Revised 3-26-10

INSTRUCTIONS TO STAFF 340:75-4-13

Revised 3-26-10

1.   (a) Family Functional Assessment. Form 04KI028E, Family Functional Assessment is completed no later than 30 days after the signature date on Form 04MP025E, Voluntary Family Service Agreement, signifying the family’s acceptance of voluntary FCS.  Form 04KI028E, is not completed by the CW worker when:

• (1) the voluntary case is closed within 30 days of Form 04MP025E, Voluntary Family Service Agreement, being signed; or
• (2) the family is referred to and accepts Comprehensive Home Based Services (CHBS) within 15 days of the parent's signature on Form 04MP025E in accordance with OAC 340:75-1-151, which provides an exemption of Form 04KI028E by substituting the CHBS Family Inventory of Needs Assessment (FIND) to be completed by the CHBS case manager.

(b) The assessment process includes meeting with the family to discuss and complete Form 04KI028E, Family Functional Assessment.  When possible, all of the family members are present along with any other persons invited by the family to participate.  A child in voluntary alternative out-of-home placement may be brought to the home for the assessment, if case circumstances and safety permit, affording an opportunity to observe parent-child interaction.  All children age 12 or older participate in the assessment process.

2.   (a) Individualized Service Plan (ISP).  Form 04KI012E, Individualized Service Plan (ISP), must be completed no later than 45 days after the family agrees to accept voluntary FCS, as documented by the signature date on Form 04MP025E, Voluntary Family Service Agreement.  Form 04KI012E, is not completed by the CW worker when:

• (1) the voluntary case is closed within 30 days of Form 04MP025E, Voluntary Family Service Agreement being signed; or
• (2) the family is referred to and accepts CHBS within 15 days of the parent's signature on the the Voluntary Family Service Agreement in accordance with OAC 340:75-1-151, which provides an exemption of Form 04KI012E by substituting the CHBS Family Intervention Plan (FIP) to be completed by the CHBS case manager.

(b) Forms 04KI030E, Assessment of Child Safety, and 04KI028E, Family Functional Assessment, are used to develop the ISP.  The ISP determines the interventions to correct the conditions that resulted in CW involvement.  Children ages 12 or older participate in the planning process.

• (1) The planning process:
  • (A) provides direction to the CW worker and family about what will occur during planned changes;
  • (B) identifies services associated with specific outcomes that are made available to the child and person(s) responsible for the child (PRFC(s));
  • (C) identifies the behaviors and conditions that must change;
  • (D) identifies specific measures that may be applied to facilitate family change;
  • (E) prioritizes what will be done, when, and for what length of time by the family, CW worker, and other providers;
  • (F) identifies the alternative permanency plan;
  • (G) establishes the length of service expected in the case; and
  • (H) includes a crisis plan to address contingencies, such as relapse, regression, domestic violence, and home or environmental conditions.

(2) The CW supervisor reviews Form 04KI012E with the CW worker to ensure that the identified safety threats and risk issues are addressed.

• (3) The CW worker:
  • (A) makes service referrals, based on Form 04KI012E;
  • (B) facilitates initiation of services with providers;
  • (C) discusses with the service provider and family agreed-upon objectives as they relate to the safety and well‑being of the child and the length of anticipated service and outcome measure.  Form 04KI012E, is used as a guide to establish the details of service utilization;
  • (D) must be sensitive to the work and school responsibilities of family members when services are scheduled;
  • (E) maintains frequent, regular contact with the child, family, any voluntary alternative out-of-home placement providers, and all collateral service providers; and
  • (F) documents the contacts and visitation on the appropriate KIDS screens.

3.   Safety planning process.

• (1) The safety plan includes actions that have or will be taken to protect each child in relation to current safety threats.
• (2) The safety plan identifies how the plan will be monitored and by whom to ensure the plan is effective.
• (3) The safety planning process is ongoing and Form 04KI030E, Assessment of Child Safety, is reviewed and updated as changes occur.
• (4) During the first 30 days of services, the  CW worker conducts home visits once or more each week, as determined by the CW supervisor, for the purpose of evaluating the safety of the child.
• (5) If the child is placed into protective or emergency OKDHS custody, while the FCS case is open, court intervention is requested unless the incident that led to the child's removal can be quickly and safely resolved.
  • (A) If Form 04KI003E, Report to District Attorney, was initially completed, the CW worker documents in an addendum the family's failure to cooperate or to change the conditions or behaviors that placed the child in danger.  The addendum and initial Form 04KI003E, Report to District Attorney, are submitted to the district attorney (DA).
  • (B) If Form 04K1030E was initially completed upon the conclusion of an assessment, Form 04KI003E is prepared and submitted to the DA.

4.   Child well-being measures.  Procedures in (1) through (3) are followed to ensure the child well-being measures of educational, physical, and mental health needs are included in service planning and are documented in the appropriate KIDS screen no later than 30 days after each child's appointment for medical, dental, or psychological services. The CW worker assists the PRFC(s) in identifying and accessing appropriate services to meet the child's:

• (1) educational needs.
  • (A) When the child is school-age, the CW worker determines whether the child is currently enrolled in school or participating in an alternative educational program.
  • (B) When the child has needs related to school performance, appropriate efforts are made to assess or address these needs.
  • (C) The case record must contain the child's educational records, including documentation of:
    • (i) present grade placement;
    • (ii) grade level performance;
    • (iii) last school attended;
    • (iv) special strengths and weaknesses; and
    • (v) relevant education information, determined appropriate by the Oklahoma Department of Human Services (OKDHS).
  • (D) When the child is in voluntary out-of-home placement, the CW worker:
    • (i) provides copies of educational records to the placement provider; and
    • (ii) documents whether the child's school enrollment was affected during the last 12 months;
• (2) physical health needs.
  • (A) The CW worker determines whether the child has received a health screening or physical examination within the last 12 months.  If not, appropriate efforts are made to provide for such.  Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) may be used, per OAC  340:75-9-2, 340:75-9-5 and 340:75‑13-62.
  • (B) The  CW worker determines whether the child, if older than three years of age, has received a dental examination within the last 12 months.  If not, appropriate efforts are made to provide for an assessment of dental needs.  Children younger than three years of age receive dental services as needed.
  • (C) Treatment is pursued for identified health and dental needs.  The CW worker assists the PRFC(s) in identifying and accessing appropriate treatment.
  • (D) Appropriate efforts are made to ensure the child's immunizations are current.
  • (E) If the child is in alternative voluntary out-of-home placement, the CW worker ensures the child's health records are provided to the placement provider within 30 days of initial or 15 days of subsequent placement.  Health records include a listing or description of the child's:
    • (i) health provider's name and address;
    • (ii) record of immunizations;
    • (iii) known medical problems;
    • (iv) medications;
    • (v) psycho-social information;
    • (vi) third-party insurance coverage available; and
    • (vii) relevant health information, determined appropriate by OKDHS; and
• (3) behavioral health needs.
  • (A) A behavioral health or developmental screening is conducted within 90 days of placement.  This may be an EPSDT examination.
  • (B) If there are indications that the child has behavioral health or developmental needs, appropriate efforts are made to assess and address these needs.

5.   Contact and conference requirements and related documentation.

• (1) A conference between the CW worker and supervisor is held a minimum of once per month, and documented in the KIDS system to review the:
  • (A) Form 04KI030E to determine if safety threats are being controlled and managed;
  • (B) progress on the Individualized Service Plan (ISP) to determine if services and interventions recommended are supporting behavioral changes; and
  • (C) frequency of CW visits to the family to determine whether visits should be increased or decreased.
• (2) The CW worker completes the age appropriate contact guide during the initial home visit and once per month thereafter for each child in the home or in voluntary alternative out-of-home placement and documents in KIDS. Guides used in gathering and documenting information are:
  • (A) Form 04MP007E, Face-to-Face Contact Guide;
  • (B) Form 04MP004E, Contact Guide Addendum for Face-to-Face Visit with Newborn(s) and Infants(s) – Age 0 to 12 Months;
  • (C) Form 04MP006E, Contact Guide Addendum for Face-to-Face Visit with Toddler(s) - Age 13 through 36 months; and
  • (D) Form 04MP008E, Contact Addendum for Face-to-Face Visit with Youth - Age 16 to 18.
• (3) The purpose of CW worker contacts with child, parent(s), and alternative caregivers, includes, but is not limited to:
  • (A) ensuring the parent(s) understands the individualized service plan and the consequences of failure to correct the conditions requiring intervention;
  • (B) assessing the parent's ability to provide a safe environment for the child;
  • (C) evaluating the home situation and progress on the individualized service plan;
  • (D) encouraging and guiding the parent(s) in the completion of individualized service plan;
  • (E) evaluating the child's safety and needs in the placement;
  • (F) evaluating whether the parent(s) is developing and maintaining a healthy parent-child relationship; and
  • (G) advising the parent(s) his or her rights, roles and responsibilities and the status of the case.
• (4) The CW worker develops a visitation plan with the parent(s) and voluntary placement provider(s) using Form 04MP047E, Visitation Plan.  The purpose of the visitation plan is to ensure that regular purposeful visits between the child, sibling, and parent are occurring.
• (5) Contact with service providers.  The CW worker maintains at least monthly contact with the service provider by phone, in person, or by correspondence and documents the contacts in the KIDS system.  It is the responsibility of the CW worker to keep the provider informed of any changes in the family's circumstances and provide the provider with a copy of Form 04KI012E, that pertains to the service provisions to be addressed.

6.   Refusal to Cooperate or Respond.  Families must be positively engaged in the treatment process for the duration of the FCS case.  When parent(s) do not make themselves available, or persistently request postponement or rescheduling of appointments, the CW worker makes every effort to encourage the parent(s) to participate and complete services.  These efforts are documented in the case.  When a family refuses to cooperate with services or requests case closure after three contact attempts, the case is staffed with the CW supervisor to evaluate the adequacy of the parent's protective capacities without services, and determination if there is a need for court intervention.