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NJ DCF Logo with reverse copy 

 

New Jersey Department of Children and Families Policy Manual

 

Manual:

CP&P

Child Protection & Permanency

Effective Date:

Volume:

X

Forms

Chapter:

A

Forms

 

2-5-2018

Subchapter:

1

Forms

Issuance:

4-10

CP&P Form 4-10, CP&P Kinship Caregiver Standards Agreement

 

 

Click here to view or print the CP&P Form 4-10.

Click here to view or print this form in Spanish, CP&P Form 4-10(S).

WHEN TO USE IT

Complete this form when determining whether a relative or family friend caregiver meets Presumptive Eligibility/compliance with the Kinship Caregiver Standards.  The Resource Family Support Worker (RFSW) completes this form when conducting the initial home visit with the Worker, before placing the child in the home.

HOW TO USE IT

The RFSW completes the entire form with the kinship caregiver(s).  The RFSW:

              Assesses compliance with the Kinship Caregiver Standards outlined in Part I by interviewing the kinship caregiver(s), other household members, and touring the home.

              Documents compliance with the agreement in Part II.

              Determines whether the kinship caregiver(s) is/are able and willing to provide care for a child based on the results of the assessment.

              Documents a corrective action plan in Part III, with the kinship caregiver(s), when necessary.

TIPS FOR COMPLETING THE FORM

The kinship caregiver(s), the RFSW, the Supervisor, the Casework Supervisor, and the LO Manager sign and date the form.

DISTRIBUTION

Original          -           Child's case record.

Copy               -           Kinship caregiver's case file.

Copy               -           Resource Family Support Unit