ATTACHMENT 5.docx

This is a Request for Dual Placement form used by South Carolina's child welfare system for placing children in therapeutic foster homes. The form is designed to facilitate the concurrent placement of two children (Child A, who is requesting placement, and Child B, who is currently placed) in the same therapeutic foster care (TFC) home. The form requires detailed information about both children, including their names, ages, genders, and the specific behavioral and emotional issues that necessitated their placement in therapeutic care. Caseworkers must provide justification for the dual placement and document the history and current behaviors of both children to ensure compatibility and safety.

The form requires comprehensive documentation of all physical, emotional, and behavioral issues—including sexual behaviors—that could place either child or other household members at risk, along with detailed mitigation strategies. The foster parent information section requires documentation of the home address, current residents, and the licensing agency overseeing the placement. Approval requires sign-offs from both the caseworker and supervisor for Child A, the caseworker and supervisor for Child B, and final approval from the designated authority responsible for Child B's case. The form ensures multiple levels of oversight and requires all parties to confirm their agreement to the dual placement before authorization is granted.