CSO-2935B Exhibit 1.pdf

EXHIBIT 1 - REOCCURRING QRTP PLACEMENT REVIEW

ARIZONA DEPARTMENT OF CHILD SAFETY

CSO-2935B

(05/22)

To be completed by QRTP Provider every 45 days and send to DCS Placement Coordinator and DCS Specialist

A. Progress on the program, moving towards discharge (list sibling(s), age and current caregiver/living arrangement) What specific treatment or trauma informed services are being provided by the QRTP to meet the needs of the child? What is the expected length of time that the child will need the treatment and services described?

Does the QRTP setting continue to provide the child with the most effective and appropriate level of care in the least restrictive environment?

Describe how placement in the QRTP remains consistent with the short- and long-term goals for the child, as specified in the permanency plan for the child.

What efforts has the QRTP made to prepare the child to return home or be placed with a fit and willing relative, legal guardian, adoptive parent or in a foster family home or kinship family?

Child's Name Date Completed

CSO-2935B

(05/22)

To be completed by QRTP Provider every 45 days and send to DCS Placement Coordinator and DCS Specialist

Please confirm if the youth has begun services as defined in their Child and Family Team (CFT) Service Plan.

B. Connection to services and Progress of their Child & Family Team (CFT) Service Plan

Describe how the youth is transitioning into the program including the development of relationships with program staff and other youth residing in the program. How is the program supporting the youth’s engagements? How is the child adjusting to relationships (peers and staff)?

Describe any Incident Reports since the youth entered the program.

A. Progress on the program, moving towards discharge (list sibling(s), age and current caregiver/living arrangement) ~ continued

CSO-2935B

(05/22)

Is the youth actively enrolled in school? How are they performing and what supports have been provided since transition into the program to aid the youth in education outcome success?

When a youth is entering a QRTP, document any changes in school enrollment to be reviewed per the Department’s standard processes including best interest evaluation?

C. School Performance

How is the youth adjusting to the service plan and how is the QRTP supporting the youth in participating in those services as well as applying any relevant skills?

B. Connection to services and Progress of their Child & Family Team (CFT) Service Plan ~ continued

CSO-2935B

(05/22)

Equal Opportunity Employer/Program. The Department of Child Safety (DCS) prohibits discrimination in admissions, programs, services, activities, or employment based on race, color, religion, sex, national origin, age, disability, genetics, or retaliation or any other status protected by federal law, state law, or regulation. Reasonable accommodations to allow a person with a disability to take part in a program, service, or activity are available upon request. To request this document in alternative format or for further information about this policy contact your local office. TTY/TDD Services: 7-1-1. Free language assistance for DCS services is available upon request. Ayuda gratuita con traducciones relacionadas con los servicios del DCS esta disponible a solicitud del cliente.

Has the DCS Specialist and family (when appropriate) been involved in the QRTP program supports for the youth

What efforts have been made and what barriers need to be overcome ensuring the family and specialist are supporting the youth’s completion of the QRTP Program?

D. Contact with Family and Visits

Completed by:

Signature Title Date Completed