MISSOURI DEPARTMENT OF SOCIAL SERVICES CHILDREN’S DIVISION Family Support Team Meeting/Adoption Staffing Team Decision Review Report
Reviewer	Title	Phone Number	Email
Review Assignment Date	Review Report Submission Date
Review Requester	Role at the FST/AD Meeting	Phone	Email
Date of FST/AD Meeting
Attendees	Date Interviewed	Comments
Attach additional pages if needed
CONCLUSION (select only one)
a. The FST/AD meeting policy was followed and a consensus was reached, the team’s decision stands. Supporting Examples provided below.
b. The FST/AD meeting was in error per policy. Supporting examples provided below.
Date and location for reconvened meeting
Decision as a result of reconvened meeting:
c. There was no consensus of the FST/AD meeting with evidence of extreme bias by one or more members. Supporting examples provided below.
Date and location for reconvened meeting
Decision as a result of reconvened meeting:
Signatures:
Reviewer (print and sign)
Circuit Manager (print and sign)	Date