Ky.gov
Effective: 10/4/2023

3.4 Initial In Home Case Planning Conference

Legal Authority

Introduction

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​ The case planning process is based on strengths, safety threats, and risk identified by the SSW during an investigation, assessment, or ongoing casework. The Department for Community Based Services (DCBS) encourages families served to participate fully in the process and to retain as much personal responsibility for case planning as possible.

The Family First Prevention Services Act (FFPSA) allows states to claim partial federal title IV-E reimbursement for in-home prevention services. There are elements of the case that require documentation on the family case plan for the prevention services to be eligible for claiming. Information from the prevention services referral will populate into the family case plan when the screens are completed in TWIST. Prevention services include Intensive Family Preservation Services (IFPS), Families and Children Together Safely (FACTS), Diversion, Family Reunification Services (RFS), Kentucky Strengthening Ties and Empowering Parents (KSTEP), and Sobriety Treatment and Recovery Teams (START). Please refer to SOP Chapter 6​ for prevention services details and referrals​​.


Practice Guidance

  1. In cases where domestic violence has been identified as a risk factor, the SSW collaborates with the family’s team to develop a logical and achievable plan for the children and family by prioritizing service needs. 
  2. Children identified as candidates for foster care will meet one of the following criteria: 
    1. ​A victim of substantiated maltreatment where existing safety threats and risk factors can be mitigated by the provision of in-home services; 
    2. A child for whom maltreatment has not been substantiated, however, moderate to severe risk factors for maltreatment are present and services are necessary to prevent maltreatment and subsequent entry into foster care; and 
    3. A child who has recently been reunified for whom services to the family will mitigate identified risk factors, preventing further maltreatment and re-entry into out-of-home care (OOHC).
  3. Safe sleep and co-sleeping:
    1. ​Review What DCBS Workers Need to Know About Safe Sleep and be prepared to relay the information to families and assess sleeping arrangements for children during home visits.​
    2. If unsafe sleeping practices are discovered through the course of the investigation and/or ongoing case, SSW will discuss with the family and may consider implementing tasks that support the ​use of safe sleeping practices within the case plan to mitigate existing safety threats and/or risk factors. 




Procedure

The SSW:

  1. Involves, to the fullest extent possible, the participation of the family, other significant persons in the child’s life not living in the family unit, (i.e., legal and/or biological parents (including identified fathers, family, friends etc.) and relatives; 
  2. Invites prevention service providers to the case planning conference; 
  3. Includes the child(ren) when age-appropriate, in case planning efforts; 
  4. Reviews the case planning process with the family and members of the family’s team​ once a case has been opened for ongoing services. This includes a discussion of the need for community partner involvement in case planning; 
  5. Provides information, during the initial case planning meeting, to develop a case plan, when appropriate, about the following: 
    1. Basis for DCBS involvement regarding risk factors ​and safety threats; 
    2. Rights and responsibilities of the parent and child(ren); 
    3. Child protective services; and 
    4. Service options that address the: 
      1. Prevention of future maltreatment, presenting problem, or need; 
      2. Individual behavior changes needed; 
      3. Risk factors that threaten the safety of all family members.
  6. Identifies if the case plan is a FFPSA plan. This is for cases where a prevention services referral has been made. This information will populate from the prevention services referral screens in TWIST if a referral for prevention services has been completed in the TWIST screens; 
  7. Identifies, when the case plan is identified as an FFPSA plan, the child(ren) that is identified as a candidate for foster care and the start date of their candidacy. This information will populate from the prevention services referral screens in TWIST; 
  8. Identifies the evidence-based practice (EBP) that will be used to mitigate the high-risk behaviors or circumstances causing the child to be a candidate for foster care. This information populates from the prevention services referral screens in TWIST; 
  9. Identifies a child-specific prevention strategy for each candidate and incorporates the EBPs into the case plan objective. Please refer to the EBP Selection Document; 
  10. Incorporates the following tasks, which is based on a family’s strengths, to develop primary objectives that are related to the prevention of further child maltreatment in the home and associated tasks to include: 
    1. Identifying strengths of the family; 
    2. Identifying high-risk behaviors; 
    3. Identifying high-risk patterns and developing a return to using a plan that includes; 
      1. Identifying early warning signals; 
      2. Planning to prevent high-risk situations.
    4. Ensuring that substance affected infant cases incorporate plan features that provide services to address the health needs of the infant and the substance misuse treatment needs of the caregiver in accordance with SOP 1.15 Working with Families Affected by Substance Misuse​ and sections 106(b)(2)(B)(ii) and (iii) of CAPTA; 
      1. Planning to interrupt high-risk situations early, if not prevented; and 
      2. Planning for escape from the high-risk situation, if early interruption fails; 
    5. Assures that the case plan is: 
      1. Specific; 
      2. Measurable; 
      3. Individualized based on identified safety threats and risk factors; 
      4. Realistic; and 
      5. Time-limited 
  11. Includes in the case plan all services offered to assist the family to improve the following: 
    1. Safety; 
    2. Care; 
    3. Relationship with their children; and 
    4. Parent’s ability to fulfill their roles to promote child and family safety, well-being, and permanency, whenever possible;
  12. Negotiates the tasks and objectives with the family and community partners and documents them in the case plan;
  13. Ensures that a secondary family level objective is designed, when the child is placed with a relative, to establish tasks and services to keep the child safe in the relative's home. These objectives and tasks should address permanency, attachment and visitation, medical and mental health needs, and education. The OOHC portion of the DPP 1281 Family Case Plan should be completed when the child is in DCBS custody instead of the secondary level objectives; 
  14. Arranges for services from community partners, through use of the assessment and case plan, which may include, but are not limited to, the following: 
    1. Child care; 
    2. Family preservation and reunification; 
    3. Home health; 
    4. Mental health; 
    5. Physical health; 
    6. Education; 
    7. Housing; and 
    8. Clothing; 
  15. Completes the case plan in TWIST; 
  16. Submits the case plan to the FSOS for approval after the case planning meeting, with or without the parents’ signature;
  17. Documents in the comment section of the DPP-1281 Family Case Plan why the parents did not sign, when applicable;  
  18. Makes efforts to discuss the case planning conference with each parent, and the child when they are unable to attend;
  19. Mails or distributes a copy of the following documents to the participants listed below: 
    1. The approved DPP-1281 Family Case Plan: 
      1. Parent or legal guardian (certified restricted mail if not in attendance); 
      2. Identified fathers (certified restricted mail if not in attendance); 
      3. Any person or agency providing services to the family (with parental consent); 
      4. Any community partners assigned a task on the case plan (with parental consent); and 
      5. The child’s guardian ad litem (GAL), when applicable; 
    2. The DPP-154 Protection and Permanency Service Appeal (certified restricted mail) to parent or legal guardian; and 
    3. All other relevant documents;
  20. Documents in the service recordings: 
    1. How the partnership is carried out in case planning and service delivery; and 
    2. When the family declines community partner involvement. 
  21. Completes candidacy redetermination via the selection on the DPP-1281, when the need for services extends beyond twelve (12) months.

The FSOS:

  1. Provides input into case plan development; 
  2. Assists the SSW in determining how to protect the safety of the non-offending parent and children, when domestic violence is involved; 
  3. Ensures that the case plan is developed within required timeframes; 
  4. Reviews and approves the case plan prior to distribution.



Elements of the Case Plan

Objectives support the overall goal and are either family-related or individual-specific.

Family Level Objectives (FLO) are those activities that the whole family can work on. They center around an everyday life event and are always directly related to the maltreatment that resulted in opening the case.

Individual Level Objectives (ILO) focus on the individual patterns of high-risk behavior that lead to maltreatment. It is important to understand why the pattern occurred,  to create the most effective objective.

Objective example:

A single-parent home with two young children, neglect was substantiated, and the case was open. The investigator identified during the assessment that the single parent was overwhelmed and that is why the home was unsafe.

Objectives
  • The FLO would surround ensuring the house is safe and free from environmental hazards. 
  • The ILO would surround helping the parent figure out why he/she is overwhelmed and make a plan to manage this issue. 
  • If the investigator had identified that the single parent was depressed and that is why the home was unsafe, the ILO could surround mental health treatment or counseling.
Strengths

A child’s and family’s available past and present experiences, assets, interests, resources, resiliency, interests, and preferences provide strengths to meet needs. These strengths should be used when building the action steps of the case plan.

Needs
  • A need is a requirement that is essential to all human beings such as the need for shelter, food, affiliation, or nurturance. 
  • A need may be a description of the underlying conditions that are often the source of the problems that a family is encountering.
Tasks

Tasks support the objectives and outline what steps will be taken to reach the objectives.

Tasks should be person-specific, measurable, and time-limited. They should answer who, what, and when, at a minimum.

Tasks also:

  • Identify difficult situations or triggers; 
  • Identify early warning signs; 
  • Assist families in avoiding high-risk situations; 
  • Assist families in coping with risk situations not avoiding them.

Footnotes

  1. The case plan is based on a partnership with the family and others. 
  2. As implemented by DCBS.

Documents

Revisions

​10/3/23 Addition: 

3.  Safe sleep and co-sleeping:
    1. ​Review What DCBS Workers Need to Know About Safe Sleep and be prepared to relay the information to families and assess sleeping arrangements for children during home visits.​
    2. If unsafe sleeping practices are discovered through the  course of the investigation and/or ongoing case, SSW will discuss with the family and may consider implementing tasks that support use of safe sleeping practices within the case plan to mitigate existing safety threats and/or risk factors. 
​​7/00/23 Deletion:
17.  Documents in the comment section of the DPP-1281 Family Case Plan (hard copy) why the parents did not sign; ​