ࡱ> wzv} @ 6_bjbj5*5* W@W@c% """""""6###8mh\h6972$%%%%&,&'5f6f6f6f6f6f6$k8R:6i" (&& ( (6""%%6*** ("%"%5* (5**:W0,""0%i @ݭY#("0 K1| 70970R;A(D;066"""";"0l%'"G'*_'s'%'%'%'6666Dzd*66zCASEWORKERS PERMANENCY PLANNING CHECKLISTGUARDIANSHIP ASSISTANCE(For Permanent Wards MCI or Court)State of MichiganDepartment of Human ServicesThis form will assist the caseworker in determining whether the childs current placement would be an appropriate home for adoption or guardianship with assistance. The form must be signed by the caseworker and the caseworkers supervisor.Do not complete this form if adoption is the permanency goal on the service plan and is being actively pursued.Child s NameCaseworker s Name FORMTEXT       FORMTEXT      Child s Case NumberCaseworker s Title FORMTEXT       FORMTEXT      Caregiver NameChild Placing Agency FORMTEXT       FORMTEXT      Caregiver AddressDate Completed FORMTEXT       FORMTEXT   / FORMTEXT   / FORMTEXT     Instructions:A separate form must be completed for each child that meets the following criteria: For a child to be eligible for guardianship with assistance as a permanent ward of the court under section 2(b) of the Juvenile Code or under the jurisdiction of the Michigan Childrens Institute (MCI), the following applies: Child has been removed from his or her home as a result of a judicial determination to the effect that continuation in the home would be contrary to the welfare of the child. Child has resided with the prospective guardian for six or more consecutive months in foster care. Child demonstrates a strong attachment to the prospective guardian. Child 14 or older has given consent for guardianship. Child is under 18 years of age. Adoption as a permanency goal has been ruled out. Placement with the guardian is in the childs best interest. A caregiver who meets all of the following criteria is eligible to receive a subsidy under the Act if: Child was placed in the caregivers home by the department as a foster care placement. The caregiver is a licensed foster parent and all adult household members have successfully completed a criminal history check and child abuse registry check. The child has resided with the caregiver in the caregivers home for six or more consecutive months. The guardian has a strong commitment to caring permanently for the child. 3. Complete the following questionnaire:YESNOa.The relative caregiver or non-relative caregiver is licensed or able to meet licensing standards. FORMCHECKBOX  FORMCHECKBOX b.The caregiver demonstrates that he/she possesses the capability to assume the role of primary caregiver. FORMCHECKBOX  FORMCHECKBOX c.The caregiver demonstrates the capability to work cooperatively with schools and other agencies to address the childs academic and well-being needs. FORMCHECKBOX  FORMCHECKBOX d.The caregiver demonstrates the capability to access appropriate medical care for the child. FORMCHECKBOX  FORMCHECKBOX e.The caregiver demonstrates the ability to manage visitation with birth parents or family members, if appropriate, so as to ensure that the child is not subject to harm or mistreatment. FORMCHECKBOX  FORMCHECKBOX f.The caregiver provides a safe and stable home environment that poses no danger to the child. FORMCHECKBOX  FORMCHECKBOX g.The caregiver demonstrates the ability to manage family issues such as illness and child rearing concerns. FORMCHECKBOX  FORMCHECKBOX h.The caregiver demonstrates the ability to meet the special needs of the child. FORMCHECKBOX  FORMCHECKBOX i.The child appears well integrated into the family. FORMCHECKBOX  FORMCHECKBOX  PERMANENCY PLANNINGIf the caseworker answers yes to all of the preceding questions, adoption or guardianship with assistance should be explored with the caregiver. If the adoption is not the appropriate permanency goal for the child, explain why: FORMTEXT      The caseworker should discuss the options with the caregiver using the Caregiver Permanency Planning Checklist and  Making the Decision to Become a Child s Permanent Family (DHS-Pub-140) information. This discussion and the answers on the checklist will help the caseworker determine whether the caregiver is interested in pursuing adoption or guardianship for the child(ren) in their care. The Caregiver Permanency Planning Checklist is to be used as documentation of the planning process. It is also important to discuss current and planned living arrangements even with young children. If the child is 14 years or older, the law requires that they consent to adoption or guardianship. The permanency goal should not be pursued for the child until the childs questions or issues have been addressed by the caseworker or through counseling. If there is a question about the youths decision, the caseworker should also schedule a separate meeting to discuss the permanency options with the child. A youth age 14 or older is required to sign the Youths Statement located at the end of the Caregiver Permanency Planning Checklist. Caseworkers are encouraged to have all children of appropriate age involved in the discussion and allowed to sign the agreement. If any of the answers to the questions listed above are no and the caseworker does not believe that adoption or guardianship is appropriate, a conference should be held between the caseworker and supervisor to determine if it is in the childs best interest to remain in the current placement. The focus must be to develop a permanency plan that will ensure permanent supports and connections for the child. 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If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you are invited to make your needs known to a DHS office in your area. 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CoStat$c b CoZip  "Supervi8sor<`, Boss! /Titl% b ' Upd. other  FieldsH on& t Macro Rem" SelA}ed$=G$ ("Curre8ntD9'`Serial = Today() + 14$5()lDure",a"GEditGoTo 0"Cre : Unlink'Grante@efirst3"ToolsProtDocum! .No@et`1, .Type@2/ .8= 2 `0 Else#FileClose D c.@- 1$nd #Sub yY ThisDocumentMyInfoUnitWorkerWorkerExtension WorkerName WorkerFax WorkerPhoneUpdateAllFieldsWorkerAreaCodeSupervisorName SvcRefHeadingTemplateProjectF=C:\Program Files\Common Files\Microsoft Shared\VBA\VBA332.dllVBA i ( F 4C:\Program Files\Microsoft Office\Office\MSWORD8.OLBWord   80FC:\WINNT\System32\StdOle2.tlbstdole aHy|9C:\WINNT\System32\MSForms.TWDMSForms AX.E .`M 3&Y}XDmDE"jC:\TEMP\VBE\MSForms.EXD AhL-[DR  2C:\Program Files\Microsoft Office\Office\MSO97.DLLOffice  yxMain \rU Enter Personal InformationNormal.MyInfo.MainfrU~} k__SRP_2&T__SRP_3 (mThisDocument*_VBA_PROJECTrU $`apx55# (SLSS<N0{00020906-0000-0000-C000-000000000046}8(Sw$HMExAttribute VB_Name = "ThisDocument" Bas0{00020P906-0C$0046} |CreatablFalse ^PredeclaIdTru "@ExposeTemplateD0eriv$eCustomiz2ID="{33DC284E-2BF9-11D4-8896-000502AE3D26}" Document=ThisDocument/&H00000000 Module=MyInfo Name="TemplateProject" HelpContextID="0" CMG="A6A4124C32744278427842784278" DPB="BAB80E782379237923" GC="CECC7A949ABCAFBDAFBD50" [Host Extender Info] &H00000001={3832D640-CF90-11CF-8E43-00A0C911005A};VBE;&H00000000 [Workspace] ThisDocument=0, 0, 0, 0, C MyInfo=0, 0, 0, 0, C a^  *\G{000204EF-0000-0000-C000-000000000046}#3.0#9#C:\Program Files\Common Files\Microsoft Shared\VBA\VBA332.dll#Visual Basic For Applications*\G{00020905-0000-0000-C000-000000000046}#8.0#409#C:\Program Files\Microsoft Office\Office\MSWORD8.OLB#Microsoft Word 8.0 Object Library*\G{00020430-0000-0000-C000-000000000046}#2.0#0#C:\WINNT\System32\StdOle2.tlb#OLE Automation*\G{7C79B5C0-E6E6-11D2-9439-0000C01A86E5}#2.0#0#C:\WINNT\System32\MSForms.TWD#Microsoft Forms 2.0 Object Library*\G{5926339E-587D-441B-9117-6D844445226A}#2.0#0#C:\TEMP\VBE\MSForms.EXD#Microsoft Forms 2.0 Object Library.E .`M *\G{2DF8D04C-5BFA-101B-BDE5-00AA0044DE52}#2.0#0#C:\Program Files\Microsoft Office\Office\MSO97.DLL#Microsoft Office 8.0 Object LibraryAB?5ThisDocument 43922e05e*D5 MyInfo ed4212466d*DZu0'0'3+=&H=&=|E)Bv;8=&'3=&(=& @=& (=& =&'3=&(=&P(=&P=&'3=&(=&(=&@=&@(=&@=&'3=&((=&(=&(3=&X=&(=&=& (3=&=&HX=&`@=&`(=&=&(3=&h=&X=&@=&(=&=&$(3=& X=&P@=&P(=&=&.(3=&p=&X=&@=&(=&=&:(3=&3ZI=&=&(=&=&F(3=&(=&=&L(3=&pHRemWordkVBAWin16~Win32MacFORMPORT stdole`MSFormsC ThisDocument< _EvaluateOfficeuTemplateProjectEModule1bSuperPhoneNumber\Main, WordBasic WW7_EditGoTod DestinationлInsertCisAddress>} WorkerNameJAreaCode PhoneNumber CountyNameDistrict}-SectionGUnitWorker8 ApDistrictApUnitPApWorkerW FsDistrictaFsUnitFsWorker SvDistrict]SvUnit/SvWorker FirstNameLastName CaseNumberA countynumberyxCareOfƻAddress1O ClientCitym ClientState ClientZipGetPrivateProfileString$xExistingBookmark SetFormResultGranteeFirstNameEWorkerExtensionGranteeLastName.GranteeClientIDGranteeAddress1AddChildInfoRow^ToolsUnprotectDocument(NextCellWW7_EditAutoTextCContextXnInsertAsInsertrCharLeftToolsProtectDocument-0NoResetgWorkerAreaCodeSupervisorNameSuperExtentionAddSvcReferral} SvcRefHeadingi&TableSelectRowTableInsertRowQNumRows CenterParaLineUpK InsertPara,LineDownxTableInsertCells ShiftCells( CharRightPTableMergeCellst BorderRight_ SuperAreaCodeq GranteeCareof CoSuppaddress^  CoPhoneNumberx ClearCaseInfohFileFind SearchName֡ SearchPath.SubDir+Title~AuthorKeywordsTSubjectRPOptions MatchCase PatternMatch DateSavedFromu= DateSavedTojdSavedByDateCreatedFrom DateCreatedToViewISortByoListBy+ SelectedFile\Kill NewParagraphqScreenUpdating! 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YourFCWLNoYourFCWN0 YourPSCNo9YourPSCNP<YourHALYYourHAFYYourDCDialogfSetPrivateProfileString= FileClose_OtherIDCoState1Correct'ansxtMsgBoxRStartOfDocument ToolsSpellingAddRowsMyInfo@UserName\ UserTitleV9 UserPhoneYourExthLFaxACjYourFaxrN UserOffice0 UserAddressFUserCity UserStateUserZipDUserCOUserDIUserSEC4UserUN0UserWKR,BossNamef BossTitleHFaxY CancelButtonYourName;R YourTitleA# YourPhone YourOffice YourAddressYourCity YourStateYourZipYourCOYourDIYourSECvYourUNVYourWKRnHidden] FormatFont&Points UnderlineColor2F StrikeThrough" Superscript SubscriptV SmallCaps~cAllCapss_SpacingSPositionKerningB KerningMin1FontUBoldItalic!CountyG8CoCityr7Date11CoZip0DocumentjUpdateAllFieldsAll_Fields_Update'ActiveDocument\Fields7Update` [ $PROJECT:PROJECTwm@>CompObjAjThisDocumentThisDocumentMyInfoMyInfo  FMicrosoft Word Document MSWordDocWord.Document.89q @ rBbjbj5*5* W@W@;^";^" ^ ^ ^ ^ ^^C^gmhmh\h^\t2id%m%m%m%m%m.Sqrsssssss$uRws- ^s%m%msss ^ ^%m%mtssss ^%m ^%mssssss ^ ^1cts%mi @ݭYC^sss ,t0\tswsws^^ ^ ^ ^ ^w ^sssssssssss^^$C^s^^C^ FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEuuuu(u*u8u:uw@wNwPwRwָΪ֟Ϊ֚|Ϊqj1hYqUj 1hYqUjUmHnHuj0U jUj/hYqUjhYqUmHnHuj@/hYqUj.hYqUjhYqUhYqjhYq5UmHnHujhYq5Uj-hYq5U,Rwfwhwvwxwzwwwwwwwwwwwwwwwwx .0>@BVXfhj~Ȁj 8hYqUjv7hYqUj6hYqUj:6hYqUjhYqUmHnHujz5hYqUUj4hYqUj4hYqUj03hYqUjhYqUjg2hYqUhYq2XT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT     FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       Ȁʀ؀ڀ܀(*,@BDHJLNbdflnprց؁ j=hYqUj==hYqUj<hYqUj;hYqUj;hYqUjhYqUmHnHuji:hYqUj9hYqUjb9hYqUhYqjhYqUj8hYqU3*Lp ,PxȂ@Bjihgfedcba`_^]\ "$(*,.BDFLNPRfhvxzƂȂʂނ.02<>BڹڮڣژڍjBhYqUj>BhYqUjbAhYqUj@hYqUjn@hYqUj?hYqUj"?hYqUhYqjhYqUmHnHujhYqUjb>hYqU./ =!"#$%Address1 UppercasedEnter the Addressee's mail address (street address, PO Box, etc., where the mail will be delivered). 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