COURT REPORT FOR EXTENSION OF DISPOSITIONAL ORDER -

[TM1]IN OUT OF HOME CARE

Name - Judge / Hearing Date / eWiSACWIS Case Number
[TM2] / [TM3] / [TM4]
Court Number / County / Case Type
[TM5] / [TM6] / CHIPS

START_DYNAMIC_TABLE=ChildInfo

IDENTIFYING INFORMATION
Name - Child (Last, First, MI) / Birthdate
[TM7] / [TM8]
American Indian Status / American Indian Tribal Name or Band
[TM9] / Yes / [TM10] / No / [TM11]
Current Caregiver
Name (Last, First, MI) / Telephone Number
[TM12] / [TM13]
Address (Street, City, State, Zip Code)
[TM14]
Mother / [TM15]Unknown
Name (Last, First, MI) / Birthdate
[TM16] / [TM17]
Address (Street, City, State, Zip Code) / Telephone Number
[TM18] / [TM19]
Marital Status / Name - Spouse
[TM20] / Married / [TM21] / Single / [TM22] / Widowed / [TM23] / Divorced / [TM24]
Status
[TM25] / Birth / [TM26] / Adoptive
Father / [TM27] Unknown
Name (Last, First, MI) / Birthdate
[TM28] / [TM29]
Address (Street, City, State, Zip Code) / Telephone Number
[TM30] / [TM31]
Marital Status / Name - Spouse
[TM32] / Married / [TM33] / Single / [TM34] / Widowed / [TM35] / Divorced / [TM36]
Status
[TM37] / Adjudicated / [TM38] / Adoptive / [TM39] / Alleged / [TM40] / Presumptive

END_DYNAMIC_TABLE=ChildInfo

Verification of American Indian status provided by: / [TM41]
In the interest of [TM42], a child who ischildren who are[TM43]in substitute care placement, the Agency is presenting the following report. The Agency is requesting an extension of the dispositional order.
I. / Child'sChildren's[TM44] Court History
On [TM45], this child wasthese children were[TM46]originally found to be a childchildren[TM47] in Need of Protection and Services under Wisconsin State Statute s. 48.13 ([TM48]) by the Honorable Children's Court Judge [TM49]. The most recent court order(s) due to expire on [TM50].
II. / Child's Placement History and Adjustment to Placement
A. / Prior Placements
Name - Child / Name - Provider / Begin Date / End Date

START_DYNAMIC_TABLE=PlacementHistoryInfo

[TM51] / [TM52] / [TM53] / [TM54]

END_DYNAMIC_TABLE=PlacementHistoryInfo

Child's AdjustmentChildren's Adjustments[TM55]to the Prior Placement(s)

[TM56]

B. / Child's AdjustmentChildren's Adjustments[TM57] to the Current Placement

[TM58]

III. / Parent's Efforts to Remedy the Factors Which Contributed to the Child'sChildren's[TM59] Placement
A. / Mother's Efforts to Remedy the Factors

[TM60]

B. / Father's Efforts to Remedy the Factors

[TM61]

IV. / Evaluation of the Plan of Care, Treatment, and / or Rehabilitation for the ChildChildren[TM62]and Family
A. / Social Worker's Evaluation of the Effectiveness of the Case Plan for the Family

[TM63]

B. / Social Worker's Evaluation of the Effectiveness of the Case Plan for the ChildChildren[TM64]

[TM65]

C. / Social Worker's Recommendation for Changes to the Plan

[TM66]

V. / The Agency's Efforts to Return the ChildChildren[TM67]Safely Home

[TM68]

VI. / Reasons Why the Return of the ChildChildren[TM69]to the Parental Home is Not Safe or Feasible

[TM70]

VII. / Parental Visitation
A. / Current Visitation Plan

[TM71]

B. / Social Worker Recommendation for Changes in Visitation Plan

[TM72]

VIII. / Permanency Plan and Permanency Plan Review Panel Report
The current permanence plan goal isgoals are:[TM73]
Name - Child / Permanence Goal

START_DYNAMIC_TABLE=PermanencyPlanInfo

[TM74] / [TM75]

END_DYNAMIC_TABLE=PermanencyPlanInfo

Attached and incorporated herein by reference is the current permanency plan and the most recent Permanency Plan Review Panel Summary dated [TM76].
IX. / Information on a ChildChildren[TM77]Placed in Out-of-Home Care for Fifteen (15) of the Most Recent Twenty-Two (22) Months
A. / Recommendations and Reasons for Pursuing or Not Pursuing TPR

[TM78]

B. / Progress Toward TPR

[TM79]

C. / Barriers to Achieving TPR

[TM80]

D. / Steps Taken or Planned to Overcome the Barriers to TPR and the Date the Steps Will be Completed

[TM81]

E. / Reasons that Adoption is in the Best Interest

[TM82]

F. / Progress in Locating an Appropriate Adoptive Resource

[TM83]

G. / Need For the Above Named ChildChildren[TM84] to Be Listed on the Wisconsin Adoption Exchange

[TM85]

X.

/

Recommendations of the Agency

A. / It is the recommendation that the current order(s) be extended (and revised) for a period of [TM86]
B.

START_DYNAMIC_TABLE=Child2Info

That, [TM87], the above named child continue in placement with [TM88]at [TM89].

END_DYNAMIC_TABLE=Child2Info

C.

START_DYNAMIC_TABLE=Child3Info

That the legal custody of [TM90], the above named child, should be awarded to [TM91].

END_DYNAMIC_TABLE=Child3Info

D. / That [TM92], parentparents[TM93] of the above named child, shall meet the following conditions prior to the return of the above named child to herhistheir[TM94]home. Indicate whether conditions are for mother (M), father (F) or both (B). Also indicate any conditions that apply to the child (C). Use the examples that apply and/or list other examples.
1. / [TM95] / Stay in touch with and cooperate with your worker. / [TM96] M [TM97] F [TM98] B
For example:
[TM99] / Meet with your worker when asked.
[TM100] / Let your worker into your house with or without notice.
[TM101] / Tell your worker your address, telephone number, and who lives with you.
[TM102] / Tell your worker as soon as any of these things change.
[TM103] / Sign papers necessary for your case (release of information, forms, etc.).
[TM104] / Cooperate with your worker to arrange the treatment or programs required by the order.
[TM105] / Be able to be reached and be available to your worker to make medical, psychological, and educational decisions about the children.
[TM106] / Give your worker copies of any papers you get which show that you have completed or participated in any programs.
[TM107] / Other examples:

[TM108]

2. / [TM109] / Have a safe, suitable and stable home. / [TM110] M [TM111] F [TM112] B
For example:
[TM113] / Have enough food, clothes, beds, bedding and furniture for your children and everyone who lives there.
[TM114] / Have a working stove and refrigerator, electricity, heat and running water.
[TM115] / Pay your bills on time.
[TM116] / Keep your home clean and safe.
[TM117] / Feed your children healthy food.
[TM118] / Do not let people who are dangerous to your children in your house.
[TM119] / Keep all dangerous things out of your children's reach.
[TM120] / Other examples:

[TM121]

3. / [TM122] / Have regular and successful visits with the children. / [TM123] M [TM124] F [TM125] B
For example, regular visits mean:
[TM126] / Cooperate with your social worker in arranging a visitation plan that works for everybody.
[TM127] / Be responsible for getting to visitation, including asking for bus tickets or transportation if required.
[TM128] / Be on time for scheduled visits and stay until the end of each scheduled visit.
[TM129] / Tell your worker and the foster parent in advance if a visit must be canceled or if you will be late.
For example, successful visits mean:
[TM130] / Pay attention to your children during the entire visit or make sure they are watched by a responsible person at all times.
[TM131] / Talk to and play with your children, as a parent should.
[TM132] / Use parenting methods you learned in parenting or nurturing classes.
[TM133] / Use proper discipline.
[TM134] / Make sure that all needs of the children are met during the visit.
[TM135] / Do not use drugs or alcohol before or during any visit.
[TM136] / Other examples:

[TM137]

If The Order Limits Your Visits, Begin To Change The M F B / 4. / [TM138] / Reasons for the limits.
[TM139] / [TM140]
5. / [TM141] / Show that you are interested in your children. / [TM142] M [TM143] F [TM144] B
For example:
[TM145] / Call your children regularly and at reasonable times.
[TM146] / Participate in your children's school programs and medical visits. Cooperate with staff and do what they tell you to help your children.
[TM147] / Avoid things that will make it harder for you to have your children returned. For example, do not do things that can cause you to go to jail or prison. Do not move away from your current area of residence, or choose friends or roommates who are dangerous.
[TM148] / Do not use alcohol or illegal drugs before or during any visit.
[TM149] / Other examples:

[TM150]

6. / [TM151] / You must not interfere with the placement of your children or with any of the services they are receiving. / [TM152] M [TM153] F [TM154] B
For example:
[TM155] / Respect the rights of foster parents or relatives where your children live.
[TM156] / Other examples:

[TM157]

7. / [TM158] / Complete a psychological evaluation / reevaluation and complete any recommended programs. / [TM159] M [TM160] F [TM161] B[TM162] C
Applies to: [TM163]
For example:
[TM164] / Go to a psychological evaluation/reevaluation to be done by [TM165][TM166] (and let the psychologist see how you act with your children).
[TM167] / Tell the truth.
[TM168] / Do what you are asked to do.
[TM169] / Meet with your worker to talk about the report when the evaluation is finished.
[TM170] / Go to the treatment and counseling programs that are recommended.
[TM171] / Do what the treatment people ask you to do.
[TM172] / Stay in the programs until the people who run them tell you that you have completed the programs.
[TM173] / Other examples:

[TM174]

8. / [TM175] / Complete any programs recommended in the psychological evaluation. / [TM176] M [TM177] F [TM178] B[TM179] C
Applies to: [TM180]
For example:
[TM181] / Meet with the worker to talk about the psychological evaluation report done by [TM182] on [TM183].
[TM184] / Go to the treatment and counseling programs that are recommended.
[TM185] / Do what the treatment people ask you to do.
[TM186] / Stay in the programs until the people who run them tell you that you have completed the programs.
[TM187] / Other examples:

[TM188]

9. / [TM189] / Complete a psychiatric evaluation and complete any recommended programs. / [TM190] M [TM191] F [TM192] B[TM193]C
Applies to: [TM194]
For example:
[TM195] / Go to a psychiatric evaluation to be done by [TM196].
[TM197] / Tell the truth.
[TM198] / Do what you are asked to do.
[TM199] / Meet with your worker to discuss the report once the evaluation is finished.
[TM200] / Go to the treatment and counseling programs that are recommended.
[TM201] / Stay in the programs until the people who run them tell you that you have completed the programs.
[TM202] / Take any medications that your treating doctor or psychiatrist tells you to. (This should not be interpreted to mean that the Court is ordering the administration of psychotropic medications.)
[TM203] / Manage your mental illness or personality disorder so that it does not interfere with your ability to parent your children.
[TM204] / Other examples:

[TM205]

10. / [TM206] / Complete any programs recommended by your psychiatrist. / [TM207] M [TM208] F [TM209] B[TM210] C
Applies to: [TM211]
For example:
[TM212] / Go to the treatment and counseling programs that are recommended.
[TM213] / Do what the treatment people ask you to do.
[TM214] / Stay in the programs until the people who run them tell you that you have completed the programs.
[TM215] / Take any medications that your treating doctor or psychiatrist tells you to. (This should not be interpreted to mean that the Court is ordering the administration of psychotropic medications.)
[TM216] / Manage your mental illness or personality disorder so that it does not interfere with your ability to parent your children.
[TM217] / Other examples:

[TM218]

11. / [TM219] / You must not hurt your children or let anyone else hurt your children. / [TM220] M [TM221] F [TM222] B
For example, your children are being hurt if they:
[TM223] / Are being hit with cords, belts, sticks or other objects.
[TM224] / Have bruises, cuts, burns or marks of any kind.
[TM225] / Are having sexual contact with anyone.
[TM226] / Are shown or allowed to see sexual activities.
[TM227] / Other examples:

[TM228]

12. / [TM229] / Cooperate with your children's therapist when asked. / [TM230] M [TM231] F [TM232] B
For example:
[TM233] / Attend meetings.
[TM234] / Tell the truth.
[TM235] / Do what the therapist asks you to do.
[TM236] / Ask what you can do to help your children.
[TM237] / Show that you have learned safe ways to treat your children.
[TM238] / Other examples:

[TM239]

13. / [TM240] / You must not allow contact between your children and [TM241]. / [TM242] M [TM243] F [TM244] B
For example, unless the therapist and your worker both say that you can, you must not let (the person who abused your child):
[TM245] / See your children.
[TM246] / Talk to your children by telephone.
[TM247] / Send letters or messages to your children.
[TM248] / Other examples:

[TM249]

14. / [TM250] / Complete any recommended alcohol or other drug abuse (AODA) programs. / [TM251] M [TM252] F [TM253] B[TM254]C
Applies to: [TM255]
For example:
[TM256] / Go to an AODA assessment when it is scheduled.
[TM257] / Tell the truth.
[TM258] / Meet with your worker to talk about the report when the evaluation is finished.
[TM259] / Do not use illegal drugs.
[TM260] / Do not use alcohol if the evaluation says you have an alcohol problem.
[TM261] / Go to the treatment and counseling programs that are recommended.
[TM262] / Stay away from people who abuse drugs or alcohol.
[TM263] / Do not allow drug use or drug users into your home or where your children are.
[TM264] / Do what the treatment people ask you to do.
[TM265] / Stay in the programs until the people who run them say you can leave the programs.
[TM266] / Give a urine sample for a drug or alcohol test if you are asked to do so. If you do not give a sample when asked to do so, your worker and the court will believe you have used illegal drugs or alcohol.
[TM267] / Other examples:

[TM268]

15. / [TM269] / Resolve all criminal charges and cooperate with your probation or parole officer. / [TM270] M [TM271] F [TM272] B[TM273] C
Applies to:[TM274]
16. / [TM275] / Show that you can care for and control your children properly and that you understand their special needs. / [TM276] M [TM277] F [TM278] B
For example:
[TM279] / Go to any parenting or nurturing programs set up by your worker and do what the program people tell you to do.
[TM280] / Go to any community support program recommended by your worker and do what the program people ask you to do.
[TM281] / Stay in the programs until the people who run them tell you that you have completed the programs.
[TM282] / Have childcare or day care that is approved by your worker.
[TM283] / Do not leave your children in the care of anyone not approved by your worker.
[TM284] / Make sure that your children see the doctor and dentist when they should.
[TM285] / Talk to doctors, teachers, and other people who care for your children to learn what your children need.
[TM286] / If you do not know who the doctors, teachers or other caretakers are, you should ask your worker to help you.
[TM287] / If your child is on prescription medication or has special medical needs, you must give the medication and take care of the special needs as ordered by the doctor. (This should not be interpreted to mean that the Court is ordering the administration of psychotropic medications.)
[TM288] / Other examples:

[TM289]

17. / [TM290] / Complete any programs recommended by your worker. / [TM291] M [TM292] F [TM293] B[TM294] C
Applies to: [TM295]
For example:
[TM296] / Go to the individual therapy, family counseling, domestic violence, group counseling, anger management, couples counseling, etc., program recommended by your worker.
[TM297] / Do what the program people ask you to do.
[TM298] / Stay in the programs until the people who run them tell you that you have completed the programs.
[TM299] / Other examples:

[TM300]

E. / Permanency Plan Recommendation(s)

[TM301]

F. / Support Recommendation(s)

[TM302]

XI. / Signatures
[TM303]
Name - Worker
[TM304]
SIGNATURE - Worker / Date Signed
[TM305]
Name - Supervisor
[TM306]
SIGNATURE - Supervisor / Date Signed
Court Report for Extension of Dispositional Order - Child in Out of Home Care / Page 1 of 7
CFS-2110 (Rev. 08/2001)

[TM1]This field is user selected. This field is editable on the template. The data can be corrected on the template. The values are: CHILD, CHILDREN.

[TM2]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Legal Documentation page.

[TM3]This field is user entered. This field is editable on the template. The data can be corrected on the template.

[TM4]This field is pre-filled. This field is not editable on the template. The data cannot be corrected.

[TM5]This field is user entered. This field is editable on the template. The data can be corrected on the template.

[TM6]This field is pre-filled. This field is not editable on the template. The data cannot be corrected, as it pre-fills with the county of the worker that created the template.

[TM7]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the child's Person Management page. If child is identified with the role of "Child" on the Legal Documentation page.

[TM8]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the child's Person Management page.

[TM9]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the child's Person Management page.

[TM10]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the child's Person Management page.

[TM11]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the child's Person Management page.

[TM12]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the child's Out of Home Placement.

[TM13]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the phone number for the provider identified on the child's Out of Home Placement.

[TM14]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the address for the provider identified on the child's Out of Home Placement.

[TM15]This field is user selected. This field is editable on the template. The data can be corrected on the template.

[TM16]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the child's mother's Person Management page. The child's mother is identified on the Parent Info tab of the child's Person Management page.

[TM17]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the child's mother's Person Management page.

[TM18]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Address tab of the child's mother's Person Management page.

[TM19]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Address tab of the child's mother's Person Management page.

[TM20]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Parent Info tab of the child's Person Management page.

[TM21]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Parent Info tab of the child's Person Management page.

[TM22]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Parent Info tab of the child's Person Management page.

[TM23]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Parent Info tab of the child's Person Management page.

[TM24]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Parent Info tab of the child's Person Management page.

[TM25]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Parent Info tab of the child's Person Management page.