ICWA Addendum for CFSR

Category/Item / Question / Response /
Face Sheet / 1.  This child has been identified in FACIS as Indian. Does ICWA apply to this particular child? / Yes / No
If no, list reason(s)
Were immediate efforts made to contact the tribe or Indian relatives at the point the child was removed from the home? / Yes / No
Is there a 1270 form for each parent in the case record?
Mother / Yes / No
Father / Yes / No
If yes, date completed?
Were all replies received?
When?
An Indian child is one who meets the following criteria:
1)  Is under 18 and unmarried,
2)  Is a member of a federally-recognized Indian tribe OR,
3)  If not a tribal member, is the child eligible for membership AND the biological child of a tribal member.
Category/Item / Question / Response /
Safety – 2
Item 3, P. 8 / 2.  What efforts were made to avert the breakup of the Indian family?
Was there a court finding that active efforts were made to prevent the breakup of the Indian family? / Yes / No
Was there a tribal recommendation that an active effort finding be made? / Yes / No
N/A (not involved)
Were imminent risk criteria met if there was a removal? / Yes / No
ICWA requires any party considering the removal of an Indian child from the home of his parents or Indian custodian to engage in “active efforts” by providing remedial and/or rehabilitative services to avoid removal of the child. Active efforts require the removing party to go beyond the reasonable efforts standard outlined in ASFA.
Category/Item / Question / Response /
Permanency – 1
Item 6, P. 15 / 3.  Were each of the following notified of each change in the child’s placement? * (Justify N/A)
Child’s tribe (or BIA if child’s tribe is unknown) / Yes / No / N/A
Child’s mother / Yes / No / N/A
Child’s father / Yes / No / N/A
Child’s Indian Custodian / Yes / No / N/A
* N/A:
Permanency – 1
Item 7, P. 18 / 4.  What efforts were made to reunify the child with his/her parents?
Was there a court finding that active efforts were made to reunify the child with the parents? / Yes / No
Was there a tribal recommendation that an active efforts finding be made? / Yes / No
N/A (not involved)
ICWA requires that once an Indian child is removed from their home, “active efforts” must be on-going with the goal of providing services to the child and family that will support the safe return of the child to the home of the parent(s) or Indian custodian. Active efforts require the party with care and custody of the child to go beyond the reasonable efforts standard outlined in ASFA.
Category/Item / Question / Response /
Permanency – 2
Item 15, P. 36 / 5.  Is the child place with extended family, someone from the child’s tribe or in another Indian home? / Yes / No
If no, what specific efforts have been made to maintain family, community and cultural connections for the child?
Utilizing Family Decision Models (FDM) or other culturally-relevant approaches for case planning creates unique family specific service plans. The plans often specify certain tasks to be done by family members. If those tasks directly affect the reunification and a family member has not completed the task, the Department will actively assist and support the family in completing the tasks and document all efforts to do so.
Category/Item / Question / Response /
Well Being – 1
Item 17, P. 41 / 6.  At the permanency hearing, did the court find that active efforts were made to finalize a permanent plan? / Yes / No
N/A (there has not been a permanency hearing)
Services Provided / Services Needed But
Not Provided
If the agency has moved to a permanent plan for the child, does the child’s Tribe agree with the plan? / Yes / No
Item 18, P. 45 / 7.  Was the tribe included in planning for the child? / Yes / No
Who was the tribal consultant?
Item 22, P. 56 / 8.  Were any health and dental services provided culturally appropriate? / Yes / No
Did the family feel comfortable with the provider? / Yes / No
Item 23, P. 58 / 9.  Were any mental health services provided to the child culturally appropriate? / Yes / No
Did the family feel comfortable with the provider? / Yes / No
ICWA Standards Not Covered in CFSR Instrument
10.  Were notification of ALL court hearings sent to the following:
Child’s tribe (or BIA if child’s tribe is unknown) / Yes / No / N/A
Child’s mother / Yes / No / N/A
Child’s father / Yes / No / N/A
Child’s Indian Custodian / Yes / No / N/A
Why N/A
11.  Did a qualified expert witness testify at the shelter hearing? / Yes / No
N/A (child returned home at shelter care or adjudicatory hearing)
12.  Did a qualified expert witness testify in court at the jurisdictional hearing? / Yes / No / N/A
13.  Did a qualified expert witness testify in court prior to the termination of parental rights on either or both parents? / Yes / No / N/A
Summary of ICWA Findings
14.  Review of information regarding ICWA compliance entered and updated in the FACIS, i.e., ICWA screen, narrative about tribal contact and involvement in the case. Is information missing? If so, what is missing? / Yes / No
Has the worker inquired about any specific cultural norms specific to this child and his/her family? / Yes / No
Any additional observations:

Revised: 6/1/2007 Page 1

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