Free SPECIFIC STEPS - Connecticut

SPECIFIC STEPS
JD-JM-106 Rev. 8-06 C.G.S. §§ 46b-129(j) P.B. Sec. 33a-6, P.A. 06-037

STATE OF CONNECTICUT SUPERIOR COURT JUVENILE MATTERS
www.jud.ct.gov
DOCKET NO.(S)

ADDRESS OF COURT NAME(S) OF CHILD(REN) NAME OF MOTHER NAME OF GUARDIAN (If applicable) DCF WORKER NAME OF CIP MONITOR CURRENT DISPOSITION PHONE PHONE NAME OF FATHER

SPECIFIC STEPS In accordance with Connecticut General Statutes section 46b-129(j) and/or Practice Book section 33a-6, the Commissioner of the Department of Children and Families (hereinafter DCF), the Petitioner herein, and
NAME RELATIONSHIP

MOTHER

FATHER

(hereinafter the Respondent), are hereby instructed to comply with the following steps to safely retain or regain the custody of the above-captioned child(ren) by the Respondent. The Respondent is ordered to: Keep all appointments set by or with DCF. Cooperate with DCF home visits, announced or unannounced, and visits by the child(ren)'s court-appointed attorney and/or guardian ad litem. Keep child(ren)'s whereabouts and your own whereabouts known to DCF, your attorney and the attorney for the child(ren). Participate in counseling and make progress toward the identified treatment goals: Parenting Individual Family Goals (specify): Accept and cooperate with in-home support services referred by DCF. Submit to substance abuse assessment and follow recommendations regarding treatment, including inpatient treatment if necessary, aftercare and relapse prevention. Submit to random drug testing; time and method of the testing shall be at the discretion of DCF. Cooperate with recommended service providers for parenting/individual/family counseling, in-home support services and/or substance abuse assessment/treatment:

Cooperate with court ordered evaluations or testing. Obtain and/or cooperate with a restraining/protective order and/or other appropriate safety plan as approved by DCF to avoid futher domestic violence incidents. Sign releases within 30 days authorizing DCF to communicate with service providers to monitor attendance, cooperation and progress toward identified goals, and for use in future proceedings before this Court. Secure and/or maintain adequate housing and legal income. Not engage in substance abuse.
(continued)

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Have no involvement/further involvement with the criminal justice system. Cooperate with the Office of Adult Probation or parole officer and comply with conditions of probation or parole. Consistently and timely meet and address the child(ren)'s physical, educational, medical, or emotional needs, including, but not limited to, keeping the child(ren)'s appointments with his/her/their medical, psychological, psychiatric, or educational providers. Make all necessary child-care arrangements insuring that the child(ren) is/are adequately supervised and cared for by appropriate caretaker(s). Immediately advise DCF of any changes in the composition of the household to ensure that the change does not compromise the health and safety of the child(ren). Maintain the child within the State of Connecticut during the duration of this case except for temporary travel out of state with the authorization of DCF or the Court in advance. Cooperate with child(ren)'s therapy. Visit the child(ren) as often as DCF permits. Within thirty (30) days of the issuance of these steps, and in a timely manner thereafter, notify DCF in writing of the name, address, family relationship and birthdate of any person(s) whom the respondent would like the department to investigate and consider as a placement resource for the child(ren). Notify DCF of the names and addresses of the grandparents of the child(ren). Other: DCF IS ORDERED TO:
1. 2. 3. 4. 5. 6. 7. Take all necessary measures to ensure the child(ren)'s safety and well being. Provide case management services. Develop periodic treatment/permanency plan and review it with the Respondent. Refer the Respondent to appropriate services (see above) and, as otherwise needed, monitor his/her progress and compliance. Monitor the welfare of the child(ren) and the circumstances surrounding his/her/their care by the Respondent. In a Domestic Violence case, assist in developing, implementing and monitoring an appropriate safety plan. Evaluate home of following person(s) as potential placement for child(ren):

8. Provide respondent with written, dated notice of all referrals to service providers and retain copies of such notices for the court. 9. Implement reasonable recommendations made by service providers and/or evaluators in this matter, or obtain relief from the court. 10. Within thirty (30) days of the receipt of written notice by the respondent, complete the investigation and consideration of any person(s) whom the respondent has properly identified as a placement resource for the child(ren).

Other: AUTHORIZED CIP MONITOR CONTACTS: DCF Worker Foster Parent or Institution Counselor or Clinic Child's/Youth's School Other: APPROVAL AND ORDER The court hereby approves and orders the above steps as preliminary specific steps. This order shall remain in effect until the court orders final specific steps.
SIGNED (Judge ) DATE SIGNED

OR The court hereby approves and orders the above steps as final specific steps that are part of the disposition of the above matter.
SIGNED (Judge ) DATE SIGNED

As the above-named respondent, I hereby agree to cooperate with the above conditions approved and ordered by the court and recognize that non-compliance with these steps results in modification of the existing order or disposition. I acknowledge that failure to achieve these specific steps will increase the chance that a petition may be filed to terminate my parental rights permanently so that my child may be placed in adoption. I understand that I should contact my lawyer and/or DCF worker if I need help in reaching any of these steps.
SIGNED (Respondent ) DATE SIGNED

JD-JM-106 Rev, 8-06 (Page 2)

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