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Monthly Treatment Contract |
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Foster Parent Name |
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Child’s Name |
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Date |
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As a professional foster parent and integral member of the treatment team, you are required to report on the progress and/or limitation of your foster child on a monthly basis. |
1. Foster Parent Observation of Child’s:
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Overall Physical Well Being |
Very Good |
Good |
Fair |
Poor |
Comments |
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Hygiene |
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Sleeping Habits |
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Eating Habits |
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Special Allergies |
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Prescribed Medications |
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Medical/Dental Appt. |
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Overall Emotional Well-Being |
Very Good |
Good |
Fair |
Poor |
Comments |
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Level of Affect |
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Ability to share feelings |
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Ability to verbalize needs |
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Anger management |
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Overall Behavioral Well-Being |
Very Good |
Good |
Fair |
Poor |
Comments |
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Interaction with peers |
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Interaction with young kids |
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Interaction with older kids |
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Ability to follow limits |
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Accepts consequences |
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Attitude Toward Interaction with Family Members |
Very Good |
Good |
Fair |
Poor |
Comments |
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Attitude toward biological family |
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Adaptation to new home |
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Ability to get along with foster family members |
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Ability to adapt to rules and structure of home |
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1. Any additional comments regarding behavior or attitude of child after interaction with biological family members (i.e. phone calls, visitation). |
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2. Comment on any observation of the child’s strengths and skills. |
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3. List any deficits of limitations you may have observed in the child’s skills and/or interactions. |
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4. Summarize any communication from the child’s school to you (i.e. reports on conduct, assessment for further testing for learning disabilities). |
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5. Comment on any relevant medical or dental issues. |
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