Instructions for the ISSP

1. Instructions for creating the ISSP in Word
   
   This is the electronic version of the ISSP.
   
   
   
   
   1. To create a new ISSP, click on File-New on the menu and select the ISSP.
   2. To copy text from any other document
      1. Copy the text with your copy button.   
         
         
      2. Place the cursor where you want the copied text to be located. From the menu select Edit | Paste Special.
         
         
         
         
      3. The Paste Special dialogue box will appear. Select Unformated Text. Click on the OK button.
         
         
         
         
   3. Save the ISSP as a Word document. Develop the habit of saving your document as you go by clicking the Save icon on your toolbar. This will prevent text loss due to power outages, network failure or thunderstorms etc
   
   
   
2. Special instructions for document distribution
   1. The Confidentiality Notice is an optional form, which can be used to remind caregivers of the confidential nature of the ISSP.
   2. A copy of the ISSP is to be provided to the caregiver except for Section V.F. Current Status/Social Summary of Parent.
   3. Create a separate ISSP for each child. If you desire, you may create an ISSP for the first child. Then from the menu do a File | Save As and rename the document with the second child's name and make the modifications as they apply to the second child.

DSHS INDIVIDUAL SERVICE AND SAFETY PLAN

1. Identifying Information
   
   

   Child's Name:				Legal No.:
   Birthdate/Age:				Case No.:
   SSN:				Receives SSI: [ ] Yes [ ] No
   Ethnicity (check all that apply): [ ] Black [ ] Native American Indian [ ] Caucasian [ ] Asian [ ] Hispanic [ ] Yes [ ] No This child is Native American Indian per Attachment A on initial ISSP report dated . (If child is not Native American Indian, subsequent reports can delete Attachment A.)
   Type of Placement:				Current Legal Status:
   Date of Petition:				Voluntary Agency Name:
   Date of Disposition: Mother: Father:				Date of Finding of Dependency: Mother: Father:
   Date(s) of Previous Review Hearings:
   Principals Involved are:

   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   

   Mother:	Phone:	Mother's Attorney:	Phone:
   Father:	Phone:	Father's Attorney:	Phone:
   Guardian ad litem/CASA:	Phone:	GAL/CASA Attorney:	Phone:
   DSHS Social Worker:	Phone:	Social Worker's Attorney:	Phone:
   Child:	Phone:	Child's Attorney:	Phone:
   Other:	Phone:	Other's Attorney:	Phone:
   Other:	Phone:	Other's Attorney:	Phone:

   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
2. Case Background
   1. Within the last 19 months the child has been in out-of-home care for a total of months (Include prior placement episodes that fall within the last 19 months. Provide any relevant explanation.)
      
      
   2. Begin date of current placement episode:
      
      
   3. Identify events and risk factors related to child safety and well being that caused child to be placed in out-of-home care:
      
      
   4. Child/family needs were originally identified as (consider medical, educational, environmental, psychological, ethnic and cultural needs):
      
      
3. Preplacement Services
   1. Identify services offered or provided to family to prevent child's placement. Indicate how services offered (relate to risk factors identified in II. C):
      
      
   2. If no services were offered to prevent placement, explain why:
   
   
   
4. Summary of Previous Case Plan and Court Order
   [ ] Does not apply
   
   
   1. Legal: Identify the Permanent Plan and Alternate Permanent Plan (during last report period). Place a "P" next to the primary plan and an "A" next to the alternate permanency plan:
      
      

      Permanent Legal Arrangements	Other Planned Arrangements
      [ ] Return Home	[ ] Long-term Relative Placement Agreement (written)
      [ ] Adoption	[ ] Foster Care Long-term Agreement (written)
      [ ] Guardianship (check one):	[ ] Independent Living (only if child is 16 or older)
      [ ] Dependency or
      [ ] Other (RCW 11.88)
      [ ] Third Party Custody (with someone other than parent, RCW 26.10)

      
      
      
      
      
      
      
      
      
      
      
      
      
      
      
      
      
      
      
      Tentative completion date for previous permanent plan was:
      
      
      
   2. Child is placed in:
      [ ] Family home with
      [ ] Relative placement with
      [ ] A non-relative, out-of-home placement.
      
      
   3. Previous Service Plan: Review and Evaluation of Services and Responsibilities.
      Discuss the services and activities offered and the progress achieved for safely returning and maintaining the child at home or achieving another permanent plan for the child.
      1. Parent(s):
         
         
      2. Child:
         
         
      3. Caregiver:
         
         
      4. DSHS/Voluntary Agency:
      
      
      
   4. Visitation Plan:
      1. Frequency:
         
         
      2. Quality:
         
         
      3. How has the visitation plan been helpful to achieve reunification of the family:
      
      
      
   5. Court Orders:
      Discuss how current placement and services offered were responsive to court orders.
      
      
      
   6. Permanency Plan (for other than return home)
      1. Discuss steps taken to finalize the current placement:
         
         
      2. Discuss barriers to finalizing the current placement:
      
      
      
5. Recommended Case Plan for New Review Period (except as amended by court order)
   1. Legal Recommendations:
      1. Identify the Permanent Plan and alternate Permanent Plan (for upcoming report period). Place a "P" next to the primary plan and an "A" next to the alternate permanency plan (if applicable). If one of the Other Planned Arrangements is selected as the primary plan, complete the compelling reasons portion of this item:
         
         

         Permanent Legal Arrangements	Other Planned Arrangements
         [ ] Return Home	[ ] Long-term Relative Placement Agreement (written)
         [ ] Adoption	[ ] Foster Care Long-term Agreement (written)
         [ ] Guardianship (check one):	[ ] Dependency or
         [ ] Other (RCW 11.88)	[ ] Independent Living (only if child is 16 or older)
         [ ] Third Party Custody (with someone other than parent, RCW 26.10)

         
         When one of the Other Planned Arrangements is selected as the primary plan, identify the compelling reasons that this plan is in the child's best interest:
         
         
      2. Tentative completion date of present permanent plan, depending on action, progress and cooperation of those involved is _______________
         
         
      3. Recommended Legal Status of the Child:
         [ ] Dependent (check one of the following):   [ ] In-home   [ ] Out-of-home care
         [ ] Dependency dismissed
         
         
      4. If one of the following circumstances exist, a petition to terminate parental rights must be filed unless compelling reasons exist to the contrary: (check any box that applies).
         
         [ ] The child is currently in out-of-home care and has been in out-of-home care for 12 of the most recent 19 months;
         
         [ ] The parent has abandoned this child as defined in RCW 13.34.030 or 13.34.180(7) OR has been convicted of abandoning this child as defined in RCW 9A.42.060, 070, or 080;
         
         [ ] The parent has been convicted of one or more of the criminal activities listed in RCW 13.34.130(2).
         
         [ ] None of the above listed circumstances apply.
         
         
      5. When one of the circumstances in V. A. 4 exists, and the case plan is not adoption, discuss compelling reasons for not filing a petition to terminate parental rights:
      
      
      
   2. Placement Recommendations:
      1. Placement in:
         1. [ ] Family home with ________ because:
            
            
         2. [ ] Relative placement with ________ because:
            
            
         3. [ ] Any non-relative, out of home placement (foster care, group care, etc.) because:
         
         
      2. If the recommendation is other than family home, discuss continued need for placement and continued risk to the child if returned to either or both parents:
         
         
         
      3. If recommendation is other than family home, discuss how this placement is the most appropriate and least restrictive setting, in close proximity to the family home, which can safely meet the best interests of the child.
         
         
         
      4. [ ] Child is not placed out of state   [ ] Child is placed out of state
         If placement is a substantial distance from a parent's home, or is out of state, explain why this placement is in the best interest of the child:
         
         
         
      5. Permanency planning if continued out of home care is recommended:
         
         1. In the event the child is unable to return home, discuss whether the current placement is expected to be the child's permanent placement:
            
            
            
         2. If the child is unable to return home and the current placement is not expected to be the child's permanent placement, discuss steps taken to identify, recruit, process, and approve a permanent placement:
         
         
         
         [ ] Does not apply because return home is imminent (less than six months).
      
      
      Child's Name:   ______________________________
      
      
   3. Recommended Services and Responsibilities for the next six months:
      1. Parents/Family - Identify services/responsibilities to meet educational, medical, environmental, social, psychological, ethnic, and cultural needs:
         
         
         
      2. Child: Identify service and responsibility to meet each identified need:
         1. Educational needs:
            
            
         2. Medical needs:
            
            
         3. Social needs:
            
            
         4. Psychological needs:
            
            
         5. Ethnic and cultural needs:
         
         
         
      3. Identify services and responsibilities to meet child and family needs:
         1. Caregiver:
            
            
         2. Voluntary Agency:
            
            
         3. DSHS
         
         
         
      4. Assessment of the Recommended Service Plan
         1. Discuss how the service plan will alleviate the current risk factors and help assure safe and proper care of the child if the child:
            1. Is returned home
               
               
            2. Remains in placement
            
            
            
         2. How will the service plan improve conditions in the parents' home?
            
            
         3. How will the service plan help to achieve a permanent plan other than return home:
         
         
         
      5. Visitation Plan:
         1. Describe plan:
            
            
         2. Discuss changes in plan and reasons for changes:
            
            
         3. Discuss how the visitation plan will assist in reunifying the family or in maintaining family ties for the child:
            
            
         4. If child is a substantial distance from the parent, discuss additional plan for maintaining contact:
            
            
   4. Independent Living Skills:
      If child is age 16 and over, what planning is being done in each of the following areas in anticipation of child reaching age 18?
      
      
      1. Educational goals:
         
         
      2. Income maintenance (include health care coverage):
         
         
      3. Vocational goal attainment:
         
         
      4. Knowledge of how to secure adequate housing:
         
         
      5. Daily living skills:
         
         
      6. Interpersonal skills (include connection to extended family or other significant adult):
      
      
      
   5. Current Status/Social Summary of Child
      
      
      
   6. Current Status/Social Summary of Parent
      This section will not be shared with the child's caregiver.
      
      Confidential information related to parents' health issues, mental health treatment and substance abuse treatment should be discussed in this section. (Recognize strengths as well as issues which interfere with parenting.)
   
   
   
6. ATTACHMENTS AND SIGNATURES:
   1. Attachments
      1. Include Attachment A, DETERMINATION OF NATIVE AMERICAN INDIAN STATUS, as required by policy.
      2. Include a copy of either the Passport Record or the Health and Education Form.
      3. If child is placed out of state, include a report from the agency providing courtesy supervision.
      4. Attach on separate pages any comments by the child, parent(s), foster parent(s), relative caregiver(s), or voluntary agency.
      
      
      
   2. Signatures (optional):
      1. Signatures by parents, child or voluntary agency indicates receipt of this ISSP. Signatures do not necessarily indicate agreement with all parts of this plan.
         
         
         

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      2. Copies of this ISSP MUST be provided to parents. Social worker certifies that copies of this ISSP were provided to parents on dates listed below:
         
         Mother: _______________________________________________________________
                                          Name                                             Date
         
         Father: _______________________________________________________________
                                          Name                                             Date
         
         Parents were notified of visitation changes:   _____________________________
                                                                                              Dates
         
         Parents were notified of placement changes: _____________________________
                                                                                              Dates
         
         Submitted by: _________________________________________________________
                               Division of Children & Family Services Social Worker          Date
         
         Approved by: __________________________________________________________
                               Division of Children & Family Services Social Worker          Date
         
         Approval for INITIAL placement in group care
         
         ______________________________________________________________________
         DCFS Administrator or Designee                                                         Date
         
         
   
   
   

1. Child is (check all that apply):
   1. [ ] A federally recognized Indian child; Member or eligible for membership in a federally recognized tribe;
      [ ] Any person determined or eligible to be found to be Indian by the Secretary of the Interior Bureau of Indian affairs. *BIA);
      [ ] An Eskimo, Aleut, or other Alaskan Native.
      Name of Tribe/Village(s):
      
      
      
   2. [ ] A Canadian First Nations child: A member or entitled to be a member of a Canadian treaty or band Metis community, or non-status Indian community from Canada.
      First Nation/Band Name:
      
      
      
   3. [ ] An Other Indian child: A person considered to be an Indian by a federally or non-federally recognized tribe or Indian organization
      
      
   4. [ ] The child may be an Indian. List tribes and Indian organizations to be contacted in order to seek verification:
      
      
      
      
   5. [ ] The following tribes have been contacted, and the child and his/her ancestors are not considered to be Indian:
      
      
      
      
   6. [ ] The child's parents and relatives have been interviewed (see ethnic identity form) and the child is not an Indian to our knowledge. (None of the above apply.) Omit II. And III. Below.
      
      
2. If the tribe is not available, or has requested staffing by LICWAC, has the child's case plan been reviewed by LICWAC?
   1. [ ] Yes     Date staffed or to be staffed:
      
      
   2. [ ] No     Reason:
      
      Discuss plan to obtain consultation from Native American Consultant or LICWAC:
      
      
      
      
3. For children under the jurisdiction of the Indian Child Welfare Act, has the tribe or Bureau of Indian affairs (BIA) been notified or custody proceedings in the state court?
   1. [ ] Yes     Date of staffing:
      
      
   2. [ ] No     Reason:
      
      

1. Better understand the child;
2. Provide appropriate care for the child; and
3. Participate in planning for the child.

1. A representative of the Department, including staff from the Division of Children and Family Services (DCFS) and Division of Licensed Resources (DLR);
2. A Child Placing Agency social worker if the child has one;
3. The child's assigned Guardian ad litem (GAL) or Court Appointed Special Advocate (CASA); or
4. Others designated by either the DCFS Social Worker or the Child Placing Agency social worker (such as the child's teacher or doctor).