Form Dss-1797 - Inter-County Agreement On The Placement Of Children Page 2
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2____ Except in instances where placement disrupts, will not initiate placement planning for child
without prior agreement from Resident County. In the event emergency replacement is
made, the Supervising County will inform Resident County immediately.
____ Will not engage in a treatment or planning relationship with child’s parents and relatives,
except upon request of the Resident County.
____ Will take necessary measures to maintain the confidentiality of case situation.
____ Will submit a written evaluation of this child’s adjustment of foster care every
months to Resident County.
____ Other activities ____________________________________________________________
_________________________________________________________________________
The ResidentCounty retains responsibility for the child and will provide the following: (
)
if applicable
____ Documentation specific to the placement resource (Kinship Assessment, etc)
____ Communication regarding the status of the child and the placement resource (for example
if the conditions of the safety resource change)
____ Will make prompt plans for the removal of child from placement upon receipt of a written
request form the Supervising County, or the placement disrupts.
____ If the placement disrupts the following actions will be taken: Discussion surrounding who
files the petition, who picks the child up, etc
____ Should this child cause damage to the foster parents’ property restitution plan is as follows:
_______________________.
____ Keep the Supervising County appropriately informed concerning the future planning for
this child, through the use of Child and Family Team meetings.
____ Payment for clothing costs and other expenses (allowances) will be made in the following
manner:
_____
.
.
____ Payment of medical, physician, and hospital costs will be made as follow ________
___________________________________________________________________.
(Director of Resident County)
(Director of Supervising County)
1 Copy
-
Resident County Department of Social Services
2 Copies -
Supervising County Department of Social Services,
one of which is signed and returned to Resident County
1 Copy
-
Childrens Service Representative (CPR)
DSS-1797 (Rev. 09/07)
FSCWS
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