Shared Responsibility Plan

Goal: To assist the minor parent in developing the skills necessary to provide a safe, stable, and permanent home for his/her infant (child).

A written shared responsibility plan is developed when a teen parent and her/his child live together in a whole family foster home. The plan is developed between the teen parent, caregiver, and a representative of the county child welfare agency or probation department. When living in a certified home, such as a Foster Family Agency (FFA) home, a representative of the FFA will also be involved. You may want to include additional input from other people like the other parent of the child or other extended family members. The plan is to be completed as soon as practically possible, but can be changed and updated if someone is not available, or the situation changes. The plan includes tasks or responsibilities that are required. You can add other tasks or responsibilities that you feel should be included.

Directions:

1) Write the names of all participating in the plan. Write N/A if not applicable. In the “other” category, please write in the name and relationship to the minor parent. Each person is to print and then sign their name.

Minor Parent: / Caregiver: / Child Welfare Worker or Probation Officer: / Certified Home Agency/
FFA Representative
Other: / Other: / Other: / Other:

2) For each Task or Responsibility listed, be as specific as you can. An example is given for one of the designated areas.

Task or
Responsibility:
Feeding Schedule / The minor parent will: Example:
1.  ______will feed her child breakfast and all meals in the evening every day.
2.  On weekends ______will assume primary responsibility for feeding the infant.
3.  ______will prepare the formula. ______will ask ______to feed the infant if the ______needs to attend meetings, court, or other functions.
4.  ______and ______develop a weekly calendar to identify times in which ______may need assistance in feeding infant. / The caregiver will:
Example:
1.  ______will feed the infant while ______attends school.
2.  ______will encourage ______to assume the primary responsibility for feeding the infant. ______will offer support to ______. / Supports needed to assist the minor parent
1.  Practice in making the formula –______to provide assistance.
2.  Learning to “burp” the infant.
3. PHN visit
What will be done when there is a concern:
1.  ______will discuss concerns with ______.
2.  ______will contact the social worker/probation officer after three attempts to discuss with ______concerns about feeding.
3.  The social worker/probation officer will convene a meeting with ______and ______to resolve the concerns.
Task or Responsibility:
Feeding
Schedule / The minor parent will: / The caregiver will: / Supports needed to assist the minor parent:
What will be done when there is a concern:
Task or Responsibility:
Clothing and Dressing / The minor parent will: / The caregiver will: / Supports needed to assist the minor parent:
What will be done when there is a concern:
Task or Responsibility:
Hygiene including diapering / The minor parent will: / The caregiver will: / Supports needed to assist the minor parent:
What will be done when there is a concern:
Task or
Responsibility:
Purchase of Items for the Infant/Child / The minor parent will: / The caregiver will: / Supports needed to assist the minor parent:
What will be done when there is a concern:
Task or Responsibility:
Health Care / The minor parent will: / The caregiver will: / Supports needed to assist the minor parent:
What will be done when there is a concern:
Task/
Responsibility:
Transportation for appointments, child care, etc. / The minor parent will: / The caregiver will: / Supports needed to assist the minor parent:
What will be done when there is a concern:
Task or Responsibility:
Child Care and Babysitting / The minor parent will: / The caregiver will: / Supports needed to assist the minor parent:
What will be done when there is a concern:
Task or Responsibility:
Sleeping Arrangements / The minor parent will: / The caregiver will: / Supports needed to assist the minor parent:
What will be done when there is a concern:
Task or Responsibility:
Visits with others (other parent, grandparents, etc)
Please Note: The share responsibility plan cannot conflict with orders of the Court / The minor parent will: / The caregiver will: / Supports needed to assist the minor parent:
What will be done when there is a concern:
Task or Responsibility:
Discipline / The minor parent will: / The caregiver will: / Supports needed to assist the minor parent:
What will be done when there is a concern:
Task/
Responsibility:
Other:
______ / The minor parent will: / The caregiver will: / Supports needed to assist the minor parent:
What will be done when there is a concern:

3) Review the Shared Responsibility Plan in two months: Date: ______

Changes to the plan can be expected as the infant child grows and new parenting skills are required. Make changes within each section as needed, and then initial and date each change. When changes are made, make a new copy for everyone involved in the plan. Consider developing a new shared responsibility plan on a yearly basis.

4) Signatures:

I have participated in making this plan and I understand my responsibilities.

______

Minor parent Date Caretaker Date

Original: Minor Parent

Copy: Caregiver

Copy: Child Welfare Worker/Probation Officer

Copy: Certifying Home Agency

Copy: Other (as needed)

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SB500| Shared Responsibility Plan | January, 2007