FOSTER / ADOPTIVE PARENT AGREEMENT (WEST VIRGINIA)

WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES

BUREAU FOR CHILDREN AND FAMILIES

DIVISION OF CHILDREN AND ADULT SERVICES

 

County______________________

FOSTER/ADOPTIVE PARENT AGREEMENT

 

      This Agreement made and entered into as of this         day of ,

by and between the West Virginia Department of Health and Human Resources, hereinafter referred to as the Department; and

                                                                      

(Names of Foster/Adoptive Parents)

 

                                                                                  

       (Street and Number (City) (County)     (State)                                   (Zip Code)

 

hereafter referred to as the Foster Parents,

 

 

WITNESSETH THAT:

 

Whereas, 49-2-16 provides that any child committed to the Department may at any time during the period of commitment be placed in a suitable foster home upon such conditions as the Department may prescribe and subject to visitation and supervision; and,

 

Whereas, the Foster Parents are available, willing and qualified to perform this function, and the Department desires that the Foster Parents perform this function;

 

NOW, THEREFORE, it is hereby and herewith mutually agreed by and between the parties hereto as follows:

 

1.         The Foster Parents agree:

 

a.             To accept any foster child(ren), mutually agreeable to the parties, that are referred by the Department into their home for foster care;

 

b.             To provide such child(ren) with a normal family life, including food, shelter, clothing, affection, training, recreation, education and opportunities for religious, spiritual, or ethical development.

 

c.             To assist the Department in its responsibilities for such child(ren) by permitting the Department’s social worker visits in their home and contacts privately with the child(ren) whenever requested.  It is understood that these visits will be planned to suit the foster parent’s convenience insofar as it is possible.

 

d.             To report immediately to the Department, if possible by telephone, any hospitalization, surgery, accident, serious illness, death, arrest or detention by a law enforcement agency of a foster child, or change of address, serious illness in the family, or other unanticipated event or incident that may have a severe impact on the child(ren).

 

e.             To notify the agency of any other significant change in the foster family structure or income.

 

f.             To participate in all required case planning, MDT’s, conferences and administrative reviews as a member of the service team to assist with the development and implementation of a treatment plan for services for the child(ren) and family.

 

g.             To cooperate with the Department in carrying out the Department’s plan for the child(ren), including any planned visit, reunification of a child to his parents, transfer to another foster home or institution, etc.

 

h.             To comply with the general supervision and directions of the Department concerning the care of the child(ren) and to cooperate in maintaining standards of child care and discipline, in accordance with the child welfare provisions of the Code of West Virginia.

 

i.             To notify the Department if the child needs hospitalization or surgery other than in an emergency situation - see paragraph 1d - or the child wishes to marry, apply for a driver’s license, or enter the Armed Forces.  It is understood that the Department, or in some instances, the parents, must be contacted for consent.

 

j.             To keep confidential all personal information concerning the foster child(ren) and his/her natural family.

 

k.             To not allow the child(ren) to be given to his parent(s) or anyone other than a representative of the Department, except when permission or authorization has been granted by the Department.

 

l.             To comply with reasonable visitation plans established by the Department.  The time for such visits shall be agreed upon by the child’s MDT, foster parent(s), the Department, the child and the child’s parent(s), or as otherwise established under court order.

 

m.             To notify and receive authorization from the Department in advance of any trips (other than routine) or vacations.  It is understood that the Department, or in some instances, the parent(s) written consent may be required for such trips or vacations.

 

n.             To discuss with the Department worker, and not with the parent(s), any complaints, problems, difficulties or suggestions concerning the foster child in an effort to resolve the issues and pressures of placement.

 

o.             To assist with necessary transportation such as medical appointments or treatments, counseling, educational, court hearings, MDT’s, reviews and family visits.

 

p.             To refrain from accepting money or other valuable items from parent(s) or a guardian with relation to the placement of their child in foster care.

 

q.             To assign to the Department all rights, title or interest for any support and maintenance monies from any person legally responsible for support and maintenance of any child placed in their care.  It is understood that this assignment shall terminate when the placement of each child is completed.

 

r.             To participate in a background check on all adult members living in the foster home as required by Department policy.  To notify the local Department within 24 hours of the charge and/or conviction of any member of the household of a misdemeanor or felony.  To report to the Department, as soon as possible, but not more than 5 days of the addition of any person over the age of 18 to their home, so that that person can receive a background check as required by Department policy.

 

s.             To obtain additional training of twelve (12) hours per year, either through Department sponsored programs or through agencies/professionals approved by the Department and to maintain current certification in CPR and First Aide.

 

t.             To ensure that the foster child(ren) in their care receives all necessary comprehensive health screens as required by Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program, known as HealthCheck.  In addition, it is further agreed that they will maintain records of all such screens and to ensure that the child(ren) is/are scheduled for and receive all necessary follow-up medical, dental, optical or psychological treatment as prescribed by screening provider.

 

u.             To provide all child(ren), who first enter care, with a life book or maintain the child(ren)’s life book as they move from one foster home to another foster home.

 

v.             To maintain the child(ren)’s Journey Placement Notebook, the monthly Out of Home Observation Reports and the Placement Wardrobe and Personal Item Inventory list. The monthly Out of Home Observation Reports and Placement Wardrobe and Personal Item Inventory will be provided to the child’s worker and a copy maintained in the Journey Placement Notebook.                   

 

w.             To adhere to the Department’s discipline policy as outlined in the Addendum to the Foster Parent Agreement.

 

  x.             To not discharge a child without an appropriate plan and living arrangement which have been agreed upon by the child=s multi-disciplinary treatment team. Unless the child displays behaviors which cannot be treated safely and effectively and the child requires a higher level of care. In the event of an emergency discharge the foster parents will give the Department ten (10) days notice, so an appropriate placement may be located.

 

2.         The Department Agrees:

 

a.             To provide such foster child(ren) with medical care and comprehensive health screens using the EPSDT Program, known as HealthCheck and Medicaid in accordance with the policies of the Department.

 

b.             To provide a Department worker to visit, counsel and supervise the care of the child(ren).

 

c.             To offer counseling and supportive services to the Foster Parent(s) in relation to the foster child(ren).

 

d.             To cooperate with the Foster Parent(s) in arranging for specialized services for the foster child(ren) such as special education, psychological services, etc., recommended by sources such as EPSDT providers, education specialists, etc., and approved by the Department.

 

e.             To reimburse the Foster Parent(s) in accordance with the rates in the following Rate Schedule.  In addition, the Department agrees to reimburse the Foster Parent(s) for additional necessary expenses in accordance with the policies of the Department as set forth in the Department’s Social Service Manual.  All payments shall be made upon receipt of appropriate billing.

 

 

               Rates:(per child)

               Age            Total Monthly       Amount Used               Amount Used

               Of             Boarding Care       For Clothing               For Child’s     

               Child          Per Child           Per Month               Personal Use

              

               0-5            $600.00             $90.00             0

               6-10           $600.00             $90.00               $10-$15.00

               11-21          $600.00             $90.00               $20-$25.00

 

3.         It is expressly understood by the parties to this agreement:

 

a.             That legal custody of the child(ren) shall at all times remain with the Department.

 

b.             That the Department shall have the responsibility for planning for the child(ren)’s future placement, and that the Foster Parent(s) shall not make independent plans for future placements.

 

c.             That the duties and responsibilities of the Foster Parent(s) under this agreement are not assignable or transferable to anyone under any circumstances.

 

d.             That failure of the Foster Parent to comply with the terms of this agreement may result in the removal of the foster child(ren) from the home and denial of future participation in the program or such other corrective action as the Department may deem necessary.

 

e.             That the Foster Parent(s) hereby certify that they have read the foregoing agreement or that it has been read and explained to them and that they understand and agree to its provisions.

 

 

 

RECOMMENDED BY:                               FOSTER/PERMANENCY PARENTS:

 

 

                                                                      

DHHR/Child’s Worker                   Date    Foster/Adoptive Father                Date  

 

 

 

                                                                      

Authorized Official, DHHR             Date    Foster/Adoptive Mother                Date

 

ADDENDUM (A) TO THE FOSTER/ADOPTIVE PARENT AGREEMENT

 

DISCIPLINE POLICY