at least every three (3) months when the goal is adoption, and in other cases, every six (6) months until permanency is achieved for the child. (Refer to Policy VIII-C.) The court reviews continue, even if a case is on appeal.

(3) Legal guardianship,

(4) Permanent custody,

If the court grants legal guardianship or permanent custody no further services or periodic reviews are required.

(5) Continue the goal of reunification only when the parent is complying with the established case plan, and orders of the court making significant measurable progress towards achieving the goals established in the case plan, and diligently working toward reunification. Reunification must be expected to occur within a time frame that is consistent with the child's developmental needs.

(6) Independence (see definition of Independence in Glossary). In the case of a child who has attained age 16, the permanency planning hearing will determine the services needed to assist the child to make the transition from foster care to independent living.

Independence shall be selected only if the child cannot be reunited with the child's family; another permanent plan is not available; and a compelling reason exists why termination of parental rights is not in the child's best interest or the child is being cared for by a relative and termination of parental rights is not in the best interest of the child.

If DHS concludes, after considering reunification, adoption, legal guardianship, or permanent placement with a fit and willing relative, that the most appropriate permanency plan for a child is

placement in another planned permanent living arrangement, DHS will document to the court the compelling reason for the alternate plan.

The Department may seek the services of the Federal Parent Locator Service to search for absent parents at any point in order to facilitate a permanency plan.

The Department shall provide the foster parent(s) of a child, and any pre-adoptive parent or relative providing care for the child with timely notice of, and an opportunity to be heard in, permanency hearings and six-month periodic reviews held with respect to the child during the time the child is in the care of such foster parent, pre-adoptive parent or relative caregiver. Notice of and an opportunity to be heard does not include the right to standing as a party to the case. The permanency hearing will also serve to address procedural safeguards as thev apply with respect to parental rights pertaining to the removal of the child from the home of his or her parents, to a change in the child's placement, and to any determination affecting visitation privileges of parents.

Judicial determinations regarding "contrary to the welfare", reasonable efforts to prevent removal, and reasonable efforts to finalize the permanency plan in effect, including judicial determinations that reasonable efforts are not required, must be explicitly documented and made on a case-by-case basis and so stated in the court order.

If reasonable efforts and "contrary to the welfare" judicial determinations are not included as required in the court orders, a transcript of the court proceedings is the only other documentation acceptable to verify that the required determinations have been made.

Neither affidavits nor nunc pro tunc orders will be acceptable as verification documentation in support of reasonable efforts and "contrary to the welfare" judicial determinations.

Court orders that reference state law to substantiate judicial determinations are not acceptable, even if state law provides that removal must be based on a judicial determination that remaining in the home would be contrary to the child's welfare or that removal can only be ordered after reasonable efforts have been made.

At any hearing in which the Department of Human Services is ordered by the court to provide services for a family, the court shall provide the Department with the opportunity to be heard. When DHS is not a party to the case, failure by the court to provide at least five (5) working days' notice to DHS renders any part of the order pertaining to DHS void.

PROCEDURE (VI-F1): Case Review Judicial Hearings for Children in Out-of-Home Placement

The Family Service Worker will:

* Receive the confirmed court date from the OCC attorney.

* Provide the OCC attorney with the name and address of any grandparent who is entitled to notice based on the conditions listed in Procedure (II-E10).

* Provide notice to the parties at least fourteen (14) calendar days before the hearing, if DHS is the requesting party.

* Complete a court report for all review hearings.

* Submit the "Court Report" (CFS-6011) to the OCC Attorney within fifteen (15) working days prior to the hearing.

* Submit the "Permanency Planning Hearing Court Report" (CFS-6024) to OCC, CASA and all parties no later than seven (7) days before the scheduled Permanency Planning Hearing.

* Invite the out-of-home placement provider to all hearings.

* Attend all hearings and be prepared to provide testimony regarding services offered or provided, progress and recommendations to the court.

* Bring case files to all hearings.

* Discuss orders of the court with the family.

POLICY (Vl-G): INTERSTATE COMPACT ON PLACEMENT OF CHILDREN (ICPC)

The Interstate Compact on the Placement of Children (ICPC) is used to move children in need of placement, treatment or adoption across state lines. When a child requires placement outside the resident state, DCFS shall use the ICPC process. The ICPC process ensures:

* Proper extensions of authority into the receiving state.

* Maximum opportunity for each child to be suitably placed.

* Proper information to authorities in the receiving state.

The juvenile division of circuit court shall retain jurisdiction to issue orders of adoption, interlocutory or final, when a child is placed outside the state of Arkansas.

PROCEDURE (VI-G1): Types of Placement Covered by ICPC

Children placed out-of-state are to go through ICPC when one of the following placements occur:

* out-of-home placement provider,

* adoptive placements,

* residential treatment programs, group homes, and institutions,

* placements with parent/relatives and non-agency guardians except for a facility for the mentally ill or educational facility or a situation in which a child is placed by a parent or close relative with another parent or close relative in another state.

If in doubt, request clarification from the Arkansas Interstate Compact Unit, P.O. Box 1437, Slot S567 Little Rock, Arkansas, 72203-1437. (Phone: (501) 682-8556)

PROCEDURE (VI-G2): Responsibilities of the Sending State

The sending party will:

* provide proper notice of the intent to place and receive authorization from the receiving state prior to the placement.

* retain jurisdiction over the child until the child no longer comes under the jurisdiction of ICPC.

* retain planning and financial responsibility for the duration of the placement.

NOTE: The one exception comes under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requiring that children under Title IV-E adoption assistance agreements and those receiving Title IV-E foster care payments will be granted Medicaid coverage in their current resident state. (See Medical Services Manual, Section 6600 to 6673.)

* Return the child to the sending state at the request of the receiving state.

PROCEDURE (VI-G3): Responsibilities of the Receiving State

The receiving state will:

* assess the proposed placement resources.

* notify the sending state in writing if proposed placement is in the best interest of the child.

* supervise placement and provide or arrange for necessary services.

* submit reports to sending party as requested.

* honor and enforce orders of the court of jurisdiction of the sending state.

PROCEDURE (VI-G4): Placing Arkansas Children in Another State and Requesting Out-of-State Home Studies

The following are procedures to use when requesting an out-of-state home study for an Arkansas child, including placement into residential treatment facilities. Always use the child's name on the correspondence.

The sending party (county office, etc.) will compile an Interstate Compact Placement Packet consisting of:

* Cover letter or memo to the Arkansas Interstate Compact Office explaining placement plans as follows:

* Request an evaluation of the proposed placement, home or facility.

* Clarify legal status and court/Division plans.

* Clarify financial planning (foster care payments are to be made, Medicaid coverage, etc.).

* Financial / Medical Plan - ICPC (CFS-592).

* Specify special needs of the child (medical, educational, etc.).

* "Interstate Compact Placement Request" (ICPC-100A). (Retain one copy and include five copies with the packet.)

* "Case Plan" (CFS-6010),

* Court order (most recent) showing that DHS has custody or the court has jurisdiction of the child,

* Complete a thorough Social Summary including background information on the child and family. Include the following additional information if applicable:

* psychological testing reports,

* school reports,

* medical reports,

* other appropriate reports/documents.

* Send packet to Deputy Administrator, Interstate Compact Unit, P.O. Box 1437, Slot S567, Little Rock, Arkansas 72203-1437.

The Arkansas ICPC Office will:

* Send packet to receiving state's compact office.

* Notify sending party of disposition.

* Coordinate the travel plans with the Family Service Worker if placement is approved. The Family Service Worker will:

* Complete and route the "Interstate Compact Report on Placement Status of Child" (ICPC-100B) to the ICPC office if the out-of-state placement is approved. Show the date of the placement or of the withdrawal of the request.

* Code the "Application for Emergency Services" (CFS-6013) to show ICPC service using the child's name.

* Key the case type in CHRIS as "ICPC" for the child placed by the Division in another state.

* Notify the Adoption Services Unit of a proposed adoptive placement, if appropriate.

NOTE: Communication between states regarding approval of placements, progress reports, case closures and disruptions must go through the ICPC office.

PROCEDURE (VI-G5): Children Entering Arkansas for Placement

Requests for placement include child placement, supervision of a child already in placement, or a request for a home study in Arkansas. All such requests and related phone calls must go through the ICPC office.

* Requests from sending state should include the same information described as the Interstate Placement Packet and outlined in Procedure VI-G4.

* Contact the Arkansas ICPC Deputy Administrator if additional information is needed from the sending state.

Exclusions to these procedures include the following:

* Protective Services referrals from another state.

* Requests for information only.

* Placements into certain hospitals, parental/relative placements, placements made through another Compact and divorce/custody cases.

The disposition of requests is as follows:

* Requests for home studies of parents, relatives, or foster homes received in the ICPC office will be forwarded to the appropriate County Office for a reply.

* Requests for home studies regarding adoptive placements from state agencies will be forwarded to the appropriate Area Manager for forwarding to the Adoption Specialist.

PROCEDURE (VI-G6): Completion of a Home Study

The Family Service Worker will:

* Complete a thorough home study, excluding the results of the criminal record check, with a definite recommendation for or against placement within thirty (30) working days of a request. If the criminal record checks have not been received, a copy of the application/request must be included in the packet.

* Notify the ICPC office if there is to be a delay.

* Include "Request for CPS Central Registry" (CFS-316) and "State Adoptions Criminal Record Check" (CFS-342B). The results of the criminal records check shall be provided to the court as soon as they are received.

* No foster child in the custody of another state agency who is placed in Arkansas shall be placed in any home if the criminal record check reveals a felony conviction of an adult in the home for:

(1) Child abuse or neglect;

(2) Spousal abuse;

(3) A crime against children, including child pornography; or

(4) A crime involving violence, including rape, sexual assault, or homicide, but not including other physical assault or battery.

If the criminal record check reveals a felony conviction of any adult in the home for physical assault, battery, or a drug-related offense and the offense was committed within the past five (5) years, the child shall not be placed in the home.

* Send the home study to the Arkansas Deputy Administrator, Interstate Compact Unit, not directly to the other state.

PROCEDURE (VI-G7): Routing of a Home Study

The Arkansas ICPC Unit will:

* Review the home study and route the home study and "Interstate Compact Placement Request" (ICPC-100A) approving/disapproving placement to the sending state requesting home study and approval.

If approved, the sending state will:

* Proceed with placement plans.

* Complete an "Interstate Compact Report on Child's Placement Status" (ICPC-100B) stating their placement plans and route the placement plan to the Arkansas ICPC Unit.

The Arkansas ICPC Unit will:

* Notify the appropriate Arkansas Family Service Worker of the placement of a child into that specific county.

PROCEDURE (VI-G8): Follow-up, Routing, and Monitoring

The Family Service Worker in Arkansas will:

* Provide monthly supervision of the child and send quarterly progress reports to the Arkansas ICPC Unit or as requested on the ICPC-100A.

* Notify the Arkansas Deputy Administrator ICPC office, immediately, if problems or changes with placement occur.

* Key the case type in CHRIS as "ICPC" for the child placed in Arkansas from another state.

PROCEDURE (VI-G9): Travel Procedures for Children Receiving Out-of-Home Placement Services

When a foster child has been approved to move into or out of Arkansas, the Family Service Worker will:

* Submit request for travel to ICPC office with "Application for Out-of-State Travel" (DHS-1010) two (2) weeks in advance. (The ICPC office will be responsible for obtaining approvals for the travel.)

* Make necessary travel arrangements through a travel agency approved by DHS.

* Submit ICPC-100B to the ICPC office for forwarding to the receiving state when arrangements are completed and approved.

When an escort (state employee or non-state employee) is needed to assist with transporting an Arkansas foster child to or from an out-of-state placement, the Family Service Worker will:

* Submit the same information as stated above for foster children travel.

PROCEDURE (VI-G10): Other Travel (Non-ICPC and Non-DCFS Children)

For Non-ICPC travel, the Family Service Worker will:

* Request prior approval, using the DHS-1010 for a child and for an escort. (Ex. to attend a funeral.)

* Direct requests and questions to the Foster Care Unit.

Exception: For children placed out-of-state by their parent, Arkansas court, or an Arkansas treatment facility, the sending party is responsible for:

* Arranging transportation and notifying the ICPC office of travel arrangements.

* Submitting an ICPC-100B to the ICPC Unit.

PROCEDURE (VI-G11): Progress Reports

The receiving state must:

* Send progress reports every three months unless otherwise stated on the ICPC-100A.

* Mail progress reports to ICPC office for forwarding to the sending state.

* File progress reports in the child's case record.

PROCEDURE (VI-G12): Out-of-State Visits

When an Arkansas foster child is going for an out-of-state visit of more than thirty (30) days: The Family Service Worker will:

* Send an Interstate Compact referral requesting approval for a visit of over thirty (30) calendar days to the Arkansas ICPC Unit. (See Procedure VI-G4.)

* Receive approval from the Interstate Compact office for the proposed visit.

* Arrange travel as specified within the previous procedures.

When an Arkansas foster child is going for an out-of-state visit of less than thirty (30) days, the Arkansas ICPC Unit is not involved.

PROCEDURE (VI-G13): Termination of ICPC Cases

An Interstate Compact Placement can only be terminated for the following reasons:

* Adoption is finalized.

* Child reaches age of majority.

* Child is emancipated.

* Child is returned to the sending state.

* Custody is returned to the parent or placed with a relative with the approval of both the sending and receiving states.

The Family Service Worker will:

* Complete ICPC-100B indicating termination reason and route it to the ICPC office for forwarding to the receiving state.

The Arkansas ICPC Unit will:

* Send the ICPC-100B to the sending or receiving state to notify them of the closure of the ICPC case.

PROCEDURE (VI-G14): Exceptions to Policy

Items and services not specified in this policy must have prior approval of the Interstate Compact Deputy Administrator.

The Family Service Worker, with the approval of the Area Manager, will:

* Write a memo to the Interstate Compact Deputy Administrator to fully explain the situation.

* Request that exceptions to policy be made. The ICPC Deputy Administrator will:

* Review the request.

* Inform the Family Service Worker of the decision.

PROCEDURE (VI-G15): Juvenile, Mental Health, and Adoption and Medical Assistance Compacts

In addition to the ICPC, three other Interstate Compacts were enacted to coordinate the interstate placements of children and juveniles as follows:

* Interstate Compact on Juveniles ~ This compact is designed to serve those children needing an out-of-state placement who have been adjudicated delinquent and who have been placed on probation or parole. This compact also provides for the return of non-delinquent runaways, escapees, and absconders. The Interstate Compact on Juveniles is administered by the Division of Youth Services.

* Interstate Compact on Mental Health ~ This compact is designed to facilitate the transfer of resident patients (both children and adults) from a state-operated mental health facility in one state to a similar state-operated facility in another state. The Mental Health Compact is administered by the Division of Mental Health.

* Interstate Compact on Adoption and Medical Assistance ~ This compact is for adoption assistance for IV-E eligible children who are under an adoption subsidy agreement. The adoption worker should notify the Adoption Subsidy Coordinator as soon as it is known that an adoptive family/child is moving out of state or has moved. The Adoption Subsidy Coordinator will send information to the new state of residence and also to the adoptive parents advising them to contact the local Medicaid office in their new state of residence. This contact will be for the purpose of getting medical benefits for their child in the new state of residence.

POLICY (Vl-H): INTERFERENCE WITH CUSTODY

The Division will provide a representative upon request to accompany the officer arresting an individual for Interference with Custody.

PROCEDURE (VI-H1): Interference with Custody

The Family Service Worker will:

* Accompany the officer arresting an individual for interference with custody. Take the minor into temporary DHS custody pending further proceedings from a court of competent jurisdiction.

* Contact OCC Attorney immediately.

POLICY (Vl-I): FOSTER CHILD TRUST ACCOUNTS

The Department of Human Services (DHS) maintains Trust Accounts for children in foster care who receive Supplemental Security Insurance (SSI), Social Security (SSA), Child Support, Veterans Benefits (VA), Railroad Benefits (RR) or any type of income. These benefits will automatically be used to pay for the child's foster care expenses, which includes the monthly board payment. DHS will become the payee for all benefits collected.

DCFS must ensure that changes in payee are made when a child receiving benefits initially enters foster care. The IV-E/Medicaid Eligibility Unit will screen all DCFS clients for potential SSI eligibility according to SSA disability criteria and make applications for those who meet minimum requirements.

The child's trust fund account must not exceed $2,000 to maintain state Medicaid eligibility, not exceed $2,000 to maintain Social Security benefits, and not exceed $10,000 to maintain Title IV-E eligibility. DCFS will coordinate the monitoring of Trust Fund accounts with the Office of Fiscal Management -General Operations Section, IV-E/Medicaid Eligibility Unit and other pertinent agencies to ensure the timely and efficient management of these accounts.

Authorized uses of different funds vary according to their sources. However, any expenditure from a foster child's trust account must be for the direct care and/or needs of the child in receipt of the income. Funds cannot be used for siblings, parents, or other individuals in the initial removal home. Authorized uses are as follows:

* SSI Income in a Regular Account has no restrictions; spending must be appropriately prioritized according to the child's needs and disability.

* SSI Income in a Dedicated Account may be used for the following with approval from the Social Security Administration:

(1) medical treatment, education or job skills training or

(2) if they pertain to an impairment -

(a) personal needs assistance

(b) housing modifications

(d) therapy or rehabilitation or

(e) other items / services if approved by the SSA.

* SSA Income and Child Support Income have no spending restrictions.

PROCEDURE (VI-l-1): OPENING A TRUST ACCOUNT

When the child enters foster care and is already receiving income, the Family Service Worker will:

* List the income source, amount and frequency on the application for Medicaid.

* Have the birth/legal parent(s) or guardian execute a CFS-491 (Consent for Use of Funds and Resources) and explain that without consent authorization, the child may accumulate excess funds which would make him ineligible for Medicaid. If permission is not given, obtain permission from the court to use conserved funds.

* Submit the change of payee forms to the appropriate agency(s) once the child is court ordered into foster care.

* Forward the CFS-376 (Authorization for Billing and Trust Account Action) and a memo containing the following information to the Trust Fund Coordinator:

* Child's name, social security number, date of birth, race, and gender

* Type of benefit

* County

* Date of request and begin date of income

* Award amount

* Back pay (optional)

* CHRIS Case & Identification Number

* Signature and telephone number of person submitting request

PROCEDURE (VI-l-2): CLOSING A TRUST ACCOUNT

To close a Trust Account when a child returns home, is emancipated, or adopted, the Family Service Worker will:

* Submit a the CFS-376 along with the CFS-334 (Foster Care Services - Authorization for Billing) requesting closure to the Trust Fund Coordinator containing the following information:

* Child's Name, SSN, CHRIS case and identification number.

* Name, telephone and signature of person submitting the request.

* Name and address of the child's custodian/legal guardian, the relationship to the child.

* Notation to return funds to the following once all outstanding bills are paid:

* Child- if emancipated and the balance does not exceed $2,000 in SSI/SSA funds.

* Social Security Administration - if the balance of the account exceeds $2000 in SSA funds, the account is a Dedicated Account, and anytime the funds are SSI funds.

* Parent/Legal Guardian - for SSA account balances under $2000 and child support income of any amount.

* Immediately request all outstanding bills from providers and forward to the Trust Fund Coordinator with appropriate documentation as soon as possible.

* Submit a change of payee request to the Social Security Administration or Office of Child Support Enforcement (OCSE) indicating the new payee/parent/guardian.

PROCEDURE (VI-l-3): CHANGE OF PAYEE REQUESTS

When a Family Service Worker becomes aware that a child entering care is already receiving benefits from SSA, SSI, VA, RR Benefits, Child Support or other income, the worker will:

* Notify the appropriate office that DHS/DCFS is the new payee: ** (see below)

* For Social Security benefits - Submit a copy of the court order placing the child in foster care and the original of Form SSA 11 to the district SSA office. Obtain the form from the IV-E/Medicaid Eligibility Unit or the Social Security Administration office directly.

* For VA benefits - Telephone or Fax the VA office with the primary recipient's benefit number and advise them that DHS/DCFS is the new payee.

* For RR benefits - Contact the Benefits Department of the specific, individual railroad company to advise them DHS/DCFS is the new payee.

* For Child Support - Submit a copy of the court order placing the child in foster care and an OCSE Referral Form to the Office of Child Support Enforcement.

* Submit a change of payee request to the appropriate agency(s), designating DHS/DCFS as the new payee.

* Designate the payee as follows: DHS Fiscal Administration for Foster Care

PO Box 8181, Slot W405 Little Rock, AR 72203-8181

* Send a copy of the completed "Change of Payee" request to the IV-E/Medicaid Eligibility Unit to include in the child's record.

* If a contract facility (rather than DHS) is designated the payee for a child's income, that facility must submit a monthly report CFS-377 (Facility Trust Account Reporting) to the DCFS Foster Care Unit to include the following information:

* Child's name and social security number

* Beginning of the month balance

* Deposits and expenses

* End of the month balance

** Under current policy, the only facilities authorized to become representative payee for Arkansas foster children are Arkansas Human Development Centers and Miller eek. Until policy is revised to state otherwise, no other facilities are to he made the payee for the income of

children in Arkansas foster care.

PROCEDURE (VI-l-4): REQUESTS FOR TRUST ACCOUNT FUNDS

To request trust account funds the Family Service Worker will:

* Complete the appropriate sections of CFS-334 indicating the amount and purpose for the funds being requested.

* Attach the original invoice or billing statement from the provider along with an original provider signature.

* Have the CFS-334 reviewed, approved and signed by the County Supervisor and/or Area Manager.

* Forward the original CFS-334 and originals of any required attachments to the Trust Fund Coordinator at Slot S571 within 7 days of the service or purchase date.

* In the event that the original invoice/receipt is lost, or a provider issues carbon copies of invoices as the client's original receipt, an agency generated Trust Account Invoice (CFS-380) must be utilized on a case by case basis.

* There is currently no mechanism in place to reimburse contract payments from trust accounts in the same manner currently utilized to reimburse board payments. Contract reimbursements will continue to be submitted on the CFS-334.

To request that trust account funds be held or conserved, the Family Service Worker will:

* Requests to hold/conserve trust account funds must be submitted to the Trust Fund Coordinator within 5 business days of the initial purchase on CFS-376 (Authorization for Billing and Trust Account Action) via fax, email or standard mail.

* A completed CSF-334 along with appropriate attachments must be forwarded to the Trust Fund Coordinator within 15 business days of the request to hold/conserve funds.

* Funds will not be held more than 30 business days of the initial request to hold/conserve funds. After 30 days, the held funds will be released for other account uses.

PROCEDURE (VI-l-5): REPORTING INFORMATION CHANGES TO THE TRUST FUND COORDINATOR

Status changes that affect a foster child's trust account will be coordinated between the IV-E/Medicaid Eligibility Unit and The Office of Fiscal Management- General Operations Section.

Status changes that affect a foster child's trust account must be submitted electronically or in writing and signed by the appropriate DCFS staff on CFS-376 (Authorization for Billing and Trust Account Action).

The Family Service Worker will report appropriate information to the Trust Fund Coordinator within 5 days of any of the following occurrences, which may effect the child's monthly benefit amount and/or SSI income payments:

* Placement changes to or from a detention or long-term care facility, Human Development Center, Mill Creek or run-away status.

* When the child is placed in a contract or long-term care facility the FSW must ensure that the child receives his/her personal need funds.

* To reinstate benefits, the FSW must make notification of return to DHS custody from the above placements.

The foster child is adopted, reaches the age of maturity or is deceased.

* Errors are found on the Trust Report or on the Assets screen in CHRIS.

PROCEDURE (VI-l-6): MONITORING TRUST ACCOUNTS FOR ACCURACY AND COMPLIANCE WITH STATE AND FEDERAL REGULATIONS

County Supervisors will:

* Supervise the trust account related work carried out by the Family Service Workers.

* Review and sign each approved CFS-334.

* Monitor trust account balances to ensure they do not exceed resource limits.

* Carry out any trust account related responsibilities delegated by their Area Managers. Area Managers will:

* Monitor monthly Trust Reports for their DCFS service area, ensuring:

* Compliance with state and federal resource limits

* Accuracy of basic information (county placement, duplicate accounts, etc.)

* Necessary actions by Family Service Workers

* Reimbursement of board payments

* Monitor CFS-334's for duplicate, repeat or unusual purchases prior to submission to the Office of Fiscal Management - General Operations Section.

* Monitor reports of trust funds being held or conserved for action by county staff.

* Distribute monthly Trust Reports to all County Supervisors via email until electronic transmission is available.

The Foster Care Unit will:

* Distribute monthly Trust Reports upon receipt from the Office of Fiscal Management - General Operations Section or any contract facilities to Area Managers and the IV-E/Medicaid Eligibility Unit via email, until electronic transmission of these reports is available.

* Distribute reports of funds held/conserved upon receipt to Area Managers and the Trust Fund Coordinator via email until electronic transmission of this report is available.

* Forward copies of all overpayment requests received to the Trust Fund Coordinator within two business days of receipt.

The DCFS Assistant Director of Community Support will:

* Designate a team to conduct an annual internal audit of DCFS Trust Account activities.

* Audit results and/or actions will be drafted and presented to DCFS Executive Staff, the IV-E/Medicaid Eligibility Unit and the Foster Care Unit.

PROCEDURE (VI-l-7): DHS OFFICE OF FISCAL MANAGEMENT -GENERAL OPERATIONS SECTION TRUST ACCOUNT RESPONSIBILITIES

The DHS Office of Fiscal Management - General Operations Section will:

* Complete trust account deposits, withdrawals, holds, and closures within 10 business days of request by DCFS staff and/or Trust Fund Coordinator.

* Forward each CFS-334 needing correction or additional information to the Trust Fund Coordinator for corrective action. Any CFS-334 that is rejected due to incomplete documentation, lack of funds, or any other reason will be handled in the following manner:

* If the form is returned due to insufficient funds in the trust account, the Trust Fund Coordinator will notify the appropriate county supervisor and forward the returned invoice to the DCFS Fiscal Officer further processing/instruction.

* If the form is returned due to missing signatures, original/agency-generated Trust Account Invoice (CFS-380), insufficient documentation or the invoice was previously paid, the Trust Fund Coordinator will forward the form(s) to the appropriate county supervisors) for correction.

* Distribute the monthly Trust Reports (General, Dedicated, County, Balances at $1,500, and Funds Held/Conserved) to the DCFS Office of Finance and Administrative Support Section, Foster Care Unit Manager and Trust Fund Coordinator by the 10^th business day of each month. These reports will be distributed via email until electronic transmission is available.

* Forward requests to close trust accounts, appropriate documentation and a net refund check (minus outstanding obligations) to the Social Security Administration within 10 business days of receipt of request.

* Make corrections to the Trust Report information as directed by the Foster Care Unit Manager, Trust Fund Coordinator, or DCFS Personnel within 10 business days of receipt of request. This includes: merging duplicate accounts, correcting names and/or social security numbers, county codes, etc.

* In order to ensure continuing Medicaid eligibility, DCFS will provide Office of Fiscal Management (OFM) with a monthly report of SSI accounts exceeding $2,000 along with a CFS-334 for payment of excess funds back to SSA.

* Process SSA Overpayment Requests and Trust Account Closeout Requests. These requests will be submitted to OFM on the CFS-379 (Closeout/Overpayment Notification). The DCFS Fiscal Officer or designees within that division will initial each form.

* Upon completion, OFM will forward copies of the CFS-379 (Closeout/Overpayment Notification) to the Trust Fund Coordinator. (When OFM transactions become available in CHRIS, this action will no longer be necessary.)

PROCEDURE (VI-l-8): CHRIS TEAM TRUST ACCOUNT RESPONSIBILITIES

The CHRIS Team will:

* Update CHRIS Asset screen information with monthly Trust Report data.

* Provide OFM with an electronic mechanism to review and approve prior to reimbursement for board payment from the trust account.

* Make corrections to CHRIS asset screens upon notification.

* Reimburse contract payments from trust accounts in the same manner currently used to reimburse board payments.

PROCEDURE (VI-l-9): IV-E/MEDICAID ELIGIBILITY UNIT / TRUST FUND COORDINATOR RESPONSIBILITIES

The Trust Fund Coordinator will:

* Assist DCFS staff with trust account related problems as needed.

* Assist DCFS with training its staff on new/revised trust account policies and procedures.

* Monitor Trust Report balances for compliance with state and federal resource limits.

* Monitor Trust Reports for accuracy (is the child still in care, duplicate accounts, incorrect Social Security Numbers, etc.).

* Monitor the monthly report of trust account funds being held or conserved pending action by the Family Service Worker.

* Forward requests for corrections on CHRIS Asset screens to CHRIS personnel for correction.

* Report the findings of its monthly monitoring of the Trust Reports to the Foster Care Unit, contract monitor, and appropriate DCFS personnel.

* Notify the Social Security Administration of changes in their recipient's status (excluding a request to close accounts) and also notify the IV-E/Medicaid Eligibility Unit.

* In accordance with page 5 of the Social Security Administration's form SSA-8202-F6, status changes must be reported within 10 days after the month in which they occur.

* Changes may be reported by -

* Calling the Social Security Administration, toll free, at 1-800-772 -1213.

* Calling, writing or visiting the local Social Security Office.

* Review and forward each completed CFS-334 to the Office of Fiscal Management- General Operations Section within 5 business days of receipt.

* Review each CFS-334 returned by OFM for needed additional information/errors/etc., and coordinate with DCFS staff for corrected re-submission of the form(s) to OFM for processing.

* Review and forward requests to open, close, hold/release or update trust accounts/funds to the Office of Fiscal Management-General Operations Section electronically within 5 business days of receipt. Requests may also be submitted in writing with appropriate DCFS staff signature(s).

* Process Overpayment Requests received from social security. Overpayment requests and requests to close trust accounts will be submitted to OFM on the CFS-379 (Closeout/Overpayment Notification) with appropriate documentation.

For the purpose of Title IV-E eligibility, a foster family home means the home of an individual or family licensed or approved as meeting the standards established by the Child Welfare Agency Review Board that provides 24-hour out-of-home care for children. (With respect to foster family homes on or near Indian reservations, approval would rest with the tribal licensing or approval authority(ies). The term includes group homes, agency-operated boarding homes or other facilities licensed or approved for the purpose of providing foster care. Foster family homes that are approved must be held to the same standards as foster family homes that are licensed. Anything less than full licensure or approval is insufficient for meeting Title IV-E eligibility requirements.

In addition, the Child Welfare Agency Licensing Act defines a foster home as a private residence of one (1) or more family members that receives from a child welfare agency any minor child who is unattended by a parent or guardian in order to provide care, training, education, custody or supervision on a twenty-four (24) hour basis, not to include adoptive homes The home must meet family foster home standards and the individual child's needs for the duration of the placement.

Foster care is a team effort involving DCFS, the family foster parents, the foster child, and the birth/legal parents. When all those directly involved in the situation understand their own and each others' roles and cooperate as team members in a team effort, the quality of the experience for all is increased, and the effect on the child's future well-being is greatly influenced. (See "Family Foster Parent Handbook" (PUB-30) for responsibilities of the Foster Care Team.) The Division shall place children in approved foster homes where the foster parents have satisfactorily completed the Division's pre-service training curriculum, have been cleared through the Central Registry and through a criminal records check. A FBI criminal records check shall be conducted on persons who have not resided in Arkansas continuously for the past five (5) years. The Division will provide documentation in the case record that the criminal record check was conducted on the prospective foster parent. An Individualized Training Plan for in-service training shall be developed for each foster parent. The plan shall take into consideration the age and characteristics of children for whom the foster parent is caring and the expressed preferences of the foster parent.

The approval process shall concurrently educate foster parents on the characteristics of children in out-of-home placement and assess their capability to meet those needs and their compliance with the DCFS standards for approval of foster homes. The Division will not approve a foster home where any adult member living in the home is homosexual.

DCFS shall re-evaluate each foster home's ability to care for children at least annually and whenever there is a major life change in the lives of foster families. Foster parents who do not meet the in-service training requirement will be placed on probation for sixty (60) days. No new children receiving out-of-home placement services may be placed during the probation period. Foster parents shall complete their annual in-service training requirements before they receive any additional children receiving out-of-home placement services unless an exception is granted.

There are three types of DCFS foster homes referenced in the CHRIS System: Foster Family Home (Non-Relative), Relative Foster Home (Kinship Only), and Relative Foster Home (Fostering and Kinship). There will be no distinction in approval requirements between kinship foster homes and all other approved foster homes in Arkansas.

Kinship foster homes are homes in which adult relatives within the first, second, or third degree of consanguinity to the parent or stepparent are recruited by the Family Service Worker to provide 24 hours per day care for children who are related through blood or marriage. These homes must meet all of the minimum licensing requirements for a family foster home. Relatives who are approved for placement of children in their home may choose to be a kinship foster home or a regular foster home. Kinship foster homes will be approved only for placement of relative children. If the relatives choose to be a regular foster home, they will have the responsibility of caring for relative and non-relative foster children.

Once permanency is achieved for the relative children placed in a kinship family foster home, relatives may choose to become a regular Family Foster Home if they remain in compliance with licensing standards. This will be a decision made by both the relatives and DCFS based on the best interest of the relative children.

DCFS employees are not permitted to be agency approved foster family homes. However, in situations where Division staff are relatives to children placed in DHS custody, and it is in the best interest of the child to be placed with the relative, the DCFS Director may grant approval on a case-by-case basis.

PROCEDURE (VII-A1): Foster Parent Training

The foster family home (Non-Relative), relative foster home (Kinship Only) and relative foster home (Fostering and Kinship) will:

* Complete the CFS-450 (Foster Home Study/Application) prior to training. Submit the CFS-450 on the first day of training.

* Complete CPR and First Aid Training and receive certification in both areas prior to approval to become a foster parent.

* Complete a minimum of thirty (30) hours of Division-sponsored or Division-approved pre-service training prior to placement of a child.

* Parti cipate in a training needs assessment process to develop a plan for needed training and support at the completion of pre-service training.

* Complete a minimum of fifteen (15) hours of Division-sponsored or Division-approved in-service training annually after the first year of service.

The Family Service Worker will:

* Refer to PUB-022 (Standards for Approval of Family Foster Homes) for training requirements.

* Maintain an "Individual Training Record Report" (CFS-6058) for each foster parent.

* Enter the foster parents' hours of in-service training on the "Evaluation" screen in the "Resource" section of CHRIS. Enter the "Directory" section and find the foster parents' file in the "Homes" section of their file then enter their hours of in-service training on the "Evaluation" screen.

PROCEDURE (VII-A2): Approval of Foster Home

The Foster Home Evaluator will:

* Complete a home study on the family. The home study must address and describe the families' compliance to the standards listed in PUB-022 (Standards for Approval of Family Foster Homes).

* Complete the approval process based upon the Division's "Standards for Approval of Family Foster Homes" (PUB-022).

* Complete the "Foster Care Criminal Record Check" (CFS-342A), and route it to the Division of Children and Family Services Foster Care Unit. The CFS-342A must be completed for each household member age fourteen (14) years and older. The Criminal Record Check will be repeated every five (5) years.

* Request a FBI criminal record check for families who have not resided in Arkansas continuously for the past five (5) years. The state criminal record check must be completed prior to requesting the FBI criminal record check. Forward the FBI print card, with the results of the state criminal record check attached, to the Foster Care Unit for processing.

* Complete the "Request for Child Protective Services Central Registry Check" (CFS-316), and route it to the Division of Children and Family Services Child Protective Services Unit. The CFS-316 must be completed on each household member age ten (10) years and older. The Central Registry Check will be repeated every two (2) years.

* Submit the information to the County Supervisor for review, with a recommendation for approval/denial.

The County Supervisor will:

* Enter a disposition as to the approval/denial of the foster home. The Family Service Worker will:

* Enter the approved foster family into CHRIS by identifying them as a Foster Family in the Resource Category field and as one of the following three Resource Types on the General Information screen in the "Resource" section:

* Foster Family Home (Non-Relative)

* Relative Foster Home (Kinship Only)

* Relative Foster Home (Fostering and Kinship)

* Continue completing the following CHRIS "Resource" screens for the new approved foster family home:

* General Information Screen

* Assign/Transfer Screen

* Status (Availability and Home Study sections)

* Homes:

* Inquiry

* Household Members

* Household Composition

* Contact Persons

* Services Admission Criteria

* Monitor the foster home on a quarterly basis for compliance with Division standards, if approved.

* Develop and maintain a record for each foster family home that contains all information and documentation required by PUB-004 (Minimum Licensing Standards for Child Welfare Agencies). The case record order shall reflect the order in Appendix VI.

PROCEDURE (VII-A3): Re-evaluation of the Foster Home

The Foster Home Evaluator will:

* Complete the "Family Foster Parent Re-evaluation" (CFS-451).

* Re-evaluate the foster home annually.

* Re-evaluate the foster home whenever there is a major life change in the life of the foster family such as:

* death or serious illness among the members of the foster family

* separation or divorce

* loss of or change in employment

* change in residence

* suspected child maltreatment of any child in the foster home

* the addition of family members

* foster parents' annual in-service training requirements are more than sixty (60) calendar days overdue.

* Document in the foster home record that the foster parent(s) maintained current certification in both CPR and First Aid.

* Request an exception for any foster parent whose annual in-service training hours are sixty (60) calendar days overdue, if appropriate.

The County Supervisor will:

* Review the CFS-451.

* Enter a disposition as to the continued approval of the home.

The Area Manager will:

* Receive the request for exception to in-service training requirements.

* Review the quality of care provided by foster families and the reasons for overdue training.

* Determine whether to grant an exception to the in-service training requirement for up to sixty (60) calendar days.

POLICY (Vll-B): PROVIDING INFORMATION TO FOSTER PARENTS

Foster parents shall be considered as team members working with other child welfare professionals for the family. Complete information, such as a child's health, education records, reasons for entering care, siblings, and probable length of placement, shall be provided to foster parents at the time of placement. The child's social security number may be given to the foster parents, only if the foster parent must have the number to obtain services, care or treatment for the child. Some examples would be to enroll the child in school or to obtain medical treatment for a child who is not Medicaid eligible, when treatment is needed. The foster parent must keep the child's social security number confidential and use the social security number only for an allowable purpose. Additional information shall be shared promptly with the foster parents.

The court shall allow foster parents an opportunity to be heard in any review or hearing held with respect to a child in their care. Foster parents shall not be made a party to such review or hearing solely on the basis that such persons are entitled to notice and the opportunity to be heard.

Foster parents are allowed to receive a copy of substantiated child maltreatment report for the child in their care.

PROCEDURE (VII-B1): Providing Information to Foster Parents

The Family Service Worker will:

* Provide foster parents with copies of the "Case Plan" (CFS-6010), "Health Services Plan" (CFS-368) and "Placement Plan-Placement Plan Provider Information Report" (CFS-6007) within five (5) calendar days of completion or revision.

* Provide the foster parent with the child's social security number, when it is required, to obtain services, care, or treatment for the child.

* Review and update the child's health and education records, and provide copies to the out-of-home care provider at the time of placement.

* Provide any additional information, as it becomes available.

* Submit the "Notification of Court Appearance" (CFS-343) to foster parents within ten (10) calendar days of any review hearing to be held with respect to a child in their care. Send the CFS-343 through certified mail for all Permanency Planning Hearings.

* Provide the foster parent with a copy of a substantiated child maltreatment report on the child in their care, if requested.

The Foster Parents will:

* Maintain the information shared as confidential.

POLICY (Vll-C): SUPERVISION OF CHILDREN IN OUT-OF-HOME PLACEMENT

Children in out-of-home placement will be visited regularly and such visits will take place no less than weekly. The purpose of these visits shall be:

* to keep open communication with the age-appropriate child;

* to assess the quality of the care being provided;

* to determine the extent to which the child's developmental, medical, intellectual, and emotional needs are being met; and

* to assess the child's adjustment to the out-of-home placement, foster parents, other persons in the home, and school.

Weekly visits will occur in the foster home and include a private conversation with the age-appropriate child to assess the quality of care being provided.

The Division shall notify the child's family, the OCC Attorney, Child Abuse Hotline and the Attorney ad litem if the child is the subject of an allegation of child maltreatment. If the alleged child maltreatment occurred in the out-of-home placement, the Attorneys ad litem for all other children placed in the home shall be notified. The information obtained during the investigation /interview will determine whether the involved children or other children in the out-of-home placement will be removed pending a final outcome of the investigation. If the alleged child maltreatment occurred and the foster family can correct the problem, which resulted in the child maltreatment, a corrective action plan may be established with the foster family. However, the safety of the children will be the first consideration and the Division may close a foster home with a true determination of child maltreatment without a corrective action plan.

PROCEDURE(VII-CI): Supervision of Children in Out-of-Home Placement

The Family Service Worker will:

* Visit with the child at least once a week in the out-of-home placement.

* Document deviation for less frequent visits and obtain supervisory approval.

* Obtain approval of the Area Manager when the deviation is due to staff shortages.

* Notify the child's parents, the OCC Attorney and Attorney ad litem immediately if the child is the subject of an allegation of child maltreatment. Report to the Child Abuse Hotline immediately.

* Follow up immediate notification by forwarding a copy of the CFS-310 (Notice of Child Maltreatment Allegation) to the child's parent (s) and Attorney ad litem whenever the child is the victim or offender named in an allegation of child maltreatment.

* Notify Attorneys ad litem, via the CFS-310, for all other children placed in the out-of-home placement if the allegation is in connection with the foster home.

* If there is an allegation of sexual abuse perpetrated by a foster child, a public defender will be assigned to the child. The investigating agency (CACD) will provide notice of the investigative determination to the juvenile, the juvenile's parents and the public defender who represented the child during the investigation via the CFS-312 (Child Maltreatment Assessment Determination). The CFS-312 must be forwarded to the Juvenile Division of the Circuit Court if there is a true finding of sexual abuse perpetrated by a child under the jurisdiction of the court.

POLICY (Vll-D): CHANGES IN OUT-OF-HOME PLACEMENT

The Division recognizes the importance of providing a stable placement for children in out-of-home placement. Family preservation services shall be utilized if necessary to address problems in the out-of-home placement in order to prevent disruption.

Changes in placement shall be made only after notification to the age-appropriate child, foster parent, the court, the OCC Attorney, Attorney ad litem, and the child's family. Notices shall be sent in writing two (2) weeks prior to the proposed change. The notice shall:

* specify reasons for the proposed change,

* provide to the Attorney ad litem the address of the proposed new out-of-home placement, and

* provide to the child the name and telephone number of the Attorney ad litem.

The age-appropriate child will be notified of the right to appeal the change and to request assistance from the Attorney ad litem. Pre-placement visits shall be conducted when possible before a change in placement. Exceptions to the advance notice requirement shall be made if the child's health or safety would be endangered by delaying a change in placement.

The Eligibility Unit will be notified concerning changes in the child's out-of-home placement. This includes situations wherein the child remains in foster care but is moved from one out-of-home placement to another; has returned home; been placed at a DYS facility, a juvenile detention center, placed with a relative (non-kinship care), on runaway status, or on a trial home visit, etc. The child's Medicaid case will close the date the child's foster care case is closed.

Good casework practice dictates that trial home visits will not exceed thirty (30) days unless the court dictates a longer duration. To comply with Title TV-E eligibility requirements, trial home visits must occur in the home of the birth parent(s) and may not exceed six (6) months in duration, unless a court orders a longer trial home visit. If a trial home visit extends beyond six (6) months and has not been authorized by the court, or exceeds the time period the court has deemed appropriate, and the child is subsequently returned to foster care, that placement must then be considered a new placement, and Title TV-E must be newly established. Under these circumstances, judicial determinations regarding "contrary to the welfare" and reasonable efforts to prevent removal are required.

At the closure of all out-of-home placement cases discharge planning must be conducted to ensure the health and safety of the child at case closure. The health and safety assessment and risk assessment are tools to be used in determining case closure. Discharge planning must be done at the staffing to close the case. Minimum licensing standards require that a discharge summary be completed on each child and a copy given to the child's parents if the Division has not been granted TPR (Termination of Parental Rights) by the court. A copy of the discharge summary must become a part of the child's case file.

PROCEDURE (VII-D1): Changes in Out-of-Home Placement

The Family Service Worker will:

* Provide written notice to the age-appropriate child, the foster parents, OCC, the court, the Attorney ad litem, and the child's family of any changes in placement two (2) weeks prior to the change.

* Arrange for a pre-placement visit.

* Provide new address to Attorney ad litem.

* Inform age-appropriate child of the right to appeal a change in placement.

* Request an exception to advance notice if an emergency exists.

* Notify the Attorney ad litem, the OCC Attorney, the court, the foster parent and the child's family within twenty-four (24) hours in the event of emergency removal.

* Submit the "Notification of Change" (CFS-495) to the Foster Care/Medicaid Eligibility Unit within 10 days of change in placement.

* Update child placement information in CHRIS. Updating the placement information will open a response window to notify the Eligibility Unit of the placement change.

POLICY (Vll-E): FINANCIAL SUPPORT TO FOSTER PARENTS

Title IV-E foster care maintenance payments for a child in foster care may cover the costs of (and the cost of providing) food, clothing, shelter, daily supervision, school supplies, a child's personal incidentals, liability insurance with respect to the child, and reasonable travel to the child's home for visitation with family or other caretakers. Local travel associated with the preceding list of items are also an allowable expense.

Foster care maintenance payments made on behalf of a child placed in a family foster home or child care institution, who is the parent of a child in the same home or institution, include amounts which are necessary to cover costs incurred on behalf of the child's son or daughter. The costs are limited to funds expended on those items described above.

The Division shall provide foster parents with a monthly board payment as an aid to cover the items listed above for each child receiving out-of-home placement services. When foster parents are caring for a child with special needs and the child's needs can not be met with the regular board payment, the Division may provide the foster parents with an additional payment to cover the extra expenses incurred. The amount of these higher, special board rates will be based on the nature and extent of the child's special needs. The amount of this additional monthly payment will not exceed $460.00 above the standard board rate for the child's age group. However, if the child is SSI eligible, the rate can go up $460.00 above the SSI rate. A special board rate is approved for a specific placement and need and will be periodically reviewed and adjusted. A change in placement will require a new request and review.

PROCEDURE (VII-E1): Financial Support to Foster Parents

Foster parents shall receive a monthly board rate according to the following chart:

Birth through 5 years	$400.00 Monthly
Board and Care	345.00
Clothing	40.00
Personal Needs	15.00
6 through 11 years	$425.00 Monthly
Board and Care	355.00
Clothing	45.00
School and Personal Needs	25.00
12 through 14 years	$450.00 Monthly
Board and Care	365.00
Clothing	55.00
School and Personal Needs	30.00
15 through 17 years	$475.00 Monthly
Board and Care	375.00
Clothing	65.00
School and Personal Needs	35.00

PROCEDURE (VII-E2): Requesting a Special Board Rate

The Family Service Worker will:

* Check documentation of the child's special need(s) and the additional activities required of the foster parents to meet the need(s).

* Complete the "Justification For Special Board Rate" (CFS-304) by determining the level of care needed in each of the three need categories, and adding the three levels.

* Submit the request for a special board rate with documentation attached to the County Supervisor for review and recommendation.

* Once approved, review the continuing need for the request on a quarterly basis and, if appropriate, resubmit for re-evaluation by the County Supervisor and the Area Manager.

The County Supervisor will:

* Review the request for completeness and appropriateness and recommend approval or disapproval within 3 working days of receipt.

* If approved, forward the request to the Area Manager for review and approval or disapproval.

* If disapproved, forward the request with a recommendation for disapproval to the Area Manager for review and action as appropriate.

* Once approved, review the continuing need for the request and, if appropriate, resubmit the request on a quarterly basis for re-evaluation by the Area Manager.

* Inform the foster parent in writing of the ultimate approval or disapproval of the request and the reason for that decision, noting that approval is only for 90 days and the documentation of continuing need must be reviewed quarterly.

The Area Manager will:

* Receive requests from the County Supervisor.

* Review the request for completeness and appropriateness, consider the County Supervisor's recommendation and either approve or disapprove the request within three (3) working days.

* Refer the request to the Foster Care Unit Manager for a second-party review if the Area Manager can not decide on approval or disapproval.

* Inform the requesting County Supervisor of the request's disposition and reasons for approval, disapproval, or referral to the Foster Care Unit Manager.

* Once approved, assure that the special board rate is reevaluated on a quarterly basis for continued appropriateness.

* Maintain a file for each approved special board rate. The file should contain the requesting memo, supporting documentation, Justification of Special Board Rate (CFS-304), Notification of approval memo, and a printout of the computer entry of the special board rate.

* Maintain a log of special board rate approvals including the following column headings: Child's Name, Case Number, County, Effective Date, Termination Date, Rate, and Reason.

The Foster Care Unit Manager will:

* Review any request referred by an Area Manager, and either approve or disapprove it.

* Return the request to the Area Manager for action as appropriate.

If the special board rate is approved, the following CHRIS procedures will be taken by the Family Service Worker and Area Manager:

The Family Service Worker will:

* Request a special board rate (e.g., Level 4) on the Difficulty of Care screen and will write a brief justification in the comment field.

* Key the date the special board rate is to begin and the amount above the standard board rate into the amount field.

* Make the request by pressing the add button, which will make approval available.

* Press "Request" and click "OK", which sends the request to the Area Manager's inbox for approval.

The Area Manager will click approval.

POLICY (Vll-F): DAY CARE FOR CHILDREN IN OUT-OF- HOME PLACEMENT

Day care for children may be provided as a part of an out-of-home placement case to provide assistance to foster parents when circumstances exist for child care, e.g., training, transporting a foster child for medical purposes, etc., or if both foster parents work.

PROCEDURE (VII-F1): Day Care for Children in Out-of-Home Placement

The Family Service Worker will:

* Assist foster parents to obtain childcare when such help is needed, for instance, when the foster parents are required to obtain training, or for the foster parents' children when transporting the child in out-of-home placement to services is reimbursable. This transportation is payable via DHS-1914. All other requests must receive prior approval from the Area Manager.

* See Procedure (V-Dl): Day Care for Children. Notify the Division of ChildCare and Early childhood Education (DCCECE) and the child care facility of changes in childcare, when payment is through DCC.

VIll. SERVICES TO PROVIDE OTHER PERMANENT LIVING SITUATIONS

POLICY (Vlll-A): PREPARING THE CHILD IN OUT-OF-HOME PLACEMENT FOR INDEPENDENCE

The Division of Children and Family Services is responsible for administering the Chafee Foster Care Independence Program (CFCIP). Each child in DHS custody, age fourteen or older, is eligible for the Chafee Foster Care Independence Program (CFCIP). CFCIP was created by federal legislation to provide services to youth in foster care that are normally unavailable through other program funds, such as Title IV-E Foster Care Maintenance Payments. Services provided are primarily educational and are intended to keep youth in school while they obtain life-skills that will assist them in transitioning to adulthood. The program coordinates age-appropriate life skills training for eligible youth who are likely to remain in foster care until age 18. CFCIP provides support for three groups of the foster care population.

(A) CFCIP provides support for children in foster care ages 14-17. Services for this age group include the Ansell-Casey Life Skills Assessment, basic life skills training, and other services such as tutoring that can be approved on a case-by-case basis. (B) Children who remain in DHS custody, between the ages of 18 and 21 and are engaged in post-secondary education, including vocational training, are eligible for CFCIP. (C) If a youth was in foster care on his 18^th birthday, and his foster care case is closed, he will be eligible for CFCIP " After Care" and can receive assistance until age 21. After Care services include limited room and board, limited start-up assistance, staff services and life-skills training sessions to acquire needed skills. PUB-404 (Chafee Foster Care Independence Program Handbook) provides additional information concerning CFCIP and service availability and should be referenced when implementing these policies.

Youth entering foster care between the ages of 14 and 18 will be immediately referred to the CFCIP coordinator to determine eligibility and be immediately assessed for basic life- skills abilities. Assessments and age-appropriate services will begin at age 14 for youth already in foster care.

DCFS shall provide those services identified in the Ansell-Casey assessment that are necessary to help the child achieve independence, either directly or through contract. The case plan must identify and address the specific independent living skill needs of each child receiving CFCIP. Each child age 14-17 receiving Independent Living Services shall be assessed every six (6) months to determine the progress in acquiring basic life skills. Basic life skills will be assessed at each staffing held for a child in out-of-home placement receiving CFCIP.

If a youth was in foster care on or after his 14^th birthday and was adopted before his 18^th birthday, he will be eligible for CFCIP services until his 21^s' birthday.

According to federal interpretation, youth who are incarcerated are not in foster care and are, therefore, ineligible for CFCIP services.

In cases where the court orders CFCIP services for a child younger than 14 or a child is more mature and needs basic life skills training, the DCFS County Supervisor and/or Area Manager may grant a waiver for services.

Each foster parent caring for, or interested in caring for, a child age fourteen or older, and each Family Service Worker responsible for any children, age fourteen or older, shall receive training in helping children acquire basic life skills.

PROCEDURE (VIII-A1): Preparing the Child in Out-Of-Home Placement for Independence

The Family Service Worker will:

* Complete the Chafee Foster Care Independence Grant Program Referral Form (CFS- 001) on all youth entering foster care between the ages of 14 and 18. The CFS- 001 will be completed also on youth who turn 14 while in foster care. All teens must be assessed for Life-Skills within 30 days of entering care or within 30 days after their 14^th birthday. The CFS-001 must be submitted 10 days after the youth enters care or 10 days after the 14^thbirthday.

* Forward the completed and signed CFS-001 to the CFCIP Coordinator for eligibility determination. The youth must sign the CFS-001 to be eligible for CFCIP.

* Document in CHRIS ILP screen youth's eligibility or ineligibility. If the youth is eligible, the worker will notify the County Supervisor who will e-mail the CFCIP Supervisor asking them to assign the CFCIP Coordinator as secondary worker.

* If the youth has been determined ineligible or unable to receive CFCIP services, send documentation to the CFCIP Coordinator along with the CFS-001.

* Assist the youth in completing the Ansell/Casey Life-Skills Assessment. (The CFCIP Coordinator is responsible for ensuring the completion of the initial assessment.)

* Conduct a staffing with the CFCIP Coordinator, the foster child, foster parents and child's parent(s) (if appropriate), to develop a case plan that will address the results of the assessment.

* Develop an initial CFCIP Participation Agreement with the youth. Use PUB-404 (Chafee Foster Care Independence Program Handbook) as a guide in developing the agreement. A sample agreement is in the PUB-404. The youth, foster parents, sponsor, CFCIP Coordinator, FSW, FSW Supervisor and the Attorney ad Litem must sign the contract.

* Complete the case plan and ILP screen after the staffing.

* Ensure that each youth age 14-17 is assessed every six (6) months to determine the level of basic life skills, and complete the Independent Living "IL" screen in the Case Plan section of CHRIS. Share the reassessment results with the CFCIP Coordinator and document the reasons for non-completion.

* Schedule a staffing when the youth is between the age of 17-17 Vi or the beginning of their final high school year whichever occurs last to determine the post-secondary education plans or plans to transition from foster care to independence. Complete the CFS-460 (Plan for Foster Child Attaining Majority).

* Update the child's CHRIS file for Independent Living Information and life-skills training sessions.

* Coordinate transportation to life skills training with the foster parent or caretaker.

* Discuss with the child the reasons the child is in Out-of-Home Placement and the child's plan for leaving Out-of-Home Placement and for maintaining relationships with family and social support systems.

* Key into CHRIS all pertinent information changes, including the change of address, any status changes and foster parent, sponsor or facility placement prior to or by the time of transfer so that current information is available in CHRIS. Information changes that occur after the transfer should be keyed by the FSW/Coordinator in the county of residence.

CHRIS instructions for FSW Caseworker/Supervisor:

* Document the date that the signed CFS-001 (CFCIP Referral) was routed to the CFCIP Coordinator in the document tracking screen.

* FSW Supervisor will request that the CFCIP Supervisor assign the CFCIP Coordinator secondary responsibility in the youth's case.

* Document the date that the CFCIP Contract/Agreement with the youth was signed and routed to all involved parties in the Document Tracking screen.

* Document the Chafee Foster Care Independence Grant Program as a Service in the youth's Services Offered/Delivered screen.

* Document the specific Life Skills in the youth's Placement Plan Child Information screen.

* Document the specific ILP needs/services in the youth's Treatment Plan Needs Based Services screen.

* Document the ILP services in the Independent Living Screen.

NOTE: If the client transfers to another county, the supervisor in the transferring county should immediately notify, by email, the supervisor and the CFCIP Supervisor in the receiving county that the client is transferring. The receiving supervisor should then make secondary caseload assignments to the Family Service Worker and the CFCIP Coordinator and directly notify the FSW and CFCIP Coordinator of the assignment. All workload assignments will go through the Coordinator's immediate supervisor and not the individual county supervisors.

If a client is transferred to another Area/County, the Family Service Worker in the residence Area/County should assist in obtaining an assessment/ reassessment if the date occurs while the client is in the other county.

* Transfer case files and all records of life-skills training sessions attended, skills acquired or mastered and copies of assessment results to the FSW and CFCIP Coordinator in the county of residence to ensure that training needs and goals will continue to be addressed.

* Use PUB-404 as a resource in conducting all CFCIP activities. The CFCIP Coordinator will:

* Review all submitted CFS-001's to determine a youth's eligibility for CFCIP services.

* Forward the CFS-001 to the referring FSW with a determination of the youth' s eligibility.

* Schedule a date and time with the youth's FSW for the youth to complete the initial Ansell/Casey Basic Life Skills Assessment. If a teen enters foster care at the age of 14 or older, they will be assessed within 30 days after entry. All teens age 14-17 should be re-assessed at 6-month intervals after the initial assessment to determine acquisition of transitional life-skills.

* Ensure that the youth complete the Ansell/Casey Life-Skills Assessment within 30 days of entering care.

* Receive results of completed Ansell-Casey Life Skills Assessment and forward results to the child, Family Service Worker, and foster parents.

* Update the Contact Screen in CHRIS each time contact is made with a teen on their caseload. Contacts include group training sessions, face-to-face contact or contact by phone, and/or the teens attendance in life-skills training. Indicate the title or content and information concerning the teen's participation.

* Develop life skills training resources.

* Complete the CFS-035 (Chafee Foster Care Independent Program (CFCIP) Statistical Summary) for monthly reporting of activities. Submit the CFS-035 to the Coordinator's supervisor and the Central Office CFCIP Statewide Coordinator by the sixth (6^th) day of the month.

* Use PUB-404 (Chafee Foster Care Independence Program Handbook) as a resource in conducting all CFCIP activities.

* Coordinate CFCIP activities with the FSW when appropriate. CHRIS Instructions for CFCIP Coordinator:

* Document the completion of the initial Ansell/Casey Basic Life Skills Assessment and any reassessments in the ILP screen.

* Document that the results of the Ansell/Casey Basic Life Skills Assessment were routed to the youth, FSW and foster parents/provider in the Document Tracking screen.

* Complete the Contact screen for all contacts with child and complete Education and Employment screens when appropriate.

* Document all contacts with youth on the Contact Screen.

* Document all CFCIP activities/services on the youth's Services Offered/Delivered screen selecting Chafee Foster Care Independence Program (Resource 112416) as the Service Provider and complete the IL Subsidy Exceptional Amount field if ILP funds were authorized.

Please refer to Chafee Foster Care Independence Program Handbook (PUB-404), Appendix II, for a step by step outline of CHRIS Procedures when a youth is receiving ILP.

POLICY (Vlll-B): CHAFEE FOSTER CARE INDEPENDENCE PROGRAM (CFCIP) POST SECONDARY AND AFTER CARE SERVICES

Ark. Code Ann. § 9-27-303 defines a juvenile as a person adjudicated dependent-neglected prior to age 18. The juvenile may request the court to retain jurisdiction beyond the juvenile's 18^thbirthday, and the court shall grant the request only if the juvenile is engaged and remains in a course of instruction or treatment. The court shall retain jurisdiction only if the juvenile remains in instruction or treatment and shall dismiss jurisdiction upon the request of the juvenile or when the juvenile completes, leaves or is dismissed from instruction or treatment. In no event shall the juvenile remain within the court's jurisdiction past the age of twenty-one (21) years.

Juveniles who request to remain in foster care and are enrolled in a post-secondary educational program such as public or private school, pursuit of a GED, vocational-technical school, rehabilitative training, trade or specialty school are eligible for CFCIP services. Post Secondary services are identified in PUB-404 (Chafee Foster Care Independence Program Handbook). Room and board expenses cannot be paid for with CFCIP funds for youth in foster care under the age 18 or for youth who choose to voluntarily remain in foster care after age 18. Board payments must be made through Title IV-E funds for teens under age 18. Board payments for youth age 18 and older remaining in care and not in a foster home must be paid using State General Revenue funds.

CFCIP funds can be used to provide assistance and services to children who have left foster care because they have attained 18 years of age and who have not attained 21 years of age. These services are called CFCIP After Care services. The youth must have been in foster care on their 18^th birthday and currently is not in DHS custody to be eligible for After Care services. PUB-404 outlines the available After Care services and must be used as a guide in providing all ---------------------------------------------------------------------------------------------------------------

PROCEDURE (VIII-B1): CFCIP Post-Secondary Services

The Family Service Worker will:

* Conduct a staffing when the youth is between the age of 17-17 Vi to determine the youth's plans when age 18 is reached. Complete the CFS-460 (Plan for Foster Child Attaining Majority). A determination of continued services, post-secondary education, employment, emancipation, housing and other factors should be made. The staffing should be attended by the foster parent(s), FSW Supervisor, sponsor (if selected), CFCIP Coordinator, the Attorney ad Litem, youth, and parent, if appropriate. Refer to PUB-404 (Chafee Foster Care Independence Program Handbook) for a list of allowable expenditures for "Post-Secondary Educational Services."

Issues to be addressed in the staffing include the following:

* The school the youth will attend,

* Living arrangements,

* Choosing a sponsor,

* Budgeted income/expenses,

* Amount of board payment,

* Start-up items (see PUB-404 for list of allowable start up items),

* Transportation needs,

* Continued Life-Skills Training, and

* Continued assistance by DCFS/CFCIP to help youth remain in school.

* Revise the Chafee Foster Care Independence Program Contract with the youth, using Pub-404 as a guide. The youth, foster parents, CFCIP Coordinator, Attorney ad Litem, Family Service Worker and the Family Service Worker's Supervisor must sign the contract.

* Assist the youth in determining whether they will live with a foster family, CFCIP Sponsor or in a school dormitory for their first school year.

* Revise the youth's CFCIP contract/agreement to include IL residence requirements once a youth has obtained upperclassman status. These decisions must be based on the maturity level of the youth. Examples of independent living residences include boarding houses, apartments or residences for men and women operated by church or civic groups. Independent living residence services can only be used for youth who choose to remain in foster care after they turn 18 and will not be living in a foster home. Expenses for the residence cannot be paid with CFCIP funds. Board payments for youth age 18 and older remaining in care and not in a foster home must be paid using State General Revenue Funds.

* Choose a sponsor, subject to DCFS approval, who may be the youth's out-of-home provider, Attorney ad litem, apartment manager/owner or a volunteer from the community.

* Approve the sponsor chosen by the youth.

* Revise the youth's participation agreement to include IL residence requirements.

* Determine who will serve as the payee for the youth.

* Determine and document on the "Independent Youth's Residence Checklist" (CFS-370) that the independent living residence selected meets minimum requirements.

* Initiate the youth's monthly board payments when in an independent living residence. Board payment for youth in college/higher education may be raised to a maximum of $630 per month based on documented need.

* Develop a monthly budget with the youth.

* Visit, or authorize the Family Support Specialist to visit, the youth at least twice monthly, or

* Obtain approval for less than twice-monthly visits from the County Supervisor, if appropriate.

* Maintain monthly contacts with the ILP sponsor. Contacts may be by telephone. The Youth's sponsor will:

* Attend all staffings.

* Assist the youth in selecting the independent living residence.

* Assist the youth with managing their budget if selected as board payment payee.

* Visit the youth at least twice monthly.

* Notify the Family Service Worker of any problems detected during the visit. CHRIS Instructions for FSW Caseworker/Supervisor:

* Document the signed Chafee Foster Care Independence Grant Program Referral Form (CFS-001) in the Document Tracking screen routed to the CFCIP Coordinator.

* FSW Supervisor will request that the CFCIP Supervisor assign the CFCIP Coordinator as Secondary Responsibility in the youth's case.

* Document the signed CFCIP Contract/Agreement or any revisions with the youth in the Document Tracking screen routed to all involved parties.

* Document the Chafee Foster Care Independence Grant Program (Resource 112416) as a Service in the youth's Services Offered/Delivered screen.

* Document the specific Life Skills in the youth's Placement Plan Child Information screen.

* Document the specific ILP needs/services in the youth's Treatment Plan Needs Based Services screen.

* Document the ILP services in the Independent Living Screen.

* If an ILP Sponsor is located, enter the ILP Sponsor as a Resource in CHRIS in order to place the youth in the ILP Sponsor's home on the Enter/Exit screen.

CHRIS Instructions for CFCIP Coordinator:

* Document the completion of the initial Ansell/Casey Basic Life Skills Assessment and any reassessments in the ILP screen.

* Document that the results of the Ansell/Casey Basic Life Skills Assessment were routed to the youth, FSW and foster parents/provider on the Document Tracking screen.

* Document all contacts with youth on the Contact screen.

* Document all CFCIP activities/services on the youth's Services Offered/Delivered screen and complete the IL Subsidy Exceptional Amount field if ILP funds were authorized.

PROCEDURE (VIII-B2): CFCIP After Care Services

The County Supervisor will:

* Make a referral to the CFCIP Coordinator for After Care Services on the CFS-001A (CFCIP After Care Referral).

* Send a copy of the CFS-001A to the ILP Supervisor.

* Upon receipt of the CFS-001A approving the youth for service, re-open the youth's closed child protective service case and assign the CFCIP Coordinator as the primary worker. If the youth is adopted, open a new case.

* Select Independent Living Program services as the case type.

Please note this information about the new Independent Living Program case type:

* Only a Supervisor can select this value in the Case Type field.

* Once an ILP case, always an ILP case (cannot be changed).

* Removal, Placement and Adoption buttons/screens are locked.

* No Ticklers in ILP case (no COR elements).

The CFCIP Coordinator will:

* If former foster youth, change the case type from Child Protective Services to Independent Living Program Services. If adoptive youth, leave case type as Independent Living Program and complete the Client General Information screen on youth.

* Complete the Contact screen for all contacts with child and complete Education and Employment screens when appropriate.

* Receive referrals (CFS-001 A) for After Care Services and document in the Document Tracking screen in CHRIS.

* Complete the CFS-001A to approve the youthfor services and obtain youth's signature on the CFS-001 A and document in the Document Tracking screen in CHRIS.

* Request supervisor to open a case to assist the youth to meet their immediate housing need.

* Documentation will include the type and extent of financial assistance to be provided. In CHRIS, complete Services Offered/Delivered screen selecting Independent Living Program-After Care Services (Resource 111074) as the Service Provider and completing status, frequency, dates and ILP Subsidy amounts fields.

* Assist the youth in selecting a residence that is appropriate for their immediate needs.

* Complete a Residence Checklist (CFS-370) to assure the residence and location are acceptable and document in the Document Tracking screen in CHRIS.

* Provide the youth with available alternatives for meeting their immediate housing needs, if appropriate.

* Recommend and arrange for any staff counseling or additional life-skills training that may be needed on the topics of money management, job search and housekeeping.

* Counsel the youth on the availability of community services or assistance and how to apply for assistance if the youth wishes to start or continue a post-secondary educational program.

All allowable payments must be made directly to one or more approved vendors.

* Submit purchase request(s) for payment of allowable assistance and document in the Document Tracking screen.

POLICY (Vlll-C): TERMINATION OF PARENTAL RIGHTS

All children have a right to a safe, permanent family. The Division of Children and Family Services shall develop and implement permanency plans for children. One option is to terminate parental rights to free a child for adoptive placement, when it has been determined that reunification with the family is not a viable option.

The court shall authorize DHS to file a petition to terminate parental rights unless the:

(a) The child is being cared for by a relative and termination of parental rights is not in the best interest of the child; (b) DHS has documented in the case plan a compelling reason why filing such a petition is not in the best interest of the child and the court approves the compelling reason as documented in the case plan; or (c) DHS has not provided to the family of the child, consistent with the time period in the case plan, such services as DHS deemed necessary for the safe return of the child to the child's home if reunification services were required to be made to the family.

The Division will file a petition to terminate parental rights in the following circumstances:

* A child (of any age) has been in an out-of-home placement for 15 of the most recent 22 months. A hearing shall be held to determine whether or not DHS shall file a petition to terminate parental rights before the end of the fifteenth (15^th) month if:

(a) The child has been in out-of of-home placement for fifteen (15) continuous months; and

(b) At the permanency planning hearing, the court continued the goal of reunification or entered a goal of independence. Trial visits with the parents and time spent on runaway status shall not count in adding up fifteen (15) months.

* The child has been determined by a court of competent jurisdiction to be an abandoned infant. The petition to terminate parental rights will be made within 30 days of the judicial determination that the child is an abandoned infant.

* The parent has been convicted of a felony and the court determines no reunification services are required. (See Policy VI-A). The petition to terminate parental rights will be made within 30 days of a judicial determination that reasonable efforts to reunify the child and parent are not required.

If a juvenile is the subject of an open case filed under the Arkansas Juvenile Code, OCC will file all subsequent petitions (i.e., termination of parental rights, adoption, guardianship) in that same juvenile court and case.

If the court adopts the goal of termination of parental rights, the Department shall file a petition to terminate parental rights within thirty (30) days from the date of the entry of the order establishing such goal.

If the court finds that the child should remain in an out-of-home placement, either long-term or otherwise, the child's case shall be reviewed every six (6) months, with an annual permanency planning hearing.

Additionally, if the child has been in an out-of-home placement 15 of the last 22 months, and a termination petition has been filed by another party, the Division will seek to join the petition. Concurrent with the filing of a termination petition, the Division will identify, recruit, process and approve a qualified family for adoption.

NOTE: For the purpose of Title IV-E compliance, the Division will file or seek to join a petition to terminate the parental rights of a parent(s) whose child has been in foster care under the responsibility of the state for 15 of the most recent 22 months. The petition must be filed by the end of the child's 15th month in foster care. In calculating when to file a petition for termination of parental rights, the Division:

(1) will calculate the 15 of the most recent 22 month period from the date the child entered foster care;

(2) will use a cumulative method of calculation when a child experiences multiple exits from and entries to foster care during the 22 month period;

(3) will not include trial home visits or runaway episodes in calculating 15 months in foster care; and

(4) only apply the 15 of the most recent 22 month rule once if the state does not file a petition because of one of the following exceptions applies.

The state may elect not to file a petition or join a petition to terminate the parental rights of parent if:

a. at the option of the state, the child is being cared for by a relative;

b. DHS has documented in the case plan (which must be available for court review) a compelling reason for determining that filing such a petition would not be in the best interests of the individual child;

c. DHS has not provided to the family, consistent with the time period in the case plan, services that DHS deems necessary for the safe return of the child to the home, when reasonable efforts to reunify the family are not required.

PROCEDURE (VIII-C1): DCFS Initiates Termination of Parental Rights

The Family Service Worker will:

* Consult the OCC Attorney to determine if legal grounds exist for disposition recommendation of termination of parental rights. See Appendix IV, Ark. Code Ann. § 9-27-341(b).

* Schedule and conduct a permanency planning staffing prior to the permanency planning hearing to determine if continuing contact with the birth/legal parent(s) or putative parent could cause harm to the child and to determine the likelihood that the child will be adopted if the termination petition is granted. Those invited to participate in the staffing are the birth/legal parent, attorney for the parent, age-appropriate child, OCC Attorney, County Supervisor, Adoption Specialist, Attorney ad litem, and foster parents.

* Obtain written consent of the Area Manager, if applicable.

* Prepare a Permanency Planning Court Report (CFS-6024) and submit it to the OCC Attorney at least seven (7) working days before the Permanency Planning Hearing.

* Work with the OCC Attorney to file a petition to terminate parental rights.

* Work with the OCC Attorney to prepare for termination of parental rights hearing within thirty (30) days from the date of the entry of the court order.

* Provide the OCC Attorney with information on the CFS-408 (Federal Parent Locator System Information) regarding the birth/legal parent(s) or putative parent so that notice of the termination petition can be provided.

* Provide the OCC Attorney with the name and address of any grandparent who is entitled to notice based on the conditions listed in Procedure II-E10.

* Refer to Policy VIII-F or VIII-G if termination of parental rights with power to consent to adoption is granted.

The Adoption Specialist will:

* Parti cipate in the staffing if adoption is to be considered as a permanent plan for a child.

* Work with the OCC Attorney to prepare for the termination of parental rights hearing.

* Refer to Policy VIII-F or VIII-G if termination of parental rights with power to consent to adoption is granted.

PROCEDURE (VIII-C2): Court Initiates Termination of Parental Rights

Sometimes the court will determine that the goal should be termination of parental rights when it is not the recommendation of DHS. In these instances the following procedures will apply.

The Family Service Worker will:

* Work with the OCC Attorney to file a petition to terminate parental rights within thirty (30) days from the date of the entry of the court order.

* Notify the Area Manager in writing with a copy of the order attached.

* Consult the County Supervisor and OCC Attorney immediately if the order should be appealed or if a rehearing is appropriate.

* Work with OCC Attorney to prepare for termination of parental rights hearing.

* Schedule and conduct a staffing, if applicable, to determine if continuing contact with the birth/legal parent(s) or putative parent could cause harm to the child and to determine the likelihood that the child will be adopted if the termination petition is granted. Those invited to participate in the staffing are the birth/legal parent, attorney for the parent, age-appropriate child, OCC Attorney, County Supervisor, Adoption Specialist, Attorney ad litem and foster parents.

* Provide the OCC Attorney with the name and address of any grandparent who is entitled to notice based on the conditions listed in Procedure II-E10.

* Provide the OCC Attorney with the name and last known address of a birth/legal parent(s) or putative parent(s) so that notice of the termination petition can be provided.

* Refer to Policy VIII-F or VIII-G if termination of parental rights with power to consent to adoption is granted.

PROCEDURE (VIII-C3): Birth/Legal Parent Requests Termination of Parental Rights

When parents want to relinquish custody to DHS and free a child for a permanent placement (refer to Policy VIII-E), the Family Service Worker or the Adoption Specialist (for unborn or newborn infants only) will:

* Discuss service options and offer services to maintain the family unit.

* Read to the parent the section of the consent form that explains the right to withdraw consent to termination of parental rights form.

* The consent to terminate parental rights shall state the person has the right to withdraw consent, within ten (10) calendar days from the signature date, by filing an affidavit with the clerk of the juvenile court in the county designated by the consent as the county in which the termination of parental rights will be filed, and providing the address of the juvenile court clerk of the county in which the termination of parental rights will be filed.

* The Family Service Worker will assist the parent in filing the affidavit to withdraw parental consent.

* If the ten-day period ends on a weekend or legal holiday, the parent may file the affidavit the next working day. No fee shall be charged for the filing of the affidavit.

* Notify OCC Attorney.

If the parents still wish to relinquish custody to DHS (refer to Policy VIII-E) after efforts to preserve the family have been offered, the Family Service Worker or the Adoption Specialist (for unborn or newborn infants only), will:

* Present a "Waiver and Consent to the Appointment of a Guardian" (CFS-410) to the parents and explain the form.

* Notify County Supervisor in writing if parents sign CFS-410, with a copy attached.

* Notify OCC Attorney in writing with the original CFS-410 attached.

* Obtain written consent of the Area Manager, if applicable.

* Work with the OCC Attorney to prepare for termination of parental rights hearing.

* Provide the OCC Attorney with the name and last known address of a birth/legal parent(s) or putative parent(s) so that notice of the termination petition can be provided.

* Refer to Policy VIII-F or VIII-G if termination of parental rights with power to consent to adoption is granted.

POLICY (Vlll-D): DECISIONS INVOLVING CHILDREN IN DHS CUSTODY WITH PARENTAL RIGHTS TERMINATED

The Department of Human Services has designated the County Supervisor, (or the Adoption Field Services Supervisor if the child has been placed with an adoptive family), as having the authority to give consent for major decisions for children whose parental rights have been terminated._________________________________________________________________________

PROCEDURE (VIII-D1): Decisions Involving Children in DHS Custody with Parental Rights Terminated

The County Supervisor, or the Adoption Field Services Supervisor if the child has been placed with an adoptive family, must:

* Give written consents in the following decisions involving children in DHS custody with parental rights terminated:

* Goal Changes in the "Case Plan" (CFS-6010)

* Marriage, if appropriate

* Driver's license issuance

* Entry into the Armed Forces

* Travel inside or outside the United States

* Retention of child in school grade

* Expenditure of child's funds

* Birth control

* Media release

* Major medical consents

The Manager, Adoption Services Unit, will give written consent to all adoptions.

PROCEDURE (VIII-D2): Financial Benefits

The Family Service Worker, or the Adoption Specialist, (if the child has been placed with an adoptive family), will:

* Work with appropriate DHS financial staff if the Department is to be made the payee of proceeds or if payee changes.

PROCEDURE (VIII-D3): Incidents/Accidents

The Family Service Worker, or the Adoption Specialist, (if a child has been placed with an adoptive family), will:

* Complete and route to the Supervisor an "Incident Report" (DHS-1910), when appropriate, for incidents/events involving a child in DHS custody with parental rights terminated.

* Complete DFA form "Safety Responsibility" (SR-1) when the child is involved in a motor vehicle accident. Send a copy of the SR-1 to the OCC Attorney.

PROCEDURE (VIII-D4): Travel

The Family Service Worker, or the Adoption Specialist, (if child has been placed with an adoptive family), will:

* Provide written consent from the Supervisor to the adult with whom the child is traveling.

* Provide information on how to reach the Family Service Worker or Adoption Specialist in an emergency.

PROCEDURE (VIII-D5): Arrest of Child

The Family Service Worker, or the Adoption Specialist, (if the child has been placed with an adoptive family), will:

* Notify the Supervisor and the OCC Attorney when a child is arrested.

* Learn where the child is being held, the place and time of hearings, and inform the Area Manager, Manager of Adoption Services Unit, if the child is placed for adoption, OCC Attorney, and the Attorney ad litem immediately of the information.

* Assist in obtaining legal counsel for the child if applicable.

* Determine that the child understands his or her legal rights.

* If appropriate, attempt to have the child released on bond or to the foster parents, adoptive parents, or a therapeutic environment consistent with the child's needs.

* Attend all hearings with the child.

* Visit the child weekly while incarcerated to ascertain the child's well being.

* Provide adequate personal care items.

* Prepare and route an "Incident Report" (DHS-1910).

* Update child placement information in CHRIS. Updating the placement information will open a response window to notify the Eligibility Unit of the placement change.

PROCEDURE (VIII-D6): Education

The Family Service Worker, or the Adoption Specialist, (if the child has been placed with an adoptive family), will:

* Notify the school principal in writing to request that a surrogate parent be appointed for a child who receives special education if one has not been previously appointed.

* Contact the Education Liaison, Community Services, State Office, prior to placement of a child out-of-state₂ if the child receives special education to assure appropriate compliance to procedures and law.

* Notify the Supervisor of problems identified at school conferences.

* Notify the Supervisor when a child is expelled or suspended and if the needs of a child receiving special education are not being met to determine if a due process hearing should be requested.

* Parti cipate in Individual Education Plan (IEP) conferences.

* Consult with the Education Liaison, Community Services, State Office, about a child who receives special education services if problems or questions arise.

PROCEDURE (VIII-D7): Stand-by Guardianship

Stand-by Guardianship is a legal mechanism which allows a parent who is chronically ill or near death to appoint a guardian for the parent's minor children. The guardianship will prevent children from coming into Out-of-Home Placement at a later date when the parent becomes unable to care for the children.

The guardian's authority will take effect:

* Upon the death of the parent;

* Upon the mental incapacity of the parent; or

* Upon the physical debilitation of the parent with the parent's consent.

Referrals should be made to legal services for the preparation of a guardianship. This is NOT a function of the OCC.

PROCEDURE (VIII-D8): Disabled Children Approaching Adulthood in Need of a Guardian

The Family Service Worker will:

* Find a responsible person who will accept guardianship by contacting contracted agencies whose purpose is to find a guardian.

Contact the OCC Attorney for specific procedures to establish guardianship.

PROCEDURE (VIII-D9): Discharge of Guardianship for Children Placed in Guardianship of DHS

The Family Service Worker, or the Adoption Specialist (if the child has been placed with an adoptive family), will:

* Schedule and conduct a staffing.

* Notify OCC Attorney to take action to discharge guardianship.

POLICY (Vlll-E): BIRTH PARENTS RELINQUISHING INFANTS FOR ADOPTION

The Division shall provide services to birth/legal parents who are planning to relinquish infants for adoption or who have relinquished their infant to a medical provider or law enforcement agency under the provisions of the Safe Haven Act.

The Safe Haven Act allows a parent of a child who is 30 days old or younger to voluntarily leave or deliver the child to a medical provider or law enforcement agency. Although the statute does not require a court order, DHS will petition the court for an order of emergency custody. The parent must not express any intent to return for the child. DHS takes custody of the child.

PROCEDURE (VIII-E1): Birth Parents Relinquishing Infants for Adoption

The Family Service Worker will:

* Refer birth/legal parents planning to relinquish an expected infant for adoption to the Adoption Specialist.

The Adoption Specialist will:

* Complete an Intake Study and the "Biological Family Background Information" (CFS-456) through one or more face-to-face interviews with parents within two (2) weeks of referral. If the parent is under 18 years of age and so desires, involve a relative or concerned advocate in the intake interview. Document the Intake Study if the parent is unavailable, uncooperative, etc.

The Intake Study will include the following information on the birth mother, legal father, and/or putative father:

* Personal information (names, birth dates, sex, race, marital status and religion of each parent and their parents, siblings, other children of either parent, social security numbers and address of each parent).

* Specific problems and needs.

* Assessment of the family's strengths and relationships and relevant social, economic and cultural circumstances pertinent to placement.

* Reasons for placement of the child and attitudes of parents toward relinquishment.

* Available physical, developmental, educational and occupational history of parents and other members of the family.

* Available medical and psychological history of each member of the family.

* Assessment of alternatives to adoptive placement and description of services which have been provided to the family and child in order to preserve and strengthen the family.

* Assessment of the effect of placement on the parents and other family members.

* Parents' short and long range goals of the placement.

* Summary of contacts between parents and DCFS to include date, location, purpose, and results of contact.

* Help parents understand their retained legal rights and obligations and those designated to DCFS by the court. Provide this information to parents in clear, simple writing. Document these actions in the Intake Study and how the information is understood by the parents.

* Obtain an affidavit of paternity. Advise the putative father of the Putative Father's Registry at the Department of Health. Document in the Intake Study.

* Comply with the Indian Child Welfare Act if there is Indian ancestry in either parent's family.

* Develop a "Case Plan" (CFS-6010) with the birth/legal parents, preferably prior to the infant's birth, which will address:

* counseling services;

* health services;

* post-placement services;

* Give "Arkansas Mutual Consent Voluntary Adoption Registry" (PUB-113) and "Choices-Adoption is an Option" (PUB-043) to all parents receiving adoption services. Document in the Intake Study.

* Assist mother in applying for Medicaid for her medical expenses. If ineligible for Medicaid, refer the mother to the private licensed adoption agencies.

* Apply for Medicaid for the infant as soon as possible after birth.

* Advise medical providers not to bill the parents for the infant's medical expenses if the parent relinquishes parental rights. Give provider a copy of the custody order.

* Notify medical providers of the infant's Medicaid number when approved.

* Give parents a blank "Waiver and Consent to the Appointment of a Guardian" (CFS-410) before birth.

* Contact OCC Attorney to make arrangements for the appointment of an Attorney ad litem for a minor birth mother and the minor father if he is the legal father of the infant.

* Wait at least twenty-four (24) hours after the infant's birth, and until the mother is lucid, to present CFS-410 for signature. Explain her right to withdraw her consent within ten (10) calendar days for the signature date.

* Obtain legal father's signature on the CFS-410/2. Explain his right to withdraw consent within ten (10) calendar days from the signature date.

* Obtain signature of minor birth mother's Attorney ad litem on the CFS-410 if in agreement with the adoption. Obtain signature of minor birth father's Attorney ad litem on the CFS-410 if the minor is the legal father.

* Advise OCC Attorney if the minor's birth parents do not agree with the adoption.

* Route the signed, notarized CFS-410s to the OCC Attorney to start termination of parental rights proceedings.

* Notify OCC Attorney immediately if the birth mother or legal father revokes her/his consent during the days allowed by law.

* Name the infant if the mother does not and advise the hospital of the infant's name.

* Advise the hospital staff of parents' wishes concerning contact with the infant.

* Prepare an adoption packet about the infant (See Appendix II-A, II-B, Policy VIII-G7).

* Contact parents at least once during ten (10) day revocation period.

* Contact parents monthly for at least six (6) months.

* Maintain a record of parents who request to relinquish an infant for adoption to include:

* personal information including medical history;

* social history;

* copy of the Intake Study;

* strengths and needs of the parents and the services required;

* Adoption Specialist's assessment and initial case plan;

* signed documents between DCFS and the parents;

* summary of dates of contact and progress toward goals;

* case review reports;

* discharge summary;

* Select an adoptive family (Policy VIII-G).

* Maintain a record of denials of application for services and reasons for denial.

PROCEDURE (VIII-E2): Voluntary Delivery of an Infant under the Provisions of the Safe Haven Act

Any medical provider or law enforcement agency shall, without a court order,

* Take possession (72 hour hold) of a child who is:

* Thirty (30) days old or younger, and

* Left with or voluntarily delivered to them by the child's parent, who does not express an intent to return for the child.

* Perform any act necessary to protect the physical health and safety of the child.

* Immediately notify the Division of Children and Family Services.

The Family Service Worker will:

* Notify OCC immediately upon taking possession of such a child.

* Refer the birth/legal parents of the relinquished infant for adoption to the Adoption Specialist.

The Adoption Specialist will:

* Carry out the same actions as those listed for the Adoption Specialist in Procedure VIII-E1.

POLICY (Vlll-F): FOSTER PARENT, KINSHIP FOSTER PARENT, AND RELATIVE ADOPTION

The Division supports adoption by a foster parent or kinship foster parent, who has a well established relationship with the child in their care and who expresses an interest in adoption, without regard to any racial or ethnic differences if such a placement is in the best interest of the child. The Division also supports adoption by a relative, who is not presently caring for the child and who expresses an interest in adoption if such a placement is in the best interest of the child. Each family and child will be carefully assessed and prepared for adoption. The Division provides pre-placement services for relative adoptions to move children into adoptive families in a timely manner. A foster child placed in an adoptive home continues status as a foster child until finalization of the adoption and the adoption subsidy is initiated. Prior to the finalization of the adoption, post-placement services are provided and services to preserve adoptive families are offered after the adoption is finalized.

Before placement of a child in the home of the adoptive parent, a home study will be conducted. The home study shall address whether the adoptive home is a suitable home, and shall include a recommendation as to the approval of the petitioner as an adoptive parent.

Before placement for adoption, the Division shall compile and provide to the prospective adoptive parents a detailed, written health history and genetic and social history of the child which excludes information which would identify birth parents or members of a birth parent's family. The information shall be set forth in a document that is separate from any document containing information identifying the birth parents or members of the birth parent's family. The detailed, written health history and genetic and social history shall be identified as such, and shall be filed with the clerk before the entry of the adoption decree. The adoption summary shall serve as the detailed health history, genetic, and social history document. Upon order of the court for good cause shown, the chancery court clerk may tender to a person identified by the court a copy of the detailed, written health history and genetic and social history.

The Division shall provide to foster parents and pre-adoptive parents of a child in Department custody, notice of any review or hearing to be held with respect to the child. The original petitioner in the juvenile matter shall provide relative caregivers notice of any review or hearing. The court shall allow foster parents, pre-adoptive parents and relative caregivers an opportunity to be heard in any review or hearing held with respect to a child in their care. Foster parents, adoptive parents, and relative caregivers shall not be made a party to such review or hearing solely on the basis that such persons are entitled to notice and the opportunity to be heard. Families are identified as pre-adoptive once a child is placed in the home and prior to the finalization of the adoption. Adoptive parents, and each member of the household age ten (10) years and older, residing in Arkansas shall be checked with the Child Maltreatment Central Registry. Adoptive parents and each member of the household age ten (10) years and older residing out of state shall provide child Maltreatment Central Registry Checks from their state of residence.

Adoptive parents and each member of the household age fourteen (14) years and older residing in Arkansas shall be checked with the Identification Bureau of the Arkansas State Police for convictions of offenses listed in ACA 9-28-409. Adoptive parents and each member of the household age fourteen (14) years and older residing out of the state shall provide State Police Criminal Record Checks from their state of residence. Out of state adoptive families do not need to do an Arkansas State Police Check if thev have never resided in Arkansas. Adoptive parents and each member of the household age sixteen (16) years and older who have not resided in

Arkansas continually for the past six (6) years, shall complete a record check with the Federal Bureau of Investigation. The Division will provide documentation in the case record that a criminal record check was conducted on the prospective adoptive parent.

A prospective adoptive parent will not be approved or licensed if, based on a criminal record check, a court of competent jurisdiction has determined that the prospective adoptive parent has been convicted of a felony involving child abuse or neglect, spousal abuse, a crime against a child or children (including pornography), or a crime involving violence, including rape, sexual assault, or homicide, but not including other physical assault or battery.

All records of any adoption finalized in the state of Arkansas shall be maintained for ninety-nine (99) years.

The Juvenile Division of Circuit Court shall retain jurisdiction to issue orders of adoption, interlocutory or final, when a juvenile is placed outside the state of Arkansas.

PROCEDURE (VIII-F1): Staffing and Recommendations

The Family Service Worker will:

* Notify the Adoption Specialist in writing within two (2) working days of the court hearing that termination of parental rights with power to consent to adoption has been granted if the Adoption Specialist was not at the hearing.

* Determine if the foster parent, kinship foster parent, or a relative is interested in adopting the child if parental rights have been terminated.

* Submit the "Notification of Court Appearance" (CFS-343) to all parties entitled to notice within ten (10) calendar days of any review hearing to be held with respect to a child in their care. Send the CFS-343 through certified mail for all Permanency Planning Hearings.

* Present a "Request for Consideration to Adopt" (CFS-489) to the foster parent or kinship foster parent if they are interested in adopting the child.

* Consider the health and safety of the child.

* Schedule and conduct a staffing within ten (10) working days from the court hearing that terminates parental rights, being sure to include the Adoption Specialist, foster parent, kinship foster parent, relative, age-appropriate child, County Supervisor, Attorney-ad-Litem. OCC Attorney. CAS A. and other professionals, if applicable. The staffing is to determine if this type of adoption is an appropriate referral for an adoptive family assessment. The following foster parent/relative placement criteria shall be considered during the staffing:

Jurisdiction:

* DCFS will participate in the adoption of a minor only if either the person seeking to adopt the child, or the child, is currently a resident of Arkansas.

Residency Requirements for Adoption in Arkansas:

* The family planning to adopt may live in Arkansas or reside out-of-state and have an approved adoption home study from a licensed adoption agency in their state. The family's home study must be on file in the Adoption Services Unit.

Residency to determine jurisdiction over an adoption may be established in accordance with one of the three following sets of criteria:

* A child under the age of six (6) months is a resident of Arkansas if:

* The biological mother resided in Arkansas for more than 4 months prior to the child's birth, and

* The child was born in Arkansas or in any city which adjoins the state line or is separated only by a navigable river from an Arkansas city which adjoins the state line, and

* The child remains in this state until the interlocutory decree has been entered. Or in the case of a nonresident adoptive family, upon receipt of Interstate Compact on the Placement of Children (ICPC) approval, the child and the prospective adoptive parents may go back to their state of residence and subsequently may return to Arkansas for a hearing on the petition for adoption.

* A child over the age of six (6) months is a resident of Arkansas if that child:

* Has resided in this state for at least six (6) months, and

* Currently resides in Arkansas, and

* Is present in this state when the petition for adoption is filed and heard by a court of competent jurisdiction.

* A person seeking to adopt is a resident of Arkansas if that person :

* Occupies a dwelling within the state, and

* Has a present intent to remain within the state for a period of time, and

* Manifests the genuineness of that intent through an ongoing physical presence within the state together with indications that the person's presence is not merely transitory in nature.

Age:

Applicant is:

* Between the age of twenty-one (21) and fifty-five (55) years.

* Between the age of twenty-one (21) and forty (40) years for an infant (up to one year old).

* A primary caregiver that is at an age so that it can be anticipated that the caregiver can parent the child into adulthood.

Marital Status:

* In a two-parent home, the husband and wife shall be joint applicants, each shall actively participate in the approval process, and shall provide verification that they have been married at least two years. The marriage shall be stable.

* A person, who is divorced must provide verification of that divorce and must have been divorced for at least one year from the date on the court order.

* A single person may apply to adopt.

General Physical and Mental Health:

* Members of the household do not have a health condition or disability that would interfere with the family's ability to parent the child. Each member of the household shall have a physical examination by a physician within six (6) months prior to the approval of the adoption home study on the prospective adoptive family.

Housing:

* Space is adequate to promote health and safety.

* All firearms are maintained in a secure, locked location.

* All water hazards and dangerous pets will be assessed.

* Children of opposite sexes will have their own separate bedrooms except for infants (up to one year old).

* Water is provided by public water system or approved by the Department of Health.

Criminal Background Check:

* Members of the household fourteen (14) years of age or older must agree to a local police and an Arkansas State Police background check and must have no history of convictions for offences listed in ACA § 9-28-409, to include capital murder, 1st or 2nd degree murder, manslaughter, negligent homicide, kidnapping, false imprisonment in the first and second degrees, permanent detention or restraint, battery in the 1st. 2nd or 3rd degree, aggravated assault, assault in the 1st or 2nd degree, terroristic threatening in the 1st or 2nd degree, any sexual offense, permitting abuse of a child, endangering the welfare of a minor in the 1st or 2nd degree, contributing to the delinquency of a minor, engaging children in sexually explicit conduct for use in visual or print medium, transportation of minors for prohibited sexual conduct, use of a child or consent to use of a child in sexual performance, and producing, directing, or promoting sexual performance by a child; incest, interference with visitation, interference with custody, engaging in conduct with respect with controlled substances, distribution to minors, public display of obscenity, prostitution, promoting prostitution, criminal attempt, criminal complicity, criminal solicitation, criminal conspiracy, any felony or misdemeanor involving violence, threatened violence or moral turpitude, and former or future law of this or any other state or of the federal government which is substantially equivalent to one of the aforementioned offenses.

* In addition applicants and all members of their household age sixteen (16) years or older must agree to a FBI criminal record check if he or she has been a resident of the state for less than six (6) years. Out of state adoptive families do not need to do an Arkansas State Police Check if they have never resided in Arkansas. Adoptive parents and each member of the household age fourteen (14) years and older residing out of the state shall provide state police criminal record checks from their state of residence.

* Any person who is found guilty of, or pleads guilty or nolo contendere to, an excluded criminal offense pursuant to ACA § 901-28-409(e)(l) shall be excluded as an adoptive parent.

Central Registry Check:

* Members of the household ten (10) years of age or older must agree to a Child Maltreatment Central Registry Check in his state of residence and any state of residence in which the person has lived for the past six (6) years, and in the person's state of employment, if different. The person must have no history of true abuse and/or neglect.

* Adoptive parents and each member of the household age ten (10) years old or older, shall repeat the check every year until the adoption decree has been issued. Adoptive parents, and each member of the household age ten (10) years or older, residing out of state shall have a Child Maltreatment Central Registry Check, if available, in their state.

Resources:

* The applicant must have sufficient resources to meet the financial, medical, physical,

educational, emotional and shelter needs of the child. Verification of income/employment is required.

Birth Family:

* The family will meet the child's needs to have continuity with the birth family if applicable.

* The family can deal appropriately with interference from the birth family.

* Geographic location will not present risks for the child to be harmed by birth family.

Foster Family Care:

* The family will continue to be able to meet this child's specific needs if they continue as foster parents. The child's health and safety are paramount.

Pre-Service Training:

* The applicant has completed pre-service training.

* The applicant is willing to complete any further training in order to meet a child's specific needs.

When exceptions to the criteria are requested, the County Supervisor will request it within the written summary of the staffing and forward it to the Adoption Field Services Supervisor within five (5) working days of the staffing. The Adoption Field Services Supervisor will make a decision and notify the County Supervisor in writing within five (5) working days of receiving the summary. If the criteria are required by the Minimum Licensing Standards for Child Welfare Agencies, the request must be approved by the Adoption Field Services Supervisor and then forwarded to the Adoption Field Services Manager for review. The Adoption Field Services Manager will forward the request to the Assistant Director of Community Services for approval. If approved by the Division Director, the request must be forwarded to the Manager of the Child Welfare Agency Licensing Unit for a decision of alternative compliance. The decision must be given in writing and filed in the case record. Alternative compliance with the standards required by the Minimum Licensing Standards for Child Welfare Agencies may be granted if the alternative form of compliance offers equal protection of the health, safety and welfare to children and meets the basic intent of the requirement for which the alternative compliance is sought.

* The Adoption Field Services Supervisor will forward a written notification to the family if the exception is not approved and will explain the internal review procedure. A copy will be forwarded to the Family Service Worker, County Supervisor, and Adoption Specialist.

The Adoption Specialist will:

* Parti cipate in the staffing.

The County Supervisor will (if staffing supports referral for an adoptive family assessment):

* Forward the following to the Adoption Field Services Supervisor within five (5) working days of the staffing:

* Written summary which provides the date of the staffing, names/titles of persons participating, findings on compliance to the placement criteria and recommendation.

* Completed "Request for Consideration to Adopt" (CFS-489) on a foster parent or kinship foster parent.

* Completed "Home Study/Application and Attachments" (CFS-450) on a foster parent.

* Initial family assessment/home study on a foster parent or kinship foster parent.

* Most recent re-evaluation assessment/home study on a foster parent.

* Most recent "Family Foster Parent Re-evaluation" (CFS-451) and all re-evaluation assessments/studies on a foster parent.

The County Supervisor will (if staffing does not support referral for an adoptive family assessment):

* Forward a copy of the written summary to the Adoption Field Services Supervisor within five (5) working days of the staffing:

* Written summary, which provides the date of the staffing, names/titles of persons participating, and findings on compliance to the placement criteria and recommendation.

* Completed "Request for Consideration to Adopt" (CFS-489) on a foster parent or kinship foster parent.

* Completed "Family Foster Home Study/Application and Attachments" (CFS-450) on a foster parent.

* Initial family assessment/home study on a foster parent or kinship foster parent.

* Most recent "Family Foster Parent Re-evaluation" (CFS-451) and all re-evaluation assessments/studies on a foster parent.

* Refer the foster parent, kinship foster parent, or relative to the Adoption Specialist in writing within five (5) working days of receiving written notification if the Adoption Field Services Supervisor disagrees with the recommendation and directs that an adoption home study be completed.

The Adoption Field Services Supervisor will (if the staffing does not support referral for an adoptive family assessment):

* Assess the recommendation and request any additional information.

* Notify the foster parent, kinship foster parent or relative in writing within ten (10) working days of the decision and state the reason(s) for the decision and internal review procedures.

* Send a copy of this written notification to the Family Service Worker, County Supervisor, Adoption Specialist Adoption Field Services Manager, and OCC Attorney.

* Send a memorandum to the County Supervisor within ten (10) working days with reasons this adoptive placement should be assessed if in disagreement with the recommendation.

* Send a copy of this memorandum to the Family Service Worker, Adoption Specialist, Area Manager and Adoption Field Services Manager.

PROCEDURE (VIII-F2): Assessment and Preparation

The Family Service Worker will:

* Assure prior to the permanency planning staffing, that the child's out-of-home placement record is up to date and that all attachments which are required for an adoption packet (see FSPP Appendix II-B) are in the child's record, and are copied and forwarded to the Adoption Specialist within three (3) working days of the permanency planning hearing.

* Send additional attachments to the Adoption Specialist once the initial adoption packet is completed in order to maintain current information until a decision is made.

* Document in the child's out-of-home placement record, and in CHRIS, the efforts to secure needed attachments and the reason for an attachment not being available.

* Provide information requested by the Adoption Specialist in the preparation of the child's adoption summary.

* Prepare the child for adoption and assist in preparing the foster parent, kinship foster parent, or relative for adoption.

* Assure compliance to Indian Child Welfare Act, if applicable. The Adoption Specialist will:

* Prepare the child's adoption packet [adoption summary and attachments - see FSPP Appendix II-A, II-B, and "Minimum Licensing Standards for Child Welfare Agencies" (PUB-04)] within thirty (30) days from the permanency planning hearing.

* Send a copy of the adoption summary to the Family Service Worker.

* Provide the following forms to the foster parent, kinship foster parent or relative immediately after the staffing that is conducted within ten (10) working days from the hearing that terminates parental rights (if the staffing supports foster parent adoption):

* "Adoption Application" (CFS-400);

* "Adoption Questionnaire" (CFS-409);

* "General Medical Form-Adoptions" (CFS-404) for each member in the household;

* "State Adoptions Criminal Record Check" (CFS-342B) and release for local law enforcement check for each member of the household who is fourteen (14) years of age or older and FBI criminal record check on each adult applicant who has not resided in the state for at least six (6) years;

* "Request for CPS Central Registry Check" (CFS-316) for members of the household who are ten (10) years of age or older;

* "Request/Consent for Health Department Services" (CFS-455) if applicable;

* "Application for Adoption Subsidy" (CFS-425) if applicable;

* "Statement of Income and Resources for Adoption Subsidy" (CFS-426) if applicable.

* Complete the assessment and preparation process with the foster parent, kinship foster parent or relative. Send the adoption home study, recommendations, completed forms, reference letters, child's adoption packet and "Change of Status" (CFS-414) to the Adoption Field Services Supervisor within four (4) months of the court hearing that terminates parental rights.

* Make at least two (2) visits in person with the prospective adoptive family with at least one visit being in the home. Have a separate, face-to-face interview with each prospective adoptive parent. Interview each household member in person who is ten (10) years of age or older.

* Refer a relative who has not been approved as a foster parent or kinship foster parent to pre-service training. Complete the assessment and preparation process with this relative and send the adoption home study, recommendation, completed forms, reference letters, child's adoption packet, and CFS-414 to the Adoption Field Services Supervisor within four (4) to six (6) months of the court hearing that terminates parental rights.

* In CHRIS:

* complete the Affidavit of Disclosure screen on the child in the child's protective service case. If Foster Parent Adoption, be sure to check the Foster Parent(s) Adoption checkbox.

* Prepare and present to the foster parent, kinship foster parent, or relative one non-identifying copy of the child's adoption packet and a complete Disclosure for Adoption (CFS-471) during the assessment and preparation process.

* Review and discuss the adoption packet with the foster parent, kinship foster parent, or relative.

* Secure signatures on the Disclosure for Adoption (CFS-471) form and assure a copy is provided.

* Assist in preparing the child for adoption and prepare the foster parent, kinship foster parent, or relative for adoption.

* Notify the foster parent, kinship foster parent or relative in writing if the adoption home study cannot be completed within sixty (60) days of the final home visit and explain the reason.

* Send a copy of this notification to the Adoption Field Services Supervisor and Family Service Worker.

* Discuss any delays in completing the assessment and preparation process with the Adoption Field Services Supervisor and document reasons.

* Complete the packet to determine eligibility for adoption subsidy, if applicable, during the adoption assessment and preparation process and forward to the Adoption Subsidy Coordinator, Adoption Services Unit.

PROCEDURE (VIII-F3): Foster Parent, Kinship Foster Parent, or Relative Adoption Decision

The Adoption Field Services Supervisor will:

* Make a decision to approve or deny the foster parent, kinship foster parent, or relative's application to adopt within ten (10) working days of receiving the completed adoption home study and send a written notification to the foster parent, kinship foster parent or relative.

* Send a copy of the approval or denial notification to the Adoption Field Services Manager. Adoption Specialist, Area Manager. Family Service Worker, County Supervisor, and OCC Attorney.

* Explain in the written notification the reason(s) for denial and the internal review procedures.

* Send a written notification to the foster parent, kinship foster parent, or relative if a decision to approve or deny the application cannot be made within sixty (60) days of the final home visit and explain the reason(s).

* Send a copy of this written notification to the Adoption Specialist and Family Service Worker.

The Family Service Worker will:

* Update and transfer the out-of-home placement case record (paper record and CHRIS) to the Adoption Specialist within five (5) working days of receiving the written notification of the approval for foster parent, kinship foster parent, or relative adoption.

* In CHRIS:

* Assign the Adoption Specialist as Primary Worker in the Assign/Transfer Screen. The child remains in the current foster parent placement until finalization.

* Enter current foster parent or relative as an adoptive resource completing the Resource Screens.

* If child is to exit current foster care placement to enter relative's adoptive home, exit child from current foster parent placement and enter child into the relative's adoptive home in the Placement screens in the child's protective service case.

The Adoption Specialist will:

* Forward a "Change of Status" (CFS-414) to the Adoption Coordinator, Adoption Services Unit, within five (5) working days of receiving notification of approval to report approval of the placement.

* Assume primary case management once written notification of approval has been received.

PROCEDURE (VIII-F4): When a Foster Parent, Kinship Foster Parent or Relative Files a Petition to Adopt Without Prior Knowledge or Consent of DCFS

The County Supervisor or Adoption Specialist, when learning about the petition, will:

* Notify immediately the Area Manager, Adoption Field Services Supervisor. OCC Attorney and Adoption Field Services Manager and follow-up with written notification.

The County Supervisor will:

* Arrange a staffing to determine if adoptive placement is appropriate to consider.

* Submit the results and recommendations from the staffing to the Area Manager.

* Direct staff to follow procedures outlined above.

* Work with the OCC Attorney in regard to pending litigation if it appears the foster parent, kinship foster parent or relative would not be a suitable adoptive parents for the child.

* Notify the Adoption Specialist if information regarding other prospective adoptive families for the child is needed.

PROCEDURE (VIII-F5): Post-Placement Services

The Adoption Specialist will:

* Provide casework counseling, support and referral to needed resources and services until the adoption is finalized.

* Visit (no less than twice a month in the home) and make contacts as needed with the family until the adoption is finalized.

* Document in narrative the reasons an adoption has not been legally finalized within two (2) months of the adoption placement date and set a time frame for finalization.

* Document in narrative, place and dates of post-placement contacts, activities, progress, concerns, etc.

* Send copies of the documentation to the Family Service Worker, and Adoption Field Services Supervisor.

* Develop a "Case Plan" (CFS-6010) within thirty (30) calendar days of written notification to the foster parent, kinship foster parent, or relative approving the application for adoption.

* Notify the foster parent, kinship foster parent, or relative of the date for a judicial review.

* Recommend initiation of procedures to finalize the adoption upon receipt of approval of the adoption by the Adoption Field Services Supervisor and approval of adoption subsidy, if applicable, if the child has resided with the foster parent, kinship foster parent or relative for at least six (6) months.

* Inform the family about post-adoption services (provide brochure).

PROCEDURE (VIII-F6): Disruption of Foster Parent, Kinship Foster Parent or Relative Adoption

If disruption (prior to finalization) of an adoptive placement is imminent, the family's Adoption Specialist will:

* Provide appropriate services to preserve the family and prevent disruption, if applicable.

* Notify the Adoption Field Services Supervisor. County Supervisor, Family Service Worker, Adoption Field Services Manager, OCC Attorney and attorney ad-Litem.

* In CHRIS:

* Document the staffing, reason for disruption, and all contacts with adoptive family in the Contacts screen.

* Exit child from current adoptive home placement selecting Placement Resource Requested Removal or Child Requested Change of Placement in the Enter/Exit screen.

* Transfer the case back to the last Primary Assigned Family Service Worker in the Assign/Transfer screen.

* Schedule and conduct a staffing to include those listed above and the foster parents, kinship foster parent(s) or relative any age appropriate child and any other significant individuals.

* Return case management responsibility to the Family Service Worker of the initiating county and transfer primary worker designation in CHRIS back to the Family Service Worker if it is not the plan to immediately select another adoptive family, and disruption occurs. Return the child's paper record back to the Family Service Worker within five working days of the disruption.

* Prepare the adoptive family for the disruption and provide casework counseling and referrals for needed services.

* Refer to Policy VIII-G.

PROCEDURE (VIII-F7): Finalization of an Adoption

The Adoption Specialist will forward the following to the Adoption Field Services Supervisor when submitting the recommendation to finalize the adoption:

* checklist for Recommendation for Finalization (CFS-432);

* "Change of Status" (CFS-414);

* "Adoption Application" (CFS-400);

* initial adoption home study of the adoptive family and all updates;

* adoption summary of the child and all updates;

* signed disclosure form;

* post-placement narrative;

* court order terminating parental rights;

* certified birth certificate of child;

* FBI criminal record check if applicable;

* "Adoption Assistance" (CFS-428) if applicable. The Adoption Specialist will:

* Inform the family of post-adoption services.

* Document in case record narrative the plan of action to resolve barrier to finalizing the adoption (if the Adoption Field Services Supervisor does not agree with the recommendation). Inform the family of the recommendation.

* Monitor and document the implementation of the plan of action and progress toward achieving the plan.

* Assist OCC Attorney in completing the adoption coupon and securing the fee from the family for an amended birth certificate.

* Forward the child and adoptive family records to the Adoption Services Unit when the adoption is finalized.

* The final decree of adoption shall be entered into the child's record prior to forwarding any records.

* In CHRIS:

* Child Protective Service Case:

* Exit child out of current 'pre-adoptive' placement by selecting Adoption as Exit Reason and entering the finalized adoption date as Exit Date.

* Close child protective service case in Case Summary screen if all children are adopted and no other child protective services are being offered to birth family or siblings.

* Adoption Case:

* Open New Adoption Case with adoptive parents and adoptive child as clients.

* Complete Client General Information screens on all clients; retrieve the adoptive child's characteristics, eligibility and affidavit of disclosure screens from old child protective service case.

* Complete Adoption Subsidy screens if adoptive parents are receiving an adoption subsidy.

* Document contacts with adoptive family in Contacts Screen. The Adoption Field Services Supervisor will:

* Assess the information and recommendation, which has been forwarded by the Adoption Specialist, within five (5) working days.

* Sign the "Change of Status" (CFS-414) if it is agreed that procedures to finalize the adoption should be initiated.

* Send a copy of the signed CFS-414 to the Adoption Specialist.

* Prepare and sign a consent for adoption if it is agreed that procedures to finalize the adoption should be initiated.

* Notify the Adoption Specialist in writing to explain if there is disagreement to initiating the procedures to finalize the adoption.

* Formulate with the Adoption Specialist a plan of action to resolve the barriers to finalizing the adoption.

The Adoption Field Services Supervisor will:

* Forward within five (5) working days a packet of information to the OCC Attorney or Private Agency Attorney . This packet will include:

* the signed consent to the adoption;

* certified birth certificate of child;

* termination of parental rights court order;

* adoption home study of the adoptive family;

* child's adoption summary (The child's adoption summary serves as the detailed, written health history and genetic and social history and must be filed with the clerk before the entry of the adoption decree.);

* "Adoption Application" (CFS-400);

* "Adoption Assistance" (CFS-428) if applicable;

* FBI criminal record check if applicable;

* Post-placement narrative.

PROCEDURE (VIII-F8): Post-Adoption Services

After an adoption has been finalized, the following services may be offered to help preserve adoptive families:

* Adoption subsidy;

* Mutual Consent Voluntary Adoption Registry;

* Casework management;

* Information about, and referral to, service providers;

* Respite care;

* Education and training;

* Adoptive parent support groups;

* Resource library;

* Intensive Family Services;

* Family Support Services. The Adoption Specialist will:

* Arrange these services upon request from the adoptive family.

* Assist the adoptive family in completing forms and in following procedures.

* Document contacts, activities, progress, concerns, etc.

Subsidy Note: Re-evaluations for state adoption maintenance subsidies are not required. However, when state funded subsidies extend beyond one (1) year, or for federally funded subsidies, verification of circumstances to continue the subsidy must be documented annually. To verify a continued need for subsidy in out of state cases the child's school, therapist, physician or clergy can provide verification by submitting a letter which states that the adoptive parent(s) still has the care and responsibility for the child.

* The Central Office Adoption Support Specialist will forward a cover letter along with the CFS-431 (Certification of Adoption Subsidy Eligibility to the adoptive parents annually. The cover letter will inform the adoptive parents that the local Adoption Specialist will contact them to schedule a visit.

* The Central Office Adoption Support Specialist will forward a copy of the cover to the local Adoption Specialist concurrently with notice to the adoptive parents.

* The adoptive parents will complete and submit the CFS-431 to the DCFS Adoptions Services Unit within ten (10) working days of the date of the accompanying cover letter. The Central Office Adoption Support Specialist will forward a copy of the completed CFS-431 to the Adoption Specialist for their records.

* The Adoption Specialist will have annual face-to-face contact with the child or otherwise verify that the child is still with the adoptive family. The Adoption Specialist should make the face-to-face contact a positive experience by exploring any needs for post adoption services. The Adoption Specialist should also inquire as whether the adoptive parents have added the adoptive child to their medical insurance and if so the family must complete a DCO -662 (Third Party Resource). The Adoption Specialist is responsible for submitting the completed form to the Medical Services Section of the Medical Services Division.

* In CHRIS:

* Document all contacts, activities, concerns in the Contact screen in the adoption case.

POLICY (Vlll-G): DEVELOPMENT OF ADOPTIVE PLACEMENT

The Division provides adoption services to recruit, retain, assess, and prepare adoptive families. The services focus on finding families for children rather than finding children for families. Assessment and preparation of prospective adoptive families are completed according to the need for homes for children. A child is assessed and prepared for adoption. The child's health and safety shall be of paramount concern in the development of the adoptive placement.

Siblings shall be placed together in the same adoptive home. Siblings may be placed separately upon written documentation by a Mental Health Professional that placement of the siblings together would be detrimental to their best interests or is otherwise not possible at the time of placement.

The Division provides pre-placement services to move children into adoptive families in a timely manner and post-placement services to help the family adjust. After finalization, services are available to help preserve adoptive families.

The placement of a child for adoption will not be denied or delayed when an approved family is available outside the jurisdiction responsible for handling the child's case. A fair hearing will be granted to any individual who alleges denial of adoption approval as a result of residing outside the jurisdiction responsible for placing the child.

The Juvenile Division of Circuit Court shall retain jurisdiction to issue orders of adoption, interlocutory or final, when a juvenile is placed outside the state of Arkansas.

Adoptive parents, and each member of the household age ten (10) years and older, residing in Arkansas shall be checked with the Child Maltreatment Central Registry. Adoptive parents and each member of the household age ten (10) years and older residing out of state shall provide child Maltreatment Central Registry Checks from their state of residence.

the household age sixteen (16) years and older who have not resided in Arkansas continually for the past six (6) years, shall complete a record check with the Federal Bureau of Investigation.

The Division will provide documentation in the case record that a criminal record check was conducted on the prospective adoptive parent.

Legal risk adoptive placements may be considered for a newborn that is being relinquished for adoption or for a child whose birth/legal parent has filed an appeal to the termination of parental rights.

All records of any adoption finalized in the state of Arkansas shall be maintained for ninety-nine (99) years.

PROCEDURE (VIII-G1): Recruitment and Retention of Adoptive Applicants

The Adoption Specialist will:

* Publicize the need for adoptive families.

* Publicize the availability and purpose of adoption subsidy.

* Recruit adoptive families that reflect the ethnic and racial diversity of children for whom adoptive homes are needed.

* Recruit for placement for specific children when necessary.

* Utilize adoptive families and volunteers in recruitment campaigns.

* Respond within three (3) working days to families wanting to adopt.

* Complete the Adoption Inquiry (CFS-413).

* Provide adoption brochures.

* Support the prospective adoptive parents during inquiry, application, preparation/assessment, approval, waiting for placement, selection, placement and finalization of adoption.

* Explain and discuss the adoption process.

* Complete the adoption preparation/assessment within four (4) to six (6) months (includes pre-service training).

The Adoption Field Services Supervisor will:

* Develop, implement and monitor an area-wide adoption recruitment plan.

* Track and monitor adoption inquiries. The Adoption Services Unit Manager or designee will:

* Develop, implement and monitor a state-wide adoption recruitment plan.

PROCEDURE (VIII-G2): Criteria for Adoption

The following criteria will be considered in determining the appropriateness of adoptive applicants:

Jurisdiction:

* DCFS will participate in the adoption of a minor only if either the person seeking to adopt the child, or the child, is currently a resident of Arkansas.

Residency Requirements for Adoption in Arkansas: * See Procedure VIII-F1 for Arkansas residency requirements for adoption.

Age Applicant is:

* between the age of twenty-one (21) and fifty-five (55) years; or

* between the age of twenty-one (21) and forty (40) years for an infant (up to one year old); and

* a primary caregiver who is at an age so that it can be anticipated that he can parent the child into adulthood.

Marital Status:

* A person who is divorced must provide verification of that divorce and must be divorced for at least one (1) year from the date on the court order.

* A_single person may apply to adopt.

General Physical and Mental Health:

Housing:

* Space is adequate to promote health and safety.

* All firearms are maintained in a secure, locked location.

* All water hazards and dangerous pets will be assessed.

* Children of opposite sexes will have their own separate bedrooms except for infants (up to one year old).

* Water is provided by public water system or approved by the Department of Health.

Criminal Background Check:

* Members of the household fourteen (14) years of age or older must agree to a local police and a State Police background check and must have no history of convictions for offences listed in ACA § 9-28-409. (See Procedure VIII-F1 for a listing.)

* In addition, applicants and all members of their household age sixteen (16) years or older must agree to a FBI Criminal Record Check if he has been a resident of the state for less than six (6) years. Out-of-state adoptive families do not need to do an Arkansas State Police Check if they have never resided in Arkansas. Adoptive parents and each member of the household age fourteen (14) years and older residing out-of-state shall provide state police criminal record checks from their state of residence. A FBI check is not required if applicant has resided in the state for six (6) years or longer.

* Any person who is found guilty of or pleads guilty to an excluded criminal offense pursuant to ACA § 901-28-409(e)(l) shall be excluded as an adoptive parent.

Central Registry Check:

Resources:

* The applicant must have sufficient resources to meet the financial, medical, physical, educational, emotional and shelter needs of the child. Adoption subsidy may be a resource for a child who meets the eligibility criteria. Verification of income/employment is required.

Pre-Service Training:

* Completion of adoption pre-service training.

When exception to the eligibility criteria are requested, the Adoption Specialist will:

Request exception to the eligibility criteria in writing to the Adoption Field Services Supervisor. The Adoption Field Services Supervisor will make a decision and notify the Adoption Specialist in writing within five (5) working days of receiving the request. If the criteria are required by the Minimum Licensing Standards for Child Welfare Agencies, the request must be approved by the Adoption Field Services Supervisor and then forwarded to the Adoption Field Services Manager for review. The Adoption Field Services Manager will forward the request to the Assistant Director of Community Services for approval. If approved by the Division Director, the request must be forwarded to the Manager of the Child Welfare Agency Licensing Unit for a decision of alternative compliance. The decision must be given in writing and filed in the case record. Alternative compliance with the standards required by the Minimum Licensing Standards for Child Welfare Agencies may be granted if the alternative form of compliance offers equal protection of the health, safety and welfare to children and meets the basic intent of the requirement for which the alternative compliance is sought.

* Discuss the decision with the applicant.

PROCEDURE (VIII-G3): Application for Adoption

The Adoption Specialist will:

* Assess and prepare the adoptive applicants for adoption.

* Refer applications from friends, relatives, and DHS employees to the Adoption Field Services Supervisor.

* Provide an interview with a prospective adoptive applicant or a meeting with a group of prospective adoptive applicants within thirty (30) working days of initial contact.

* Notify Adoption Field Services Supervisor if this time frame cannot be met. The Adoption Field Services Supervisor will:

* Decide who will assess and prepare an adoptive applicant if there is a conflict of interest.

The Adoption Specialist will share the following information during the adoption inquiry interview or meeting:

* The adoption program is child focused, and the family who will best meet the child's individual needs will be selected.

* Application approval does not guarantee placement.

* A child's health and safety are paramount in the development of an adoptive family for a child.

* The completed adoption home study on the family is the basis for selection.

* Priority is given to completing an adoption home study on families for children with special needs who are waiting for placement.

* Adoption Specialist's role and responsibilities;

* adoption process;

* assessment and preparation process and time frames;

* reasons children enter Out-of-Home Placement and are legally freed for adoption;

* explanation of children with special needs;

* eligibility criteria for adoption;

* adoption subsidy;

* discussion of children currently awaiting placement (have photo-listing available);

* legal procedures;

* adoption registry and "Adoption Information Registry Guide" (PUB-113).

The Adoption Specialist may provide the following forms during the interview or group meeting:

* "Adoption Application" (CFS-400)

* 'Adoption Questionnaire" (CFS-409)

* "Adoption Fact Sheet" (CFS-401)

* "Family Assessment Information (CFS-405)

* "State Adoptions Criminal Record Check" (CFS-342B) and release for local law enforcement check for each member of the household who is fourteen (14) years of age or older, and a FBI criminal record check on each adult applicant who has not resided in the state for at least six (6) years.

* "Request for CPS Central Registry Check" (CFS-316) for members of the household who are ten (10) years of age or older.

* "Request for Health Department Services" (CFS-455), if applicable.

* "General Medical Form - Adoption" (CFS-404) on each member in the household and completed within six (6) months of approving the adoption home study on the prospective adoptive family.

PROCEDURE (VIII-G4): Assessment and Preparation of Adoptive Applicants

The Adoption Specialist will:

* Set up pre-service training for the applicants.

* Make at least two visits in person with the prospective adoptive family with at least one visit in the home.

* Have a separate, face-to-face interview with each prospective adoptive parent.

* Set up pre-service training for the applicants.

* Interview each household member separately who is ten (10) years of age or older.

* Ask the adoptive applicant to complete a photograph album.

* Provide information about the following to the adoptive applicant:

* parenting children with special needs;

* the importance of a child's birth family and out-of-home placement history;

* child maltreatment;

* separation and attachment;

* child development;

* disabilities;

* support systems;

* resources to meet a child's special needs;

* disruption of an adoption;

* adoption related issues.

* Require a professional assessment of an applicant's ability to parent, if needed. It may be necessary for the adoptive applicant to pay for that assessment.

PROCEDURE (VIII-G5): Adoption Home Study

Upon completion of assessment and preparation, the Adoption Specialist will prepare a narrative summary [refer to desk guide and "Minimum Licensing Standards for Child Welfare Agencies" (PUB-04)] about the adoptive applicants.

The Adoption Specialist will:

* Submit the narrative summary and written recommendation, all required forms and references to the Adoption Field Services Supervisor within forty-five (45) days of the final home visit.

* Notify the applicant in writing if this packet cannot be completed within sixty (60) days of the final home visit and explain the reason.

* Send a copy of this notification to the Adoption Field Services Supervisor.

* Evaluate with Adoption Field Services Supervisor to determine whether to proceed with approving the applicant if there are any concerns.

* Explain the reasons for denial in a personal interview and refer for professional services if indicated.

* Send a copy of this narrative summary, written notification of approval, all required forms, reference letters, and photograph album to the Adoption Coordinator, Adoption Services Unit when an application is approved.

The Adoption Field Services Supervisor will:

* Determine the approval or denial of the adoptive applicant.

* Notify the adoptive applicant in writing of the approval or denial within fifteen (15) days of receiving the narrative summary and related information from the Adoption Specialist.

* In CHRIS:

* Upon approval of the adoptive applicant enter the new adoptive family in CHRIS by completing the Resource screens to obtain a resource provider number. Also, the Vendor Maintenance Form - F10021 must be completed and sent to AASIS as soon as possible.

* Explain in writing the reason for a denial and the internal review procedures.

* Notify the adoptive applicant in writing if a decision cannot be made within sixty (60) days of the final home visit and explain the reason. Send a copy of the notification to the Adoption Specialist.

* Return the narrative summary and entire record to the Adoption Specialist with a copy of the written approval or denial notification.

PROCEDURE (VIII-G6): Re-evaluation of Approved Adoptive Applicant's Record

A foster child placed in an adoptive home continues status as a foster child until finalization of the adoption. The adoptive home must be re-evaluated annually until the adoption is finalized. If an approved applicant has not had a child placed within one (1) year, or a child has been placed and the adoption has not been finalized, the Adoption Specialist will:

* Visit in the home and ascertain changes in the situation and assess the family's continued interest in adoption.

* Update the narrative summary and record annually from the date in the approval letter until a child is placed and the adoption is finalized.

* Submit within forty-five (45) days from the home visit a packet to the Adoption Field Services Supervisor to include:

* Narrative summary with recommendation;

* "Adoption Questionnaire" (CFS-409);

* "General Medical Form-Adoption" (CFS-404s) on each member of the household;

* "State Adoptions Criminal Record Check" (CFS-342Bs) and releases for local police checks signed by household members who are fourteen (14) years of age or older;

* "Request for CPS Central Registry Check" (CFS-316s) signed by household members who are ten (10) years of age or older.

* "Request/Consent for Health Department Service" (CFS-455), if applicable.

* "Change of Status" (CFS-414).

* Send a copy of the narrative summary, all required forms and written notification of approval to the Adoption Coordinator, Adoption Services Unit when a re-evaluation is approved.

* In CHRIS:

* Complete the Resource Evaluation Screen on the adoptive family.

* Complete the Contact Screen on all activities concerning re-evaluation process.

* Update the Resource Household Members screens especially the Criminal Record Checks and the Central Registry Checks.

* Complete the Resource Contracts/Status screen to enter the new Home Study re-evaluation date and Status of the approved home study and Request for Approval.

* If the approved applicant experiences any major changes (e.g., marriage, divorce, separation, or changes in health, residence or family composition), the Adoption Specialist will reevaluate the family prior to placement of the child. The Adoption Specialist will not wait for the annual re-evaluation. An additional home visit is required if there has been a change of residence. Completion of new forms, listed above, will be necessary depending on the type of change. A new narrative summary with a recommendation is also required.

The Adoption Field Services Supervisor will:

* Refer to Procedure VIII-G5.

* In CHRIS:

* Review the Resource Evaluation screen on adoptive family.

* Review and approve the new Home Study and Status on the Contracts/Status screen on adoptive family.

PROCEDURE (VIII-G7): Selection of an Adoptive Family

The Family Service Worker will:

* Notify Adoption Specialist of staffings that address the permanency plan of adoption. (See Procedure VI-A2 "Concurrent Planning".)

* Notify the Adoption Specialist within two (2) working days of the court hearing that termination of parental rights with power to consent to adoption has been granted if the Adoption Specialist was not at the hearing.

* Assure prior to the permanency planning staffing that the child's out-of-home placement record is up to date and that all attachments which are required for an adoption packet (Appendix II-B) are in the child's record. These will be copied and forwarded to the Adoption Specialist within three (3) working days after the permanency planning hearing.

* Send additional attachments to the Adoption Specialist once the initial adoption packet is completed in order to maintain current information until a child is placed with an adoptive family.

* Document in the child's out-of-home placement record and in CHRIS the efforts to secure needed attachments and the reason for an attachment not being available.

* Provide information requested by the Adoption Specialist in the preparation of the child's adoption summary and in the selection of an adoptive family.

* Place siblings together in the same adoptive home. Separate siblings by placement only upon written determination by a Mental Health Professional that placement of the siblings together would be detrimental to their best interest or is otherwise not possible at the time of initial placement.

* Continue to prepare the child for adoption.

* In CHRIS:

* Complete the Recommendation for Termination of Parental Rights screen and the Termination of Parental Rights screen to document the dates, Notice Type and Outcome of Hearing.

The Adoption Specialist will:

* Determine prior to the ninety (90) day, six (6) months, and eleven (11) months staffings if there is a resource of approved adoptive applicants to consider for a child who may have a permanent plan of adoption (enter characteristics of child into the computer matching system to obtain listing of approved adoptive applicants). If there is not an adequate resource of approved adoptive applicants, the Adoption Specialist will initiate generalized recruitment for an adoptive family who may be interested in adopting a child with similar characteristics.

* Prepare the child's adoption packet (adoption summary and attachments ~ see Appendix II-A and II-B) within thirty (30) days from the permanency planning hearing.

* In CHRIS:

* Complete the Adoption Characteristics section in the Child's Characteristic's Screen in the child's child protective service case.

* Enter characteristics of the child into the computer matching system, Adoption Data Matching (CFS-468), within five (5) working days from the court hearing that terminated parental rights to obtain a listing of approved and registered adoptive applicants from in and out-of-state.

* Contact the Adoption Coordinator, Adoption Services Unit, to request adoption assessments on the approved adoptive applicants.

* Decide within ten (10) working days from receiving the listing and adoption assessments if recruitment of an adoptive family is needed.

* Assist the Family Service Worker in preparing the child for adoption.

* Complete and maintain an Individualized Recruitment Plan (CFS-433) written recruitment plan if an appropriate adoptive family is not available.

* Send the following to the Adoption Coordinator, Adoption Services Unit, if a photo-listing and website registration of the child is needed: ten close-up color photographs, adoption summary, special evaluations if applicable, the Adoption Recruitment Agreement (CFS-467) if ten (10) years or older and a draft of the completed registration page.

* Notify the Adoption Coordinator in writing if registrations are needed on available, national adoption exchanges.

* Monitor and document recruitment activities on the Individualized Recruitment Plan (CFS-

433) .

* Enter characteristics of the child into the computer matching system Adoption Data Matching (CFS-468) on a consistent basis if the initial listing did not result in the selection of an appropriate adoptive family.

* Update the child's adoption summary every six (6) months until an appropriate adoptive family is selected and assure that attachments are updated. Send a copy of the updated adoption summary and special evaluations to the Adoption Coordinator if the child has a photo-listing, website and/or adoption exchange registration. Send a copy of the updated summary to the child's Family Service Worker.

* Send ten (10) color photographs every twelve (12) months to the Adoption Coordinator, Adoption Services Unit, to update a child's registration in the photo-listing and website.

* Assure compliance with Indian Child Welfare Act, if applicable.

* Consult with the Family Service Worker, the family's Adoption Specialist and other appropriate DCFS staff and professionals involved with the child in the selection of an adoptive family. Schedule and conduct a staffing, if applicable.

* Select the most appropriate approved adoptive applicant for the child consistent with the child's needs. Ensure the applicant's ability to meet the special needs of the child. Refer to desk guide and "Minimum Licensing Standards for Child Welfare Agencies" (PUB-04). Document the selection by completing the Selection of Adoptive Family (CFS-470).

* Send the completed Selection of Adoptive Family (CFS-470) to the Adoption Field Services Supervisor within ten (10) working days of receiving the assessments of approved adoptive applicants for a child who does not have a special need(s) and within thirty (30) working days for a child with a special need(s). Attach a copy of the child's adoption summary and the selected family's adoption assessment to the CFS-470).

* Delete identifying information in the child's adoption packet as it relates to the child's birth/legal parent and extended family. Make a copy of the non-identified adoption packet for the selected adoptive family and one for the family's Adoption Specialist, if different from the child's Adoption Specialist. Upon approval of the selection, complete a Disclosure for Adoption (CFS-471). Forward packets and CFS-471) with a memorandum to the family's Adoption Specialist if different from the child's Adoption Specialist.

* The memorandum should include significant information about the child including the need for special resources/services, provide a schedule for pre-placement activities and convey any other significant information that relates to the placement of the child.

* Send a copy of the memorandum to the Adoption Field Services Supervisor. Family Service Worker, and OCC Attorney for the child's initiating county.

* Discuss delays in the selection of an adoptive family with the Adoption Field Services Supervisor and document reasons for the delay.

* Determine immediately if another approved adoptive applicant can be selected if the Adoption Field Services Supervisor, the adoptive family, or child does not agree with a selection. Document if another approved adoptive family cannot be selected and continue recruitment activities.

* Forward a written notification to the Adoption Specialist for each approved adoptive applicant who has been considered, and provide the reason(s) for the applicant not being selected. The applicant's Adoption Specialist will notify the approved applicant in writing if he had asked to be considered for a child who is registered in the DCFS photo-listing and website but was not selected.

* Initiate and follow ICPC procedures if an out-of-state approved adoptive applicant is selected.

The Adoption Coordinator will:

* Complete, within five (5) working days of receiving the required information, a photo-listing and website registration for a child referred by an Adoption Specialist.

* Coordinate and maintain a photo-listing book and website of children with special needs to be distributed to each Adoption Specialist.

* Complete, within five (5) working days of receiving the required information, a registration on an available adoption exchange for a child referred by an Adoption Specialist.

* Send to a Adoption Specialist within three (3) working days names of prospective adoptive families who respond to recruitment activities.

* Coordinate and maintain the computer matching system to assist in the selection of an adoptive family.

* Maintain the file for adoption assessments of approved adoptive applicants who reside within the state and out-of-state.

* Maintain the file for photograph albums of approved adoptive applicants and send an album to a child's Adoption Specialist's at the time an adoptive family is selected.

* Forward to the Adoption Specialist within three (3) working days of receiving notification, the assessments of approved adoptive applicants to determine if there is an appropriate family for a child.

* Provide technical assistance on recruitment and selection of adoptive families. The Adoption Field Services Supervisor will:

* Assess the child's adoption packet, the assessment of the approved adoptive applicant, and the Selection of Adoptive Family (CFS-470) from the Adoption Specialist and determine the appropriateness of the selection within ten (10) working days.

* Document the determination to approve or deny the selection on the Selection of Adoptive Family (CFS-470) from the Adoption Specialist and explain in writing the reason(s) for a denial.

* Return all information to the Adoption Specialist.

PROCEDURE (VIII-G8): Disclosure, Pre-Placement, and Placement Activities

After the selection of an adoptive family has been approved , the child's Adoption Specialist will:

* Continue to assist the Family Service Worker in preparing the child for adoption.

* Assist the Family Service Worker in preparing the child to meet the selected adoptive family (including the presentation of the family's photograph album) after the adoptive parents have signed the disclosure form.

* In CHRIS:

* Complete the Affidavit of Disclosure in the child's child protective service case once an adoptive family has been selected.

* Document all contacts, visits, activities, progress, concerns in the Contact Screen in the child's protective service case.

* Arrange and conduct pre-placement visits between the child and the selected adoptive family. There must be at least three pre-placement visits for a child who is two (2) years of age or older. These visits shall not be scheduled until the selected adoptive parent(s) have signed the disclosure form.

* Supervise visits of the child with the selected adoptive family when the visits are in the child's locale.

* Review information about the child with the selected adoptive family and answer questions.

* Provide support to the selected adoptive family.

* Assess the acceptance and development of a relationship between the selected adoptive family and the child.

* Remain in contact with the adoptive family's Adoption Specialist.

* Coordinate times, dates, places, and activities for the pre-placement visitation schedule with the family's Adoption Specialist and child's Family Service Worker.

* Arrange any needed appointments with the Family Service Worker for the selected adoptive family to meet with special providers, i.e., mental health counselors, doctors, school personnel, etc.

* Assess the child's wardrobe. Arrange purchases of any additional clothing with the Family Service Worker.

* Arrange with the Family Service Worker a physical exam and developmental assessment by a physician within thirty (30) days prior to adoptive placement and completion of the "Health Screening" (CFS-366).

* Present and explain the Legal Risk Adoption Placement Agreement (CFS-420) to the selected adoptive parent(s) if a legal risk adoptive placement is planned. Secure the adoptive parent's(s) signature on the CFS-420 prior to placement.

* Document dates of pre-placement visits, contacts, activities, progress, concerns, etc. and send a copy to the family's Adoption Specialist, Adoption Field Services Supervisor. Family Service Worker, and OCC Attorney for the child's initiating county.

The Adoptive Family's Adoption Specialist will:

* Review, discuss and present to the selected adoptive parent the child's non-identifying adoption packet and Disclosure for Adoption (CFS-471) and document in narrative.

* Assist in assessing appropriateness of the selection.

* Secure the signature of the selected adoptive parent on the CFS-471.

* Give the selected adoptive parent a copy of the signed CFS-471.

* Advise the child's Adoption Specialist of the family's interest in adopting the child.

* Coordinate with the child's Family Service Worker and Adoption Specialist a pre-placement visitation schedule.

* Supervise visits of the child with the selected adopted family when visits are in the family' s area.

* Discuss and coordinate with the selected adoptive parent resources (adoption subsidy, counseling, medical, educational services, etc.) which a child may need. In addition, when discussing an adoption subsidy, the Adoption Specialist will be clear that thev will only be screening for a determination of special needs, subsidy eligibility and making a recommendation to the Adoption Services Unit. The Adoption Specialist will notify the family of approval/denial of an adoption subsidy. (See Procedure VIII-H1 [Initial Application for Adoption Subsidy!.) The Adoption Specialist must also explore other resources and assistance that may be available for the child and adoptive family when screening for a subsidy.

* Document dates of contacts, activities, progress, concerns, etc., and send a copy to the child's Adoption Specialist, Area Manager or designated Adoption Field Services Supervisor. Family Service Worker, and OCC Attorney for the child's initiating county.

* Send a completed "Change of Status" (CFS-414) to the Adoption Coordinator, Adoption Services Unit, when the child has been placed.

The Family Service Worker will:

* Continue to prepare the child for adoption.

* Prepare the child to meet the selected adoptive family with the assistance of the child's Adoption Specialist after the adoptive parents have signed the Disclosure for Adoption (CFS-471).

* Prepare and support the foster family or out-of-home placement provider for separation and enlist their help with the child.

* Prepare child's school personnel, therapist, and other professionals for the proposed adoption.

* Coordinate with the child's Adoption Specialist times, dates, places and activities for the pre-placement visitation schedule.

* Parti cipate in pre-placement and placement activities and remain involved until the process is completed.

* Assess the feelings and reactions of the child and the foster parents or out-of-home placement provider and share these with the child's Adoption Specialist.

* Provide information about the child to the selected adoptive family.

* Assure that the child's clothing and personal belongings are appropriately prepared and packed for the move to the adoptive family's home.

* Transfer the child's out-of-home placement record (including CHRIS record) to the adoptive family's Adoption Specialist within five (5) working days of the placement date (after pre-placement visits have been completed). The family's Adoption Specialist will assume primary case management responsibility at the time of placement.

* In CHRIS:

* In the Enter/Exit screen, exit child from current foster home placement selecting Pre-Adoptive Placement and enter child in the adoptive family's home.

* Update Contact screen, Characteristic Screen, Court Hearing screen and Termination of Parental Rights screen to document all current available information on child.

* In the Assign/Transfer screen, assign the family's Adoption Specialist as the Primary Responsible Person for case.

The Foster Parent or Out-of-Home Placement Provider will:

* Help prepare the child for adoption.

* Parti cipate in the pre-placement and placement activities.

* Provide the selected adoptive family with information about the child.

* Assess and report the child's feelings, actions and reactions to the Family Service Worker and/or the Adoption Specialist.

* Encourage and support the child to accept the adoptive family.

PROCEDURE (VIII-G9): Post-Placement Services

The Adoptive Family's Adoption Specialist will:

* Provide casework counseling, support, and referral to needed resources/services until the adoption is finalized.

* Visit the adoptive family in their home at least once a week during the first four (4) weeks after placement and at least twice a month in the home until the adoption is finalized.

* Have a private conversation with the age-appropriate child during each visit.

* Process an application for adoption subsidy, if applicable, prior to recommending finalization of the adoption. (Refer to FSPP Policy VIII-H.)

* Document place and dates of contacts, activities, progress, concerns, etc., and send a copy to the Family Service Worker, Area Manager or designated Adoption Field Services Supervisor, child's Adoption Specialist, and OCC Attorney for the child's initiating county.

* Develop a "Case Plan" (CFS-6010) within thirty (30) days of the child's placement.

* Notify the pre-adoptive parent of the date for a judicial review.

* Establish time frame for finalization of the adoption, and document the reasons the adoption has not been finalized within six (6) months.

* Inform the family about post-adoption services (provide brochure).

* In CHRIS:

* Document all adoption post placement services in the Contact Screen of child's protective service case.

* Complete Case Plan Treatment Goal screens when case plan has been revised within thirty days of placement.

* Complete the Court Hearing screens on all judicial reviews.

PROCEDURE (VIII-G10): Disruption of Adoptive Placement

If a disruption of an adoptive placement is imminent before the final decree, the family's Adoption Specialist will provide appropriate services to preserve the family and prevent disruption, if applicable.

* Notify immediately the Adoption Field Services Supervisor. From the initiating county notify the County Supervisor, Family Service Worker, Adoption Specialist, OCC Attorney and Attorney ad litem.

* Schedule and conduct a staffing to include those listed above and the adoptive parent(s), age appropriate child and any other significant individuals.

* Return the following case management responsibilities to the initiating county Family Service Worker if there is no plan to immediately select another adoptive family and disruption occurs:

* Primary case management responsibility for the case.

* Primary information management responsibility in CHRIS.

* The child's paper record within five (5) working days of the disruption.

* Prepare the family for disruption and provide casework counseling and referrals for needed services.

* In CHRIS:

* Document the staffing, reason for disruption, and all contacts with adoptive family in the Contacts screen.

* Exit child from current adoptive home placement selecting Placement Resource Requested Removal or Child Requested Change of Placement in the Enter/Exit screen.

* Transfer the case back to the last Primary Assigned Family Service Worker in the Assign/Transfer screen.

PROCEDURE (VIII-G11): Finalization of an Adoption

Refer to FSPP Procedure VIII-F7.

POLICY (Vlll-H): ADOPTION SUBSIDY

The Division provides a federal or state funded adoption subsidy as a service to assist in making adoption possible for a child, who, with special needs , might not otherwise be adopted and for whom a family is not readily available. A foster child placed in an adoptive home continues status as a foster child until finalization of the adoption and the adoption subsidy is initiated.

A special needs child is defined as a child who is free for adoption and belong to a group of children for whom the Division does not have an adequate resource of approved applicants to provide a pool of available waiting adoptive families. Other children may be eligible for adoption assistance under this category if they have severe medical or psychological needs that require ongoing rehabilitation or treatment. These children include:

* a Caucasian child nine years or older.

* a healthy child of color who is two years or older,

* or a member of a sibling group of three or more being placed together, and the child is:

* legally free for adoption with parental rights terminated,

* under eighteen years old and whose adoption has not been finalized prior to approval of the subsidy,

* (for the purposes of a State Subsidy only), in DHS custody, or

* a member of a Non-Custody/Out-of-Home Placement Services case, or

* (For the purposes of private and independent adoptions only), who is SSI eligible at the time the adoption petition is filed.

Children at high risk for the development of a serious physical, mental, or emotional condition may be considered special needs if documentation of the risk is provided by a medical professional specializing in the area of the condition for which the child is considered at risk, but no subsidy payment will be made without documentation that the child has developed the actual condition. (See Procedure VHI-H3.")

Adoption subsidies can be funded through federal Title IV-E adoption assistance or state funds depending on the child's eligibility.

Adoption assistance payments may be made to parents who adopt a child with special needs. A child will not be considered special needs unless:

* The state has determined the child cannot or should not be returned to the home of his parents;

* The state has determined that a specific factor or condition exists with respect to the child (such as ethnic background, age or membership in a minority or sibling group; or the presence of factors such as medical conditions or physical, mental, or emotional disabilities) because of which it is reasonable to conclude that such a child cannot be placed for adoption

without providing adoption assistance or medical assistance under Title XIX; and

* A reasonable, but unsuccessful, effort has been made to place the child without providing assistance except where it would be against the best interest of the child due to such factors as the existence of significant emotional ties with prospective adoptive parents while in the care of such parents as a foster child.

For the purpose of this policy. "AFDC" refers to the AFDC program as in effect 7-16-1996.

There are four ways that a child can be eligible for title IV-E adoption assistance:

1. The child is AFDC-eligible and meets the definition of a child with special needs.

Adoption assistance eligibility that is based on a child's AFDC eligibility is predicated on a child meeting the criteria for such both at the time of removal and in the month the adoption petition is initiated. At the time adoption proceedings were initiated the child must have been removed from the home of a specified relative as a result of a judicial determination to the effect that continuation therein would be contrary to the welfare of the child. In addition, the special needs determination must be made prior to finalization of the adoption.

2. The child is eligible for Supplemental Security Income (SSI) benefits and meets the definition of a child with special needs.

A child is eligible for adoption assistance if, at the time the adoption petition is filed, the child meets the requirements for title XVI SSI benefits, and prior to the finalization of the adoption is determined by the state to be a child with special needs. There are no additional criteria that a child must meet to be eligible for title IV-E adoption assistance when eligibility is based on a special needs child meeting SSI requirements. Specifically, how a child is removed from his home or whether the state has responsibility for the child's placement and care is irrelevant in this situation. The child's eligibility for SSI benefits must be established no later than at the time the adoption petition is filed.

3. The child is eligible as a child of a minor parent and meets the definition of a child with special needs.

A child is eligible for title IV-E adoption assistance in this circumstance if:

* The child's parent is in foster care and receiving title IV-E foster care maintenance payments that cover both the minor parent and the child at the time the adoption petition is initiated. AND

* Prior to the finalization of the adoption, the child of the minor parent is determined by the state to meet the definition of a child with special needs.

There are no other additional criteria that must be met in order for the child to be eligible for title IV-E adoption assistance if the child's eligibility is based on his minor parent's receipt of foster care while placed with the minor parent in foster care.

As with SSI, there is no requirement that a child must have been removed from the home as a result of a judicial determination. However, if the child and minor parent have been separated in foster care prior to the time of the adoption petition, the child's eligibility for title IV-E adoption assistance must be determined based on the child's current and individual circumstances.

4. The child is eligible due to prior title IV-E adoption assistance eligibility and meets the definition of a child with special needs.

In the situation where a child is adopted and receives title IV-E adoption assistance, but the adoption later dissolves or the adoptive parents die, a child may continue to be eligible for title IV-E adoption assistance in a subsequent adoption. The only determination that must be made by the state prior to the finalization of the subsequent adoption is whether the child is a child with special needs. Need and eligibility factors must not be re-determined when such a child is subsequently adopted because the child is to be treated as though his circumstances are the same as those prior to his previous adoption. Since title IV-E adoption assistance eligibility need not be re-established in such subsequent adoptions, the manner of a child's removal from the adoptive home, including whether the child is voluntarily relinquished to an individual or private agency, is irrelevant.

If eligible, the Division will make adoption assistance payments to adoptive parents in amounts so determined through an adoption assistance agreement. The amount of such payment:

* Will take into account the circumstances of the adopting parents and the needs of the child being adopted;

* May be adjusted periodically with the concurrence of the adoptive parents to reflect changing circumstances; and

* May not exceed the foster care maintenance payment, which would have been paid during the period if the child with respect to whom the adoption assistance payment is made had been in a foster home.

In determining eligibility for State funded adoption assistance payments, there is an income eligibility requirement (means test) for the adoptive parents. There is no means test for determining eligibility for federal Title IV-E adoption assistance payments.

Adoption assistance payments may be terminated if it is determined that:

* The child has attained the age of 18 (or the age of 21,where the state determines that the child has a mental or physical disability which warrants the continuation of assistance), or

* The parents are no longer legally responsible for the support of the child, or

* The child is no longer receiving support from the adoptive parents.

The adoptive parents are required to inform the Division of circumstances that would make them ineligible for adoption assistance payments or eligible for adoption assistance payments in a different amount.

An Adoption Assistance Agreement, a written binding agreement between the adoptive parents and the Division, must be in place prior to the finalization of the adoption.

The Adoption Assistance Agreement must:

(1) be signed by the adoptive parents and the Division and be in effect before adoption assistance payments are made under Title IV-E, but no later than the finalization of the adoption;

(2) specify the duration of the agreement;

(3) specify the amount of the adoption assistance payment (if any) and the nature and amount of any other payments, services and assistance to be provided (including non-recurring adoption expenses in agreements that became effective on or after January 1, 1987, for expenditures incurred by the parents on or after that date);

(4) specify the child's eligibility for Title XIX and Title XX;

(5) specify, with respect to agreements entered into on or after October 1, 1983, that the agreement remains in effect regardless of the state of residence of the adoptive parents;

(6) contain provisions for the protection of the interests of the child in case the adoptive parents and child should move to another state while the agreement is in effect; and

(7) for agreements entered into on or after October 1. 1983. if needed service specified in the agreement is not available in the new state of residence, the state making the original assistance payment remains financially responsible for providing the specified service(s). However, in cases of unknown medical and psychiatric conditions that surface after finalization, applications for federally funded assistance may be submitted. After the initial denial of this application occurs, in accordance with federal regulations, the adoptive family may appeal the decision.

The types of situations that would constitute grounds for an appeal include:

(1) relevant facts regarding the child, the biological family or the child's background were known, but not presented to the adoptive parents prior to the adoption's finalization;

(2) Any subsidy decision which the adoptive parents deem adverse to the child;

(3) erroneous determination by the Division that a child is ineligible for adoption assistance, and

(4) failure by the Division to advise adoptive parents of the availability of adoption assistance. If an appeal is upheld, the child may be eligible for a IV-E or state subsidized adoption. The effective date of a IV-E retroactive subsidy payment will be the date of finalization or a date subsequent to finalization. Authorized retroactive state funded subsidy payments will be two (2) months prior to the date of the "Application For Adoption Subsidy" (CFS-425).

For foster parent and kinship adoptions, it is not necessary to determine that without subsidy the child would not otherwise be adopted.

Payments for a maintenance subsidy and special services subsidy are to meet the needs of the child. In addition, payments for one-time expenses, known as a non-recurring adoption subsidy, may be obtained in order to reimburse the family for out-of-pocket pre-adoptive/finalization expenditures.

The Division will ensure health insurance coverage for any child determined to be a child with special needs for whom there is an adoption subsidy agreement in effect. Federal Title IV-E Medicaid will be utilized to provide medical coverage for a IV-E eligible child. Medical coverage, for a non-Title IV-E eligible child who has a special need for medical or rehabilitative care, may be provided under the Medicaid category Non-Title IV-E Special Needs Adoptive Child if the child is eligible for state maintenance subsidy and meets specified Medicaid eligibility requirements. (See Medical Services Policy 6590.2 Eligibility Requirements.) If the child does not qualify for Medicaid under federal Title IV-E or Non-Title IV-E Special Needs Adoptive coverage, the family may make application for Medicaid under a different category.

Any eligible child for whom there is an adoption assistance agreement in effect is deemed to be a dependent child and is deemed to be a recipient of AFDC (per AFDC requirements in effect 7-16-1996 ). Any child of such eligible child will be eligible for such services.

The Division shall access resources as necessary in Arkansas, the region and nation to find adoptive families for children with special needs.

PROCEDURE (VIII-H1): Initial Application for Adoption Subsidy

The Adoption Specialist will:

* Follow the same subsidy-related policy and procedures, including subsidies for non-recurring legal expenses, regardless if the adoption is being handled in-state or out-of-state.

* Ensure close coordination with the other state's adoption worker, if applicable.

* Determine that the child has a special need in relation to adoption planning, is between the age of birth to eighteen (18) years, is in the custody of DHS (for state subsidy only), and is legally free for adoption.

Note: These procedures should be followed for federal IV-E adoption maintenance subsidy and state funded adoption maintenance subsidy. Determine if the child is eligible for federal IV-E adoption maintenance subsidy first. If ineligible, establish eligibility for state funded adoption maintenance subsidy.

* Determine that a reasonable, but unsuccessful, effort has been made to place the child without providing adoption subsidy. Such an effort might include the use of adoption exchanges, referral to appropriate specialized adoption agencies, or other such activities. There are exceptions to this requirement when applying for a IV-E maintenance subsidy. These exceptions are:

(1) It would not be in the best interests of the child because of such factors as the existence of significant emotional ties with prospective adoptive parents while in the care of those parents as a foster child. (2) Another circumstance is adoption by a relative, in keeping with the statutory emphasis on the placement of children with relatives.

Exceptions for state maintenance subsidy: In the case of a child who has established significant emotional ties with prospective adoptive parents while in their care as a foster child, the Department may certify the child as eligible for a subsidy without searching for families willing to take the child without a subsidy.

* Review the adoption subsidy program with the adoptive parent, determine what type of adoption subsidies are needed, and complete all application procedures at the same time the adoption assessment is being completed for a foster parent, kinship foster parent, or relative adoption and within sixty (60) days of placement for all other adoptions

* Review and sign the "Application for Adoption Subsidy" (CFS-425) after the adoptive parent completes it.

* Request IV-E verification of eligibility from the Eligibility Unit.

* Assist the adoptive parents in completing the "Statement of Income and Resources for Adoption Subsidy" (CFS-426) Attach to the CFS-426 verification of family income when a state funded adoption special subsidy is requested. The CFS-426 is not required for a federal funded adoption maintenance subsidy.

* Review the adoptive parents' health insurance policy if a special subsidy is requested to determine if it will allow for any medical, dental, or psychological costs and, if so, to what extent. Document on the CFS-426.

* Be clear in their discussion with the family that they will only be screening for a determination of special needs, subsidy eligibility, and making a recommendation to the Adoption Services Unit. Under no circumstances will the Adoption Specialist give the adoptive family the subsidy determination prior to receipt of approval from the Adoption Services Unit. The Adoption Specialist must also explore other resources and assistance that may be available for the child and adoptive family when screening for a subsidy.

* Complete the "Determination of Eligibility for Adoption Subsidy" (CFS-427).

* Attach the following to the CFS-427:

* Verification of the costs for a private attorney to finalize an adoption whether in-state or out-of-state, if applicable.

* Verification of court costs to finalize an adoption if applicable.

* Complete the CFS-429 (Special Adoption Subsidy Needs Assessment) to verify the child's medical, dental, psychological, etc. condition by a professional which includes the diagnosis, prognosis, and costs of treatment for one (1) year if a special subsidy is requested.

* Statement that lists the child's financial resources (source and amount') other than foster care board payment, if applicable.

* Special needs subsidy based on a "high risk" condition - Children at high risk for the development of a serious physical, mental, or emotional condition may be considered special needs if documentation of the risk is provided by a medical professional specializing in the area of the condition for which the child is considered at risk, but no subsidy payment will be made without documentation that the child has developed the actual condition.

* Verification from the appropriate agency which explains the child's eligibility for financial benefits (SSI, other types of Social Security benefits, VA, etc.) once the adoption is finalized if applicable (provide the agency with the amount of the adoptive parent's income in order that a statement can be prepared). Once a child has been determined eligible for a federal subsidy, the adoptive parents cannot be rejected for adoption assistance or have payments reduced without their agreement because of their income or resources or the child's resources.

* Verification from Children's Medical Services (CMS) which explains the child's eligibility for services once the adoption is finalized if applicable (provide CMS with the amount of the adoptive parent's income in order that a statement can be prepared).

* Utilize the scale that is established and published annually by the Adoption Services Unit. The scale shall be 225% of the yearly published Federal Poverty Level for the state of Arkansas.

* The adoptive parent's income is an eligibility criterion for state funded adoption maintenance subsidy. The adoptive parent's income is not an eligibility criterion for a federally funded adoption maintenance subsidy (i.e., a child who is IV-E or SSI eligible).

* Special subsidies are state funded, and the Adoption Subsidy Coordinator, Adoption Services Unit will consider the child's eligibility on a case-by-case basis. The consideration will be based on the information developed during the Adoption Specialist's determination of the child's special needs in relation to adoption planning. The adoptive parent's gross income will be considered as well as other financial resources and health insurance in determining eligibility for a special subsidy

* Complete the CFS-426 (Statement of Income and Resources for Adoption Subsidy) for all special subsidy requests.

* Utilize the following scale to determine the amount of a full monthly adoption maintenance subsidy based upon the standard foster care board payment:

AGE of CHILD	Amount of MONTHLY Maintenance
Birth through 5 years	$400.00
6 through 11 years	$425.00
12 through 14 years	$450.00
15 through 17 years	$475.00

* Request a larger monthly adoption maintenance subsidy for the child who has received a higher than standard monthly foster care board payment. A monthly subsidy payment cannot exceed the child's foster care board rate which is in effect at the time a subsidy is approved.

* Note: Special Board Rate formulas and procedures will be used strictly as guides in determining an appropriate nonstandard rate to discuss with the family and to use in negotiating a lower rate (when appropriate). No subsidy will exceed $460.00 above the standard board rate for the child's age group. However, if the child is SSI eligible, the rate can go up $460.00 above the SSI rate.

* Provide the following documentation with the initial adoption subsidy application packet:

* Emergency Petition

* Emergency Order or other initial custody court order

* Petition and Order for Termination of Parental Rights with Power to Consent to Adoption

* "EMS 96 or DCO-93 ", or if applicable, award letter for SSI

* A copy of the approved selection form for an adoption that is NOT a foster parent, kinship foster parent, or relative adoption that documents efforts to place the child without adoption subsidy. (Not required for a foster parent, kinship foster parent, or relative adoption.)

* Prepare a narrative entitled "Subsidy Family Profile" about the adoptive family to include:

* Type of adoption (foster parent, kinship foster parent, non-foster parent, relative);

* Type of subsidy (maintenance, special, non-recurring, non-IV-E Medicaid);

* Funding source (federal or state);

* Child to receive subsidy (first name, age, race, developmental information, description of special needs, problems, limitation, reasons for being in out-of-home placement, and brief description of out-of-home placement history);

* Adoptive father (name, age, education, employment and health);

* Adoptive mother (name, age, education, employment and health);

* Other children in family (adopted, birth custody, out-of-home placement, name, age, education, and health);

* Others in household (explain if applicable);

* Marriage (length and comments about the quality of the relationship);

* Housing (brief description);

* Income/resources (sources and amounts, health insurance coverage, etc.);

* Exploration of other resources and assistance that may be available for the child and adoptive family when screening for a subsidy.

* Family and adoptive child relationship (description to include strengths and challenges);

* Reason for adoption subsidy (explain reason child needs adoption subsidy and reason for the adoptive parent requesting it);

* Subsidy request (maintenance costs per month and for not more than a year), special subsidy type of service and costs for not more than a year, legal assistance, if the OCC Attorney is requested to finalize the adoption, court costs, etc., other subsidy requests and costs;

* Recommendation to approve or deny.

* Submit the completed packet to the Adoption Field Services Supervisor for review and comment. (The Adoption Field Services Supervisor has three (3) days to review and sign-off on the packet before returning the packet to the Adoption Specialist.)

* Upon completion of supervisory review, send completed forms, narrative, documents, and other attachments to the Adoption Subsidy Coordinator, Adoption Services Unit for a decision to approve or deny the initial adoption subsidy application prior to finalization of the adoption.

* Upon receipt of approval of the adoption subsidy, meet with the adoptive parent to explain an approval, to review the "Adoption Assistance Agreement" (CFS-428), and to secure the adoptive parent's signature on the CFS-428 within ten working days from receipt of the agreement. Advise the adoptive parent to notify the local adoption specialist if they decide to add the child to their medical insurance policy.

* Send the Adoption Subsidy Coordinator and adoptive parent a copy of the signed CFS-428 within three (3) working days upon receipt.

* Contact the Adoption Subsidy Coordinator in writing within three (3) working days from the meeting if the adoptive parent has a disagreement with the contents of the CFS-428.

* Meet with the adoptive parent to explain a denial, review the decision, and explain internal review procedures within ten (10) working days from receipt of written notification to deny.

* Send a copy of the Adoption Petition for and Final Decree of Adoption to the Adoption Subsidy Coordinator within five (5) working days upon receipt.

* In CHRIS:

* Open a new Adoption Case on adoptive family entering the adoptive parents and adoptive child as clients. If child was in the custody of DHS, you must retrieve the child's eligibility, medical and characteristics screens from the closed child protective service case by entering the child's protective service case and client numbers in the child's General Information screen. If child was not in foster care prior to being adopted, the adoptive child's Characteristic and Medical screens must be completed to identify the special needs.

* Complete the Adoption screens: General Information screen, Affidavit of Disclosure screen, and Subsidy screen. Request for Approval on subsidy.

The Adoptive Subsidy Coordinator will:

* Assess all submitted forms and documentation, approve or deny the adoption subsidy application, and provide written notification to the Adoption Specialist of the decision within fifteen (15) working days of receiving the initial application packet from the Adoption Specialist. Contact the Adoption Specialist if additional information/forms are needed.

* Prepare the CFS-428 (Adoption Assistance Agreement) if the adoption subsidy application is approved, and route the CFS-428 to the Manager of the Adoption Services Unit and Community Support Section Administrator for approval, then send the CFS-428 to the DCFS Director or designee for signature.

* Send signed CFS-428 to the Adoption Specialist with written instructions.

* Notify the adoptive parent in writing if the application is denied and explain the reason and the internal review procedures and Administrative Fair Hearing procedures.

* Send a copy of the notification of denial to the Adoption Specialist.

NOTE ON RE-DETERMINATIONS/RE-EVALUATIONS:

The federal Title IV-E adoption assistance program does not require re-determinations of a child's eligibility. Although, the Title XIX Medicaid Program and the programs that, in part, may qualify a child initially for adoption assistance, such as AFDC and SSI, require re-determinations, they are unnecessary for the purpose of maintaining a child's eligibility for Title IV-E adoption assistance. Once a child has been determined eligible and is receiving Title IV-E adoption assistance, a state may terminate the assistance only under three circumstances:

1. The child has attained the age of 18 (or if the State determines that the child has a mental or physical disability which would warrant continuation of assistance up to the 21st birthday).

2. The State determines that the adoptive parents are no longer legally responsible for support of the child.

3. The State determines that the adoptive parents are no longer providing any support to the child.

* The Adoption Support Specialist must immediately notify the Adoption Specialist at the time the adoption subsidy is terminated. (See procedure VIII-H7 Termination of Adoption Subsidy)

Re-evaluations for state adoption maintenance subsidies are not required. However, when state funded subsidies extend beyond one (1) year, or for federally funded subsidies, verification of

circumstances to continue the subsidy must be documented annually. To verify a continued need for subsidy in out of state cases the child's school, therapist, physician or clergy can provide verification by submitting a letter which states that the adoptive parent(s) still has the care and responsibility for the child.

* The Central Office Adoption Support Specialist will forward a cover letter along with the CFS-431 (Certification of Adoption Subsidy Eligibility) to the adoptive parents annually. The cover letter will inform the adoptive parents that the local Adoption Specialist will contact them to schedule a visit.

* The Central Office Adoption Support Specialist will forward a copy of the cover letter to the local Adoption Specialist concurrently with notice to the adoptive parents.

* The Adoption Specialist will have annual face-to-face contact with the child or otherwise verify that the child is still with the adoptive family. The Adoption Specialist should make the face-to-face contact a positive experience by exploring any needs for post adoption services. The Adoption Specialist should also inquire as whether the adoptive parents have added the adoptive child to their medical insurance and if so the family must complete a DCO-662 (Third Party Resource). The Adoption Specialist is responsible for submitting the completed form to the Medical Services Section of the Division of Medical Services.

* In CHRIS:

* Complete the Contact screen documenting all activities with the adoptive family.

* Print the Contact screen information and send the Adoption Support Specialist a copy of the documented contact (CHRIS screen) for the subsidy file.

PROCEDURE (VIII-H2): SUBSIDY PAYMENTS And SUPPORT For NON-CUSTODY ADOPTIONS (Out-of-Home Placement Services, SSI Eligible Private Agency and Independent Adoptions)

ELIGIBILITY CRITERIA FOR NON-CUSTODY/OUT-OF-HOME PLACEMENT SERVICES:

If in the month of initiation for court proceedings leading to removal and the language of "contrary to the child's welfare to remain in the home" is included in the court order and all other above criteria are met, a child not currently in DHS custody can be eligible for a subsidy.

Services shall be offered to families on whom the Department has filed a dependency-neglect petition when the court has placed the child (ren) in the custody of a relative or other person. Adoption services shall be offered to families who have custody of children due to a dependency and neglect order, if the family requests such services.

Sections 406 and 407 of the Social Security Act allow for Title IV-E subsidy eligibility, if certain criteria are met, in regards to the method of removal of a child from a home. These criteria are:

* If the child is removed from the home pursuant to a judicial determination, such determination must indicate that it was contrary to the child's welfare to remain in the home;

* In the month the court proceedings were initiated to remove the child, the child must have been AFDC eligible in the removal home;

* The child must be AFDC eligible in the month in which the adoption proceedings were initiated;

* The state must determine that the child meets the three (3) criteria in the definition of a child with special needs; and

* The adoption assistance agreement is signed prior to the finalization of the adoption.

The Adoption Specialist will:

* Accept and review referrals for non-custody adoptions.

* Forward a request to the Eligibility Unit to determine if the child is eligible for Title IV-E adoption assistance. The request consists of a cover letter indicating that this is a Non-Custody/Out-of-Home Placement Services case needing AFDC determination for the initiation of an adoption petition. The request must be submitted within the first five (5) working days of the month. The request must be mailed or faxed to the Eligibility Unit.

The request must include the following information:

* The cover letter requesting the AFDC determination.

* A completed CFS-487. The application must include everyone in the adoptive home at the time the form is signed and all the income and resources for each family member. Include the relationship of the adoptive child to everyone in the adoptive home.

The following is a list of the eligibility factors that must be satisfied for AFDC determinations. Listed for each factor is the information needed to make the determination.

Complete the CFS-487 (Application for Title IV-E Payments/Medicaid) by listing everyone in the adoptive home at the time the form is signed. This includes individuals who may be temporarily absent from the home such as individuals on vacation, away at school, etc. Provide a birth certificate or some other legal document that verifies the custodial blood relatives' relationship to the child.

1. Age Requirement.

Children must be under 18 years of age. The child's birth certificate must be submitted to verify age.

2. Citizenship or Alienage Requirement.

Eligible members must be US citizens or lawfully admitted aliens intending to permanently reside in the US. Since this will be child only AFDC determination the birth certificate should verify citizenship.

3. Residence Requirements. The individual(s) must presently reside in Arkansas and intend to make it his home. No specific duration of residence is required. If the applicant has the present intention to make the state his home, his eligibility will not be affected by the fact that he intends to leave the state at some future time. Residence is not affected by temporary absence from the state.

4. Deprivation of Parental Care and Support Requirement.

Submit the TPR court order to satisfy this eligibility requirement.

5. Assignment of Rights to Support to the State.

Since there has been TPR. there is no assignment of rights as there are no legal parents of the child at this time.

6. Cooperation in Child Support Enforcement Activities.

Since there has been TPR. there is no cooperation requirement with OCSE as there are no legal parents of the child at this time.

7. Relationship Requirement and Living with Specified Relative.

TPR has not changed the relationship of the adoptive parent to the child. The relationship does no change until the adoption is finalized.

Degrees of Relationship

The child must be living with a relative who is in one of the following degrees of relationship to the child.

1st degree -Parent.

2nd degree - Grandparent, sibling.

3rd degree - Great-grandparent, uncle, aunt, nephew, niece.

4th degree - Great-great-grandparent, great-uncle, great-aunt, first cousin.

5th degree - Great-great-great-grandparent, great-great-uncle, great-great-aunt, first cousin once removed (i.e. the child of one's first cousin).

Half relationships will be considered the same as full relationships.

Step father, step mother, step brother, step sister.

Spouses of any persons named in the above groups. Such relatives may be considered within the scope of this provision though the marriage is terminated by death or divorce.

Relationship must be verified by birth certificates, baptismal records, Bureau of Vital Statistics Records, other authentic documents, or by written statement of a collateral which provides conclusive evidence that the relative is so related to the dependent child.

Persons Who Must be Included in the Standard of Need - Standard Filing Unit

The following relatives of an AFDC dependent child or a child for whom application is made must be included in the assistance unit with the child if they are living in the home with the child and are otherwise AFDC eligible:

The income and resources of these individuals must be reported and verified as part of the determination.

* The natural or adoptive parent of the child, including an unemancipated minor parent.

* All brothers and sisters of the child who are under age 18, unemancipated, and meet the deprivation of parental care or support requirement. This includes brothers and sisters of half-blood relationships but not step-brothers or step-sisters.

8. Non-Participation in a strike.

No additional documentation needed.

9. Project SUCCESS Requirement. No additional documentation needed.

10. Social Security Enumeration Requirement.

Submit a copy of the child's Social Security Card if available. If the card is not available ensure that the Social Security Number is documented on the CFS-487.

11. Need Requirement.

In completing the CFS 487, carefully read and answer appropriately each question about the type of income and assets of the child. Since you are the authorized representative for the family's AFDC determination it is critical that these questions are answered as accurately and completely as possible.

* The Eligibility Unit will make the AFDC eligibility determination within five (5) working days of receipt of the completed application and fax the determination to the Adoption Specialist.

NOTE: If the CFS-487 is not completed and all supporting documentation needed is not submitted in a timely manner the eligibility determination cannot be made.

* Notify OCC immediately of the child's eligibility status. If the child is determined IV-E eligible OCC must file the petition for adoption in the same month of the eligibility determination, therefore the

* Follow Policy and Procedure VIII-F (Foster Parent, Kinship Foster Parent and Relative Adoption) in approving the family for adoption.

* Refer the family for "Foster Pride/Adopt Pride " training. The family must complete the training prior to approval.

* Complete the CFS-425 (Application for Special Subsidy) and specify "Use of Agency Attorney" to receive legal services from OCC for those children in a Non-Custodv/Out-of-Home Placement Services case who do not meet the criteria for special needs. Children in a Non-Custodv/Out-of-Home Placement Services case who do not meet the special needs criteria are eligible for "Use of Agency Attorney" to finalize an adoption.

* Document in the "Subsidy Family Profile" that the children are in a Non-Custody/Out-of-Home Placement Services case and state. "But for the child's placement with a relative or other person, the child would still be in foster care."

CRITERIA FOR SSI ELIGIBLE PRIVATE AGENCY AND INDEPENDENT ADOPTIONS

A child who is SSI eligible and is part of an independent adoption (i.e., not in the custody of a public or private agency) is eligible for a Title IV-E subsidy. Cases in which a child is subsequently adopted who received Title IV-E adoption assistance in a previous adoption that dissolved or in which that adoptive parents died are eligible for Title IV-E adoption subsidy. (See FSPP Policy VHI-H.)

The Adoption Subsidy Coordinator will:

* Accept and review referrals for independent adoption and private agency subsidy applications.

* Assess all submitted forms and documentation, approve or deny the adoption subsidy application, and provide written notification to the applicant, the person who arranged the independent adoption or the private agency representative of the decision within fifteen (15) working days of receiving the initial application packet from the Adoption Specialist. Contact the applicant, the person who arranged the independent adoption or private agency representative if additional information/forms are needed.

* Send signed CFS-428 (Adoption Assistance Agreement) to the Applicant and Private Agency representative, if applicable, with written instructions.

* Notify the adoptive parent in writing if the application is denied and explain the reason for denial and the internal review and Administrative Fair Hearing procedures.

* In CHRIS:

* Open a new Adoption Case on adoptive family entering the adoptive parents and adoptive child as clients.

* Complete the adoptive child's Characteristic and Medical screens to identify the special needs.

* Complete the Adoption screens: General Information screen, Affidavit of Disclosure screen, and Subsidy screen. Request the Approval for the adoption subsidy.

PROCEDURE (VIII-H3): Amendment to an Adoption Subsidy

The Adoption Specialist will:

* Follow the same subsidy-related policy and procedures, regardless if the adoption is being handled in-state or out-of-state.

* Ensure close coordination with the other state's adoption worker, if applicable.

* Amend a subsidy if there is documentation that an "at risk" child has developed a serious physical, mental or emotional condition.

* Determine with adoptive parent if an amendment to the existing adoption subsidy is needed. (An amendment may be requested at any time.)

* Determine if there has been a material change in circumstances in the adoptive family to amend a federally funded subsidy. Material changes in circumstances include, but are not limited to. a different medical problem or a change in the type of condition of the child or a significant change in household. A state may renegotiate an adoption assistance agreement if the adoptive parents request an increase in payment due to a change in their circumstances

and a higher foster care rate would have been paid on behalf of the child if the child had still been in foster care. Alternatively, a state may negotiate an adoption assistance agreement that automatically allows for adjustments to the adoption assistance payment when there is an increase in the foster care board rate.

* Determine with adoptive parent what type of adoption subsidy is needed.

* Review and sign the "Application for Adoption" (CFS-425) after the adoptive parent completes it.

* Assist the adoptive parents in completing the "Statement of Income and Resources for Adoption Subsidy" (CFS-426). Attach verification of family income to the CFS-426 when a state funded adoption special subsidy is requested. The CFS-426 is not required for a federal adoption maintenance subsidy. Note that an amendment for an increase of a state subsidy will not exceed the amount the child would have received for a special board rate if in foster care. The amount of any amendment will not exceed $460.00 above the standard board rate for the child's age group. However, if the child is SSI eligible, the rate can go up $460.00 above the SSI rate.

* Carefully review all requests for increases in payment for state funded subsidies and special subsidies. As state dollars are limited, an exploration of other resources is required and must be documented in the narrative when submitting an amendment request. The Division Director can review extraordinary circumstances at his discretion.

* Complete the "Determination of Eligibility for Adoption Assistance" (CFS-427) if a special subsidy is requested.

* Complete a narrative to address the type of subsidy needed, the source of funding, the reason for the subsidy, the costs, and recommendation.

* Send all requests, the forms, narrative, and any other documents to the Adoption Field Services Supervisor within twenty (20) working days from the initial contact with the adoptive parent. The Adoption Field Services Supervisor must submit all requests, except for special board rate increases, to the Adoption Subsidy Coordinator within five (5) working days of receipt.

* For requests of special board rate increases, forward completed packets to the Adoption Field Services Supervisor for review and comment. Upon completion of the review, the Adoption Field Services Supervisor will forward within three (3) working days the packet to the Adoption Field Services Manager. The Adoption Field Services Manager will review and make recommendations and submit the packet to the Subsidy Coordinator within five (5) working days of receipt.

* Meet with the adoptive parent to explain an approval, to review the CFS-428 (Adoption Assistance), and to secure the adoptive parent's signature on the CFS-428 within ten (10) working days from receipt of the agreement.

* Send the Adoption Subsidy Coordinator and adoptive parent a copy of the signed CFS-428.

* Send the Adoption Subsidy Coordinator a written notification within three (3) working days from the meeting with the adoptive parent to explain a disagreement with the contents of the CFS-428.

* Meet with the adoptive parent to explain a denial, review the decision, and explain internal review procedures within ten (10) working days from receipt of the written notification to deny.

* In CHRIS:

* If subsidy amendment is approved, change the Subsidy Ending Date on the Adoption Subsidy screen to stop the existing adoption subsidy. Then, click Clear and enter the new amended subsidy with the new Beginning and Ending dates and the subsidy amount. Request the Approval for the amended subsidy amount.

The Adoption Subsidy Coordinator will:

* Assess all submitted forms and documentation, approve or deny the amendment and notify the Adoption Specialist of the decision within fifteen (15) working day of receiving the application packet from the Adoption Specialist.

* Contact the Adoption Specialist if additional information/forms are needed.

* Send the completed CFS-428 to the Adoption Specialist with written instructions.

* Notify the adoptive parent in writing if the application is denied and explain the reason and the internal review and Administrative Fair Hearing procedures.

* Send a copy of the notification of denial to the Adoption Specialist.

PROCEDURE (VIII-H4): Reinstatement of Adoption Subsidy

If a child's adoption subsidy has been closed, it may be re-opened if eligibility requirements are met. Refer to Procedure VIII-H1.

PROCEDURE (VIII-H5): Request for Continuation of Federal and State Funded Adoption Maintenance Subsidy after Age Eighteen

In some cases a federal adoption maintenance subsidy or state funded maintenance subsidy may be continued for adoptees eighteen (18) to twenty-one (21) years old. Medicaid, however, cannot be extended past age 18 for state funded subsidies. While the foster care Medicaid cannot be extended beyond the month the child turns eighteen (18). the family may apply for another type of Medicaid.

If the adoptive parent requests that the adoption subsidy be continued past the child's eighteenth birthday, the following criteria must be met:

* The adoptive parent must be receiving a federal or state funded adoption maintenance subsidy prior to the child's eighteenth birthday.

* The child must have applied for and been denied SSI.

* A psychologist, psychiatrist or physician must certify that the child has a mental or physical disability that prevents the child from becoming independent from the adoptive home.

* The Central Office Adoption Support Specialist will

* Include the above documentation and recommend whether the adoption subsidy should be continued past the child's eighteenth birthday.

* Approve or deny the request for adoption subsidies after age eighteen.

* Notify the adoptive parent in writing if the request is denied and explain the reason for denial and procedures for the internal review and Administrative Fair Hearing.

* In CHRIS:

* If subsidy has been extended, change the Subsidy Ending Date on the Adoption Subsidy screen to continue subsidy past child's eighteenth birthday.

PROCEDURE (VIII-H6): Interstate Compact on Adoption and Medical Assistance (ICAMA)

A child who is receiving Medicaid as a result of an adoption subsidy may continue to receive the subsidy if the child moves to or from another state.

The Adoption Specialist will:

* Contact the ICAMA Coordinator or refer an adoptive parent to the ICAMA Coordinator in the DCFS Adoption Services Unit.

* Provide the ICAMA Coordinator with the adoptive family's new address, phone number, and the effective date of the move.

The ICAMA Coordinator will:

* Complete the ICAMA forms in relation to a child who is moving from the state and forward the forms to the new state of residence. Forward the following:

(1) Form 6.01 (Notice of Medicaid Eligibility/Case Activation), (2) Form 6.02 (Notice of Action), and (3) Form 6.03 (Change in Child/Family Status), if applicable.

* Forward completed ICAMA forms to the Eligibility Unit in relation to a child who moves into the state. Forward the following:

(1) Form 6.01 OR a COBRA Letter and (2) a copy of the Adoption Subsidy Agreement.

* Notify the Eligibility Unit via the CFS-495 when an ICAMA child leaves the state of Arkansas, and make documentation in CHRIS.

PROCEDURE (VIII-H7): Termination of Adoption Subsidy

Termination of an adoption subsidy will occur:

* Upon the adoptive parent(s)' request.

* When the child reaches the age of 18. Adoption assistance will be provided until the child is 21 years of age if the child has a mental or physical disability which warrants continuation, and a federal funded subsidy or state maintenance is received. (See VIII-H5.)

* Upon the child's death.

* Upon the death of the adoptive parent(s) of the child (one parent if a single parent family and both in a two-parent family).

* At the cessation of legal responsibility of the adoptive parent(s) for the child.

* If the Division determines that the child is no longer receiving support from the adoptive parent(s).

The Adoption Specialist will:

* Notify the Adoption Support Specialist of any change in the adoptive family's circumstances, which would warrant termination of the adoption subsidy.

* In CHRIS:

* If adoption subsidy is terminated, change the Subsidy Ending Date on the Adoption Subsidy screen to stop the existing adoption subsidy.

* If there are other adoptive siblings with existing adoption subsidies:

* End-Date the adoptive child's Involvement in Case selecting the appropriate reason on the Child's General Information screen.

* If there are no other adoptive siblings with existing adoption subsidies:

* Close the adoption case on the Case Summary screen selecting the appropriate reason.

The Central Office Adoption Support Specialist will:

* Determine if termination of the adoption subsidy is necessary.

* Conduct a staffing with the Manager, Adoption Services Unit.

* Provide written notification to the adoptive parent to explain the reason for the termination of the adoption subsidy and the internal review procedures.

* Provide a copy of the notification to the Adoption Specialist.

* Enter computer data to terminate the adoption subsidy.

PROCEDURE (VIII-H8): Payment for Non-recurrinq Adoption Expenses and Special Subsidy

The Adoption Specialist will:

* Submit a billing packet to the Adoption Subsidy Coordinator for non-recurring adoption expenses within sixty (60) days after the finalization of the adoption.

* For non-travel related expenses, the packet will include the DHS-1914. W-9. original invoice, a copy of the CFS-428 and final adoption decree.

* For travel related expenses the packet will include the TR-1, receipts, a copy of the CFS-428 and the final adoption decree.

* For payment of a special subsidy, the packet will include: DHS-1914, W-9, original invoice, copy of the CFS-428 and the final adoption decree.

The Adoption Subsidy Coordinator will:

* Review, code and forward each completed billing packet within ten (10) working days and forward to the manager of the Adoption Services Unit for approval. The Manager of the Adoption Services Unit will forward approved packet to the office of finance for payment within ten (10) working days of receipt from the subsidy coordinator.

POLICY (Vlll-I): MUTUAL CONSENT VOLUNTARY ADOPTION REGISTRY

The Division recognizes that some adults who were adopted as children and some birth parents who voluntarily or involuntarily relinquished a child for adoption, as well as relatives within the second degree to the adoptee, may wish to be identified to each other. The Division also recognizes that some adult adoptees, birth parent(s), and/or relatives to the second degree of the adoptee are unwilling to be identified. The Division further recognizes that some adult adoptees, birth parent(s) of the adoptee, adoptive parent(s), or, in the event of their death, guardians of the adoptee may wish to obtain non-identifying information pertaining to the birth family. In order to protect the privacy of those who choose not to be identified and to attempt to meet the needs of those who do wish to be identified and to provide non-identifying formation, the Adoption Services Unit administers the Mutual Consent Voluntary Adoption Registry in accordance with Act 957 of 1985 and Act 1060 of 1987. The Division will keep records of every adult adoptee and birth parent reunited through the use of the Mutual Consent Voluntary Adoption Registry.

A.C.A. § 9-9-505 Requires compilations of nonidentifving histories of adoptions be available upon request, throughout the time the agency is required to maintain records, to the following persons only:

(a) The adoptive parents of the child or, in the event of death of the adoptive parents, the child's guardian; (b) The adoptee; (c) In the event of the death of the adoptee, the adoptee's children, the adoptee's widow or widower, or the guardian of any child of the adoptee; (d) The birth parent of the adoptee; (e) Any child welfare agency having custody of the adoptee. Any additional nonidentifving information which may have been added on health or on genetic and social history, but which excludes information identifying any birth parent or member of a birth parent's family or the adoptee for any adoptive parent of the adoptee, shall be made available ONLY to the persons listed in this paragraph.

Any affidavits filed for placements on the registry and any other information collected shall be retained for ninety-nine years following the date of registration. Any qualified person may choose to remove his name from the Registry at any time by filing a notarized affidavit with the Registry.

PROCEDURE (VIII-11): Mutual Consent Voluntary Adoption Registry and Related Services

The Registry Administrator will:

* Prepare forms to be shared with administrators of other agencies.

* Prepare monthly, quarterly, or annual demographic reports.

* Host a meeting of other Registry Administrators at least once every twelve (12) months.

* Prepare policies and procedures related to the operation of the Registry.

* Establish office procedures which will assure the confidentiality of the Registry, its records, and identifying information.

* Put the information for the affidavit form for placement on the Mutual Consent Voluntary Adoption Registry (MCVAR) at the Department of Human Services Internet website by one of two methods:

* Print, fill out and send the CFS-434 (MCVAR Affidavit/Registration) to the web site manager, or

* Fill out the CFS-434 directly on the website electronically.

* Ensure that information contained in the Registry or obtained by Registry staff consists of non-identifying information only.

* Send information packets, which have registration requirements and procedures and an affidavit to any person who inquires about registration.

* Have access to the agency's closed adoption records and to court records limited to the act of verifying a Registry match or for compilation of non-identifying information.

* Collect fees for registration services and accept affidavits for registration.

* Provide written notification to qualified registrants within twenty (20) working days as to the status of the initial search of all registrants who wish to be identified.

* Send notification to match registrants by certified mail, return receipt, restricted delivery.

* Determine if non-identifying information is available and if the registrant is eligible to receive it.

* Provide non-identifying genetic, health and social history of the adoptee within sixty-five (65) working days from the date of registration.

* Mail non-identifying information to the registrant by certified mail, restricted delivery, return receipt requested.

* Maintain copies of non-identifying information in a secured location.

* Keep records of every adult adoptee and birth parent reunited through the use of Mutual Consent Voluntary Adoption Registry.

* Provide a copy of the foster care record to the adoptee upon request. De-identify the names of any reporters of child abuse and/or neglect.

* Arrange for an adoptee to review his foster care record upon request. This access is NOT available to adoptees who were placed as infants for the sole purpose of adoption.

The Adoption Specialist will:

* Refer any person who inquires about the Registry to the Registry Administrator, Adoption Services Unit.

* Provide a minimum of no less that one (1) hour of counseling to Registry applicants for receipt of identifying information and sign the affidavit to verify the service.

POLICY(VIII-J): INTERNATIONAL ADOPTIONS

The Adoption Services Unit shall provide assistance with Inter-Country Adoptions.

PROCEDURE (VIII-J1): International Adoptions

The Manager, Adoption Services Unit, or designee will:

* Respond to inquiries/referrals about international adoptions.

* Provide list of licensed private adoption agencies who will complete adoption assessments for inter-country adoptions.

* Determine if an adoption assessment prepared by a qualified licensed social worker or others designated by the court meet child placement licensing requirements for adoption in Arkansas. (Licensed adoption agencies are exempt from this review.)

* Provide an approval letter to the United States Immigration and Naturalization Service upon request to verify compliance to licensing requirements.

* Maintain permanent adoption files.

* Train staff with licensed private adoption agencies, licensed social workers, and others designated by the court involved with inter-country adoption.

The Adoption Specialist will:

Refer inter-country adoption inquiries/referrals to the Manager, Adoption Services Unit or designee.

X. SPECIAL SERVICES

POLICY (X-A): HOME STUDIES AND SUPERVISION

The Division will conduct home studies or provide supervision services when ordered by the juvenile division of the circuit court. The Division will also conduct home studies for cases in which DCFS is a party of the litigation and for Interstate Compact on the Placement of Children (ICPC) cases. A court order to conduct a home study is not required for cases in which DCFS is a party to the litigation nor for ICPC cases.

The Division will not be required to conduct a court ordered home study, investigation or supervision related to private litigation cases (i.e. divorce, custody) unless the court has first determined that the responsible party is indigent.

The following policy statements are in accordance to the Uniform Adoption Act. The Department or any licensed certified social worker shall conduct a home study before placement of a child in the home of the petitioner. Home studies on non-Arkansas residents may also be conducted by the person or agency in the same state as the person wishing to adopt as long as the person or agency is authorized under the law of that state tes requested from other states will only be conducted through nducted through ICPC.

PROCEDURE (X-Al): Guidelines for a Home Study

Upon receipt of a request for a home study, the Services Supervisor will:

Assign the case to a Family Service Worker or. if it is a request to conduct a non-relative independent

uest to the Adoption Services Unit, Slot S565 for assignment to an Adoption Specialist.

n case that does not contain indigent language indicating the responsible party is unable to pay.

Service Worker will:

* ter the appropriate forms to be completed by the family: "Home Study/Supervision Client Questionnaire" (CFS-421/1-6), "Request for Central Registry Check" (CFS-316). and

* "State Adoptions Criminal Record Check" (CFS-342B, whichever is applicable. The family will be advised to return the completed forms to the worker within seven (7) working days.

* y has not returned the completed forms within the seven-day period. Advise the family that the completed forms must be returned within five (5) working days. If the family does not respond to the second request, the worker will send a letter to the requesting party advising that the family has not responded to efforts to conduct the home study. Completion of the home study should not proceed if the information forms are not completed. Any assistance in completion of the forms should be provided or arranged by the worker in situations of

* d or arranged by the worker in situations of physical or mental disabilities or illiteracy.

Contact the family to schedule a home interview upon receipt of the completed forms.

Interview the family. Follow the guidelines for completing a home study as outlined in policy. The home study is to be completed within thirty (30) working days of receipt of the request. Notify the requesting party if additional time will be required to complete the home study.

Forward the completed home study with a cover letter to the court and the requesting party if different. A copy of the home study will be retained in the county office case file.

In CHRIS:

* n, Status screen, and Homes screens.

Close the family as a Resource on the General Information screen upon completion of the home study.

PROCEDURE (X-A2): Content of the Home Study

Purpose of the Home Study: Discuss the basis of the action and primary persons involved.

Household Composition: The full legal names of everyone residing in the home, birth dates,

* omposition: The full legal names of everyone residing in the home, birth dates, relationships to one another, and a brief physical description.

* tare, length of time at residence, upkeep and housekeeping standards, future residence

* ngements.

Income and Expenses: Employment history for the last five (5) years (duration, salary,

* ther sources of income, monthly living expenses, outstanding debts, and insurance.

* Current health of each family member, prior illnesses or medical problems, disabilities,

* and purpose), and hospitalization for alcohol abuse, drug abuse, or mental illness.

* nting classes attended, child's school, child's teacher (verification with school personnel on how the child is doing, academically and behaviorally), child's current school grades, child's

* school problems or successes experienced by the child.

Child Care Arrangements or Plans: Current arrangement or proposed arrangement as it relates to their working hours and income.

Child Rearing Practices: Purpose of discipline, correction methods, how they show affection,

* hods, how they show affection, how they handle stress, allowance, chores, and homework.

Daily Schedule: Routines, sleeping habits, feeding habits, personal hygiene habits and consistency with routine.

Social History: Highlights and verification regarding action of marriages and divorces, children, relationships' support system, future plans, any significant extended family

* icant extended family members not living in the home, and any significant personal,

Family Activities: Religious interests, social organizations, activities with children, and family roles.

Collateral and Reference Contacts: Discuss the results of contacts with the "Request for

* s the results of contacts with the "Request for Central Registry Check" (CFS-316), "Request

* eck" (CFS-306), school, day care providers, and "Reference Letter for Home Study" (CFS-421/2). Any problems or concerns identified through collateral or reference contacts should be shared when appropriate with the family for clarification and further discussion.

Impressions, Conclusions and Recommendations: Evaluate the family's situation and ability

* usions and Recommendations: Evaluate the family's situation and ability to provide for a

* e information obtained during the home study.

PROCEDURE (X-A3): Supervision Record

The Family Service Worker/Adoption Specialist will:

In CHRIS:

Document services delivered and activities conducted on the Services Provided To Resource screen in Resource.

Maintain a file containing the court order, correspondence, narrative and any forms.

APPENDIX

I. GLOSSARY

* of age and whose parent, guardian or custodian left the child alone or in the possession of return for the infant.

* provide reasonable support and to maintain regular contact with the juvenile. When this

he future, the failure to support or maintain regular contact with the juvenile without just cause or an articulated intent to forego parental responsibility.

ABUSE ~ Any of the following acts or omissions by a parent, guardian, custodian, foster parent, or any person who is entrusted with the juvenile's care by a parent, guardian, custodian, or foster th the juvenile's care by a parent, guardian, custodian, or foster parent, including, but not limited to, an agent or employee of a public or private residential home, child care facility, public or private school, or any person legally responsible for the juvenile's welfare:

Extreme or repeated cruelty to a juvenile;

Engaging in conduct creating a realistic and serious threat of death, permanent or temporary disfigurement, or impairment of any bodily organ.

igurement, or impairment of any bodily organ.

Injury to a juvenile's intellectual, emotional or psychological development as evidenced by observable and substantial impairment of the juvenile's ability to function within the juvenile's normal range of performance and behavior.

Any history that is at variance with the history given.

Any non-accidental physical injury.

* knowing acts, with physical injury:

* g, kicking, burning, biting or cutting a child. Striking a child with a closed fist. Shaking a child.

Striking a child on the face.

Any of the following intentional or knowing acts, with or without injury:

* following intentional or knowing acts, with or without injury: Striking a child age six or younger on the face.

Shaking a child age three or younger.

Interfering with a child's breathing.

NOTE: The prior list of unreasonable actions are considered illustrative and not exclusive.

* ns are considered illustrative and not exclusive.

1. buse.

* r purposes or restraining or correcting the child.

3. ble restraint if:

* Id Welfare Agency Licensing Act;

The agency has policy and procedures regarding restraints;

* o control the child except for a restraint;

The child is in danger of hurting himself or others;

* de-escalation, and conflict resolution techniques; and The restraint is for a reasonable period of time.

1. physical discipline inflicted by a parent or guardian shall not include any act that is likely to cause

2. than transient pain or minor temporary marks.

5. determining whether the physical discipline is reasonable or moderate.

* sexually abused or a determination by a judge that there is little likelihood that services to the family will result in successful reunification.

* rson ten (10) years of age or older who is entrusted with a child's care by a parent, guardian,

custodian, or foster parent, including, but not limited to, an agent or employee of a public or private

home, child care facility, public or private school, or any person legally responsible for a child's welfare.

CHILD ~ Individual who is under the age of eighteen, married or single; is under the age of twenty-one, married or single, who was adjudicated delinquent under the "Arkansas Juvenile r the "Arkansas Juvenile Code" for an act committed prior to the age of eighteen and for whom the court retains jurisdiction; or was adjudicated dependent-neglected under the "Arkansas Juvenile Code" before reaching the age of eighteen and who, while engaged in a course of instruction or treatment, requests the court to retain jurisdiction until the course has been completed.

CHILD ABUSE HOTLINE - This hotline is maintained by the State Police Crimes Against

SE HOTLINE ~ This hotline is maintained by the State Police Crimes Against Families Division, for the purpose of receiving and recording notification made pursuant to the "Child Maltreatment Reporting Act". The Child Abuse Hotline is staffed twenty-four (24) hours per day and has statewide accessibility through a toll-free telephone number.

CHILD CARE INSTITUTION - A private child care institution, or a public child care institution which accommodates no more than 25 children, and is licensed by the State in which it is situated or has been approved by the agency of such State or tribal licensing authority (with respect to child care institutions on or near Indian reservations) responsible for licensing or approval of institutions of this type as meeting the standards established for such licensing. This definition

ng schools, or any other facility operated primarily for the detention of children who are determined to be delinquent.

CHILD MALTREATMENT - Physical abuse, sexual abuse, emotional abuse, neglect sexual exploitation or abandonment of a child.

CHILD MALTREATMENT INVESTIGATION - A fact finding assessment that occurs when an allegation of child maltreatment is received. Completion is reached when a determination is made concerning the allegations.

CUSTODIAN - A person (not a parent or legal guardian) who stands in loco parentis to the child OR an agency or institution given custody of a child through a court order.

DEPENDENT JUVENILES - Includes any child:

Whose parent is under the age of eighteen (18) and is in the custody of the Department of hose parent is under the age of eighteen (18) and is in the custody of the Department of Human Services;

dian is incarcerated and the parent or guardian has no appropriate relative or friend willing or able to provide care for the child;

tly, such that the parent or guardian cannot provide care for the juvenile and the parent or guardian has no for the child;

* es and no stand-by guardian exists;

* adoption; or

Whose parent has delivered him/her to a medical provider or law enforcement agency when the

* no intent to return for the child (Safe Haven Act-2001).

DEPENDENT-NEGLECTED JUVENILE - Any juvenile who as a result of abandonment, abuse, sexual abuse, sexual exploitation, neglect or parental unfitness to the juvenile, a sibling, or another

* substantial risk of serious harm.

* ny act of sexual gratification involving:

* anus or mouth of one person by the penis of another person; or

The penetration, however slight, of the labia majora or anus of one person by any body member or

person.

DOMESTIC ABUSE - Physical harm, bodily injury, assault or the infliction of fear of imminent physical harm, bodily injury or assault between family or household members; OR any sexual conduct between family or household members, whether minors or adults, which constitutes a crime under the * of this state. "Family or household member" means spouses, former spouses, parents and

* ons related by blood within the fourth degree of consanguinity, any child residing in the ed or cohabited together and persons who have or have had a child in common.

EXEMPTED FROM TRUE DUE TO RELIGIOUS EXEMPTION - Determination will be entered when the parent's decision to withhold medical treatment is based solely upon a religious belief, and the child is furnished with treatment by spiritual means alone, through prayer, in accordance with a recognized religious method of healing by an accredited practitioner. Such prohibition shall not limit the administrative or judicial authority of the State to ensure that medical services are provided to the child when the child's health requires it.

FAMILY A spouse, parent, child, sibling, or a person related by consanguinity to another person.

spouse, parent, child, sibling, or a person related by consanguinity to another person.

FAMILY STRENGTHS AND NEEDS ASSESSMENT - This is the in-depth assessment that is to be initiated whenever a report of child maltreatment or community or self referral is received. The "Family Strengths and Needs Assessment" (CFS-6009) is used to complete this assessment if a family services case is opened.

FEDERAL ADOPTION SUBSIDY (IV-E) - Payments for a child who is categorized as IV-E (TEA/TANF, SSI-AB or SSI-AD) at the time of placement for adoption by the Division and who meets

een documented that a reasonable effort has been made to place the child without the benefit of subsidy. FORCIBLE COMPULSION - Any act of physical force or intimidation, or any threat, express or implied,

The age, developmental stage and stature of the victim and the relationship of the victim to the assailant, as well as the threat of deprivation of affection, rights and privileges from the victim by the assailant, shall be considered in weighing the sufficiency of the evidence to prove compulsion.

GUARDIAN- Any person, agency or institution so appointed by a court.

titution so appointed by a court.

HOLISTIC-- View of the family and accompanying circumstances that take into consideration the entire family. This view includes the psychological, sociological, physical, and environmental factors which influence the functioning of the family.

HOME STUDY- Assessment of circumstances in a specified situation involving custody, placement, or adoption.

HOMOSEXUAL- In the context of DCFS Policy VII-A, homosexual shall mean any person who voluntarily and knowingly engages in or submits to any sexual contact involving the genitals of one

on, and the mouth or anus of another person, of the same gender, and who engaged in such activity after the foster home is approved, or at a point in time that is reasonably close in time to the filing of the application to be a foster parent.

USEHOLD MEMBER- Means a person currently or formerly residing in a place of abode with another person.

- The Interstate Compact on the Placement of Children is a legislative-enacted agreement currently entered into by al fifty states. It is used to move children in need of placement, treatment or adoption across state lines.

INACTIVE- The child maltreatment assessment cannot be completed.

INDECENT EXPOSURE-Exposure by a person of the person's sexual organs for the purpose of arousing or gratifying the sexual desire of the person, or of any other person under circumstances in which the

n, or of any other person under circumstances in which the person knows the conduct is likely to cause

ont or alarm.

INDEPENDENCE ~ (replaces the definition of long-term foster care) A permanency planning hearing disposition for the juvenile who will not be reunited with his/her family and for whom no other permanent plan is available and:

ble and:

hts is not in the juvenile's best interest; or

The juvenile is being cared for by a relative and termination of parental rights is not in the best interests of the juvenile.

JUVENILE - A person adjudicated dependent-neglected prior to age 18. The juvenile may request the

quest the court to retain jurisdiction beyond the juvenile's 18th birthday, and the court shall grant the request only if the juvenile is engaged and remains in a course of instruction or treatment.

* sdiction only if the juvenile remains in instruction or treatment and shall dismiss jurisdiction

* e request of the juvenile or when the juvenile completes, leaves or is dismissed from

all this person remain within the court's jurisdiction past the age of twenty-one (21) years.

KINSHIP FOSTER PARENT-Any relative within the first, secon⁴ or third degree of kin by blood or proved to be a foster parent.

LAW ENFORCEMENT AGENCY - Any police force or organization whose primary responsibility as established by law or ordinance is the enforcement of laws of this state and is staffed 24 hours a day.

MAINTENANCE SUBSIDY ~ Established monthly payment to cover the costs of maintaining and providing for the basic needs of the child in an adoptive placement on a regular basis. The payment is not

Id in an adoptive placement on a regular basis. The payment is not to exceed the child's foster care board rate which is in effect at the time the adoption subsidy is approved. The amount may increase in

Is depending on the child's age.

MANDATED REPORTER - Individuals identified in the "Child Maltreatment Reporting Act" who must hey have reasonable cause to suspect that a child has been subjected to child maltreatment, or who observe the child being subjected to conditions or circumstances which would reasonably result in child maltreatment or that a child has died as a result of child maltreatment. These individuals include: any physician, surgeon, coroner, dentist, osteopath, resident intern, licensed nurse, medical personnel who may be engaged in rse, medical personnel who may be engaged in admission, examination, care, or treatment of persons, teacher, school official, school counselor, social worker, Family Service Worker, Division of Youth Services employees, employees working under contract for the Division of Youth Services, domestic violence shelter employees, domestic violence volunteers, domestic abuse advocate, day care center worker, or any other child or foster care worker, mental health professional, peace officer, or law enforcement official.

MEDICAL PROVIDER - Any emergency department of a hospital licensed under § 20-9-214.

NEGLECT ~ Acts or omissions of a parent, guardian, custodian, foster parent, or any person who is entrusted with the juvenile's care by a parent, custodian, guardian, or foster parent, including, but not limited to, an agent or employee of a public or private residential home, child care facility, public or private school, or any person legally responsible under state law for the juvenile's welfare, which constitute:

Failure or refusal to provide the necessary food, clothing, or shelter, and education required by law, or ecessary for the juvenile's well-being, except when the failure or refusal is caused primarily by the financial inability of the person legally responsible and no services for relief have been offered or rejected;

Failure to take reasonable action to protect the juvenile from abandonment, abuse, sexual abuse, sexual exploitation, neglect, or parental unfitness where the existence of such condition was known or should

* ave been known;

Failure or irremediable inability to provide for the essential and necessary physical, mental, or emotional, needs of the juvenile;

Failure to provide for the juvenile's care and maintenance, proper or necessary support, or medical, surgical, or other necessary care;

Failure, although able, to assume responsibility for the care and custody of the juvenile or participate

* e care and custody of the juvenile or participate in a plan to assume such responsibility.

NON-RECURRING ADOPTION EXPENSE SUBSIDY - Payment for nonrecurring adoption expenses incurred in the adoption of a child with special needs

* 1 needs and is limited to $ 1,500 per child. Payment will be made to or on behalf of

* merit for the purpose of adoption.

ORDER OF LESS THAN CUSTODY - A court order that DCFS may seek when

* ng a child, but the Division does not want to seek custody.

OUT-OF-HOME PLACEMENT - Placement in a home or facility other than

h services center, a detention facility, or the home of a parent or guardian of the juvenile; or placement in the home of an individual other than a parent or guardian, not including any placement where the court has

tion services or six-month reviews are required.

PARENT ~ Biological mother, an adoptive parent, a man to whom the biological mother was married at onception or birth, or has been found by a court of competent jurisdiction to be the biological father of the juvenile.

PORNOGRAPHY ~ Obscene or licentious material, including pictures, movies and videos. Applying contemporary community standards, the material will be considered pornographic if an average person would find that the material taken as a whole appeals to the prurient interest or if the material depicts in a patently offensive way sexual conduct. The material must lack serious literary, artistic, political or y offensive way sexual conduct. The material must lack serious literary, artistic, political or scientific value to be considered pornographic.

PREPONDERANCE OF THE EVIDENCE - Evidence which is of greater weight or more convincing than the evidence which is offered in opposition to it; that is, evidence which as a whole shows that the han the evidence which is offered in opposition to it; that is, evidence which as a whole shows that the fact to be proved is more probable than not.

PUTATIVE FATHER - A man who claims or is alleged to be the biological father of a juvenile, but has not been so deemed or adjudicated by a U.S. court.

REASONABLE EFFORTS - Efforts to preserve the family, prior to the placement of a child in foster care,

e and efforts to reunify a family, made after a child is placed out of the home, to make it possible for the child to safely return home.

They also include efforts made to obtain permanency for a child who has been in an out-of-home placement for more than twelve (12) months or for fifteen (15) of the last twenty-two (22) months.

ement for more than twelve (12) months or for fifteen (15) of the last twenty-two (22) months.

ing by the court to relieve DHS from providing reasonable efforts to reunite. It further defines juvenile court a court of competent jurisdiction for purposes of determining the fast-track grounds and adds the following to the list of fast-track grounds:

Committed a felony battery or assault that results in serious bodily injury to any child.

t results in serious bodily injury to any child.

Abandoned an infant.

RECEIVING PARTY ~ Local agency, office, facility, or individual who will be supervising a child placed into a state under the provisions of the ICPC.

e provisions of the ICPC.

RECEIVING STATE ~ State to which a child is sent for supervision under the provisions of the ICPC.

SENDING PARTY ~ Local agency, office, facility, court or individual who has custody/jurisdiction of a

* fICPC.

fthelCPC.

SEVERE MALTREATMENT- Sexual abuse, sexual exploitation, acts or omissions which may or do uries, burns, immersions, suffocation, abandonment, medical diagnosis of failure to thrive, or any of the

eanor of the child.

SEXUAL ABUSE -(A) Sexual intercourse, deviate sexual activity or sexual contact by forcible pulsion or attempted sexual intercourse, deviate sexual activity or sexual contact by a person ten (10) years of age or older to a person younger than eighteen (18) years of age; (B) Sexual intercourse, deviate sexual activity or sexual contact or solicitation or attempted sexual intercourse, deviate sexual activity or sexual contact that occurs between a person eighteen (18) years of age or older and a person not his spouse who is younger than sixteen (16) years of age; (C) Sexual intercourse, deviate sexual activity or sexual teen (16) years of age; (C) Sexual intercourse, deviate sexual activity or sexual contact or solicitation or attempted sexual intercourse, deviate sexual activity or sexual contact between a person younger than eighteen (18) years of age and a sibling or caretaker; or (D) indecent exposure or forcing, permitting or encouraging the watching or pornography or live human sexual activity.

SEXUAL CONTACT-Any act of sexual gratification involving the touching, directly or through clothing, of the sex organs, buttocks, or anus of a person or the breast of a female. Normal affectionate hugging is not construed as sexual contact.

SEXUAL EXPLOITATION- Allowing, permitting, or encouraging participation or depiction of the juvenile in prostitution, obscene photographing, filming, or obscenely depicting a juvenile for any use or purpose.

SPECIAL NEEDS CHILD- A child who is free for adoption and has severe medical or psychological cal needs that require ongoing rehabilitation or treatment. Other children may be eligible for adoption assistance under this cks, or anus of a person or the breast of a female. Normal affectionate hugging is not construed as sexual contact.

SPECIAL NEEDS CHILD - A child who is free for adoption and belong to a group of children for whom the Division does not have an adequate resource of approved applicants to provide a pool of available waiting adoptive families. Other children may be eligible for adoption assistance under this category if they have severe medical or psychological needs that require ongoing rehabilitation or treatment. These children include:

* a Caucasian child nine years or older,

* a healthy child of color who is two years or older,

* or a member of a sibling group of three or more being placed together, and the child is:

* legally free for adoption with parental rights terminated.

* under eighteen years old and whose adoption has not been finalized prior to approval of the subsidy,

* (for the purposes of a State Subsidy only), in DHS custody, or

* a member of a Non-Custody/Out-of-Home Placement Services case, or

* (For the purposes of private and independent adoptions only), who is SSI eligible at the time the adoption petition is filed.

SPECIAL SUBSIDY -- A payment to provide for the costs of special services related to the child's needs which cannot be met by the adoptive parent. It may include, but not be limited to, legal/medical/psychological/therapy services and corrective appliances.

STATE ADOPTION SUBSIDY - Payments for a child who is not categorized as IV-E or SSI eligible at the time of placement for adoption by the Division. Such a child, who meets other defined special needs characteristics, may be eligible for subsidized adoption from state moneys if it has been documented that a reasonable effort has been made to place the child without the benefit of an adoption subsidy. A child must be in DHS custody to be eligible for a State funded subsidy.

SUBJECT OF THE REPORT - The alleged offender, the parents, guardian and legal custodians of the child who are subject to suspected maltreatment, and the child who is the subject of suspected maltreatment.

SUPERVISION - Involves periodic visitation to the home, school, or other places to monitor or observe a child's situation or condition. This service also may include arrangement and observation of visitation.

TRUE - Determination when the allegation of child maltreatment is supported by a_preponderance of the evidence.

UNSUBSTANTIATED ~ Determination when the allegation of child maltreatment is not supported by a preponderance of the evidence.

II. ADOPTIONS GUIDELINE FOR AN ADOPTION SUMMARY- DETAILED HEALTH HISTORY AND GENETIC AND SOCIAL HISTORY

Before placement for adoption, the Division shall compile and provide to the prospective adoptive parents a detailed, written health history and genetic and social history of the child which excludes information which would identify birth parents or members of a birth parent's family. The detailed, written health history and genetic and social history shall be set forth in a document that is separate from any document containing information identifying the birth parents or members of the birth parent's family. The detailed, written health history and genetic and social history shall be clearly identified as such, and filed with the clerk before the entry of the adoption decree. Upon order of the court for good cause, the clerk may tender to a person identified by the court a copy of the detailed, written health history and genetic and social history.

Adoption Summary of Child

A. Birth Information: Prenatal care, birth date, measurements at the time of birth, a description of the delivery, any complications that occurred, alcohol/drug and tobacco involvement of birth parent during pregnancy and how it effected the infant, and any birth defects. Describe the nursery progress, discharge weight and recommendations of the doctor on discharge and results of any special health screenings/tests.

B. Physical Description: Race, weight, height, hair and eye color, complexion, birthmarks, and bone structure. Describe any physical handicaps.

C. Developmental and Social History: Social, intellectual, emotional and physical development of the child, noting any delays/limitations. Early developmental milestones should be discussed. For example:

Cognitive Development

* Recognition of significant others

* Comprehension of fact vs. fantasy

* Language development

* Comprehension of concepts such as time, space, quantity, etc. Motor Development

* Head control

* Kicking ~ pushing feet

* Lifting chest

* Rolling over

* Holding toys

* Reaching for objects

* Waving bye-bye

* Sitting up

* Eye movements

* Walking

* Crawling

* Running

* Coordination

* Ability to skip

* Ability to catch ball Social/Emotional Development

* Smiling - Laughing

* Cooing

* Ability to respond appropriately in social situations

* Self-help skills D. Health History:

* medical history (diseases, conditions, disabilities, allergies, hospitalizations, serious injuries etc.), present problems/needs, future problems/needs

* genetic history

* dental history, present problems/needs, future problems/needs

* mental health history, present problems/needs, future problems/needs

* type of mental health counseling and frequency of sessions

* sickle cell test results for a child with African American heritage

* medications (name, dosage, and reason)

* status of immunizations

* how health problem affects child's life

* child's attitude about health problems

* all special health care providers and frequency of appointments

* parental demands in relation to providing for child's special health care needs

* any special appliances to meet special needs

* statement whether female's menstrual periods have begun, feelings about, hygiene practices, any complications

* statement whether male is circumcised

E. Personality: general personality; for example, quiet, outgoing, withdrawn, depressed, angry, sad, happy, alert, shy, talkative, questioning, active, etc.

* interests, likes, dislikes, talents, special skills

* causes of depression and how expressed

* causes of anger and how expressed

* what makes child happy

* how child gives and receives love/affection

* child's self-esteem

* how child relates to adults, peers, younger and older children

* how child relates to siblings

* type of people the child likes/dislikes

* description of what is enjoyable about parenting the child

* description of what is difficult about parenting the child

* child's hopes, wishes, and desires

* fears and worries

* how child relates to parental/authority figures

* behavioral problems (state whether child has displayed: lying, stealing, fire setting, running away, aggression, destruction, withdrawal, bed wetting, encopresis, self harm, suicide attempts, depression, abusiveness to animals, cursing, defiance, sexual acting out (be specific), alcohol/substance abuse, etc. and, if so, explain)

* how easy or difficult is the child to discipline ~ what works, what doesn't

* how child responds to discipline; what rules is the child accustomed to following

* what rules are easy for the child to comply with, and which ones are difficult for the child

* eating habits (ability to feed self, table manners, food likes/dislikes)

* sleeping habits (bedtime routine, nightmares, night light, sleeping difficulties, etc.)

* grooming/hygiene habits

* how child cares for belongings

* how child relates with pets/animals

* smoking practices (if tobacco products are used)

* play habits

* child's behavior in social situations such as church, restaurants, department stores, etc.

* knowledge child has about sex

* experience with sex

F. Daily Schedule:

* Birth to one year old ~ Give detailed information regarding schedule. For example, when discussing sleeping, indicate not only the times the child sleeps but the length of naps; whether child is rocked, patted, etc., to sleep; whether child sleeps with a special blanket, pacifier, or toy; type of bed child sleeps in and the position child prefers to sleep in (i.e., stomach, back, etc.). Indicate the types of food the child likes/dislikes and the amount child eats and intervals between meals. Include the name of the formula.

* Over one year old ~ Briefly describe the child's general schedule on a typical day. Indicate whether the child follows a daily routine or has a flexible schedule.

G. Clothing:

* sizes of clothing and shoes

* type/preference of clothes

* amount of clothing

* quality of clothing (good condition, worn, etc.)

* any special requirements in relation to clothing

H. POut-of-Home lacement Experiences:

* date child entered Out-of-Home Placement and for what reasons

* describe any child maltreatment and who was offender

* statement as to how many foster homes and/or institutions child has lived in and length of time in each placement

* description of reasons for moving from each foster home and/or institution

* brief profile of current foster family or institutional setting ~ for example, foster family composition and life style

I. School Experiences:

* description of the type of school the child is attending ~ for example, public school, special school (school for the deaf, blind, etc.) and whether resource classes/special education classes are utilized and its schedule (whole day, half day, or certain classes)

* grade level

* history of school attendance (past and present)

* experience with schools; for example, accomplishments, problems, etc.

* attitude towards school

* best subject areas as well as weak areas

* relationship with school mates and teachers

* how teachers view child

* involvement with school activities, clubs, sports, band, etc.

* potential in relation to school

* attitude towards homework

J. Income: Indicate if the child has a source of income. If so, give the source of income and amount (Social Security, SSI, VA, etc.) which the child receives while in Out-of-Home Placement. Do not include foster care board payment.

K. Siblings: Provide a brief description which includes first name, birth date, living arrangement and sibling status (full sibling, half sibling, step sibling, etc.). If siblings are not placed together, explain frequency of contacts.

Birth/Legal Parent(s):

Discuss each parent separately. Obtain as much information about the parents as possible. Be objective with descriptions of the parents and give factual information about them. Do not make derogatory remarks.

A. Physical and Personality Description: Include race, ethnic background, age, height, weight, eye and hair color, complexion, bone structure, outstanding features, general appearance, and dominant physical traits within the larger family group. Describe personalities and any special talents, interests or hobbies.

B. Health: Discuss any medical and mental illnesses, genetic history, allergies, alcohol/substance abuse and/or physical handicapping conditions. Discuss any medical and mental illnesses within the extended birth family including those of a hereditary nature. Discuss any history of neglect, physical abuse and/or sexual abuse within the extended family. Discuss any alcohol/substance abuse within the extended family. If the birth/legal parent is deceased, state the cause and date.

C. Education: State highest educational level achieved. Discuss overall academic performance, best and weak subjects, and extracurricular activities. Discuss any mental retardation and/or learning disabilities in relation to the birth parent(s) and the extended birth family.

D. Religion: Provide information about religious affiliation.

E. Employment: Describe employment history.

F. Other Significant Information:

* birth family' s lifestyle

* history of criminal behavior

* reasons child can't return to birth/legal family

* date child last had contact with birth/legal family, type of contact, and reaction

Preparation of the Child for Adoption

A. Dealing with Birth/Legal Family Issue

* Reasons child gives for entering Out-of-Home Placement

* Reasons child has been given for entering Out-of-Home Placement

* Reason child gives why the child cannot return home

* Reason child was given why the child cannot return home

B. Child's feelings about not returning home

C. Dealing with Out-of-Home Placement Issues

* Reasons child gives for placement changes while in Out-of-Home Placement

* Child's feelings about Out-of-Home Placement experiences and placements

D. Dealing with Adoption Issues

* Child's understanding about the difference in birth/legal family, foster family, and adoptive family

* Child's feelings about accepting an adoptive family's last name

* Child's understanding of the adoption process (selection of a family, pre-placement visits, post-placement visits, etc.)

* Child's feelings, fears and worries about adoption

* Child expectations about adoption/an adoptive family

* Child's preferences in relation to an adoptive family

Recommendations:

* The Adoption Specialist may describe the type of family the child needs and state if the child should not be placed in a certain location due to proximity to birth/legal parents/relatives.

* The Adoption Specialist may request the child be placed in a home of the same racial or ethnic heritage if indicated by an individualized determination that this placement is needed to advance the best interests of the child.

* If there are siblings, the Adoption Specialist will explain whether they should be placed together. If separation is recommended, reasons will be stated.

* The Adoption Specialist may state preferences in relation to pre-placement visits between the child and an adoptive family.

B. ATTACHMENTS TO THE ADOPTION SUMMARY

* Photographs:

* Twenty-five (25) color photographs of a child with special needs (non-family foster parent adoption).

* Five (5) color photographs of a child without special needs (non-family foster parent adoption).

* Photographs of a child are not needed for a family foster parent adoption.

* birth certificate

* hospital birth records (delivery, care, discharge)

* CFS-457 (Hospital Data) for newborn infants being relinquished for adoption

* CFS-456 (Biological Family Background Information) ~ complete Medical Passport, complete medical/developmental evaluation reports (CFS-366, EPSDT, etc.), hospitalization reports, etc. since placement in Out-of-Home Placement

* complete medical/developmental evaluation reports prior to placement in Out-of-Home Placement if accessible

* up-to-date immunization record

* sickle cell evaluation report for child with African American heritage

* dental evaluation reports since placement in Out-of-Home Placement

* vision evaluation reports since placement in Out-of-Home Placement

* psychological evaluation reports since placement in Out-of-Home Placement and any such reports prior to placement in Out-of-Home Placement if accessible

* mental health counseling (progress) reports since placement in Out-of-Home Placement and any such reports prior to placement in Out-of-Home Placement if accessible

* therapeutic Out-of-Home Placement monthly progress reports if applicable

* speech evaluation reports since placement in Out-of-Home Placement if applicable

* hearing evaluation reports since placement in Out-of-Home Placement

* complete academic transcript from kindergarten to the present

* current Individual Education Plan (IEP) if applicable

* any school academic testing results (achievement tests)

* current Out-of-Home Placement Case Plan (CFS-6010)

* termination of parental rights/court order and most recent judicial review court order

* psychological evaluations of birth parents if one has been previously completed (not for disclosure to the Adoptive family)

* written consent of child (adoption of child for whom placement is not readily available) ten (10) years of age or older to utilize photograph, video, etc. in activities to recruit an adoptive family

NOTE: Placement Specialist, Adoption Services Unit, Central Office will complete the "Child's Information Sheet" (CFS-412) on a child with special needs (adoption of child for whom placement is not readily available) if activities to recruit an adoptive family are needed.

VI. RECORD ORDER/RECORD FILE FOLDER (Family Foster Homes)

Special divided folders shall be used for the case records of foster family homes. When a foster family home is approved, the foster family home record shall be established according to the order below.

Front left: Approval/Renewal

Copy of the CFS-342 (A) (Foster Care Criminal Record Check), all information received and, in case of a report of violations, a summary of the face-to-face discussion, determination, and reasons for the determination.

Copy of the CFS-316 (Request for CPS Central Registry Check), all information received and, in case of a report of violations, a summary of the face-to-face discussion, determination, and reasons for the determinations.

CFS-450 (Foster Home Study/Application and attachments) Summary with Recommendations

CFS-455 (Request/Consent for Health Department Services)

CFS-480 (Alternate Compliance of Water Supply Agreement), when appropriate

CFS-478 (Physician's Report)

Verification of Marriage and/or Divorce

CFS-449 (Reference Letters)

CFS-463 (Knowledge of Pre-Service Training Material)

CFS-464 (Foster Parent Evaluation)

CFS-475 (Checklist for Compliance)

Approval or Denial Letter

CFS-481 (Family Foster Home Approval Certificate)

CFS-462 (Initial Foster Home Agreement)

CFS-462 (A) (Foster Home Agreement Addendum)

CFS-485 (Foster Home Face Sheet)

Order: Foster Home Face Sheet on top, Approval or Denial Letter, CFS-475, etc., filed in chronological order with the most current on top.

Front Right: Copy of information contained in the Resource and Placement Screen in CHRIS (i.e., changes in placements, case transfer, provider changes, etc.)

Order: File information in chronological order with the most current on top. Center Left: Narrative

Order: Filed in chronological order with the most current entry on top.

Center Right: Ongoing Monitoring/Annual Reevaluation/Transfer/Closure

CFS-451 (Foster Parent Reevaluation Form)

Reevaluation Summary or Closure Summary

Letter of Notification of Disposition of Reevaluation or of Closure

CFS-475 (Checklist for Compliance) for Ongoing Monitoring/Annual Reevaluation or Closure as appropriate.

CFS-479 (Foster Home Reevaluation Notice)

Order: CFS-479 on top, Letter of Notification of Disposition of Reevaluation or of Closure, CFS-475, Summary etc., filed in chronological order with the most current on top.

Back Left: Correspondence

Letters

Memos

Order: Filed in chronological order with the most current on top. Back Right: Miscellaneous - Documents/Forms

TR-1 (Travel Expense Reimbursement Form)

CFS-375 (Volunteer Cover Letter)

DHS-1914 (Department of Human Services Requisition)

Order: Filed in chronological order with the most current on top.

VII. CASE RECORD ORDER (Out-Of-Home Placement Cases)

The Family Service Worker shall maintain and organize the current case record on every foster child in his caseload. Policy (I-D): Official Record Keeping, states that a hard copy file of case information will be maintained for data not in CHRIS. Hard copy files will be created, if necessary for case review. The following is the case record order to maintain files on information not in CHRIS. This case record order will also be used when hard copy files are created for case review.

Front Left______Legal Section

Services Face Sheet CFS-386

Client Information CFS-6002

6 Month Review Order

Adjudication Order

Emergency Order

Summons

Warning Orders

Order Terminating Parental Rights and Granting to DHS the Power to Consent to Adoption

Petitions

Affidavit CFS-411

Birth Certificate

Social Security Card SS-5

Order: CFS-386 (Services Face Sheet) on top. Order Terminating Parental Rights (if applicable), next to the top, then most current court order followed by all legal documents related to that order (i.e., petition, warning orders, summons, etc.). Other information behind this is filed in chronological order with the most current on top. Behind each court order, file all legal documents related to the order.

Front Right Case Plan, Staffings, and Progress Reports

Case Plan (CFS-6010)

Treatment Plan - signed CFS-6010

Placement Plan - signed CFS-6008

Child's Health History Services Plan CFS-368/Medical Passport

Independent Living Case Plan (if applicable)

Order: CFS-6010 (Case Plan) on top and applicable medical passport forms, and staffing reports filed in chronological order with the most current on top.

Center Left Child's Social Record and Narrative

Family Strengths and Needs Assessment CFD-6009

Case Summary CFS-6022

Client Services CFS-6005

Contacts/Visits CFS-6006

Court Report CFS-6011

Home Studies

Order: File in chronological order with the most current on top.

Center Right Correspondence

Invitation to Family Centered Meeting CFS-590

Change in Placement Review CFS-331

Letters/Memos

Incident Reports (use IRIS link on DHS Gold)

Order: Most current on top.

Back Left______Medical and School Record

CFS-362 Medi-Alert Form (Initial Placement)

Placement Plan - Placement Provider Information CFS-6007

Client Medical and Psychological Information (each client) CFS-6012

Child Health Services Plan CFS-368

Health Screening CFS-366

Medical, Dental, Vision, Hearing and Psychological Episodic Form CFS-352

Past Medical History Records Requested CFS-353

Consent for Release of Information DHS-81

School Records (Report Cards. IEP. etc.)

Psychological Evaluations

Order: Child' medical record on top; others intermixed with most current on top.

Note: Educational records and reports of each age appropriate child, not just those children with special educational needs, shall be filed in the foster child's case record. Reports and records include report cards. Individual Education Plan (I.E.P). etc.

Back Right_____Financial

Application for Title IV-E Payments/Medicaid CFS-487 (print from CHRIS screen)

Referral/Information Transmittal DHS-91

Notification of Change (print from CHRIS screen)

Requisition DHS-1914

Authorization for Billing CFS-334 (Only for payments from Child's Trust

Account)

Homemaker Referral CFS-322

Information/Referral DHS-3300

Order: Intermixed with most current on top.

Notes

016.15.03 Ark. Code R. § 005

9/8/2003

State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.

No prior version found.