Child Welfare/Juvenile Probation Case Plan (including Permanency Plan)
Needs and Services Plan from current placement provider (if applicable)
Additional documentation to ensure a complete and comprehensive QI assessment, may be included at the time of the referral by the Placing Agency Social Worker/Probation:
List of services that have been provided to preserve the current placement, including child welfare funded services and interventions
Any current family visitation orders including no contact orders
Education information including current IEP or 504 plan if applicable (Health and Education Passport)
Placement History including successful placements and services printed out from CWS/CMS – full history
Medical history including medical hospitalizations (Health and Education Passport)
Psychological Evaluations
Pathway to Wellbeing Screening
CANS Screening Tool
Developmental Assessment if applicable including documentation related to both being assessed for and receiving services authorized through a Regional Center or provided by a Regional Center vendor
Juvenile Probation specific assessments and latest social studies report
Mental Health Plan Clinician – List of services that have been provided during the prior 12 months (at a minimum), including wraparound and Specialty Mental Health Services
Mental Health Plan Clinician- Psychological Evaluations
Mental Health Plan Clinician- History of Psychiatric Hospitalizations
Please Note: Once a completed Referral for Qualified Individual Assessment is received, the process for completing the comprehensive assessment and recommendations may take up to thirty (30) days.
