Pennsylvania Standardized CHILD’S PERMANENCY PLAN
(CPP) Instructions
INTRODUCTION
The following instructions are to be used with the Pennsylvania
standardized child’s permanency plan (CPP). Along with the standardized family
service plan (FSP), the CPP promotes consistent family focused practice around
the state. The CPP is an amendment to the FSP specific to each child in out of
home care and does not replace the FSP. The CPP contains service objectives
otherwise not identified in the FSP or that must occur in order to achieve the
permanency goal established for the child.
The standardized form is provided in 12 separate sections (in the order
below) to accommodate the needs of all 67 county children and youth social
service agencies. The manner in which each county will offer the form may vary
but the structure and information required in each section may not. As certain
sections are required for every plan to be considered complete while others are
optional based on the child’s situation, each supervisor and caseworker must
become familiar with each section, the order of the sections and the information
necessary in order to complete the CPP.
TABLE OF CONTENTS
Page
Section A Opening, Efforts Made & Circumstances 2
Section B Review of CPP 4
Section C Identifying Information 5
Section D Placement Location, Type & Setting 8
Section E Placement Proximity, Hearings and Permanency Goal 11
Section F Health Information (two page section) 13
Section G Educational Information 15
Section H Visitation Plan 18
Section I Preparation for Independence 20
Section J Service Plan 22
Section K Notice Right to Appeal 26
Section L Participation & Signatures 27
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Issued December 2005
Pennsylvania Standardized CHILD’S PERMANENCY PLAN
(CPP) Instructions
SECTION A
OPENING, EFFORTS & CIRCUMSTANCES
This section is required in order for the CPP to be considered complete.
Family Name
• The maximum characters available- 30.
• Insert the name by which the county identifies the family.
• This name may change.
County
• Insert the name of the county developing the CPP with the family.
Case Number
• The maximum characters available-20.
• Insert the case specific county identifier.
• The case number will not change even if the mother’s name changes or more
children are added to the family composition.
Date Child Entered Placement
• Insert the date (MM/DD/YYYY) into the date field.
• Insert the date the child entered out of home care.
Date of Initial/Revised Plan
• Insert the date (MM/DD/YYYY) of the meeting held to develop the most
recent plan.
• The child and family must be given the opportunity to participate in the
development of the plan.
• If the child or family refuses to participate in the development of the plan,
enter the date the meeting was scheduled to occur.
• For situations in which more than one meeting is required due to safety or
other logistical issues, enter the date the latest meeting was scheduled to
occur.
• The plan may be based on court ordered services. Do not enter the date of
the court hearing unless it is the same as the date on which the plan was
developed.
• The CPP must be developed prior to the child entering out of home care for
planned placements. The CPP must be completed within 30 days of the child
entering out of home care for emergency placements.
• Indicate by using the check boxes, if the plan is the initial CPP or a revised
CPP. There will only be one initial plan during each placement episode.
Each subsequent plan is a revision of the initial CPP.
• A CPP must be reviewed and revised accordingly at least every six months.
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Pennsylvania Standardized CHILD’S PERMANENCY PLAN
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SECTION A
CONTINUED
Date of Next Plan Review
• Insert the date (MM/DD/YYYY) of the next plan review.
• The date of the review is based on the date of the most recent CPP.
• Insert N/A for a closing CPP.
Efforts Made/Services Provided to Prevent Placement
• The maximum characters available- 1365.
• There are approximately 15 lines of text.
• This sub-section must be a bulleted list of the efforts made by the county
agency and the services provided for or arranged by the county agency to
prevent the child’s placement in out of home care.
• Enough information should be provided in order to make this issue clear for
both the family and the court.
Circumstances That Make Placement Necessary
• The maximum characters available- 1365.
• There are approximately 15 lines of text.
• This sub-section is used to outline the specific circumstances that lead to the
child not being safe in the home and which necessitated out of home
placement.
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Issued December 2005
Pennsylvania Standardized CHILD’S PERMANENCY PLAN
(CPP) Instructions
SECTION B
REVIEW OF CPP
Other than for an initial CPP, this section is required in order for the CPP
to be considered complete.
Heading
At the top of each page within this section:
• Insert the date (MM/DD/YYYY) of the plan.
• Insert the case number. The maximum characters available -20.
• Insert the family name. The maximum characters available -30.
Progress Made During Review Period
• The maximum characters available- 2366.
• There are approximately 26 lines of text.
• List or describe progress made toward the completion of objectives or tasks
by all individuals during the period under review.
• Address a child’s return home or achieving permanency in this section if
applicable.
Circumstances and Concerns During Review Period
• The maximum characters available- 2366.
• There are approximately 26 lines of text.
• List or describe circumstances that occurred or concerns that arose during
the period under review that have or will make an impact on the child
placement or the child achieving permanency.
• List or describe any changes or new developments in the child’s placement,
health or education.
• List or describe any concerns regarding the child’s visitation with parents,
siblings or other individuals.
Family Engagement Models
Counties offering the family engagement models of FGDM or FGC to families
should utilize this sub-section for the following areas of the FGDM or FGC
process:
• Bottom Line Concerns
• Court/Legal Involvement
• Concerns
• Decision for Follow-Up conference
• Safety Concerns
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Issued December 2005
Pennsylvania Standardized CHILD’S PERMANENCY PLAN
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SECTION C
IDENTIFYING INFORMATION
This section is required in order for the CPP to be considered complete.
Heading
At the top of each page within this section:
• Insert the date (MM/DD/YYYY) of the plan.
• Insert the case number. The maximum characters available- 20.
• Insert the family name. The maximum characters available- 30.
General Instructions
Name:
• The maximum characters available:
o First Name- 32. Place suffix after first name (Example: David Jr.).
o Middle initial- 1.
o Last Name- 32.
• Insert the legal name. Do not include aliases.
• The name must be verified through a legitimate form of identification such as a
social security card, driver’s license or state ID card, Access card, birth
certificate or marriage license.
• A text box has been included next to each heading for the option of inserting a
unique county identifier.
Date of Birth (DOB):
• Insert DOB in date field (MM/DD/YYYY).
• An accurate DOB must be verified through a legitimate form of identification as
listed above.
• If the DOB is unknown or cannot be verified, type unknown in the text field
located below the date field. The form should be updated to include the
accurate DOB when the information is obtained.
Address:
• Total characters available:
o Address 1 (Street address)- 26.
o Address 2 (Apartment number)- 26.
o City- 16.
o State- 2.
o Zip 1- 5.
o Zip 2- 4.
• Insert the address of residence at the time the plan was developed/revised.
• Do not use a mailing address. Use the physical location of the residence.
• If the address is unknown, type “unknown” in the address box.
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Pennsylvania Standardized CHILD’S PERMANENCY PLAN
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SECTION C
CONTINUED
Phone:
• The maximum characters available:
o Area Code- 3.
o Phone- 8.
• Insert the telephone number at which the individual can be reached.
Mother
• There is only one mother for each case.
• List the birth or adoptive mother even when deceased. If deceased, type
“deceased,” in the address box.
• Step-mothers are listed in Section D- Household Members or Section E-
Individuals/Groups Significant to the Family of the Family Service Plan, not in
this section of the CPP.
Father
• List all potential fathers.
• List undisputed biological father first (this includes an adoptive father).
• List legal father next (the person the mother was married to one year prior to or
after the child’s birth, the person who has signed a “Voluntary
Acknowledgement of Paternity” or the person determined by the court to be the
legal father).
• Lastly list any alleged/putative father (when biological father is disputed, the
name of the father listed on the child’s birth certificate).
• Insert the father’s name even when deceased. If deceased, type “deceased,”
in the address box.
• Step-fathers are listed in Section D- Household Members or Section E-
Individuals/Groups Significant to the Family of the Family Service Plan, not in
this section of the CPP.
Other Caregiver(s)
• This sub-section may not be relevant to every plan. If this section is not
relevant, check the box marked N/A in the heading and move on to the next
section.
• For an initial CPP, a caregiver listed in this section is the individual other than a
parent who was the primary caregiver for the child and with whom the child
resided at the time of placement in out of home care; this includes someone
who had physical or legal custody of the child and functioned as the child’s
parent.
• For revisions of the CPP, a caregiver listed in this section is the individual other
than a parent who is the primary resource for permanency purposes for the
child.
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Pennsylvania Standardized CHILD’S PERMANENCY PLAN
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SECTION C
CONTINUED
• More than one caregiver may be listed; however, the caregivers must reside in
the same residence.
• Do not list the individual with whom the child resides while in placement. This
information is captured in Section D- Placement Location, Type and Setting of
the CPP.
Relationship to Child:
• The maximum characters available- 50.
• This is an identification of the specific relationship of the caregiver to the child.
• Example: maternal aunt, grandmother, god father.
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Issued December 2005
Pennsylvania Standardized CHILD’S PERMANENCY PLAN
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SECTION D
PLACEMENT LOCATION, TYPE AND SETTING
This section is required in order for the CPP to be considered complete.
Heading
At the top of each page within this section:
• Insert the date (MM/DD/YYYY) of the plan.
• Insert the case number. The maximum characters available - 20.
• Insert the family name. The maximum characters available - 30.
Child’s Location
• Indicate by using the checkbox if the child’s placement location has been
withheld by the court. If information has been withheld by the court, move on to
the Placement Agency sub-section.
• Insert information specific to the current physical location (placement) of the
child.
• Total characters available:
o Address 1 (Street address)- 26.
o Address 2 (Apartment address)- 26.
o City- 16.
o State- 2.
o Zip 1- 5.
o Zip 2- 4.
o Phone:
► Area Code- 3.
► Phone- 8.
Name or Resource Parent(s)/Caregiver or Facility:
• Insert the name of the resource parent(s)/caregiver(s) or the facility in which the
child is placed.
• The maximum characters available- 50.
• Examples: John and Lisa Smith or Dietrich cottage.
Placement Agency
Name:
• Insert the name of the placement agency.
• The maximum characters available- 50.
• Examples: Pinebrook Services for Children and Youth or Bethany Children’s
Home.
Agency Caseworker:
• The maximum characters available- 50.
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Pennsylvania Standardized CHILD’S PERMANENCY PLAN
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SECTION D
CONTINUED
• Insert the name of the placement agency caseworker.
Phone:
• The maximum characters available:
o Area code- 3.
o Phone- 8.
• Insert the phone number for the placement agency at which the caseworker
can be contacted.
Address:
• Insert the placement agency address.
• The maximum characters available:
o Address 1 (Street address)- 26.
o Address 2 (Suite address)- 26.
o City- 16.
o State- 2.
o Zip 1- 5.
o Zip 2- 4.
Placement Type
• Check the box that is applicable to the child’s placement.
• Only one checkbox for placement type may be checked unless the child is
placed in a Resource Family Home.
• A child placed in a Resource Family Home requires the first box to be checked
followed by one of the following boxes to be checked:
o Kinship Foster Care- placement in the home of individuals (relative or non-
relative) who have a relationship with the child or the child’s parent(s) and
are approved as foster parents for the child.
o Foster Care- placement in the home of non-kinship approved foster parents.
o Pre-Adoptive- placement in the home of a family selected by the county
agency or court who intends to adopt the child and the adoption finalization
is pending.
o Adoptive- placement in the home of a family who has finalized the adoption
of the child. This is only used in a closing CPP.
• If the checkbox for other is used, an explanation must be provided describing
the type of placement the child is in.
o The maximum characters available- 60.
Expected Length of Placement
• Insert the length of time in months.
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Pennsylvania Standardized CHILD’S PERMANENCY PLAN
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SECTION D
CONTINUED
Placement Setting
• Check the boxes that assure that the child’s placement setting is the least
restrictive, most family-like, age-appropriate setting consistent with the child’s
safety, best interest and well being.
• Check all of the boxes that apply.
• If a checkbox for Other is used, an explanation must be provided describing
how the placement setting is the least restrictive, most family-like, age-
appropriate setting that meets the child’s safety, best interest and well being.
o The maximum characters available- 23.
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Pennsylvania Standardized CHILD’S PERMANENCY PLAN
(CPP) Instructions
SECTION E
PLACEMENT PROXIMITY, HEARINGS AND PERMANENCY GOAL
This section is required in order for the CPP to be considered complete.
Heading
At the top of each page within this section:
• Insert the date (MM/DD/YYYY) of the plan.
• Insert the case number. The maximum characters available - 20.
• Insert the family name. The maximum characters available - 30.
Placement Proximity
• Indicate whether the child’s placement location is in proximity to the child’s
community by using the appropriate checkbox.
o If the checkbox for No is used, an explanation must be provided as to why
the child was not placed within proximity to the child’s community.
o The maximum characters available- 142.
• Indicate if the child is in placement in another state or more than 150 miles from
the child’s community.
o If the checkbox for Yes is used, an explanation must be provided as to why
such placement is necessary and consistent with the safety, best interest, and
special needs of the child.
o The maximum characters available- 142.
Hearings
• Insert the date of the most recent court hearing.
• Explain the results of the court hearing.
• Check the box or boxes indicating the type of hearing scheduled to next occur.
• Insert the date (MM/DD/YYYY) for the next scheduled court hearing.
Permanency Goal
Primary Permanency Goal
• Check the approved permanency goal.
• For a closing CPP check the achieved permanency goal.
• Insert the date (MM/DD/YYYY) the court approved the corresponding
permanency goal.
• Check the most appropriate permanency goal if the court has not approved a
permanency goal for the child. In this situation the date the child was placed in
out of home care is the default date.
Concurrent Permanency Goal
• Check the most appropriate concurrent goal for the child.
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Issued December 2005
Pennsylvania Standardized CHILD’S PERMANENCY PLAN
(CPP) Instructions
SECTION E
CONTINUED
• Insert the date (MM/DD/YYYY) the court approved the corresponding
permanency goal.
• For a closing CPP do not check a concurrent permanent goal as this sub-section
does not apply.
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Issued December 2005
Pennsylvania Standardized CHILD’S PERMANENCY PLAN
(CPP) Instructions
SECTION F
HEALTH INFORMATION
This section is required in order for the CPP to be considered complete.
Heading:
At the top of each page within this section:
• Insert the date (MM/DD/YYYY) of the plan.
• Insert the case number. The maximum characters available - 20.
• Insert the family name. The maximum characters available - 30.
General Instructions
Practice:
• Insert the name of the practice providing treatment to the child.
• The maximum characters available- 32.
Physician/Dentist/Doctor/Practitioner:
• Insert the name of the specific practitioner providing treatment to the child.
• The maximum characters available- 32.
Phone:
• The maximum characters available:
o Area code- 3.
o Phone- 8.
Address:
• The maximum characters available:
o Address 1 (Street address)- 26.
o Address 2 (Suite address)- 26.
o City- 16.
o State- 2.
o Zip 1- 5.
o Zip 2- 4.
Last Known Physician/Dentist/Doctor/Practitioner:
• Insert the name of the last practitioner to provide the same type of treatment
to the child.
• The maximum characters available- 20.
Other Care Providers;
• If this sub-section is used, insert the type of specialty in the header.
• The maximum characters available 54.
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Pennsylvania Standardized CHILD’S PERMANENCY PLAN
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SECTION F
CONTINUED
Immunizations
• Use the first checkbox if the child’s immunization records have been obtained.
o Insert the date (MM/DD/YYYY) on which the child’s immunization records
were obtained.
o A copy of the child’s immunization record must be attached to the CPP.
• Use the second checkbox if the child’s immunization records have not yet
been obtained.
o Insert the date (MM/DD/YYYY) on which a request was made for the
child’s immunization records.
Known Medical Conditions/Disabilities
• This sub-section may not be relevant to every plan. If the child does not have
any known medical conditions or disabilities, check the box marked N/A in the
heading and move on to the next section.
Condition/Disability
• The maximum characters available- 30.
• Under each Physical, Emotional, Mental and Other, list the child’s known
conditions or disabilities.
• Conditions for which the child is seen by a practitioner listed in this section
must be listed in this sub-section.
Medication(s)
• The maximum characters available- 30.
• List medications the child takes related to each condition listed in the
previous column.
Other Treatment
• The maximum characters available- 45.
• Identify any other treatment the child receives related to each condition or
disability listed in the first column.
Date of Diagnosis
• Insert the date (MM/DD/YYYY) on which the child was diagnosed with the
related condition or disability in the first column.
Other relevant health information
• The maximum characters available- 144.
• In a concise manner, identify any other health information for the child.
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Issued December 2005
Pennsylvania Standardized CHILD’S PERMANENCY PLAN
(CPP) Instructions
SECTION G
EDUCATIONAL INFORMATION
This section is required in order for the CPP to be considered complete.
Heading:
At the top of each page within this section:
• Insert the date (MM/DD/YYYY) of the plan.
• Insert the case number. The maximum characters available - 20.
• Insert the family name. The maximum characters available - 30.
General Instructions
• This sub-section may not be relevant for every plan. Indicate by using the
checkboxes in the heading if the child is not enrolled in school or not of school
age.
• If either of the checkboxes in the heading is checked, move on to the next
section.
Name of School:
• The maximum characters available- 50.
• Insert the name of the school that the child attends while in placement.
School District:
• The maximum characters available- 50.
• Insert the school district in which the child is enrolled.
Contact Person:
• The maximum characters available- 50.
• Insert the name of a contact person at the school the child attends.
(Example: Mrs. Jones).
Title:
• The maximum characters available- 30.
• Insert the title of the individual named as the school contact person.
• Example:
o Guidance Counselor.
Phone:
• The maximum characters available:
o Area Code- 3.
o Phone- 8.
• Insert the telephone number at which the school contact person can be
reached.
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Pennsylvania Standardized CHILD’S PERMANENCY PLAN
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SECTION G
CONTINUED
Address:
• Insert the address of the school.
o Address 1 (Street address)- 26.
o Address 2 (Apartment number)- 26.
o City- 16.
o State- 2.
o Zip 1- 5.
o Zip 2- 4.
Child’s Grade:
• Insert the grade that the child is currently in.
• If the CPP is developed between grades, the most recently completed grade
should be listed.
Disability or need requiring services:
• Check the appropriate box indicating whether the child has a disability or
need which requires special education services or accommodations.
• If the Yes checkbox is marked, check all boxes that apply below:
o Early Intervention Services and the Child has an Individualized Service
Plan.
o Special Education Services and the child has an Individualized Education
Program.
o The child has a disability or condition requiring a 504 Plan for
Accommodations.
► Example: A child in a wheelchair needs a key to the faculty elevator in
order to get to classes on upper floors.
o Other. An explanation of need requiring any special services in school
must be provided.
► The maximum characters available- 110.
o Child is eligible for an Educational Parent Surrogate. Check this box if the
child requires Special Education Services and parental rights or
educational rights have been terminated.
Educational Parent Surrogate:
• Enter the name of the Educational Parent Surrogate.
o The maximum characters available- 80.
• Enter the individual’s telephone number.
o Area Code- 3.
o Phone- 8.
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Pennsylvania Standardized CHILD’S PERMANENCY PLAN
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SECTION G
CONTINUED
• Enter the individual’s address:
o Address 1 (Street address)- 26.
o Address 2 (Apartment number)- 26.
o City- 16.
o State- 2.
o Zip 1- 5.
o Zip 2- 4.
Statement of Placement in Same School
• Check the appropriate box indicating if the child’s placement setting allows
the child to remain in his/her same school.
• Check the appropriate box indicating if a change in school was necessary.
o If Yes is check, an explanation as to why a change in school was
necessary is required.
o The maximum characters available- 1040
o There are approximately 8 lines of text.
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Issued December 2005
Pennsylvania Standardized CHILD’S PERMANENCY PLAN
(CPP) Instructions
SECTION H
VISITATION PLAN
This section is required in order for the CPP to be considered complete.
Heading:
At the top of each page within this section:
• Insert the date (MM/DD/YYYY) of the plan.
• Insert the case number. The maximum characters available - 20.
• Insert the family name. The maximum characters available - 30.
Participant(s)
• List all individuals who will participate in each scheduled visit.
• The maximum characters available- 100.
• Example: If the mother visits with all children on a weekly basis, list mother
and the children on one row. If the mother and maternal grandmother visit
with the children on a monthly basis, on another row list mother, all the
children and the grandmother.
• List the parent, guardian or custodian, a child or any other individual who has
the right to visit with the child or had been included in visits with a child. This
becomes important in order to show refusal or limits imposed by the court in
the next column.
Refused/Limited
• Check the first box if an individual listed in the first column has refused visits
in writing.
• Check the second box if the court has limited visits with an individual listed in
the first column.
• Enter the date (MM/DD/YYYY) of the court order limiting visitation.
• Enter the name of the judge who issued the court order limiting visitation after
Hon.
• The maximum characters available- 40.
Frequency/Duration
• Describe how often visits are scheduled.
• Describe the length of time each visits is scheduled to last.
• The maximum characters available- 45.
• Example: Weekly/2 hours.
Level of Supervision
• Describe restrictions on the level of contact an individual is allowed to have
with the child during visits which will require varied levels of supervision.
• The maximum characters available- 60.
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SECTION H
CONTINUED
• Examples:
o Mother may not be alone at any time with the child;
o Mother is not allowed to feed the child; or
o Visit is unsupervised for the first hour.
Location
• List the exact location, if possible, of the visits.
• The maximum characters available- 60.
• Examples:
o The county agency;
o Bethana Lancaster office;
o Park City mall;
o Varies based on recommendations of therapist.
Transportation Responsibility
• List the agency or individual who has responsibility to transport the child to
and from visits.
• List the agency or individual who has responsibility to transport the parent(s),
guardian or custodian, siblings or other individuals to and from visits.
• The maximum characters available- 68.
• Examples:
o Foster parent/child;
o KidsPeace/mother;
o Grandmother/self.
Accommodations/Barriers
• List any special accommodations needed by any individual involved in the
visit or barriers that could impact visitation.
• The maximum characters available- 144.
• Examples:
o Weekends due to mother’s work schedule;
o Following soccer games;
o Large room needed for extended family members; or
o Grandmother in wheelchair, first floor room needed.
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Pennsylvania Standardized CHILD’S PERMANENCY PLAN
(CPP) Instructions
SECTION I
PREPARATION FOR INDEPENDENCE
This section is required in order for the CPP to be considered complete
when the child will be turning 16 years of age during the plan period and
every period thereafter.
Heading:
At the top of each page within this section:
• Insert the date (MM/DD/YYYY) of the plan.
• Insert the case number. The maximum characters available - 20.
• Insert the family name. The maximum characters available - 30.
General Instructions
• This section must be completed for each child age 16 and older in out of
home care; however, can be completed for any child believed to be in need of
services to prepare them for independence and adulthood.
• This section must be completed when the child will be turning 16 years of age
during the plan period.
• Each of the six Independent Living Service Areas in the first column must be
addressed.
Results of Formal Independent Living Needs Assessment
• The maximum characters available- 240.
• List the assessment tool or instrument used.
• List the date (MM/DD/YYYY) the assessment or reassessment was
completed.
• As determined through the assessment process, list the needs of the child in
each Independent Living Service Area.
• Be concise but specific.
• Example: Employment- Ansel-Casey assessment occurred on
DD/MM/YYYY. The child is interested in clerical work; however, a visual
disability will require a referral to OVR for job coaching and other available
services.
• All Independent Living Services that are to occur during the plan period must
be addressed in Section K- Service Plan, of the CPP.
Explanation of Why Services Will Not Be Provided During the Plan Period
• The maximum characters available- 245.
• If the needed Independent Living Services will not be provided during the plan
period, an explanation as to the reason why must be provided.
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Pennsylvania Standardized CHILD’S PERMANENCY PLAN
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SECTION I
CONTINUED
• Example: Support- Although the child was assessed as needing a mentor,
due to placement several counties away, a referral for mentoring in the child’s
own community is not appropriate at this time.
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Pennsylvania Standardized CHILD’S PERMANENCY PLAN
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SECTION J
SERVICE PLAN
This section is required in order for the CPP to be considered complete.
Heading
At the top of each page within this section:
• Insert the date (MM/DD/YYYY) of the plan.
• Insert the case number. The maximum characters available - 20.
• Insert the family name. The maximum characters available - 30.
General Instructions
• Insert the date (MM/DD/YYYY) of the most recent FSP.
• Objectives addressed in the CPP are those not identified in the FSP or those
which must occur in order to achieve the child’s permanency goal.
• Objectives and tasks relating to the child’s concurrent permanency goal
should be addressed in this section.
• Each objective receives a separate Service Plan page. Utilize more than one
page as necessary.
• Tasks will not be removed when completed, in order to provide an
explanation of progress in meeting/achieving objectives.
• A comprehensive task analysis is necessary to consider an objective
achieved. “Task analysis” means that every significant step that is required to
complete an objective is listed in the approximate order that a person would
do the tasks. Some families will need more detail here to understand their
expected participation where others may need less. It is recommended that
the initial CPP contain more detail and as the family demonstrates an ability
to make the required changes, that less detail is needed in the CPP reviews.
• Counties offering the family engagement models of FGDM or FGC to families
should utilize this section for the following areas of the FGDM or FGC
process:
o Bottom Line Concerns.
o Concerns.
o Actions agreed to during conferences.
o The family’s plan for the child(ren).
Objective
• The maximum characters available - 140.
• There is approximately 1 line of text.
• An objective describes the desired change to be achieved.
• An objective must be written in clear and concise language.
o The child will be prepared for adoption.
o The child will be prepared for partial independence and transition into the
adult MR system.
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Issued December 2005
Pennsylvania Standardized CHILD’S PERMANENCY PLAN
(CPP) Instructions
SECTION J
CONTINUED
• Counties offering the family engagement models of FGDM or FGC to families
may utilize this sub-section for the following areas of the FGDM or FGC
process:
o The family’s plan for the child(ren).
o Decision for Follow-Up Conference.
Related Concerns (risk factors)
• The maximum characters available- 135.
• There is approximately 1 line of text.
• Objectives must address concerns which are high or moderate risk factors on
the risk matrix. Insert the concerns/risk factors which relate to the identified
objective.
• More than one concern/risk factor may be identified for each objective.
• Example:
o Vulnerability, prior abuse/neglect, extent of emotional harm.
Who
• The maximum characters available- 42.
• There are approximately 2 lines of text.
• Insert the names of the individuals or agency service providers associated
with the action to achieve the objective.
Will Do What Task
• The maximum characters available- 70.
• There are approximately 2 lines of text.
• In a concise manner, insert the specific task/activity for the identified
participant or agency service provider in order to achieve the objective.
• The most immediate issues are to be listed first.
• Activities must specify the steps the parent, child or other participant must
take to achieve the objectives and address how the participant will reach that
point.
• Tasks must be broken down into specific measurable activities.
• Example for youth:
o Go to work as scheduled.
o Cooperate with OVR job coach.
o Visit prospective MR group homes with caseworker.
• A task for caseworker contact (public or private) with the child/family
consistent with the level of risk should be included in this sub-section.
• Examples for caseworker:
o Meet with child on a monthly basis to review the plan for independence.
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Issued December 2005
Pennsylvania Standardized CHILD’S PERMANENCY PLAN
(CPP) Instructions
SECTION J
CONTINUED
o Make referral for child preparation through SWAN.
o List child on PAE.
o Review family profiles from PAE.
By When
• Insert the realistic projected date (MM/DD/YYYY) of accomplishment.
How This Task is Measured
• The maximum characters available- 56.
• There are approximately 2 lines of text.
• Insert the method through which the progress will be measured.
• Explain how the progress will be collected or obtained.
• Examples:
o Self-report;
o Reports from providers;
o Contact with children, family or other sources;
o Observation; and
o Documentation in case record.
Started
Insert the date (MM/DD/YYYY) the task was initiated.
Completed
• This sub-section is only completed during a review.
• Insert the date (MM/DD/YYYY) the task was completed.
• Completed tasks should be considered for identification in the family
strengths section.
Comments
• The maximum characters available- 550.
• There are approximately 3 lines of text.
• This sub-section should be utilized to provide a brief explanation of
tasks/actions that are in progress but have not been completed during the
period under review.
• Example:
o The resource family has not completed the family profile and cannot be
considered a pre-adoptive placement.
• This sub-section should be utilized to document that an addition page for the
service plan section is necessary for the same objective.
• Example:
o Objective continued on additional page.
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Issued December 2005
Pennsylvania Standardized CHILD’S PERMANENCY PLAN
(CPP) Instructions
SECTION J
CONTINUED
• This sub-section should be utilized to document when an objective has been
achieved.
• Example:
o All tasks have been completed. Objective achieved.
• An explanation of tasks not completed should be included in this sub-section
on a closing CPP.
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Issued December 2005
Pennsylvania Standardized CHILD’S PERMANENCY PLAN
(CPP) Instructions
SECTION K
NOTICE OF RIGHT TO APPEAL
This section is required in order for the CPP to be considered complete.
Heading
At the top of each page within this section:
• Insert the date (MM/DD/YYYY) of the plan.
• Insert the case number. The maximum characters available- 20.
• Insert the family name. The maximum characters available- 30.
General Instructions
County agency:
• The maximum characters available- 265.
• There are approximately 5 lines of text.
• Insert the name of the county children and youth social service agency on the
first line of the notice.
Legal representation:
• The maximum characters available- 312.
• There are approximately 6 lines of text.
• Enter the office, agency or organization individuals in your area one must
contact if they cannot afford to provide their own attorney and include the
address and telephone number.
• This section of the FSP should be reviewed with and explained to the
parent(s), guardian or custodian and the child when applicable.
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Issued December 2005
Pennsylvania Standardized CHILD’S PERMANENCY PLAN
(CPP) Instructions
SECTION L
PARTICIPATION AND SIGNATURES
This section is required in order for the CPP to be considered complete
when the FSP is not revised in conjunction with and as a result of a child’s
placement.
Heading
At the top of each page within this section:
• Insert the date (MM/DD/YYYY) of the plan.
• Insert the case number. The maximum characters available- 20.
• Insert the family name. The maximum characters available- 30.
Service Plan Participants
• If more individuals participate in the development of the service plan than
there are spaces available, attach a separate sheet to the plan containing
their information.
• Counties offering the family engagement models of FGDM or FGC to families
must list the following individuals in this sub-section:
o Parents, guardian or custodian.
o Children.
• For counties offering the family engagement models of FGDM or FGC to
families, a full list of conference attendees should be placed in Section I-
Family Group Decision Making/Conferencing, an optional section of the FSP.
Name:
• The maximum characters available- 49.
• Insert the names of all individuals who participated in the development of the
service plan.
• Other than parents, guardians or legal custodians, children 14 years of age and
older and the agency caseworker and supervisor, the individuals who participate
in the development of the plan do not sign the plan.
Relationship:
• The maximum characters available- 15.
• Insert the relationship of the individual to the family.
Phone:
• The maximum characters available:
o Area Code- 3.
o Phone- 8.
• The regular telephone number is the number which may be listed in the
identifying information section of the plan.
• Also insert an emergency telephone number for each participant as appropriate.
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Issued December 2005
Pennsylvania Standardized CHILD’S PERMANENCY PLAN
(CPP) Instructions
SECTION L
CONTINUED
• Telephone number(s) in this sub-section must be removed when contact
information is withheld due to safety issues.
Date and Method of Invitation to Participate:
• In the first column insert the date (MM/DD/YYYY) that the individual was
invited to participate in the development of the service plan.
• In the second column insert the method by which the invitation to participate
was extended to the individual.
o The following are examples of abbreviations which could be used in this
sub-section:
► IPC- In person contact;
► TC- Telephone call; or
► WC- Written communication.
o The maximum characters available- 8.
Date and Method of Actual Participation:
• Insert the actual date (MM/DD/YYYY) that the individual participated in the
development of the plan.
• Insert the manner in which the individual participated in the development of
the plan. See examples above.
o The maximum characters available- 8.
Service Plan Signatures
Name:
• The maximum characters available- 50.
• Insert the names of parents, legal custodians, guardians or children 14 years
of age and older in this section. Children younger than 14 years of age may
be included in this sub-section when appropriate.
Signature: The individuals listed must be given the opportunity to sign the service
plan.
Date: Insert the date (MM/DD/YYYY) in which each individual signed the service
plan.
Refused to sign: Check this box if the individual refuses to sign the service plan.
Plan and Rights Distribution Date
• Insert the date (MM/DD/YYYY) a copy of the service plan was hand delivered.
• Insert the date (MM/DD/YYYY) a copy of the service plan was mailed.
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Issued December 2005
Pennsylvania Standardized CHILD’S PERMANENCY PLAN
(CPP) Instructions
SECTION L
CONTINUED
Comments:
• The maximum characters available- 568.
• There are approximately 4 lines of text.
• Individuals who participate in the development of the service plan should be
given the opportunity to add comments and concerns regarding the service
plan in this sub-section.
• If the caseworker is typing the individual’s comments onto the service plan,
those comments must be reviewed with and approved by the individual before
the service plan can be considered complete.
Caseworker:
• The maximum characters available- 75.
• Write or type the name of the caseworker who assisted the family in
developing the plan.
• The caseworker must sign the plan.
Supervisor:
• The maximum characters available- 75.
• The supervisor must review the plan within 10 days of the plan’s development
and either approve the plan or return the plan to the caseworker for revision.
• Write or type the name of the supervisor.
• The supervisor must then sign the plan.
29
Issued December 2005