PERMANENCY HEARING REPORT PERMANENCY HEARING DATE CERTAIN: Judge / Referee Court // Part IN THE MATTER OF: Child's Name Date of Birth // DATE OF REPORT PREPARATION: / Sex / Person ID (PID) Docket Number All information must be current and represent an update of events and circumstances since removal or the previous Permanency Hearing Case Name: CONNECTIONS Case ID: Local Case #: Case Manager & Phone: Agency with Planning Responsibility: Law Guardian: Attorney for Parent(s) or Person(s) Legally Responsible: Attorney for DSS/ACS: Caseworker & Phone: Child Protective Worker/Monitor & Phone: PARENTS AND PERSONS LEGALLY RESPONSIBLE Name Relationship SECTION I. PERMANENCY PLAN SUMMARY Child's Name Current Permanency Planning Goal (PPG) Return to parent(s) Placement for adoption Referral for legal guardianship Permanent placement with fit and willing relative Placement in another planned living arrangement with significant connection to an adult PPG/Date Established / / Anticipated PPG Return to parent(s) Placement for adoption Referral for legal guardianship Permanent placement with fit and willing relative Placement in another planned living arrangement with significant connection to an adult / / Date by which it is expected that the current or anticipated PPG will be accomplished: Date Printed 10/25/2005 1:33 PM Page 1 of 13 PH-1 Individual Child (FINAL 10/25/05) American LegalNet, Inc. www.USCourtForms.com PERMANENCY HEARING REPORT SECTION II. PERMANENCY PLANNING 1. If there is a plan for continuing placement for the child, describe the reason placement continues to be necessary and in accordance with the best interests and safety of the child, including whether the child would be at risk of abuse or neglect if returned to the parent or other person legally responsible. 2. If there is a plan for continuing placement for the child, describe the efforts made since removal or the last permanency hearing, if any, to locate any absent parent or relative(s) of the child and to notify each of them of the child's placement in foster care. 3. State whether the absent parent or relative expressed an interest in obtaining custody of or planning for the child, or whether any relative is interested in becoming a foster parent for the child. If interest has been expressed, what has been done to further any of these outcomes? 4. Describe the concurrent plan or any other permanency discharge resource being considered for the child, in the event the child is unlikely to be able to return home. 5. If there is a plan for trial discharge in the next six months, specify the anticipated date and explain why such discharge is safe and appropriate. 6. If there is a plan for final discharge in the next six months, specify the anticipated date and explain why such discharge is safe and appropriate. Date Printed 10/25/2005 1:33 PM Page 2 of 13 PH-1 Individual Child (FINAL 10/25/05) American LegalNet, Inc. www.USCourtForms.com PERMANENCY HEARING REPORT 7. If the permanency plan includes trial or final discharge from foster care, describe the Discharge Plan for the child. Living Arrangement (include location): Educational/Vocational Plan: Health Coverage: Follow-up Health/Mental Health Treatment Plan: Other: Date Printed 10/25/2005 1:33 PM Page 3 of 13 PH-1 Individual Child (FINAL 10/25/05) American LegalNet, Inc. www.USCourtForms.com PERMANENCY HEARING REPORT SECTION III. REASONABLE EFFORTS TO FINALIZE PERMANENCY 8. Has there been a court determination that reasonable efforts to reunify the child with his or her parent(s) are not required? Yes No If Yes, for both parents, skip Question 9. If No, for one or both parents, answer Question 9. 9. For each parent for whom the answer to Question 8 is "No" and who has not had his or her parental rights terminated or surrendered, describe the reasonable efforts that have been made since removal or the last permanency hearing to enable the child to return home safely. The question must be answered regardless of the child's permanency planning goal. 10. If the permanency planning goal is Adoption and the child is not completely legally free: a. Describe the reasonable efforts to free the child, which shall include, but are not limited to, information regarding the potential for a surrender, whether any surrender is complete and, if so, whether it includes any terms or conditions; whether a Termination of Parental Rights proceeding has been filed and if so, when; whether any diligent search has been completed on an absent parent, including the methods and outcome. b. Is the child placed in a pre-adoptive home? Yes No If no, describe efforts made to identify an adoptive resource. c. What services are anticipated in the next six months? 11. If the permanency goal is Guardianship or Placement with a Fit and Willing Relative: a. Describe reasonable efforts made and services provided to finalize this plan. Specify the name and relationship of the guardian or fit and willing relative. b. What services are anticipated in the next six months? Date Printed 10/25/2005 1:33 PM Page 4 of 13 PH-1 Individual Child (FINAL 10/25/05) American LegalNet, Inc. www.USCourtForms.com PERMANENCY HEARING REPORT 12. If the permanency goal is Another Planned Permanent Living Arrangement: a. Provide the compelling reason for determining that it would not be in the best interests of the child to be returned home, placed for adoption, placed with a legal guardian, or placed with a fit and willing relative. b. Describe how this arrangement provides the child with a significant connection to an adult who is willing to be a permanency resource for the child. Specify the arrangement and the name of the adult, and describe reasonable efforts made and services provided to finalize this plan. If no adult has as yet been identified, describe efforts made to identify a permanency resource. c. What services are anticipated in the next six months? 13. Is the child AWOL? Yes No If yes, describe efforts to locate the child. Date Printed 10/25/2005 1:33 PM Page 5 of 13 PH-1 Individual Child (FINAL 10/25/05) American LegalNet, Inc. www.USCourtForms.com PERMANENCY HEARING REPORT SECTION IV. CHILD'S PLACEMENT(S) 14. Child's Name Physical Removal Date # of Changes in Placement Since Removal or Previous Permanency Hearing Child Currently Placed / / Foster Boarding Home Non-relative Relative Congregate Care Facility Relative (Direct Placement) Other 15. Provide current information regarding the placement of the ch