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

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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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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