MISSOURI DEPARTMENT OF SOCIAL SERVICES CHILDREN’S DIVISION 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.
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
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:
TYPE OF MEETING:
24 Hour 30 Day 60 Day 90 Day 6 Month/PPRT Review Progress Placement Change Goal Change Revise Service Agreement At the parent’s request
Other:
PURPOSE OF MEETING	GROUND RULES
Assessing safety of the child	Be respectful of each other
Determine if the child can be reunited	One person speaks at a time
Discuss case goal and need for permanency	Focus on the purpose
Determine service and treatment needs	Everyone has a chance to speak and be heard
Review placement options and appropriateness	It is ok to disagree
Develop/Review/Revise case plan	Speak to each other, not about each other
Evaluate case progress	Encourage honesty without blaming or shaming
Review of services needed/in place	No idea is a bad idea
Develop/Review visitation plan	Ideas should not be judged
Adoption and Safe Families Act discussed.
Indian Child Welfare Act
Does the child have Indian Ancestry? Yes No
Reason for Removal/Identified Threats of Danger:
SUMMARY OF PROGRESS
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 Update:
Progress/Services/Treatment Needs Necessary to Achieve Permanency:
Written Service Agreement:
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
PERMANENCY PLAN:
Reunification Adoption Guardianship Placement with Fit and Willing Relative Another Planned Permanent Living Arrangement
CONCURRENT PLAN:
Adoption Guardianship Placement with Fit and Willing Relative Another Planned Permanent Living Arrangement
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

RESIDENTIAL REAUTHORIZATION ATTACHMENT
REASON FOR RESIDENTIAL PLACEMENT (List specific behaviors that lead to residential placement):
LIST SPECIFIC SERVICES IN PLACE:
SERVICE	FREQUENCY (weekly, bi-weekly, monthly)
Individual Therapy
Family Therapy
Group Therapy – List specific group participation:
Art Therapy
Substance Abuse Treatment
Sexual Offender Services
Other
The FST should be choosing the services/therapies the child is involved in to ensure they are directly relating to the problem/reason for referral.
Are the services in place still necessary to address the problem/reason for referral? Yes No
RFA Payment Level
Level II Level III Level IV Level IV+
Is the child receiving the correct amount of services for the payment level? Yes No Level II – services one time per week Level III – services six times per month Level IV – services twice per week
CSPI score:
Rehab Begin Date in FACES: