Case Summary Report

DCFS QUALITY CASE REVIEW

CASE SUMMARY REPORT

THIS REPORT IS CLASSIFIED AS “PROTECTED” PURSUANT TO UTAH CODE 63G-2-305(9) ANDMAY BE ACCESSED ONLY ACCORDING TO THE PROVISIONS OF UTAH CODE 63G-2-305(10)(25).
ANY GRAMA REQUESTS FOR A CASE SUMMARY REPORT SHOULD BE
FORWARDED TO THE OFFICE OF SERVICES REVIEW
Date of Review / QCR Number
Child’s Name / Child’s Age
DCFS Office / Months Open
Case Type / Permanency Goal: / Concurrent Goal:
Reviewers
Interviews
Core Story for the Child and Family:
Youth and Family Status Ratings
SAFETY
Child’s Safety from Others: 1 2 3 4 5 6
Child’s Risk to Self or Others: 1 2 3 4 5 6
Basis for Ratings:
STABILITY
Indicator Rating: 1 2 3 4 5 6
Basis for Rating:
3 / PROSPECTS FOR PERMANENCE
Indicator Rating: 1 2 3 4 5 6
Basis for Ratings:
4 / HEALTH/PHYSICAL WELL-BEING
Indicator Rating: 1 2 3 4 5 6
Basis for Rating:
5 / EMOTIONAL/BEHAVIORAL WELL-BEING
Indicator Rating: 1 2 3 4 5 6
Basis for Rating:
6 / LEARNING/DEVELOPMENT
Indicator Rating: 1 2 3 4 5 6
Basis for Rating:
7 / FAMILY CONNECTIONS
Rate how well the Child’s Connection to the following has been maintained:
Overall: 1 2 3 4 5 6 NA
Mother 1 2 3 4 5 6 NA
Father 1 2 3 4 5 6 NA
Siblings 1 2 3 4 5 6 NA
Other 1 2 3 4 5 6 NA
Basis for Rating:
8 / SATISFACTION
Indicator Rating:
Overall: 1 2 3 4 5 6 NA
Child 1 2 3 4 5 6 NA
Mother 1 2 3 4 5 6 NA
Father 1 2 3 4 5 6 NA
Caregiver 1 2 3 4 5 6 NA
Other 1 2 3 4 5 6 NA
Basis for Ratings:
System Performance Ratings
1 / ENGAGEMENT
Indicator Ratings:
Overall 1 2 3 4 5 6 NA
Child 1 2 3 4 5 6 NA
Mother 1 2 3 4 5 6 NA
Father 1 2 3 4 5 6 NA
Caregiver 1 2 3 4 5 6 NA
Other 1 2 3 4 5 6 NA
Basis for Ratings:
2 / TEAMING
Indicator Rating: 1 2 3 4 5 6
Basis for Rating:
3 / ASSESSMENT
Indicator Ratings:
Overall 1 2 3 4 5 6
Child 1 2 3 4 5 6
Mother 1 2 3 4 5 6 NA
Father 1 2 3 4 5 6 NA
Caregiver 1 2 3 4 5 6 NA
Other 1 2 3 4 5 6 NA
Basis for Ratings:
4 / LONG-TERM VIEW
Indicator Rating: 1 2 3 4 5 6
Basis for Ratings:
5 / CHILD AND FAMILY PLAN
Indicator Rating: 1 2 3 4 5 6
Basis for Rating:
6 / INTERVENTION ADEQUACY
Indicator Ratings:
Overall 1 2 3 4 5 6
Child 1 2 3 4 5 6
Mother 1 2 3 4 5 6 NA
Father 1 2 3 4 5 6 NA
Caregiver 1 2 3 4 5 6 NA
Other 1 2 3 4 5 6 NA
Basis for Rating:
7 / TRACKING AND ADAPTING
Rating: 1 2 3 4 5 6
Basis for Rating:
Strengths and Recommendations
Strengths that Lead to Favorable Outcomes:
Recommendations for Practice Improvement:

Child Status and System Performance Ratings

Child Status

Rating

System Performance

Rating

1a. Child’s Safety from Others
1b. Child’s Risk to Self and/or Others / 1.Engagement
2.Stability / 2.Teaming
3.Prospects for Permanence / 3.Assessment
4.Health/Physical Well-Being / 4.Long-Term View
5.Emotional/Behavioral Well-Being / 5.Child and Family Plan
6.Learning/Development / 6.Intervention Adequacy
7.Family Connections / 7.Tracking and Adapting
8.Satisfaction
OVERALL STATUS / OVERALL PERFORMANCE

Qualitative Case Review Results

Outcome:
1: pos. child status and pos. system performance2: neg. child status and pos. system perf.
3: pos. child status and neg. system performance4: neg. child status and neg. system perf.

FY20181