HomeMy WebLinkAbout20184013.tiff RESOLUTION
RE: APPROVE REVISIONS TO SECTION 2.000 CHILD WELFARE OF THE DEPARTMENT
OF HUMAN SERVICES POLICIES AND GUIDELINES MANUAL
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with the Revisions to Section 2.000 Child
Welfare of the Department of Human Services Policies and Guidelines Manual, and
WHEREAS, after review, the Board deems it advisable to approve said revisions, a copy
of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Revisions to Section 2.000 Child Welfare of the Department of Human
Services Policies and Guidelines Manual be, and hereby is, approved.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 12th day of December, A.D., 2018.
BOARD OF COUNTY COMMISSIONERS
WELD
COUNTY, COLORADO
ATTEST:dajdo.,
Steve Moreno, Chair
Weld County Clerk to the Board
r ara Kirkmeyer Pr -Tern
Deputy CI rk o the Boar fat
(3 � can P. Conway
APP D A 0ORM va6i � ` k,Cci etda"t
` lie A. Cozad
unty A :money 1�
Mike Freeman
Date of signature: 1/21/141
CGaASD,ciNcio4) 2018-4013
1112/1q HR0089
PRIVILEGED AND CONFIDENTIAL
MEMORANDUM
DATE: December 4, 2018
1861
TO: Board of County Commissioners—Pass-Around
FR: Judy A. Griego, Director, Human Services
L�G 0 UN RE: Weld County Department of Human Services
Policies and Guidelines Manual Revision
Please review and indicate if you would like a work session prior to placing this item on the
Board's agenda.
Request Board Approval of the Department's Policies and Guidelines Manual Revision. This
policy was revised due to Colorado Department of Human Services' form updates in 2016. The
significant change in the Relative Guardianship Assistance Program now allows families to obtain
Assignment of Parental Rights (APR) or Guardianship. Additionally, the inclusion of foster parents who
had placement of a youth for a year's period allows them to seek subsidized guardianship or APR when
the youth would not consent to an adoption(after proper counseling around the issue). This policy was
developed by involved Department staff and submitted to Legal for review and input.
2.3.210. -Relative Guardianship Assistance Program (Revision)
This policy offers possible assistance to a relative guardian for aid in achieving permanency for an
eligible child or youth. This policy is intended to remove financial barriers and should only be considered
when other permanency options have been exhausted. This policy includes Exhibits A-G, which help the
Department to determine eligibility. These exhibits are listed below:
Exhibit A: Family Services Plan
Exhibit B: Proposed Documents for Weld County Kinship Guardianship Program
Exhibit C: Child(ren) Social History
Exhibit D: Relative Guardianship Assistance Program Information Sharing Acknowledgement
Exhibit E: Kinship-Guardianship Checklist for Assistance for Prospective Kinship Guardianship
Case
Exhibit F: Relative Guardianship Assistance and Agreement Referral Form
Exhibit G: Free Credit Report
Pass-Around Memorandum; December 4,2018—(Not in CMS) Page 1
2018-4013
ROOB'9
PRIVILEGED AND CONFIDENTIAL
I do not recommend a Work Session. I recommend approval of this policy revision.
Approve Schedule Other/Comments:
Recommendation Work Session
Sean P. Conway
Julie A. Cozad
Mike Freeman
Barbara Kirkmeyer, Pro-Tem \(--,
Steve Moreno, Chair ,(27`1"\-
L
Pass-Around Memorandum; December 4,2018—(Not in CMS) Page 2
Department of Human Services Policies
CHAPTER 2—Child Welfare
ARTICLE III—Foster/Kinship
Sec. 2.3.210. - Relative Guardianship Assistance Program
A. Introduction
The Relative Guardianship Assistance Program (as set forth in Colorado Department of
Human Services (CDHS) Volume 7, Section 7.311)offers possible assistance to a relative
guardian to aid in achieving permanency for an eligible child or youth. The program is
intended to remove financial or other barriers and to allow for the relative guardian to raise
the Colorado child or youth by providing assistance. The Weld County Relative
Guardianship Assistance Program (RGAP) shall only be considered when all other
permanency options have been exhausted.
B. Determining Eligibility for RGAP
The Department of Human Services (DHS)will determine if legal permanency through the
RGAP may be an option for a child/youth. All requests are approved on a case-by-case
basis, based upon compelling reasons related to permanency and in the best interest of the
child(ren).
1. Reunification and adoption must be ruled out and documentation from providers must
support guardianship or allocation of parental responsibilities.
a) The provider documentation, plus a staffing with the Supervisor, Permanency
Manager, and Legal, is required prior to moving forward.
2. The caseworker and supervisor must determine whether the family meets all the criteria
for the Relative Guardianship Assistance Program (CDHS Volume 7.311 and DHS
Operations Manual 2.3.210. —Relative Guardianship Assistance Program).
3. The caseworker will consult with the kinship family or eligible foster family, Assistant
County Attorney, Guardian ad Litem, and kinship/foster care coordinators.
4. If the child(ren) and family meet all criteria and are interested in obtaining more
information about the program, the caseworker and the kinship/foster care coordinator(if
applicable) provides the family with RGAP information.
C. Certification for RGAP
Kinship families must be certified as a foster home (with the children in their care) for six (6)
consecutive months to proceed with RGAP finalization.
1. The family must be referred to the Foster Care Licensing Specialist to begin the licensing
process.
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Department of Human Services Policies
2. For a non-relative foster parent RGAP, the youth must have been in their care for twelve
(12)consecutive months, while fully certified, before proceeding.
D. Processing RGAP
1. Once eligibility is determined and the family elects to proceed, the caseworker and
supervisor will staff the plan to move forward with the Permanency Manager, Child
Welfare Division Head, and the Director/Deputy Director.
2. Once approved, the caseworker must complete the FSP 5A form (Exhibit A),
documenting how the RGAP program meets the child's best interests and why
reunification or adoption are not being pursued.
3. A child specific home study, specifically related to RGAP, is required in addition to the
regular foster care SAFE home study.
a) The caseworker will submit a referral for a home study contractor to be assigned.
b) All required background checks must be completed as part of the home study process.
4. If the plan is to pursue guardianship through the Probate Court, the family must also
complete a credit check, per Probate Court instructions.
a) Refer to the Free Credit Reports Guide (Exhibit G).
b) A credit check is not required for APR through D&N case.
5. The caseworker will complete a current RGAP Child Social History(Exhibit C) for the
child(ren).
a) Siblings can be addressed in one report for the RGAP program. (Refer to Caseworker
Guide, Exhibit B).
6. The caseworker will send the Relative Guardianship Assistance Referral and Agreement
Form (Exhibit F), along with the RGAP Child Social History(Exhibit C)to the Relative
Guardianship Assistance Negotiator.
7. All mental health, medical and educational records must be scanned and indexed with the
child's name and Trails Case ID.
8. The Transfer Checklist will be updated and maintained, with all tasks, throughout the
RGAP process.
E. RGAP Team Meeting
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Department of Human Services Policies
The caseworker will schedule an Information Sharing meeting and complete the CWS-RGA-
7 Information Sharing Acknowledgement(Exhibit D). This meeting can be scheduled along
with a case closure Family Team Meeting (FTM) and the recorded information sharing
portion can be held after this meeting.
1. RGAP Specialist will schedule a meeting with the family to discuss the RGAP, review
documentation, discuss the child's and family's needs, etc.
2. Once the meeting with the relative or non-relative foster family is complete, the RGAP
Specialist will schedule a meeting with the Adoption/RGAP Assistance Approval Team
(Financial Supervisors, Adoption Supervisor, Resource Manager, Permanency Manager
and Assistant County Attorney assigned to the Approval Team).
3. Once the team has approved the RGAP Assistance proposal, the RGAP Specialist will
present the proposed RGAP Assistance to the family and will obtain signatures on the
RGAP Information Acknowledgement Form from the prospective guardians.
a) If the family is not in agreement with the proposal, the family will submit their
reasoning/argument to the RGAP Specialist. The RGAP Specialist will schedule
another Adoption/RGAP Assistance Approval Team meeting for further review.
F. Completing RGAP
Once reviewed and approved by the Financial Supervisor, the RGAP Specialist will email the
agreements to the supervisor and the caseworker.
1. The caseworker will insert the special needs summary required for RGAP Agreements,
which must include the following:
a) Brief summary of child's history; and
b) Description of barriers to reunification; and
c) Reasonable but unsuccessful effort to place the youth/child for adoption; and
d) Justification for the proposed relative guardianship assistance; and
e) Prognosis for relative guardianship without provision of assistance; and
f) A chronological list of youth's/child's placement for foster care, adoption, or relative
guardianship.
2. Once the agreements have been electronically signed by the supervisor and caseworker,
the caseworker will email the RGAP Child Social History and the RGAP Assistance
Agreements to the Child Welfare Division Head.
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Department of Human Services Policies
3. The caseworker will schedule a meeting with the Child Welfare Division Head within a
week of receiving the completed agreements.
a) The objective of the meeting is to discuss the agreements, the child's needs and the
prospective guardian's ability to meet those needs.
4. The Child Welfare Division Head will meet with the DHS Director(s)to present the
agreements.
a) Once approved, the DHS Director will sign and return the agreements to the Child
Welfare Division Head
b) The Child Welfare Division Head will forward the agreements to the supervisor and
caseworker.
5. The caseworker will take the original signed agreements and present them to the family
for their final signature.
a) The family must sign the final Relative Guardianship Assistance Agreements.
b) The fully signed agreements (caseworker, supervisor, Child Welfare Division Head,
Director(s), and caregivers) must be scanned into OnBase and appropriately indexed
no later than thirty(30 days) before the Guardianship appointment or Allocation of
Parental Responsibilities is finalized by the Court.
G. Filing the Petition
The final APR or Guardianship Hearing must not be scheduled on the docket until all the
DHS' RGAP paperwork(Agreements, social history, home study) is complete.
1. Probate Court: Once all the required Child Welfare/subsidy paperwork has been
completed, the family will file the Petition for Guardianship and all required supporting
documents with the Probate Court.
a) The family may file the documents with an attorney, or they may file the petition pro
se.
b) The caseworker will continue to monitor the case and inform all parties (as well as
the D&N Court) that the petition has been filed.
c) Copies of all documents filed with the Probate Court should also be provided to the
DHS.
2. APR through D&N: Once all the required Child Welfare/subsidy paperwork has been
completed, the Guardian Ad Litem will file for APR.
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Department of Human Services Policies
a) The caseworker will continue to monitor the case and prepare the case for transfer to
the Relative Guardianship Specialist.
H. Hearings
1. Probate Court: The Guardianship hearing is held in the Probate court, and if possible,
the caseworker needs to attend this hearing.
a) Once the Guardianship has been appointed, the caseworker will prepare a Legal
Update sheet and submit it to Legal.
b) Legal will dismiss the D&N or dismiss the child from the D&N petition, if there are
other children remaining open with the DHS.
2. APR through D&N: The APR hearing is held, and the D&N case is closed terminated.
I. Finalizing RGAP
1. The caseworker will complete the Transfer Checklist(Exhibit E): CP Ongoing/YS to
Relative Guardianship, including all the tasks detailed on the Checklist.
2. Once the Guardianship or APR has been appointed, the caseworker will complete the
Placement Information Form, to close the child's removal and placement in Trails.
3. The caseworker will complete all tasks required to close the parent case on Trails, if
possible, within 3 days of the date the Guardianship or APR has been granted by the
Court.
4. The RGAP Specialist will open the Relative Guardianship case on Trails and will notify
the caseworker when the parents Trails case can be closed.
5. When the parent case closes in Trails, the caseworker must make certain all documents
are scanned in OnBase and indexed appropriately (including the agreements signed by all
parties).
J. Reviews
RGA agreements shall be reviewed every three (3)years from the date of the initial
agreement.
1. WCDHS shall initiate the written notice for RGA assistance sixty(60) days prior to the
three(3)-year anniversary of the agreement.
2. WCDHS may renegotiate the current rate at the time of each review.
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Department of Human Services Policies
3. Changes in the needs of the child shall relate to the original barrier(s) identified at the
time the RGA assistance was established.
4. If it is determined there is no current need for a cash payment for a special needs child, a
"core" or"dormant" assistance will be established.
5. The amount and/or kind of assistance is reviewed for relevance, given the child's needs
and the circumstances of the guardian.
6. Documentation of any change of circumstance shall be required.
7. The relative guardian may request a review of the agreement, prior to the three (3)-year
review if changes in the needs of the child or family circumstances occur.
8. The RGA Review Team, shall review and draft proposals for all RGA renegotiation
requests submitted by the RGA Specialist.
K. Successor Guardian
To prevent re-entry into foster care for a youth or child, due to incapacitation or death of the
original guardian, a successor guardian may be identified in the original Relative
Guardianship Assistance Agreement or Addendum. For definitions, eligibility, and
responsibilities regarding successor guardians, reference CDHS Volume VII, Section
7.311.64.
1. The Guardianship Assistance Agreement or Addendum must be dated prior to the
incapacitation or death of the relative guardian, for continuity of relationship and
permanency.
L. Termination
Reference the CDHS Volume VII, Section 7.311.9 on termination procedures.
1. Weld County DHS will terminate RGA payments when:
a) The relative guardian requests the termination of payments;
b) The youth reaches eighteen (18)years of age;
c) WCDHS determines the relative guardian(s) are no longer legally responsible for the
support of the youth or child;
d) The youth or child is no longer receiving any support from the relative guardian;
e) The county of responsibility verifies the child or youth's death, or marriage.
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Department of Human Services Policies
M. Reinstatement
Reinstatement of the original RGA agreement is prohibited, when the court appointed
relative guardian no longer has guardianship of the youth or child. For details, reference
CDHS Volume VII, Section 7.311.91.
N. Right to Appeal
Please refer to the CDHS Volume VII, Section 7.311.92, regarding the appeal guidelines.
RGA NEGOTIATIONS
O. Initial RGA Negotiations
1. The caseworker(s) for the youth or child shall inform the RGA Specialist when a case is
ready for RGA negotiations.
a) The caseworker shall provide a detailed assessment of whether the child will qualify
for the RGA program.
b) The caseworker shall scan all supporting documentation of the child's qualifications
for the RGA program into the electronic case file, for review by the RGA Specialist.
c) All negotiations will occur with the RGA Specialist, rather than the caseworker.
2. The RGA Specialist shall promptly mail a letter to the guardian(s). The letter will
include:
a) Statements advising the following: RGA outlined criteria; the agreement process prior
to the court appointed relative guardianship; and the final approval process by the
Department of Human Services Director(DHS Director), regarding the amount and
kind of Relative Guardianship Assistance;
b) A procedure for setting up a time to start RGA negotiations with the RGA Specialist
and a deadline by which to respond;
i. Failure to respond and set up a meeting or phone conference by the time indicated
in the letter will result in the case being placed on hold.
ii. Cases with scheduled meetings will take priority over cases on hold.
iii. For cases placed on hold, the RGA Specialist will provide the caseworker with a
letter for the court, explaining the reason for the delay in granting guardianship.
c) A Weld County Relative Guardianship/APR Assistance Information form, WC-GA-1,
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Department of Human Services Policies
(Exhibit A)explaining the possible assistance that may be available to families;
d) A Special Needs Assessment Worksheet for Relative Guardianship/APR Assistance,
WC-GA-3, (Exhibit C) for the guardian(s)to complete and bring to the RGA
meeting;
i. The Special Needs Assessment Worksheet will outline the special needs of the
child that might pose a barrier for the guardianship.
ii. The Special Needs Assessment Worksheet will contain a statement that there
must be written documentation from professionals regarding any concerns or
issues with the child(ren) and that this documentation must be submitted to the
RGA Specialist at the time of negotiations.
iii. The written documentation may take the form of letters from doctors, therapists,
or other professionals.
iv. The letter will also advise that any negotiations will be postponed until the written
documentation is available.
e) A Relative Guardianship/APR Assistance Resource Questionnaire, WC-GA-4,
(Exhibit D) for the guardian(s)to complete and bring to the RGA meeting with their
most current Federal tax return;
f) A Refusal of Relative Guardianship/APR Assistance form (Exhibit E) which the
guardian(s) may sign before a notary indicating that they are declining any assistance;
g) Tax credit information;
h) School Attendance form for the guardian(s)to complete and bring to the RGA
meeting;
i) An advisement that the guardian(s) may be represented by an attorney at the RGA
meeting, at their own cost, if they so desire;
3. The RGA Specialist will meet with the guardian(s) at the scheduled time and will do the
following:
a) Review the Weld County Relative Guardianship/APR Assistance Information form,
WC-GA-1, (Exhibit A)with the guardian(s).
b) Inform the guardian(s)of the approximate maximum monthly maintenance assistance
amounts and services available, if a child qualifies.
c) Review the Relative Guardianship/APR Assistance Resource Questionnaire, WC-
GA-4, (Exhibit D) with the guardian(s).
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Department of Human Services Policies
d) Review the Special Needs Assessment Worksheet for Relative Guardianship/APR
Assistance form, WC-GA-3, (Exhibit C) with the guardian(s).
i. Unless the form is filled out completely and/or all professional documentation is
provided, the meeting may be stopped and rescheduled by the RGA Specialist
until the required documentation is provided by the guardian(s).
e) The RGA Specialist will match the special needs identified for the child(ren)
according to Rule 2.3.210. of the WCDHS Manual and CDHS, Volume VII.
i. The RGA Specialist will develop a proposal, to be staffed with the RGA Review
Team, regarding the type and/or amount of assistance that could be offered by
WCDHS, based on information submitted.
ii. Once staffed, and an RGA assistance proposal is agreed upon by the team, the
RGA Specialist will send the guardian(s) a completed Relative Guardianship/APR
Assistance Acknowledgment form, WC-GA-2 (Exhibit B), outlining the
assistance that is being proposed.
iii. The proposed offer is not binding on the WCDHS, until the DHS Director or
designee approves it.
4. The guardian(s) will indicate there is an agreement on the Relative Guardianship/APR
Assistance Acknowledgment form, WC-GA-2, (Exhibit B)by circling"agreed", signing
and returning the form to the RGA Specialist.
a. The RGA Specialist will prepare the State prescribed forms, based on the agreement,
and submit the forms to the guardian(s) for signature.
b. The signed Relative Guardianship/APR Assistance Acknowledgment form will be
filed in the electronic adoption assistance file for documentation purposes.
5. If an agreement is not reached, the RGA Specialist will present the recommendations to
the RGA Review Team for review.
a) A determination of whether to attempt to renegotiate, or to refer the matter to the
DHS Director, will be made promptly by the review team in consultation with the
Child Welfare Division Head.
b) The decision will be made within fourteen (14) days of the referral date to the RGA
Review Team.
c) The guardian(s) shall be notified by letter from the RGA Specialist if the decision is
to continue negotiations.
6. When the WCDHS will not consider further negotiations, the guardian(s) shall be advised
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Department of Human Services Policies
of the WCDHS's final offer in a letter from the DHS Director.
a) The Relative Guardianship/APR Assistance Acknowledgment form, WC-GA-2,
(Exhibit B) reflecting the final offer, will be sent with the advisement letter informing
the guardian(s)of their appeal rights and the process for appealing to an
administrative law judge (AU)at the CDHS.
b) If the Relative Guardianship Assistance Acknowledgment form is received back
signed and in agreement, the RGA Specialist will postpone negotiations.
7. If, at any time, the guardian(s) request the presence of an attorney at negotiations, the
RGA Specialist may request that an Assistant County Attorney be present.
8. RGA assistance applications and renewal forms are not considered final until signed by
the DHS Director or designee.
P. RGA Renewal Negotiations
1. The RGA Specialist and the Adoption Resource Specialist shall review all RGA cases
every three (3) years.
a) The guardians may be asked to submit documentation of current special needs.
b) Documentation shall consist of reports or evaluations by independent professionals.
2. All RGA cases will be reviewed annually for Medicaid eligibility, as outlined in the
CDHS, Volume VII.
3. If the RGA Specialist and the Adoption Resource Specialist determine that there may be
a change in circumstance, the initial RGA negotiations process will be followed to
determine the amount of assistance.
a) Documentation shall consist of reports or evaluations by independent professionals.
b) RGA applications, agreements, and renewal forms are not considered final until
signed by the DHS Director or designee.
c) Appeal procedures will be adhered to, according to CDHS, Volume VII, Section
7.311.92
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Exhibit A
DEPARTMENT OF HUMAN SERVICES
1861 P.O. BOX A
GREELEY, CO. 80632
kl /`i Website: www.co.weld.co.us
r� �UJ� �� = �� Administration and Public Assistance (970)352-1551
Child Support (970) 352-6933
l'' 1couNTY
FAMILY SERVICES PLAN
PART 1: FAMILY INFORMATION
Court Case#: Hearing Type:
Date/Time: Division:
County: HH#:
FAMILY MEMBERS:
Name:
DOB:
Relationship:
Employer:
Address:
Phone:
Attorney:
Name:
DOB:
Relationship:
Employer:
Address:
Phone:
Attorney:
Name:
DOB:
Relationship:
Employer:
Address:
Phone:
Attorney:
1
Exhibit A
Name:
DOB:
Relationship:
School:
Address:
GAL:
Removal Date:
Name:
DOB:
Relationship:
School:
Address:
GAL:
Removal Date:
Name:
DOB:
Relationship:
School:
Address:
GAL:
Removal Date:
Some or all of the above information has changed since the last court appearance:
Special Respondent/Intervener:
Others Involved:
CASEWORKER: DATE:
Caseworker Name and position
2
Exhibit A
FAMILY SERVICES PLAN
PART 5A: REVIEW
Review Date:
Reason(s) for Review:
_90 day supervisor/caseworker
_Court review
_Change in treatment plan
Court Case#: Division:
Family Name:
FAMILY ASSESSMENT UPDATE:
SERVICES:
• Are court-ordered/agreed-upon services being provided? YES/NO
• Are services/placement appropriate and do they continue to meet the needs of the
child, the family,the foster parents? YES/NO
• Were abuse/neglect allegations investigated in this setting during this review
period? YES/NO
• Are the number of children and the presenting problems of the children in the
home limited sufficiently to meet the safety needs of this child? YES/NO
• Describe any safety concerns for this child's placement. If safety concerns are
identified,what is the plan?
PROGRESS:
DILIGENT SEARCH:
ICWA:
BARRIERS TO PERMANENCY:
3
Exhibit A
PERMANENCY GOALS:
Child Name:
Permanency Goal:
Concurrent Goal:
Target date:
Are the existing permanency goal(s)still appropriate? YES/NO
Time frames: Are the time frames for the treatment objectives still appropriate? YES/NO
Summary of Foster Care Review Results:
Summary of Parental Fee Status:
RECOMMENDATIONS:
Date of most recent approved court-ordered treatment plan:
Are changes recommended? YES/NO
Based upon the information set forth in this Family Services Plan,this caseworker
respectfully recommends that the Court enter the following findings and orders:
SIGNATURES:
Caseworker Name,credentials Date
Title
Supervisor Name, credentials Date
Title
Attachments:
CC:
4
Exhibit B
Proposed Documents for Weld County Kinship Guardianship Program
Weld County Kinship Guardianship Program Policy
Weld County Kinship Guardianship Program Assistance Policy-Fiscal
Weld County Kinship Letter
To Be Used by Caseworkers:
Procedures for Kinship Guardianship Assistance Program
Costs for Relatives Handout
Free Credit Report Handout
Kinship Guardianship Assistance Child Specific Home Study Referral
Kinship Guardianship Caseworker Entries on the FSP 5A
Kinship Guardianship Assistance and Agreement Referral Form
CW-RGA-7 Relative Guardianship Program Information Sharing Acknowledgement
Transfer Checklist: CP Ongoing/YIC to Kinship Guardianship
To Be Used by the Subsidy Worker:
Kinship Guardianship Checklist for Assistance
Kinship Guardianship Assistance Review Checklist
CWS-RGA-1 Title IV-E Summary and Application(determine eligibility no later than one calendar month prior to
court appointment or the relative guardianship)
CWS-RGA-2 Title IV-E Assistance Agreement(signed and dated before the court ordered guardianship)
RGA-2A Addendum to Original Title IV-E Agreement
CWS-RGA-3 Title IV-E Relative Guardianship Assistance Review Form
CWS-RGA-4 Non-Title IV-E Application and Summary(determine eligibility no later than one calendar month prior
to court appointment or the relative guardianship)
CWS-RGA-5 Non Title IV-E Agreement(signed and dated before the court
ordered guardianship)
CWS-RGA-6 Non Title IV-E Relative Guardianship Assistance Review Form
1
Exhibit B
Proposed Documents for Weld County Kinship Guardianship Program
Weld County Kinship Guardianship Program Policy
Weld County Kinship Guardianship Program Assistance Policy-Fiscal
Weld.County Kinship Letter
To Be Used by Caseworkers:
Procedures for Kinship Guardianship Assistance Program
Costs for Relatives Handout
Free Credit Report Handout
Kinship Guardianship Assistance Child Specific Home Study Referral
Kinship Guardianship Caseworker Entries on the FSP 5A
Kinship Guardianship Assistance and Agreement Referral Form
CW-RGA-7 Relative Guardianship Program Information Sharing Acknowledgement
Transfer Checklist: CP Ongoing/YIC to Kinship Guardianship
To Be Used by the Subsidy Worker:
Kinship Guardianship Checklist for Assistance
Kinship Guardianship Assistance Review Checklist
CWS-RGA-1 Title IV-E Summary and Application(determine eligibility no later than one calendar month prior to
court appointment or the relative guardianship)
CWS-RGA-2 Title IV-E Assistance Agreement(signed and dated before the court ordered guardianship)
RGA-2A Addendum to Original Title IV-E Agreement
CWS-RGA-3 Title IV-E Relative Guardianship Assistance Review Form
CWS-RGA-4 Non-Title IV-E Application and Summary(determine eligibility no later than one calendar month prior
to court appointment or the relative guardianship)
CWS-RGA-5 Non Title IV-E Agreement(signed and dated before the court
ordered guardianship)
CWS-RGA-6 Non Title IV-E Relative Guardianship Assistance Review Form
1
Exhibit C
DEPARTMENT OF HUMAN SERVICES
I,/ r;! 1= A P.O. BOX A
=z GREELEY, CO 80632
- � � � Website: www.co.weld.co.us
tC O UNITY — Administration and Public Assistance(970) 352-1551
Child(ren) Support(970)352-6933
CHILD(REN) SOCIAL HISTORY
(Relative Guardianship)
Date of Report:
Child(ren)'s and Date of Birth:
GENERAL DESCRIPTION
Describe the child(ren)'s age, ethnicity/nationality, race, religious preference (if any),
languages spoken, physical description including height/weight/hair color/eye
color/complexion, anything distinctive about the child(ren)'s appearance.
LEGAL HISTORY
Describe what brought the child(ren) to the attention of the Department, Trails history,
history of court involvement, including dates of emergency hearings, adjudications,
termination orders (if applicable), etc. Describe efforts to achieve permanency through
reunification, permanent custody and adoption. Why is relative guardianship in the
child(ren)'s best interest?
FAMILY HISTORY
Describe for each birth parent the following: current residence, ethnicity/nationality/race,
religious preference, languages spoken, physical description, level of education, history
of abuse and criminal involvement, medical history, mental health history, substance
abuse history, marital/relationship history, level of functioning. If the child has siblings,
discuss the first name and age of the siblings, their relationship, and their whereabouts.
Exhibit C
PLACEMENT HISTORY
Give a chronological listing of the child(ren)'s placements since his/her initial
involvement with the Department. Give the following information for each change in
placement(if applicable): type of placement (i.e., Weld County Foster Home, Lutheran
Family Services Foster Home, Mount Saint Vincent Children's Home Residential Child
Care Facility, etc.), dates/length of placement, reasons for moves, and child(ren)'s
adjustment to the placement changes. Does the child(ren) maintain any
contact/relationship with any of his/her previous caregivers? .
MEDICAL HISTORY
List the name/address/phone number of all the child(ren)'s current physicians, dentists,
therapists, etc. Is the child(ren)'s immunizations current? Describe any serious or
chronic health conditions/diagnoses. List the child(ren)'s current medications, as well
as medication history. Is there any family history of medical problems?
DEVELOPMENTAL HISTORY
Describe the following: developmental milestones (if known), any current therapies (OT,
PT, speech), and any known disabilities/delays.
ACADEMIC FUNCTIONING
Describe the child(ren)'s current grade level and name of current school. Is there an
IEP, behavioral plan, or does the child(ren) receive any special services? Is there any
significant school history(suspensions, truancy issues, etc.)? Has the child(ren) ever
been held back? What are the child(ren)'s academic strengths/weaknesses? What are
the child(ren)'s favorite subjects? Is the child(ren) involved in any extra-curricular
activities/sports? If the child(ren) is not of school age, describe the child(ren)'s day
care/preschool history.
DAILY ROUTINE/SOCIAL DEVELOPMENT
Describe the lifestyle of the child(ren)'s current placement (i.e., religious practices,
routines, recreational activities, family composition, etc.). Is he/she involved in any
social groups or activities? Does the child(ren) identify with any racial, ethnic, cultural,
religious or community groups? Does the child(ren) have any favorite foods or
activities?
PSYCHOLOGICAL EVALUATION/EMOTIONAL FUNCTIONING
Describe the following: Child(ren)'s IQ (if known), DSM diagnoses, history of therapeutic
interventions/hospitalizations, attachment issues, abuse history. What is the child(ren)'s
understanding of why he/she cannot return to his/her parents? Does the child(ren) have
any significant behaviors (sexually reactive, physical aggression, cruelty to animals, fire-
setting, etc.)?
READINESS FOR RELATIVE GUARDIANSHIP
Explain the child(ren)'s understanding of relative guardianship. What relationships need
to be maintained following the finalized relative guardianship? Is there any contact
2
Exhibit C
between the siblings, parents and other relatives? What is your recommendation for
sibling/parent/relative contact following the finalized relative guardianship?
SUMMARY AND RECOMMENDATIONS
Is the child(ren)'s Guardian ad Litem, therapist, and other interested parties in
agreement with your recommendations regarding relative guardianship?
Respectfully Submitted By,
Caseworker Name/Credentials Date
Title
Approved By,
Supervisor Name/Credentials Date
Title
3
Exhibit D
coHs COLORADO CWS RGA-7, RGAP Information Sharing
Acknowledgement
' Office of Children, R-9/15
C w Youth&Families
Division of Child Welfare
Relative Guardianship Assistance Program
Information Sharing Acknowledgement
Use for Title IV-E and Non-Title IV-E Assistance Agreements
with Relative Guardians and Successor Guardians
(County Department Name)
I/We do hereby acknowledge receipt of the following documents from the
(Relative Guardian Name)
1 (County Department Name) regarding the relative guardianship of
(Name of youth/child)
List documents received:
1. 1 2.
3. 4.
5. 6.
7. 8.
9. 10.
I/We have learned about and have received a written copy of the youth's/child's
birth, family, and genetic history, and educational, physical, and mental health records
(audio copies optional).
I/We have been informed of the reason the youth/child was placed in out-of-home
care.
I/We have been informed of the number and type of out-of-home placements the
youth/child has experienced in the care of the agency and the reasons for the placements.
I/We have been provided contact information and have been encouraged to contact
therapists, teachers, previous out-of-home placement providers, and others with knowledge of
the youth/child.
I/We have been informed of known trauma or unusual incidents (abuse, neglect,
deaths, divorce, etc) experienced by the youth/child while in the care of the agency.
I/We have understand that if a decision is made to decline proceeding to relative
guardianship, all materials regarding the youth/child that were provided by the agency shall be
returned to the agency within 48 hours of the decision.
I/We attest that the Relative Guardianship Assistance has been discussed, including
the legal differences between relative guardianship and adoption.
OF•GpG'
1575 Sherman Street,2nd Floor, Denver, CO 80203 P 303-866-5932 F 303-866-5536 www.colorado.gov/cdhs hew �a
John W. Hickenlooper,Governor I Reggie Bicha, Executive Director tn
*1876;
C G4 7, RGAP Information Sharing Acknowledgement
R-9/16
I/We attest that a plan to address the future relationship with the youth's/child's
family and visitation has been discussed.
I/We have been provided with sufficient information to make an informed decision
to request relative guardianship of (Name of youth/child)through the Probate Court or
approval of Allocation of Parental Responsibilities (APR).
Additional information that was obtained prior to the appointment of relative guardianship:
1. 1 2.
3. 4.
5. 6.
Review Dates Initials
(Proposed Relative Guardian-printed name) (Signature)
(Proposed Relative Guardian-printed name) (Signature)
(Caseworker Signature) Date of all Signatures
Approved by
(Name Title Date)
OR
(Proposed Successor Guardian-printed name) (Signature)
(Proposed Successor Guardian-printed name) (Signature)
(Caseworker Signature) Date of all Signatures
Approved by
(Name Title Date)
coio�,
1575 Sherman Street,2nd Floor, Denver,CO 80203 P 303-866-5932 F 303-866-5536 www.colorado.gov/cdhs 4ti
John W. Hickenlooper, Governor I Reggie Bicha, Executive Director
4z.."
1876 .,
ifiyy1-7, RGAP Information Sharing Acknowledgement
R-9/16
INSTRUCTIONS
This form must be signed at the time a youth/child has been identified as being considered for
relative guardianship and the prospective Relative Guardian(s) or Successor Guardian(s) needs
additional information before making a final decision to request relative guardianship through
the Probate Court or approval of APR. The prospective Relative Guardian(s) or Successor
Guardian(s) must initial each of the boxes next to the identified information that was provided.
If additional information is obtained during the time the youth/child resides in foster care with
the prospective Relative Guardian(s) or Successor Guardian(s), the information should be
included on this form, and initialed by the caseworker and the prospective Relative Guardian(s)
or Successor Guardian(s).
Information that is provided should include available and known medical/genetic background of
the youth/child and birth parents, prior placement history, educational records, psychological
evaluations about the youth/child, developmental history, and current behavior. All material
must be de-identified.
ov-cot
1575 Sherman Street,2nd Floor, Denver,CO 80203 P 303-866-5932 F 303-866-5536 www.colorado.gov/cdhs /4' ¢?�
John W. Hickenlooper,Governor I Reggie Bicha, Executive Director O
* is *
\!876,
Exhibit E
KINSHIP GUARDIANSHIP CHECKLIST FOR ASSISTANCE
FOR PROSPECTIVE KINSHIP GUARDIANSHIP CASE
Youth/Child's Names:
Caseworker: Trails Case ID:
❑ Copy of Kinship Guardianship Checklist for Caseworkers for Biological Case and associated documents.
❑Youth/Child(ren)'s Birth Certificates
❑Youth/Child(ren)'s Social Security Cards(Optional)
❑Most recent removal order or voluntary placement agreement
❑Youth/Child(ren)'s School Records and IEP or 504 Plans
❑Psychological Evaluations or Mental Health Records
❑Medical and Medication Records
❑ Social History Summary
❑Relinquishment order or termination of parental rights order(if applicable)
❑ SS-9 IV-E Foster Care Determination
❑ SS-10s IV-E Foster Care Redetermination
❑ SS lAs Medicaid Eligibility/Redeterminations
❑ CW-RGA-7 Relative Guardianship Program Information Sharing Acknowledgement
Ti Complete the Adpt/Rel Gd Screens for Relative Guardianship in Trails.
❑Application for Foster Care from Foster Care Licensing File
❑ SAFE Home Study for Foster Care from Foster Care Licensing File
and applicable updates
❑Medical Records for prospective relative guardian(s).
❑Placement History for Provider
For Title IV-E Youth/Child(ren)
❑ CWS-RGA-1 Title IV-E Summary and Application(determine eligibility no later than one calendar month prior to court
appointment or the relative guardianship)
❑CWS-RGA-2 Title IV-E Assistance Agreement(signed and dated before the court ordered guardianship)
❑RGA-2A Addendum to Original Title IV-E Agreement
For Non Title IV-E Youth/Child(ren)
❑ CWS-RGA-4 Non-Title IV-E Application and Summary(determine eligibility no later than one calendar month prior to
court appointment or the relative guardianship)
❑CWS-RGA-5 Non Title IV-E Agreement(signed and dated before the court
ordered guardianship)
❑ Copy of Guardianship Orders
❑ Enter the Kinship Guardianship information into Trails within thirty(30)calendar days following the date
the court appoints the kinship guardian.
1
Exhibit F
Relative Guardianship Assistance and Agreement Referral Form
E-mail to Adoption/Relative Guardian Assistance Specialist and Associate Fiscal Manager
Caseworker:
Today's Date: / /
TRAILS CASE ID :
CHILD 1
CHILD'S BIRTH NAME :
LAST FIRST MIDDLE
CHILD'S CURENT NAME :
(IF DIFFERENT) LAST FIRST MIDDLE
SOCIAL SECURITY NUMBER OF THE CHILD (birth SSN)
DATE OF BIRTH SEX SEX RACE/ETHNIC GROUP
CHILD 2
CHILD'S BIRTH NAME :
LAST FIRST MIDDLE
CHILD'S CURENT NAME :
(IF DIFFERENT) LAST FIRST MIDDLE
SOCIAL SECURITY NUMBER OF THE CHILD (birth SSN)
DATE OF BIRTH SEX SEX RACE/ETHNIC GROUP
CHILD 3
CHILD'S BIRTH NAME :
LAST FIRST MIDDLE
CHILD'S CURENT NAME :
(IF DIFFERENT) LAST FIRST MIDDLE
SOCIAL SECURITY NUMBER OF THE CHILD (birth SSN)
DATE OF BIRTH SEX SEX RACE/ETHNIC GROUP
NAME OF RELATIVE GUARDIAN(S)
LAST FIRST MIDDLE
LAST FIRST MIDDLE
ADDRESS
PHONE NUMBER
* * * PLEASE PROVIDE A COPY OF THE SOCIAL HISTORY* * *
Exhibit F
Legal Status of Child/ren(Check all that apply):
❑ Current Dependency and Neglect action
Court Docket Number:
❑ Legal custody with the Department
Date of most recent custody order:
❑ Mother:
Relinquished ❑ Terminated ❑ Court: Docket Number: Date:
❑ Father of child/ren(child/ren's name):
Relinquished ❑ Terminated ❑ Court: Docket Number: Date:
❑ Father of child/ren(child/ren's name):
Relinquished ❑ Terminated ❑ Court: Docket Number: Date:
❑ Father of child/ren(child/ren's name):
Relinquished ❑ Terminated ❑ Court: Docket Number: Date:
Steps taken to place child/ren for adoption without adoption assistance(Check all that apply):
❑ Registration with CARR(and use of all media resources)
Child 1 Date: Child 2 Date: Child 3 Date:
❑ Diligent search of the child's record
Child 1 Date: Child 2 Date: Child 3 Date:
❑ Interview child for adoption/permanency resources
Child 1 Date: Child 2 Date: Child 3 Date:
OR
The best interest of the child would not be served by such efforts for one of the following reasons
(Check any that apply):
Child 1: 0 Youth/Child has significant emotional ties to kinship foster parent.
❑ Youth/Child is placed with a relative within the 5th degree of kinship
Date:
Child 2: 0 Youth/Child has significant emotional ties to kinship foster parent.
❑ Youth/Child is placed with a relative within the 5th degree of kinship
Date:
Child 3: ❑ Youth/Child has significant emotional ties to kinship foster parent.
❑ Youth/Child is placed with a relative within the 5th degree of kinship
Date:
RELATIVE GUARDIANSHIP ASSISTANCE AGREEMENT EFFECTIVE DATE:(date Legal
Guardianship is finalized) Leave Blank if Unknown
GENERAL DIAGNOSTIC STATEMENT: (Include brief summary of child's history,description of barriers to
adoption,reasonable but unsuccessful effort to place the youth/child for adoption(7.311.5,B,3),justification for the
proposed relative guardianship assistance,prognosis for relative guardianship without provision of assistance and a
chronological list of youth's/child's placement for foster care,adoption,or relative guardianship.)
Child 1: (child's name)
Child 2: (child's name)
Child 3: (child's name)
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