CASA for Children
Monthly Activity Report
Hours spent on case this month: 6.25
Miles spent on case this month: 45
Please remember the following when submitting this monthly report:
1. Submit a separate monthly report for each case assignment.
2. Include activities conducted in monthly increments (1st-31st).
3. Include only case related activities such as direct casework, indirect casework (travel, waiting at court, preparing monthly report or court report, reading documents & attending meetings) & all contacts with your case supervisor. This Report is not to include the following: training/in-service activities, fundraising, committee involvement or socials.
4. Submit monthly case notes which should detail dates of activity, description, time & mileage to your Volunteer Supervisor by the 3rd with this report
Volunteer Name: Sally Williams
Case Name: Sam Smith
Reporting Month/Year: February 2012
Organize Monthly Case Notes
Insert monthly notes here; Include dates of activity, description of activity, hours spent on activity and mileage. Remember to also copy/paste emails into your notes.
02/06/12 – I attended the FPM at SVDSS. Sam, Mr. Smith, Mrs. Smith, Cherish Humphries (DSS), Meg Kinchloe (PPI), Becky Orbaugh, Megan Demastus (Facilitator), Sylvia Hottinger (Adoption worker) present. See attached notes. 2 hours 10 miles
02/06/12 – CASA Staff sent releases to Dr. Showalter requesting the parents’ psychological evaluations. He sent them immediately via Email.
02/06/12 – Avery Cousins stopped in the office and we briefly discussed the FPM meeting today. He is representing Mrs. Smith. 10 minutes
02/08/12 – Attended the Smith Hearing: Mr. and Mrs. Smith, Cherish Humphries, Avery Cousins, Eric Swortzel, and Scott Baker present. Mr. Swortzel addressed some concerns the parents had over the technicalities of the foster care plan and the timeline to complete each task. Mr. Smith wanted to do his psychological services while working in Pennsylvania and was told by Cherish that that was fine with the Department as long as he signs a release for both agencies to share information. I informed Scott Baker that I would be the CASA Volunteer on this case and asked him to let me know if I could do anything for him. I met with the parents in the hallway after the hearing and scheduled a time to meet with them at their home on 02/20/12 at 1:00. They both gave me their email address: and and I promised that I would email them the agreed date and time since they did not have their calendars with them. I sent them this email from my Ipad while still at the court house:
Good Afternoon Mr. and Mrs. Smith, The purpose of this correspondence is to remind you of the meeting scheduled at your residence on 02/20/12 at 1:00. Please let me know when your next visitation is scheduled. I look forward to meeting with you. Sally Williams, CASA Volunteer (540) 213-2272 (office), (540) 222-2222 (cell). I also gave them my card with the office information on it. 2 hours, 15 miles
02/09/12 – CASA Staff sent my court appointments to the People Places caseworker and requested copies of any reports thus far as well as in the future and asked her to notify Sally Williams of any meetings scheduled for the parents.
02/09/12 – Cherish responded to my email: Mr. and Mrs. Foster – address 123 Foster Lane Mailing P.O. Box 789 Bridgewater, VA 540-555-5555, 540-888-8888 home
02/15/12 – I spoke to Scott Baker in court today. I let him know that I would be the worker on this case and that I had a meeting scheduled with the Smith’s on 02/20 at 1:00. 10 minutes
02/20/12 - Announced visit to Mr. and Mrs. Smith’s residence: Mr. and Mrs. Smith and Mrs. Smith’s mother present. It is a beautiful home in a new subdivision. The yard was neat and well kept. Upon entering the home it was noted that the home was neat, clean, and apparent for learning activities for the children. Immediately to the right of the entry way was the steps leading to the second floor. Mr. and Mrs. Smith share the large master bedroom and private bath. Sam’s room was neat and furnished with a bed, tv and dvd player, desk and many toys, books, and stuffed animals. Back on the first floor, immediately to the left of the entry way, was a large room filled with toys, games, and learning activities posted on the walls. The room that would typically be the dining area was also set up with learning activities and a piano. The kitchen contained a table that would comfortably accommodate 5-6 people. Off of the kitchen is a large family room with a television and door leading to the garage. The back door led to the fenced in backyard. The family also has a medium sized dog that slept under the sliding board and did not move.
During the interview process Mrs. Smith broke into tears when talking about missing Sam’s first day of school 1.5 hours, 20 miles
02/22/12 – I sent this mail to Mr. and Mrs. Smith: Good Afternoon Mr. and Mrs. Smith,
I sent out requests for information related to Sam’s medical records. Can you please verify for me what office Dr. Cough is located? I would greatly appreciate it! I hope that your visit went well on Monday. 5 minutes
02/22/12 – Mr. Smith responded to my email: Records were with Dr. Cough at Waynesboro Pediatrics. Records may have been/were probably moved to UVA Pediatrics in Charlottesville by DSS following removal. You will probably need to ask DSS for clarification concerning this. Feel free to contact us as needed. Thanks. 5 minutes
02/30/12 – I received Sam’s school records and reviewed. There was a message on the front page that stated, “I would encourage you to please telephone Sam’s teacher and guidance counselor for important information regarding Sam. 5 minutes
02/30/12 – I sent this email to Sam’s teacher: Good Afternoon Dr. Parks, I am the CASA volunteer Advocate for Sam. I received educational records for Sam today. I was encouraged to speak with several folks involved with Sam prior to his placement into foster care. I was wondering if I could possibly schedule a meeting for us to sit down and discuss his history at your school. I have also sent an email to Cherish Humphries, DSS foster care caseworker, to see if would like to join any discussion about Sam. If she is unable to attend or has already met with these folks, I would just send her my notes to add with hers. I will be leaving the office shortly and not returning until Tuesday of next week. I would be more than happy to meet at time that best suits your busy schedules; early morning or late afternoons. I look forward to hearing from you and speaking with you in person about Sam. Have a great weekend… Sally Williams
5 minutes
02/30/12 – I sent this message to Scott Baker: Good Afternoon Mr. Baker. I just wanted to touch base with you on the Smith case. I am in the process of scheduling a meeting with Sam’s previous teacher, and guidance counselor - where he was attending prior to foster care. I received his school records and there was a note on the front encouraging me to speak with these folks. I will send you my notes from that meeting if you want them! Just let me know :) I hope you have a wonderful weekend! Sally Williams 5 minutes
Monthly Activity with Child
Child’s Name: Sam
Face to Face contact w/child? ☒Yes ☐No
Other Indirect contact w/child? ☐Yes ☒No
Is child currently in therapy? ☒Yes ☐No
If yes, list name of therapist/agency: Therapist at People Places
Did volunteer review psych report for child? ☒Yes ☐No ☐ NA
Child referred to therapy this month? ☐Yes ☒No
If yes, list name of therapist:
Review med info for child? ☒Yes ☐No
Review education info for child? ☒Yes ☐No
Was child assessed for any educational needs ☐Yes ☒No
this month? (IEP, tutoring, etc)
If so, please list details: Click here to enter text.
Check current placement of child as of the end of the month:
☐Own home ☐With Relative ☐Therapeutic Foster Home
☒Foster Home ☐Adoptive Home ☐Detention Center
☐Hospital ☐Residential Facility ☐Other:
Was there a change in the child’s placement this month? ☐Yes ☒No
If yes, list reason, date and new address: Click here to enter text.
Visitation
Did the child have visitation with the bio mother? ☒Yes ☐No ☐ NA
Did the child have visitation with the bio father? ☒Yes ☐No ☐ NA
If applicable, please provide the following information:
Where do visits take place? SVDSS
What day/time do visits take place? Wednesdays 4-5pm
CPS Allegations
Any allegations of abuse/neglect made to CPS this month? ☐Yes ☒No
If yes, did CASA make the report? ☐Yes ☒No
If CASA didn’t make the report, did you support it? ☐Yes ☐No ☒ NA
Which children were involved in the allegations? Click here to enter text.
If a CPS complaint was filed this month, what was the nature of the alleged abuse?
Click here to enter text.
Contact with Biological Parents
Face to Face Contact with Mother? ☒Yes ☐No ☐ NA
Other Indirect Contact with Mother? ☒Yes ☐No ☐ NA
Face to Face Contact with Father? ☒Yes ☐No ☐ NA
Other Indirect Contact with Father? ☒Yes ☐No ☐ NA
Learn of any court hearing dates this month? ☒Yes ☐No
If yes, list details: Hearing scheduled for 4/4/12 at 1pm
Contact with Social Worker
Face to Face Contact with social worker? ☒Yes ☐No ☐ NA
Other Indirect Contact with social worker? ☒Yes ☐No ☐ NA
Was there a change in SW this month? ☐Yes ☒No
If yes, give name: Click here to enter text.
Contact with Child’s GAL
Face to Face Contact with GAL? ☒Yes ☐No ☐ NA
Other Indirect Contact with GAL? ☒Yes ☐No ☐ NA
Was there a change in GAL this month? ☐Yes ☒No
If yes, give name: Click here to enter text.
Was there an FPM this month? ☒Yes ☐No
If yes, did you attend? ☒Yes ☐No
If yes, what was the date? 2/6/2012
If no, is there an FPM scheduled? Click here to enter a date.
Was there a FAPT meeting this month? ☐Yes ☒No
If yes, did you attend? ☐Yes ☐No
If yes, what was the date? Click here to enter a date.
If no, is there a FAPT meeting scheduled? Click here to enter a date.
List any positive things that happened this month: Click here to enter text.
List any negative things that happened this month: Click here to enter text.