Probate Clerk's Manual

PERMANENCY HEARING REPORT

PERMANENCY HEARING DATE CERTAIN:

IN THE MATTER OF:

DATE OF REPORT PREPARATION:

All information must be current and represent an update of events and circumstances since the child was freed for adoption or the previous Permanency Hearing

SECTION I. PERMANENCY PLAN SUMMARY

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.

2. If there is a plan for trial or final discharge in the next six months, specify the anticipated date and explain why such discharge is safe and appropriate.

3. 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:

SECTION III. REASONABLE EFFORTS TO FINALIZE PERMANENCY

4a. Describe the child-specific recruitment efforts that have been made and the outcome of these efforts.

4b. What further recruitment efforts are anticipated in the next six months?

5a. If the child is age 14 or older and voluntarily withheld consent to his/her adoption, describe the facts and circumstances related to the child’s decision.

5b. Describe efforts that have been made to counsel the child about adoption.

6a. If the child is free and placed in a pre-adoptive home, describe reasonable efforts and barriers to finalizing the adoption.

6b. What additional services/assistance is anticipated in the next six months to facilitate finalizing the adoption?

7. If applicable, has the child’s case been transferred to an adoption unit? Yes No NA

8. Adoption milestones

Documents secured for finalizing adoption: check all that apply

Birth Parents
order(s) terminating parental rights
surrender(s)
consent(s)
death certificate(s)

Child
birth certificate, two copies
medical report
consent (child over age 14)

Adoptive Parent(s)
financial disclosure affidavit
medical report
marriage certificate
divorce certificate
death certificate (of adoptive spouse)
back-up resource

Attorney
affidavit of readiness
financial disclosure affidavit
certification of service upon OCA

9. Putative Father Registry request, if applicable.

Was a Putative Father Registry request made? Yes No

Date of request: Found Not Found

10. Will an adoption subsidy application be submitted for the child? Yes No

If No, explain why not.

If Yes, check the status of the Adoption Subsidy Application:

Date submitted:

OR Not Applicable

Date review initiated:

Date submitted to OCFS NYSAS:

Date rejected/returned:

Date of resubmission to OCFS NYSAS:

Date of approval:

Date of denial:

Date of appeal:

Date of decision:

Decision:

Delay in final subsidy approval and actions to overcome delay:

Why was the subsidy denied?

For approved subsidy, check the applicable category and level of rate:

Handicapped Basic Special Exceptional

Hard-To-Place Basic Special

11. Have the adoptive parent(s) retained an attorney? Yes No

12. Has the adoption petition been filed? Yes No

If Yes, Date of filing: Docketed Scheduled for hearing on:

13a. If the permanency goal is Guardianship or Placement with a Fit and Willing Relative, describe reasonable efforts made and services provided.

13b. What services are anticipated in the next six months?

14a. If the permanency goal is Another Planned Permanent Living Arrangement, provide the compelling reason.

14b. Describe how this arrangement provides significant connection to an adult and the efforts made to finalize the plan.

14c. What services are anticipated in the next six months?

15. Is the child AWOL? Yes No

If yes, describe efforts to locate the child.

SECTION IV. CHILD’S FREEING FOR ADOPTION AND PLACEMENT(S)

16. Child’s Name / Means of Freeing / Parent / Date / Appeal Pending / Date Child was Completely Freed for Adoption

Child’s Name

Means of Freeing
TPR Surrender Death of Parent

Parent
Mother Father

Date

Appeal Pending
Mother Father

Date Child was Completely Freed for Adoption

# of Changes in Placement Since Freeing or Previous Permanency Hearing

Child Currently Placed
Foster Boarding Home
Non-relative
Relative
Congregate Care Facility
Relative (Direct Placement)
Other

17. Provide current information regarding the placement of the child.

18. Is the child placed out of state? Yes No

If Yes, explain why it is appropriate, necessary and in the best interests of the child?

SECTION V. VISITING

19. Describe the current visiting plan.

Describe any anticipated modifications to the visiting plan in the next six months, and the reasons therefor.

SECTION VI. SERVICES PROVIDED TO CHILD

20. Describe all services offered and/or provided to the child since child was freed for adoption or the last permanency hearing and the outcomes or progress the child has made.

Describe any additional services for the child anticipated in the next six months.

21. If the child is age 14 or older, describe the Independent Living Skills Services provided to the child and the skills attained.

Describe any additional Independent Living Skills Services anticipated for the child in the next six months.

SECTION VII. OTHER SERVICES

22. Describe any other services and assistance that have been provided to the prospective adoptive parent(s) to expedite the adoption of the child.

Describe the plan for post-adoption services.

SECTION VIII. CHILD’S HEALTH AND WELL-BEING

23. If applicable, note the following for the child:

Significant Chronic Conditions: None

Significant Developmental Delay: None

Mental Health Diagnoses: None

Serious Injuries/Hospitalization: None

Current Medication: None

24. Describe any other significant information about the child’s current health and well-being not included above.

Date of Last Physical

Date of Last Mental Health Appointment, if applicable

Date of Last Dental Appointment

Date of Last Vision Screening

Date of Last Hearing Screening

Immunizations Up-To-Date Yes No

25. Describe any follow-up treatment or recommendations for the child, as a result of the above appointments/screensings.

SECTION IX. CHILD’S EDUCATION

26. Provide information on the child’s current grade level or program, academic progress and achievements, and any other relevant educational information.

27. Describe the steps the agency will take during the next six months to enable prompt delivery of appropriate educational and/or vocational services.

28a. If the child is under age 3, check which criteria the child meets.

Referred for EI Referral Date Receiving EI Services Not Eligible

Describe the steps taken to refer the child to Early Intervention Services.

28b. If the child is eligible for Pre-Kindergarten, check the appropriate boxes.

Pre-K Not Available Pre-K Available Not Enrolled Enrolled

If Pre-kindergarten is available and the child is NOT enrolled, describe steps taken to enroll the child.

28c. If the child is age three or older and is suspected of having a disability or has been found eligible for Special Education, describe the status of the referral and IEP recommendations.

28d. If the child is school age, describe the steps taken to enroll the child in or continue in a program leading to a high school diploma.

28e. If the child is over age 16/17 and has elected not to participate in a high school diploma program, describe steps taken to assist with employment or vocational program.

VERIFICATION

that I am employed at , as a caseworker;

that I have the foregoing permanency report and know the contents thereof;

that the information is true and complete to my own knowledge, or believed to be true based on information derived from official records and/or reports kept in the regular course of business...

that this report is a true and complete copy of the report that was mailed to the parties 14 days prior to the date certain of the permanency hearing.

Sworn to before me this

day of

Notary Public

Commissioner of Deeds