1.1.4 Child’s Section – (Cover Sheet: White)

This section has two parts, the Child’s Section and the Child’s Recruitment Section; both are created only if a child is placed in out-of-home care. Make a separate section for each child in out-of-home care. The Child’s Section includes:

  • Child/Family Health and Developmental Assessment, (CW-103)
  • Indian Child Welfare Act Checklist (CD-123)
  • Indian Ancestry Questionnaire (CD-116)
  • Reports which relate specifically to the child, i.e., counseling, school, medical, etc.
  • Income Entry Log, CS-KIDS-1
  • Residential Treatment Referral, CS-9 (if applicable)
  • Title XIX FFP Application/Eligibility Determination Worksheet, CS-66, (SSI referral)
  • A copy of the most recent Alternative Care Client Information screen, SS-61, is to be used as a face sheet
  • Birth certificate
  • Social security card
  • Child Assessment and Service Plan (CS-1)

Child’s Recruitment Section – (Cover Sheet: White)

This section is to include all documents pertaining to recruitment efforts specific to the child.  This section may include, but is not limited to:

  • Consent for Special Recruitment Efforts – CD-AEM-1
  • Court order allowing special recruitment for the child
  • Child’s long profile, short profile and media profile
  • Adoption Staffing Decision Worksheet – CD-189
  • Adoption Staffing Prospective Adoptive Family Interview Questionnaire – CD-134
  • Statement of Confidentiality for Adoption Staffing Team Members – CD-135
  • Family Response Form – CD-192

A separate record is established for a child if parental rights are terminated.

Chapter Memoranda History: (prior to 1/31/07)

Memoranda History: