Post-Placement Supervisory Report #1 John and Jane Doe
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PRE PLACEMENT VISIT REPORT
Name of Family:John & Jane Doe
Address of Family:Anywhere, USA, 00000
Contact Phone Number:(555) 000-0000
Name of Child (if applicable): Joel David Doe
Date of Birth: March 1, 1998
Anticipated Date of Placement: March 1, 2007
Date of Pre-Placement Visit: March 23, 2007
State/Country of Guardianship or Birth:XX/XX/XXXX
Brief Description of Child (or birth parent for infant placements), Visitation Hx & Placement Plan:
Include a short narrative about the child being placed in the home along with a short description of the family and why it would appear that this would be an appropriate match
Address the visitation history (if applicable)how things have been progressing
Note any concerns & state the plan for following up after placement
List anticipated date of placement and pick up plan etc.
General Pre-Placement Plan Summary:
Give a brief overview of things discussed at pre-placement meeting including (but not limited to the following items). Also include a general statement of the family’s readiness for this placement.
Bedroom Prepared (please note that it is clean & appropriately furnished with a description of child-appropriate furniture and space)
Verify that the home still meets the safety standards as outlined in the “Foster & Adoptive Home Checklist” which the family has already signed (VA homes only)
School Enrollment On Track
Childcare Plans In Place
Time Off Scheduled (Barker recommends 12 weeks of maternity/paternity leave for working parents and requires a minimum of 6 weeks of leave. For school aged children, Barker requires a period of 12 weeks where the child is not enrolled in before or after care.)
Therapist Identified & Initial Appointement Made
Psychiatrist Identified & Initial Appointement Made
Pediatrician Identified & Initial Appointement Made
Medication Routine Known & Medication Available
Health Insurance Set Up
Safety Planning
Sibling Preparation
Placement Agreement
Note that placement agreement was reviewed and signed and the family has a good understanding of their responsibilities at time of placement.
For Follow Up
Note Items for follow up by the family in preparation for placement.
Social Work Summary
Note your general summary and impressions. Include any special plans for follow up during post placement period.
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Social Worker’s Name & CredentialsDate
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Supervisor’s Name & CredentialsDate