ࡱ> IKH!` Ibjbj\\ >V>> (((8F(T( GchJ)H*****`+|+@q`#bbbbbb$dhgbE,**,,b**c`.`.`.,**B`.,q``.`.<h=*>) e.(,,(=@<c0Gc+=hT,h =h=,,`.,,,,,bbV. ,,,Gc,,,, $ $ $b PLACEMENT PROVIDER HOME VISIT CHECKLIST MISSOURI DEPARTMENT OF SOCIAL SERVICES CHILDREN S DIVISIONDate of Visit:Case Name:Placement Date: FORMTEXT       FORMTEXT       FORMTEXT      Provider s Name:Provider s Address: FORMTEXT       FORMTEXT      Child(ren) s Name(s): FORMTEXT      Case Manager s Name:Worker Conducting Visit: FORMTEXT       FORMTEXT       DISCUSS WITH PROVIDER, AS APPROPRIATE:Child's reaction to separation from family Child s visitation with parents and siblings Any additional contact with parents/siblings outside of regular visitation. Child's perception/understanding of the problem and what he would like to see happen. Child's adjustment to placement and the placement provider's perception of the child's adjustment. Placement providers adjustment to the childs placement in their home. Children's Service Worker's observation of the child's adjustment to placement. Any changes in household composition or structure. Any concerns with household members behaviors and/or interactions. Any stressors on the family (physical or mental health concerns, financial issues, marital or familial conflicts, hotlines, etc.) any concerns noted or discussed should be referred to the licensing worker for the family Any safety concerns noted during the home visit (such as structural hazards, weapons or medications accessible to children, household cleanliness, etc.) staff should address these concerns immediately with the family and their supervisor. Licensing staff should also be informed of these concerns. Childs eating habits and general nutrition. Providers concerns regarding childs behaviors. Childs education and developmental progress Parents progress in treatment plan. Placement providers support and/or concern with the treatment plan. Additional services necessary to maintain the placement. Upcoming court proceedings and FST/PPRT meetings. 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COMMENTS: (Please address items discussed with providers.) 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