Form M-10D Form M-10D Long Term Foster Care Foster Parent Checklist

Updated: 02/25/2020					OMB 0970-#### [valid through MM/DD/YYYY]
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to allow ORR Monitoring Team staff to ensure that programs are meeting ORR policies and procedures related to the maintenance of personnel files during biennial site visits. Public reporting burden for this collection of information is estimated to average 1.0 hour per response (if the site visit is performed by a contractor monitor), including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a mandatory collection of information (Homeland Security Act, 6 U.S.C. 279). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of information please contact [email protected].
LTFC Foster Parent Checklist
Program:
Name of Foster Parent(s):
Date Foster Parent(s) started with program:
Reviewer:
Date of Review:
General Documentation:	In file? Y/N	Date, if applicable	Notes
Resume (Effective: 04/15/17)
Foster Parent Application (to include asking about past work and volunteer experiences)
Personal References (at least one) (Effective: 1/14/19)
Professional References (Effective: 04/15/17)
Educational records/diploma (Effective: 04/15/17)
Criteria for the employee's selection, hiring, suspension, or termination (Effective: 04/15/17)
Results of medical exam (as required by State licensing, including results of TB tests and immunization records) (Effective: 04/15/17)
Child Abuse Mandated Reporter Agreement (signed)
Confidentiality Policy Acknowledgement (Effective: 04/15/17)
Foster Home License (not required to be in file, program should provide if requested)
Annual Performance Review (signed, with foster parent's written comments, must incl. questions about any prior misconduct since last background investigation)
Prevent and Report Sexual Abuse and Harassment (signed by applicant (foster parents licensed since Feb. 2019), acknowledging receipt; Effective: 01/14/19)
Fraud Scheme Acknowledgement (signed; Fraud Scheme training document signed by foster parent is acceptable)
Background Investigation Documentation:	In file? Y/N	Initial Clearance Date	Notes	Updated Clearance Date	Notes
FBI fingerprint check of national and state criminal history repositories (Documentation of the review and conclusion. Completed prior to obtaining license)
CPS check (child abuse and neglect record check) with the foster parent's State(s) of U.S. residence for the last 5 years (Documentation of the review and conclusion. Completed Completed prior to obtaining license)
Background Investigation updates at a minimum of every 5 years of the foster parent's start date or last background investigation update. (Documentation of the review and conclusion)
Driver's Record and Clearance (If transporting children and youth. Effective: 04/15/17)
Efforts to ask applicants about previous misconduct and employee's response (Effective: 02/22/15)
Efforts to contact past employers where applicant had access to children and youth, including asking about any substantiated allegations of sexual abuse and sexual harassment (Effective: 02/22/15)
Pre-Service Trainings (Before the employee has access to UAC in care)	In file? Y/N	Date	Notes (i.e. #hours obtained, topic title if different from ORR, etc.)
ORR Standards to Prevent, Detect, and Respond to SA and SH involving UAC. New employees must complete training before hire.(Effective: 02/22/15)
State license required trainings (Foster Parents - 30 hours of MAPP training or equivalent foster parent training curriculum. Effective: 4/15/17)
Pre-Service trainings include date, number of hours, subject-matter, a confirmation that the employee understood each training, and the name of the individual and/or entity providing the training (Spot check. Effective: 04/15/17)
Annual Trainings	In file? Y/N	Current Date	Notes (i.e. #hours obtained, topic title if different from ORR, etc.)	Previous FYs Date	Hours: length of the class Topic: Some programs title the training difernet from what ORR has in policy Notes (i.e. #hours obtained, topic title if different from ORR, etc.) (Hover for additional comments)
40 hours per year (Effective: 4/15/17)
Flores Settlement Agreement, HSA 2002, TVPRA 2008, and Perez-Olano (2 hours per year. Effective: 4/15/17)
ORR Policies and Procedures (10 hours per year. Effective: 4/15/17)
ORR-provided refresher training about avoiding inappropriate relationships and reporting sexual abuse and sexual harassment (Every six months. Effective: 1/14/19; Currently not a requirement until further notice)
ORR Standards to Prevent, Detect, and Respond to SA and SH involving UAC (per training list under 4.3.6)
State licensing requirements (Foster Parents. Effective: 04/15/17)
Administrator: How does the employee confirm comprehension of a training? i.e. quiz/test score or signature confirming comprehension Annual trainings include date, number of hours, and topic area, a confirmation that the employee understood each training, and the name of the individual and/or entity providing the training (spot check. Effective: 04/15/17) (Hover for additional comments)
Trainings Every Two Years Per Cooperative Agreement	In file? Y/N	Current Date	Notes (i.e. hours obtained, topic title if different from ORR, etc.)	Date of completion for at least two complete training years, if applicable. Previous FYs Date (Hover for additional comments)	Notes (i.e. hours obtained, topic title if different from ORR, etc.)
Safe and Timely Release Process (Effective: 4/15/17)
Cultural Competency, including awareness of and sensitivity to different cultural backgrounds (Effective: 4/15/17)
Prohibition against providing legal advice or counsel (Effective: 4/15/17)
Strengths-based behavior management approaches, such as using conflict resolution, problem solving skills, using rewards and consequences, de-escalation techniques and helping children and youth learn accoutnability and self-control (Effective: 4/15/17)
Crisis/intervention procedures and techniques (Effective: 4/15/17)
Immigration and child welfare systems (local, national, international) (Effective: 4/15/17)
Child development theory (Effective: 4/15/17)
Issues related to loss and family separation (Effective: 4/15/17)
Common health and mental health issues (Effective: 4/15/17)
First aid and CPR (Effective: 4/15/17)
Infection control procedures and OSHA or equivalent course that covers blood bourne pathogens, airborne pathogens, and employee safety (Effective: 4/15/17)
Working with victims of human trafficking and other crimes (Effective: 4/15/17)
Mandatory child abuse and neglect reporting requirements: prevention, signs, and reporting (Effective: 4/15/17)
Professional boundaries (Effective: 4/15/17)
Emergency disaster preparedness (Effective: 4/15/17)
Prohibition against conflicts of interest (Effective: 4/15/17)
Grievance policies and procedures (Effective: 4/15/17)
Incident Reporting (Effective: 4/15/17)
Medication Management (Foster parents who dispense medications)
Child-friendly and trauma informed interviewing, assessment, observation, and identification of suspected victims of human trafficking and children who have been smuggled into the country (Foster Parents)
Administrator: How does the employee confirm comprehension of a training? i.e. quiz/test score or signature confirming comprehension Trainings include date, number of hours, and topic area, a confirmation that the employee understood each training; and the name of the individual and/or entity providing the training (spot check; Effective: 04/15/17) (Hover for additional comments)
COMMENTS