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Training/Technical Assistance & Best Practices

General Instructions For Completing the IFSP:

• You must use the TAB key to manuever from field to field.

• To save the file, you must click on FILE and then SAVE AS to save it to the directory of your choice. You will then need to go into Microsoft Word to complete the document.  Once you have finished, it will ask you to save it as a Word Document. You may give it your own name at this time.

• This form was created for purposes of filling it out electronically.  Printing it out and manually entering the information is not appropriate. However, the last page with the signatures MUST be manually filled out with original non-electronic signatures obtained.

Detailed Instructions:

A) Demographic Information:

• Client Name: First and last name of child/youth involved
• CSA ID No: Local CSA identification case number
• Date of FAPT: Date of current FAPT team meeting
• DOB: Date of birth for child/youth involved
• Age: Age of child/youth involved
• Sex: Sex of child/youth involved
• Race: Race of child/youth involved
• Parents/Legal Guardians: Names of current parents and or legal guardians
• Address: Current family address for child/youth and family
• Phone No: Phone number of current family address for child/youth and family
• Siblings: Siblings of child/youth involved
• Others Involved: Significant family and non-family members involved with child/youth

B) Referral Information:

• Initial Referral: yes or no
• If no, date of initial referral:  Indiate initial referral date to FAPT
• Reason for Referral to CSA: Briefly explain
• Referral Agency: Locality referral agency to FAPT
• Agency Case Manager: Locality Case Manager
• Phone Number: Phone number for locality Case Manager
• Email Address: Email address for locality Case Manager
• Does the Youth Receive Special Education Services: Indicate yes or no
• If yes, date of last IEP: If yes, indicate date of last IEP
• School Division Currently Attending: Indicate school division child/youth attending
• Grade: Grade level child/youth currently attends
• Last School LEA attended: Indicate the last school or local educational area the child/youth attended
• Disability: yes or no. If yes, explain
• Is Youth in Custody of DSS?: Indicate yes or no
• Basis for Custody: Check by the appropriate action
• Title IV- Funding: Indicate yes or no
• Has Youth has Criminal Charges: Indicate yes or no
• Current Court Involvement: Indicate yes or no
• Medicaid: Indicate yes or no
• FAMIS: Indicate yes or no
• Child Support: Indicate yes or no
• Parental Co-Pay: Indicate yes or no
• Other Insurance: Indicate yes or no
• Current Medications: List and describe Doctor’s name, medication type, dosage and frequency

C) Child and Family Strengths (Strengths related to Psychological/Behavioral/Emotional Functioning, Home Environment, School Environment and Legal-Custody Status):

• Describe:

D) Child and Family Needs (Needs related to Psychological/Behavioral/Emotional Functioning, Home Environment, School Environment and Legal-Custody Status):

• Describe:

E) Date of Last CAFAS and CAFAS SCORE:

• Indicate:

F) Goals:

• Child/youth and family long tem goal(s): Describe
• Child/youth and family current priority goa(s): Describe
• Youth desired outcomes, strategies/services, person/agency responsible, units/frequency and start/end dates: Describe
• Family desired outcomes, strategies/services, person/agency responsible, units/frequency and start/end dates: Describe
• The steps action on behalf of child/youth, family, providers and others involved to "step down" or discharge from the current IFSP plan: Describe

G) Mitigating Circumstances:

• Indicate: check system factors that apply from the checklist
• Describe: system factors that apply not on the checklist
• Indicate: check individual factors that apply from the checklist
• Describe: individual factors that apply not from the checklist

H) Level of Need (Score):

• Indicate Level of need score (LON)

I) Next Review Date:

• Indicate next FAPT review date and time

Signature Requirements:

• Signature: FAPT team members and comments
• Signature: Participant members and comments
• Signature: Parent or Legal Guardian indicates agreement or non-agreement with IFSP
• Signature: Locality CSA Coordinator

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