MISSOURI DEPARTMENT OF SOCIAL SERVICES CHILDREN’S DIVISION 72 HOUR FAMILY SUPPORT TEAM MEETING
Family Name:	Date:
CONFIDENTIALITY STATEMENT: We the undersigned are participants in the FSTM for the
family. We understand we have the family’s permission to share information here today that will help the family meet their goals. We also understand and agree to keep this information confidential pursuant to the confidentiality laws and policies of the State of Missouri. This form should be signed by all participants at the beginning of the meeting. At the conclusion of the meeting, participants should indicate whether or not they agree with the plan by checking yes or no in the appropriate box. Per Children’s Division policy 6.7.8, a request for review of the FST decision may be made if requester provides specific examples of perceived bias or procedural error per FST policy 4.7.2.
Participant Invited	Relationship to Family	*Agree with Plan?	Signature Signifying Attendance and Agreement with Confidentiality Statement
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
*If indicated do not agree with the case plan, specifically state the nature of disagreement:
Participant’s Name	Nature of Disagreement
Date/Time of Next Meeting	Location of Next Meeting

Family Name:	Date:
Adoption and Safe Families Act Explained
Indian Child Welfare Act
Does the child have Indian Ancestry? Yes No
Reason for Removal/Identified Threats of Danger:
PROGRESS NOTES:
Child Education:
Child Health/Mental Health/Child Vulnerability:
Parents’ Health/Mental Health/Caregiver Protective Capacity:
Special Needs of the Family (if applicable):
Diligent Search (absent parent, relatives, kin):
Resource Provider:
Normalcy Activities
Services/Treatment Needs:
Review of Court Orders:
VISITATION RECOMMENDATIONS:
Who Will Visit	Supervised Yes/No	If Supervised by Whom	Frequency/Duration/Location
Parent 1	Yes No
Parent 2	Yes No
Sibling	Yes No
Other:	Yes No
RECOMMENDATIONS:
The child will remain in alternative care with the following provider:
The child will return home on a Trial Home Visit with Mother / Father / Other
An Intensive In-Home Services (IIS) referral will be made.
Task	Who will do task?	Timeframe