Free 52691.FH11 - Indiana

INDEPENDENT LIVING TRANSITION PLANNING TOOLKIT
State Form 52691 (8-06) / CW 2112 DEPARTMENT OF CHILD SERVICES

There are three (3) components to this form: the foreword, the transition plan, and the prompt questions for the transition plan.
FOREWORD

Transition Planning Conference Transition planning for a youth works best when a team approach is taken with the youths involvement. The youths Family Case Manager (FCM) or Probation Officer is responsible for putting together a transition planning case conference, bringing together all those involved in the youths case, which may include: Family Case Manager Youths caregiver CASA / GAL Mentor Employer Probation Officer Youths placement caseworker Therapist Relatives Other supportive adults The transition planning conference is to take place within 30 days of the youths seventeenth birthday for all youths who are in foster care*. The conference is an opportunity to support the youth in building a plan for the future as well as determining if a transitional living placement is appropriate for the youth. Bringing together all those involved in the youths case with their knowledge and resources is advantageous in helping the youth develop and carry out a transition plan. The budget worksheet should be used during the conference to determine if the youth has a viable plan based on possible earnings and expenses. Guidance should be provided to assist the youth in carrying out decisions. Youths who are placed away from their home county may choose to remain in the county where they are placed. When this occurs, the referral for transition services must be made to a Chafee IL service provider in the county where the youth has chosen to reside. Assistance may be provided in locating a service provider in another region by contacting the Child Welfare Regional Coordinator for that region.

Components of the Toolkit

Youth Inventory The youth inventory provides an at a glance look at the youths assets so that the youth and his/her supportive adults can gain an understanding of the youths strengths and needs. Youths should be involved in all stages of their own transition planning. The youth inventory is designed to be non-intimidating and simple enough for youths to fill out by themselves with minimal assistance from an adult. In order to develop a stronger understanding of a youths readiness for adult living, it is recommended that the most recent Ansell-Casey Life Skills Assessment (ACLSA) be made available at the conference. If a period of months has passed since the last ACLSA was completed, it would be advisable for the youth to complete a new assessment just prior to the transition planning conference. It is important to have the most recent information when planning takes place.

Transition Plan The initial planning conference is to assist youths in developing a plan to transition into their own housing when their case is dismissed at age 18 or older. This is a time for everyone working with the youth to start serious planning for the youths future. The youth should complete the youth inventory of strengths to use as a guide in developing the transition plan. The plan is designed to be a flexible tool that can incorporate other plans prepared for the youth, such as the Individualized Education Plan / Individualized Treatment Plan through special education programs. This will avoid a duplication of services. Referral for transition services to a Chafee IL service provider should be made following the 6-month update planning conference for all youths in out-of-home placement, regardless of the type of placement. The transition plan as well as the youth inventory should be included with the referral form.

*

Foster care is designed as 24-hour substitute care for children placed away from their parents / guardians / custodians and for whom the state agency has placement and care responsibility. Facilities that are outside the scope of foster care include, but are not limited to: detention facilities, psychiatric hospital acute care, forestry camps, or facilities that are primarily for the detention of children who are adjudicated delinquents. Page 1

INDEPENDENT LIVING TRANSITION PLANNING TOOLKIT
Part of State Form 52691 (8-06) / CW 2112

YOUTH INVENTORY
First name and initial

Date plan completed (month, day, year)

To be completed at the Transition Planning Case Conference. YOUTH INFORMATION
Last name Date of birth (month, day, year) Age ICWS number Sex

Initial 6-month update

Projected date youth will leave care (month, day, year)

Male INDEPENDENT LIVING PREPARATION
Participating in independent living program Level of involvement Date completed (month, day, year) Date placed (month, day, year) Transition plan completed

Female

Yes Yes
Placed in transitional living placement

No
Date completed (month, day, year)

Ansell-Casey Lifeskills Assessment completed

No No

Yes
Youth approved of plan

No
Initials of youth

Yes

Yes SOCIAL DEVELOPMENT & SUPPORTIVE RELATIONSHIPS PERMANENCY

No

Permanency obtained

Permanency obtained with

Legal relationship to youth (guardianship, adoptive home, etc.)

Telephone number

Yes

No

(

)

Address (number and street, apartment or unit number, city, state, and ZIP code) Supports offered (advice, emergency housing, career guidance, place to go for holidays, help with finances)

SUPPORTIVE ADULTS
Name Address (number and street, apartment or unit number, city, state, and ZIP code) Supports offered (advice, emergency housing, career guidance, place to go for holidays, help with finances) Name Address (number and street, apartment or unit number, city, state, and ZIP code) Supports offered (advice, emergency housing, career guidance, place to go for holidays, help with finances) Name Address (number and street, apartment or unit number, city, state, and ZIP code) Supports offered (advice, emergency housing, career guidance, place to go for holidays, help with finances) Telephone number Telephone number Telephone number

(

)

(

)

(

)

HOUSING, TRANSPORTATION, & COMMUNITY RESOURCES HOUSING & TRANSPORTATION
Address after leaving foster care (number and street, apartment or unit number, city, state, and ZIP code) Only complete within three months of exit date. Emergency shelter, if needed (please identify) Participated in visits to housing options Has mode of transportation (owns vehicle, bicycle, uses public transportation)

Yes Sample rental application completed & attached Photo identification in youths possession Social Security card in youths possession

No

PERSONAL DOCUMENTS Selective Service registration if 18 (males) Registered to vote if 18 Birth certificate in youths possession State identification County and state of birth: ______________________________ Drivers license

Personal filing system (i.e., 3-ring binder, file cabinet, full-size expandable envelope, etc.) Location of filing system

COMMUNITY RESOURCES
Spiritual support [list organization(s)] Other community connection (Boys/Girls Club, etc.) Name of contact person Name of contact person Telephone number

(

)

Telephone number

(

)

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MONEY MANAGEMENT
Bank account open Savings account open Name of bank or other financial institution Other sources of income (list on separate sheet) Monthly amount

Yes

No

Yes

No

Savings for leaving foster care

Goal: $ ____________

Current balance: $ ____________ WORK & STUDY SKILLS EDUCATION

High school diploma

Name of school

Date obtained (month, day, year) Date obtained (month, day, year) High school credits / transcripts attached

Yes
GED

No
Name of school

Yes Yes
Currently employed

No
Name of school

Enrolled in college or vocational program

No EMPLOYMENT
Current employer

Yes

No

Sample employment application completed & attached

Full-time
Previously employed

Part-time
Previous employer

Yes Yes SELF CARE
Applied for Medicaid one (1) month prior to 18th birthday Medicaid number Telephone number

No No

Employment ended in firing

Full-time

Part-time

Medical coverage after foster care

Yes
Name of doctor Name of dentist

No

Yes

No

Address (number and street, city, state, and ZIP code) Address (number and street, city, state, and ZIP code) Name of provider Name of provider Drug & alcohol free In treatment Non-smoker

( ( ( (

) ) ) )

Telephone number Telephone number Telephone number Reporting method

Emergency provider identified Mental health coverage Age

17 Yes

18 No

19+

Yes
Felony

No No

Yes
Parent

No No

Yes
Number of children

No
Age & gender of children

Currently on probation or parole

Yes

Yes

DAILY LIVING SKILLS
List demonstrated daily living skills

SIGNATURES OF TRANSITION TEAM MEMBERS
Signature of youth Signature Signature Signature Signature Signature Role Role Role Role Role Telephone number

( ( ( ( (
Page 3

) ) ) ) )

Telephone number Telephone number Telephone number Telephone number

INDEPENDENT LIVING TRANSITION PLANNING TOOLKIT
Part of State Form 52691 (8-06) / CW 2112

TRANSITION PLAN
First name and initial

Date plan completed (month, day, year)

To be completed at the Transition Planning Case Conference. YOUTH INFORMATION
Last name Date of birth (month, day, year) If yes, date of referral (month, day, year) Teen parent Age ICWS number Sex

Initial 6-month update

Family case manager / probation officer Referred for transition services

Male
Pregnant / father-to-be

Female
If yes, number of children

Yes

No

Yes

No

Yes

No

YOUTHS STRENGTHS (including hobbies & interests)

IDENTIFIED NEEDS

ADDITIONAL NEEDS

ADDITIONAL NOTES

PLAN DEVELOPMENT (Indicate how the youth was involved in the development of the plan.)

YOUTH PLAN
Does the youth have an Individualized Transition Plan (ITP) through the special education program at school?

Yes

No Development Disabilities Individual Service Plan (BDDS) Temporary Assistance to Needy Families (TANF) Workforce Investment Act (WIA) Other (please specify)
Initials of youth

Please check all that apply and attach a copy to this form.

Ansell-Casey Life Skills Assessment Individualized Education Plan / Individualized Transition Plan (IEP / ITP) Treatment Plan & Discharge Plan (residential, group home, mental health, etc.) Vocational Rehabilitation Individual Plan for Employment

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Name of youth

ICWIS number

Initial 6-month update

EDUCATION CURRENT EDUCATIONAL STATUS
(In school, in what grade, how are grades, IEP / ITP, graduated, GED, other program, etc.)

FUTURE GOALS OR PLANS FOR EDUCATION
(Attend college, type of program - 2 or 4 year, vocational training, Job Corps, military)

To help achieve long-term goals / plans

SHORT-TERM GOALS

Steps to achieve the short-term goals & services to be offered

STEPS & SERVICES

PROGRESS

Initials of youth

HOUSING CURRENT LIVING SITUATION
(Estimated date of independence, resources, concerns, risks, obstacles)

PLAN FOR HOUSING UPON DISCHARGE
(Where, with whom, live with parents, host home with foster parents or relatives, transition to BDDS group home))

FUTURE PLANS / GOALS FOR HOUSING
(Long-range goals after discharge, rent apartment, own a home, live in the dorm, shared housing, live with relatives)

To help achieve long-term goals / plans

SHORT-TERM GOALS

Steps to achieve the short-term goals & services to be offered

STEPS & SERVICES

PROGRESS

Initials of youth

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Name of youth

ICWIS number

Initial 6-month update

SUPPORTIVE RELATIONSHIPS & COMMUNITY CONNECTIONS CURRENT COMMUNITY SUPPORT, ACTIVITIES & INTERESTS
(Who is currently your support system? How are they a support? How are you involved in your community?)

FUTURE GOALS OR PLANS FOR SUPPORTIVE RELATIONSHIPS & COMMUNITY CONNECTIONS
(What is your plan for community involvement? Do you know where to find resources in your community?)

To help achieve long-term goals / plans

SHORT-TERM GOALS

Steps to achieve the short-term goals & services to be offered

STEPS & SERVICES

PROGRESS

EMPLOYMENT CURRENT EMPLOYMENT STATUS
(Skills needed, job search, placement, maintain employment, etc.)

FUTURE GOALS OR PLANS FOR EMPLOYMENT / CAREER
(What career field do you wish to pursue? How will you gain the skills necessary for your career goals? Who can help you obtain experience in this career area? Plan for job shadow or internship?)

To help achieve long-term goals / plans

SHORT-TERM GOALS

Steps to achieve the short-term goals & services to be offered

STEPS & SERVICES

PROGRESS

Initials of youth

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Name of youth

ICWIS number

Initial 6-month update

HEALTH CURRENT HEALTH STATUS
(Physical, mental, emotional strengths and needs)

FUTURE GOALS FOR MAINTAINING GOOD HEALTH
(Is next dental and physical exam scheduled? What is your plan to meet ongoing physical or mental health needs? What is your plan for obtaining medical insurance or Medicaid? Do you have an understanding of nutrition and fitness?)

To help achieve long-term goals / plans

SHORT-TERM GOALS

Steps to achieve the short-term goals & services to be offered

STEPS & SERVICES

PROGRESS

Daily living skills Nutrition / safety

MISCELLANEOUS SKILLS INDEPENDENT LIVING SKILL AREA Transportation Legal Interpersonal / social Money management CURRENT STATUS

Recreation / leisure Other

FUTURE GOALS OR PLANS

To help achieve long-term goals / plans

SHORT-TERM GOALS

Steps to achieve the short-term goals & services to be offered

STEPS & SERVICES

PROGRESS

Initials of youth

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Name of youth

ICWIS number

Initial 6-month update

SIGNATURES OF PARTICIPANTS AT TRANSITION PLANNING CASE CONFERENCE
Signature Name Role Telephone number

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Initials of youth

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INDEPENDENT LIVING TRANSITION PLANNING TOOLKIT
Part of State Form 52691 (8-06) / CW 2112

PROMPT QUESTIONS FOR TRANSITION PLAN
Education Emphasize and assist with school continuity. Evaluate credits (if behind, create a plan to make up missed credits). Identify education options and goals such as job training, Job Corps, vocational / technical training, community college / university. Identify career direction. Identify and start preparing for requisite tests (PSAT, SAT, ACT). Assist with practice SAT tests at www.collegeboard.com. Take relevant tests (assist with determining which tests are necessary based on career and educational goals and assist with scheduling them). Complete GED, high school or training program. Submit applications to school or work (assist with resume, completing applications, FAFSA, personal statement, interview questions). Complete the FAFSA before March 10th in order to be eligible for state grants. Assist with participation in College Goal Sunday for help with FAFSA completion. Identify scholarships and support (ETV, Orphan Foundation scholarship, etc.). Housing Start saving money. Identify housing goals. Identify expected housing needs. Identify preferred transition housing placement (scattered site apartments, group home, etc.). Identify viable post-emancipation housing options such as college, host home, relative, parents, own apartment. Identify costs and financial resources (rent, Chafee eligibility, financial aid, employment, subsidized (Section 8) housing, relative and/or foster parent support, opening a bank account). Identify social and supportive needs (proximity to family, friends, support groups, therapy, ideal roommate situation). Decide where to live. Learn skills and legal rights around housing (discuss landlord / tenant law and housing rights, review a lease form, list reference, discuss dealing effectively with landlords). Facilitate moving process (obtain furniture, truck, moving help, etc.). List fallback resources (family, friends, shelters). Supportive Relationships and Community Connections Provide opportunities for youth to create, maintain, or strengthen supportive and sustaining relations with birth families, relatives, foster and adoptive families and significant others (identify relationships youth would like to explore, nurture, repair and/or restore; and what supports are needed from family and adults to accomplish the youths goals. Encourage youth to select people involved in his/her life.). Connect youth with peer and adult mentors to develop long-term relationships to serve as role models in areas like employment, transitional life skills, social support and friendship (identify through organizations in the community). Create opportunities for youth to play an active role in community life through volunteerism, leadership and community service. Facilitate knowledge of and access to community resources. Connect youth with culturally specific events and services in the community. Facilitate youth becoming a mentor. If prepared, the transition from the mentored to the mentor fosters confidence, creates a bond among foster youths and provides them with the opportunity to teach what they have learned. Encourage youth to become a resource within community organizations.

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Employment Identify natural skills and abilities. Discuss with youths what they enjoy doing, where they excel and how their talents, skills, and abilities can translate into employment opportunities. Identify long-term employment goals (youths interests, desired occupations, plans three years from now, plans at age 30, etc.). Identify short-term employment needs and strategies. Identify long-term and short-term employment options. Identify educational and training needs to attain goals. Develop job search skills (WorkOne, newspaper, Internet, signs in business window, word-of-mouth). Develop job-landing skills (work with youths resume, application completion skills; practice interviewing, how to approach an employer). Develop education and training skills necessary to achieve employment goals (HS / GED, Job Corps, college, apprenticeship, job shadows, internships, etc.). Health Identify ongoing need for physical health, mental health, and substance abuse services. Provide access to health education (healthy sexual decision-making, awareness of birth familys physical and mental health history, prevention and transmission of sexually transmitted diseases, effects of trauma, substance abuse issues, constructive methods for coping with stress, addressing social and relationship problems, anxiety, depression, and other mental health issues). Provide access to safety education (maintaining personal safety in social and in-home relationships, preventing and avoiding accidents and violence, reporting unsafe events and developing safety response plans). Learn how to manage own health care needs (applying for insurance, Medicaid, accessing services, articulating health care needs and keeping appointments). Provide youth with information to access available health care resources of his/her choice. Assist with consolidating and updating health records (past and present diagnostic and treatment information, obtaining and maintaining medical and mental health records). Anticipate further health needs and plan for provision of services (arrange continuation of treatment of ongoing physical and mental health needs; prepare youth for potential needs; i.e., birth control).

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