Delinquency Case Plan A Case Identification Name Of Child

delinquency case plan a. case identification name of child dob county name cause number date of child’s first placem

Delinquency Case Plan

A. Case Identification
Name of Child
DOB
County Name
Cause Number
Date of Child’s First Placement
Date of Dispositional Decree (Attach)

 
 
 
 
 
Individuals consulted to develop Case Plan: (Must include (1) foster
parent or caretaker)
Name:
Role:
1.  
1.  
2.  
2.  
3.  
3.  
B. Services to Prevent Removal
Describe the services that were offered/provided to prevent removal of
the child from the home, i.e. prior Informal Adjustment, Home
Detention, etc.
 
C. Placement Information
Name of Placement
Address of Placement
Date of Placement
 
 
 
If the placement is located outside of Indiana, complete the
following:
1. Has the written approval of the D.C.S. Director or Director’s
designee been received?
Yes
No
2. If no:  
a. Is the Facility within 50 miles of the county or residence of the
child?
 
b. Explain the reasons why a comparable placement within Indiana is
not available.
 
Is this placement the least restrictive family like setting that is in
close proximity to the parent, custodian or guardian?
Yes
No
If Yes: How?  
Was consideration given to suitable/willing relative caretakers?
Yes
No
If Yes: Who, with details of the consideration:  
Please explain the appropriateness of this placement based on the
child’s special needs and best interests.  
D. Permanency Plan
Choose from: Reunification, Adoption, Guardianship, Placement with a
Fit and Willing Relative, Alternative Planned Living Arrangement. If
more than one plan is identified, list plans in order of preference.
If the child is 16 years of age or older, include a written
description of the programs and services which will help such child
prepare for the transition from foster care to independent living; or,
describe why such a plan is not appropriate.
Plan:  
Estimated Date for Permanency Plan:  
Date of Permanency Plan Court Hearing:  
E. Rehabilitative Services Recommended
Is there a Parental Participation Order? Yes No
If yes, please describe services ordered.  
For Parents/Guardians/Caretakers/Children including efforts already
made to provide services:
Efforts Already Made:  
Begin Date
End Date
Provider
 
 
 
Outcomes:  
Services Recommended (educational, provision of necessary clothing and
supplies, medical and dental care, counseling and remediation or other
as identified in this plan):  
Begin Date
End Date
 
 
Efforts to be made to provide the services ordered by the court:  
F. Education
School Status: Full-Time Part-Time None
Name of School:  
Address of School:  
Current Performance Level in School Including Any Learning Needs:  
Special Needs Designation (if applicable):  
Most Recent Individualized Education Plan date (if applicable):  
G. Health
Please attach all available health records and summarize the health
status of the child.
 
H. Visitation Arrangements for Parent/Guardian/Custodian
Is a visitation plan in place: Yes No
Please describe:  
I. Acknowledgement/Agreement of all Parties
I am aware of the reason for wardship and/or placement of the
above-named children.
I have reviewed the Case plan and agree do not agree
Parent/Guardian/Custodian
Review Date
Signature Date
Signature
 
 
 
 
 
 
J. Case Plan Review
After completion of the initial case plan within the first 60 days,
the case plan must be reviewed and updated by the probation department
at least once every one hundred eighty (180) days.
Date of 1st Review:  
Date of 2nd Review:  
(Include additional review dates if appropriate).
Date of Next Review:  
K. Current Circumstances at each 180 days
Have the parent, guardian or custodian’s addresses changed? Yes No
If yes, please provide:  
Please complete the following if there have been any changes since the
last report. If there are none, check the N/A box.
Child’s earned or unearned income or any other type of funds from any
source? N/A
 
Parents earned or unearned income or any other type of funds from any
source? N/A
 
Copy of the Case Plan (Notification) delivered to:
Child’s Mother
Date:
 
 
Hand Delivery First Class Mail
Child’s Father
Date:
 
 
Hand Delivery First Class Mail
Child’s Guardian/Custodian
Date:
 
 
Hand Delivery First Class Mail
Agency with Legal Responsibility
Date:
 
 
Hand Delivery First Class Mail
Department of Child Services
Date:
Electronically
 
 
Hand Delivery First Class Mail
Probation Officer’s Signature:
Typed Signature:  
Date:  
*Please retain a signed copy for the probation records.
*Please send to: D.C.S. Probation Services Coordinator
302 W. Washington Street Room E306 – MS 47
Indianapolis, IN 46204-2739
Or email: Paula Buchanan at: [email protected]
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7.1.2008