Kenna Pruitt, Family Partnerships Manager September 1, 2011

Performance Standards, ACYF-PI-HS-95-0 (Program Instruction)  Record Keeping  C. Family records. Grantee and delegate agencies must establish and maintain records on individual families, which contain: (1) Recruitment, enrollment, and attendance data, including enrollment forms and income documentation; (2) Family Partnership Agreements and ongoing documentation of progress toward meeting family goals, including information about the services provided to or arranged for families, service referrals, and follow-up reports; (3) Reports on home visits and staff-parent conferences; and (4) Documentation of all contacts with the child's family related to poor or irregular attendance, in accordance with the requirements of 45 CPR on attendance.

Strength Assessment

Family Home Visit Form

Family Partnership Agreement

Family Partnership Agreement— Goal Sheets

FPA- Goal Sheets

Child Plus FPA 1 1.In family goal setting process- Only select Yes if family is doing FPA 2.Family Partnership Agreement- Only select Yes if family is doing FPA 3.Effective Date-First date is the date you complete FPA, the to date is last day of school 2 3 4

Child Plus FPA

Family Partnership Agreement  Remember to complete referrals for FPA objectives  You can have one event as FPA, and then multiple actions under that event

Referral Form (top half of form goes in brown folder)

Referral Form— (bottom half of form goes to parent to give to agency)

1. 1.Add Event 2.Enter Date 3.Event Type-Need Identified 2 3

4 4. Description-Type concern 5. Service Area-choose from drop down menu 6. Issue-choose from drop down menu 5 6

9 7. Source of Info-choose who you obtained information from 8. Family Member-this is who you spoke with about referral 9. Event Notes-Here you describe exactly what is needed 8 7

Add Action- Here you will add any action that goes with the event above. For example, referrals to needs that have been identified.

Scheduled-Date you plan to provide referral 13. Action Date-date you provided the referral 14. Referred To-Drop down menu connects to resources in Child Plus 15. Referral Type-Choose verbal or written

Type of Contact-this is the physical location where you gave the family referral 17. Description-type here what family needs 18. Status-choose here the status of referral ONLY put Action Completed if family received services 19. Action Notes-explain here what and where you referred family to

Referral Follow-Up Form

1 1. Add Action- you will add an action to the same event as the need identified 2. Action Type-follow up 3. Scheduled-date you plan to follow up 4. Action Date-date you actually followed up

1 5. Type of Contact-Choose how you contacted family for follow-up 6. Description-what you were following up on 7. Status-choose the status of referral Only choose Action Completed if family received services 8. Action Notes-explain here what you found out about the referral

Crisis Intervention Form

Only Difference is Event Type 1 1.Event Type-Select Emergency Crisis (everything else is the same as referral 2.2. Continue to use Part 2 actions for referral and follow-up

Crisis Intervention Form  Once you have completed crisis intervention form, referral form and all contact notes, FCP Manager, child’s name and date of crisis.

Crisis Intervention Follow-Up

In Child Plus  Your follow-up for crisis is done the same way as referral. In the second part, as an action.

 Questions/Comments