Prediction Path Packet

State of Kansas Prediction Path PPS 5330

Department for Children and Families January 2017

Prevention and Protection Services Page 3 of 3

Prediction Path Packet of

CHILD______

LICENSED WORKER ______

Date Completed ______

PLACEMENT TRAIL

Date Placement Began / Date Placement Ended / Length of Placement / Specific Reasons for Move / Name/Role of Caregivers/Location / Adjustment Observations

STRENGTHS AND NEEDS OF CHILD

Child’s Strengths: Abilities, Skills, Talents, Positive Characteristics, etc. / Child’s Needs: Areas in need of help, care, nurturing, parental attention, continues growth, etc.

PREDICTION NARRATIVE

Expected Need / When is this need likely to occur? / What events have triggered the need in the past? / Possible Interventions / Suggested Preventions / Significant Dates for the Child

SIGNATURES

We/I have heard and read all information on this form PPS 5330 regarding our child’s ______, placement history, strengths and needs, and potential future behaviors. We/I understand that the agency has made a good faith effort to predict potential future needs, however, the list may not be exhaustive due to factors or information unknown to the agency.

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Date signed Parent 1 signature Parent 2 signature

The following individuals participated in the sharing of information contained in this packet:

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Written by IHS for the Ohio Child Welfare Training Program – Revised 2015

Adapted, with permission, for State of Kansas Department of Children and Families-January 2017