FAMILY INTERACTION PLAN

Name – Child
[TM1] / Case Name
[TM2] / Effective Date
[TM3]
List those allowed to visit with child
Name / Relationship to child
[TM4] / [TM5]
Parent / CaregiverLevel of Supervision and Location

Parent / Caregiver 1: [TM6]

Minimum Level Required:[TM7] / Frequency:[TM8]
Supervised by:
[TM9] / Department or contracted provider
[TM10] / Foster Home – Name(s):[TM11]
[TM12] / Relative – Name(s):[TM13]
[TM14] / Other – Name(s):[TM15]
Least Restrictive Location Permissible: [TM16]

Parent / Caregiver 2: [TM17]

Minimum Level Required: [TM18] / Frequency: [TM19]
Supervised by:
[TM20] / Department or contracted provider
[TM21] / Foster Home – Name(s):[TM22]
[TM23] / Relative – Name(s):[TM24][TM25]
[TM26] / Other – Name(s):[TM27]
Least Restrictive Location Permissible: [TM28]
Rationale for Level of Supervision and Location
Describe each parent’s / caregiver’s diminished protective capacities that impact child safety warranting supervised family interactions.

[TM29]

Plan to Transition Family Interaction
Describe what needs to happen in order to transition the family interaction plan. If supervised, describe what is needed to control impending danger threats in order to transition to unsupervised family interaction. If unsupervised, at what points will family interaction increase in frequency and duration. Be specific.
[TM30]
Description of Parental / Caregiver Responsibilities
Include each parent’s / caregiver’s responsibilities to:arrange / confirm interactions with the agency worker, plan and prepare activities for the family interaction and assist their child with the transition at the conclusion of the family interaction.

[TM31]

Description of Agency Responsibilities
Include how agency will assure that family interactions will occur on a regular basis.

[TM32]

Transportation
Document how any necessary transportation will take place and who is responsible for the transportation.

[TM33]

Description of Sibling Interaction Plan
When siblings are not seeing each other as part of the family interaction plan, a sibling interaction plan is necessary. Describe how, when and at what frequency sibling interactions will occur.

[TM34]

Comments

[TM35]

Signatures
SIGNATURE – Family Member / Date Signed
SIGNATURE – Family Member / Date Signed
SIGNATURE – Other / Date Signed
SIGNATURE – Other / Date Signed
[TM36]
Name – Worker / Date Signed
SIGNATURE – Worker
[TM37]
Name – Supervisor / Date Signed
SIGNATURE – Supervisor

Family Interaction Plan Page 1 of 2

DCF-F-CFS2087-E (R. 04/2011)

[TM1]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: If the child's name is spelled wrong, the name can be updated on the child's Person Management page.

[TM2]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: update the Case field on the Maintain Case page.

[TM3]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: update the “Effective Date” field on the Family Interaction Plan page.

[TM4]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: update the Name field from the “Those Allowed to Visit with Child” group box on the Basic tab of the Family Interaction Plan page.

[TM5]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: update the Relationship to Child field in the “Those Allowed to Visit with Child” group box on the Basic tab of the Family Interaction Plan page.

[TM6]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: The “Parent / Caregiver 1” field is pre-filled with the name of the person identified as ‘Child’s Mother’ on the Parent Info tab of the child’s Person Management page. If no person is identified as ‘Child’s Mother’ or if the person identified as ‘Child’s Mother’ has a date in the ‘Death Date’ field on her Person Management page, then this field will pre-fill with the person identified as ‘Child’s Guardian (1)’ on the Parent Info tab of the child’s Person Management page. If neither ‘Child’s Mother’ or ‘Child’s Guardian (1)’ is identified, this field will pre-fill with ‘N/A.’

[TM7]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: update the Minimum Level Required field in the Supervision Parent / Caregiver (1) group box on the Basic tab of the Family Interaction Plan page.

[TM8]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: update the Frequency field of the Supervision Parent / Caregiver (1) group box on the Basic tab of the Family Interaction Plan page.

[TM9]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: select or unselect the Department or contracted provider checkbox from the Supervision Parent / Caregiver (1) group box on the Basic tab of the Family Interaction Plan page.

[TM10]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: select or unselect the Foster Home checkbox from the Supervision Parent / Caregiver (1) group box on the Basic tab of the Family Interaction Plan page.

[TM11]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: update the text box for the Foster Home field from the Supervision Parent / Caregiver (1) group box on the Basic tab of the Family Interaction Plan page.

[TM12]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: select or unselect the Relative checkbox from the Supervision Parent / Caregiver (1) group box on the Basic tab of the Family Interaction Plan page.

[TM13]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: update the text box for the Relative field from the Supervision Parent / Caregiver (1) group box on the Basic tab of the Family Interaction Plan page.

[TM14]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: select or unselect the Other checkbox from the Supervision Parent / Caregiver (1) group box on the Basic tab of the Family Interaction Plan page.

[TM15]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: update the text box for the Other field from the Supervision Parent / Caregiver (1) group box on the Basic tab of the Family Interaction Plan page.

[TM16]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: update the Least Restrictive Location Permissible field in the Supervision Parent / Caregiver (1) group box on the Basic tab of the Family Interaction Plan page.

[TM17]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: The “Parent / Caregiver 2” field is pre-filled with the name of the person identified as ‘Child’s Father’ on the Parent Info tab of the child’s Person Management page. If no person is identified as ‘Child’s Father’ or if the person identified as ‘Child’s Father’ has a date in the ‘Death Date’ field on his Person Management page, then this field is pre-filled with the person identified as ‘Child’s Guardian (2)’ on the Parent Info tab of the child’s Person Management page. If neither ‘Child’s Father’ or ‘Child’s Guardian (2)’ is identified, this field is pre-filled with ‘N/A.’

[TM18]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: update the Minimum Level Required field in the Supervision Parent / Caregiver (2) group box on the Basic tab of the Family Interaction Plan page.

[TM19]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: update the Frequency field of the Supervision Parent / Caregiver (2) group box on the Basic tab of the Family Interaction Plan page.

[TM20]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: select or unselect the Department or contracted provider checkbox from the Supervision Parent / Caregiver (2) group box on the Basic tab of the Family Interaction Plan page.

[TM21]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: select or unselect the Foster Home checkbox from the Supervision Parent / Caregiver (2) group box on the Basic tab of the Family Interaction Plan page.

[TM22]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: update the text box for the Foster Home field from the Supervision Parent / Caregiver (2) group box on the Basic tab of the Family Interaction Plan page.

[TM23]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: select or unselect the Relative checkbox from the Supervision Parent / Caregiver (2) group box on the Basic tab of the Family Interaction Plan page.

[TM24]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: update the text box for the Relative field from the Supervision Parent / Caregiver (2) group box on the Basic tab of the Family Interaction Plan page.

[TM25]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: update the text box for the Relative field from the Supervision Parent / Caregiver (2) group box on the Basic tab of the Family Interaction Plan page.

[TM26]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: select or unselect the Other checkbox from the Supervision Parent / Caregiver (2) group box on the Basic tab of the Family Interaction Plan page.

[TM27]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: update the text box for the Other field from the Supervision Parent / Caregiver (2) group box on the Basic tab of the Family Interaction Plan page.

[TM28]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: update the Least Restrictive Location Permissible field in the Supervision Parent / Caregiver (2) group box on the Basic tab of the Family Interaction Plan page.

[TM29]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: update the Description tab on the Family Interaction Plan page.

[TM30]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: update the Description tab on the Family Interaction Plan page.

[TM31]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: update the Description tab on the Family Interaction Plan page.

[TM32]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: update the Description tab on the Family Interaction Plan page.

[TM33]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: update the Description tab on the Family Interaction Plan page.

[TM34]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: update the Description tab on the Family Interaction Plan page.

[TM35]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: update the Description tab on the Family Interaction Plan page.

[TM36]This field is pre-filled.

This field cannot be updated on the template.

The data can be corrected as follows: this field pre-fills with the name of the Worker who initially created the Family Interaction Plan. The worker’s name can be updated (by supervisor) on the Basic tab of the worker's Person Management page.

[TM37]This field cannot be updated on the template.

This field cannot be updated on the template.

The data can be corrected as follows: the supervisor’s name (spelling) can be updated (by supervisor) on the Person Management page/Basic tab. An incorrect supervisor selection can be updated in the Supervisor Name field on the Maintain Worker Information window for the worker who created the document.