Instructions for Form FST-3 "Family Support Team Meeting Template/Sign-In/Confidentiality Statement" - Missouri

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This document contains official instructions for Form FST-3, Family Support Team Meeting Template/Sign-In/Confidentiality Statement - a form released and collected by the Missouri Department of Social Services.

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Instructions for Form FST-3 "Family Support Team Meeting Template/Sign-In/Confidentiality Statement" - Missouri

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Instructions for Form FST-3 "Family Support Team Meeting Template/Sign-In/Confidentiality Statement" - Missouri, Page 2

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FAMILY SUPPORT TEAM MEETING TEMPLATE/SIGN-IN/CONFIDENTIALITY

STATEMENT, FST-3 INSTRUCTIONS

Purpose:

This form is used to improve engagement, to document what is occurring during

Family Support Team Meetings and to keep the Family Support Team Meeting on

track. The FST-3 provides workers with a guide to summarize case progress. The

FST-3 will be used for all additional meetings after the 72 hour meeting. Taking notes

on the form during the meeting can be made optional based on the supervisor’s

discretion. This form also serves as a confidentiality statement and a sign in sheet for

Family Support Team Meetings. It also documents participant’s agreement regarding

confidentiality as well as their agreement with the Written Service Agreement

developed during the meeting.

Instructions for Completion:

Enter the family’s name

Enter the date of the meeting

Indicate whether or not the meeting is a PPRT

Enter the names of individuals invited to attend to a Family Support

Team meeting

Enter the participant’s relationship to the family

Ask participants to read the confidentiality statement

Have participants sign the form across from their name signifying that they

are in attendance and they are in agreement with the confidentiality

statement

At the close of the Family Support Team Meeting, have participants check the

appropriate “yes” or “no” box to indicate whether they are in agreement with

the Written Service Agreement developed by the team

If they are not in agreement with the plan, document the nature of a

participant’s disagreement in the bottom section of the form

Document the date/time and location of the next meeting

Type of Meeting:

Check the box applicable for the type of Family Support Team Meeting

Reason for Removal:

Document the reason for removal and check if the Adoption and Safe Families Act was

discussed with the family.

FAMILY SUPPORT TEAM MEETING TEMPLATE/SIGN-IN/CONFIDENTIALITY

STATEMENT, FST-3 INSTRUCTIONS

Purpose:

This form is used to improve engagement, to document what is occurring during

Family Support Team Meetings and to keep the Family Support Team Meeting on

track. The FST-3 provides workers with a guide to summarize case progress. The

FST-3 will be used for all additional meetings after the 72 hour meeting. Taking notes

on the form during the meeting can be made optional based on the supervisor’s

discretion. This form also serves as a confidentiality statement and a sign in sheet for

Family Support Team Meetings. It also documents participant’s agreement regarding

confidentiality as well as their agreement with the Written Service Agreement

developed during the meeting.

Instructions for Completion:

Enter the family’s name

Enter the date of the meeting

Indicate whether or not the meeting is a PPRT

Enter the names of individuals invited to attend to a Family Support

Team meeting

Enter the participant’s relationship to the family

Ask participants to read the confidentiality statement

Have participants sign the form across from their name signifying that they

are in attendance and they are in agreement with the confidentiality

statement

At the close of the Family Support Team Meeting, have participants check the

appropriate “yes” or “no” box to indicate whether they are in agreement with

the Written Service Agreement developed by the team

If they are not in agreement with the plan, document the nature of a

participant’s disagreement in the bottom section of the form

Document the date/time and location of the next meeting

Type of Meeting:

Check the box applicable for the type of Family Support Team Meeting

Reason for Removal:

Document the reason for removal and check if the Adoption and Safe Families Act was

discussed with the family.

Progress Notes Section:

Provide progress notes on the areas listed:

Child Education

Child Health/Mental Health

Parents’ Health/Mental Health

Special Needs of the Family (if applicable)

Diligent Search (absent parent, relatives, kin)

Resource Provider

Progress/Services/Treatment Needs Necessary to Achieve

Permanency

Compliance with Written Service Agreement

Visitation Recommendations:

Visitation recommendations completed as agreed upon by the Family Support Team

Permanency Plan / Concurrent Plan:

This section is to document the current permanency and concurrent plan for the child.

Recommendations:

Check the box applicable as agreed upon by the Family Support Team.

Residential Reauthorization Attachment:

The attachment provides the Family Support Team with information on the youth’s current

residential placement.

Discuss behaviors that lead to residential placement

Residential services in place and the frequency of services

Residential payment level and services associated with the payment level

The attachment is only required for youth in residential placement.

Number of Copies and Distribution:

At the close of the meeting provide copies of the form to participants who request it. A

copy should be provided to the parents. The original should go in the case record.

Instructions for Retention:

This form is to be maintained in the assessment and services section of the case record.

, CD13-75

Memoranda History: CD05-72,

CD10-17

FST-3 (8/13)

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