Get Involved ›
Volunteer
Careers
Walk in counseling
Pay Bill
Forms
Contact Us
MENU
About Us
Our Mission
Our Story
Leadership
Partners
Publications
Get Involved
Contact Us
What We Do
In-Home Counseling
Outpatient Clinic
School-Based Health Centers
Early Care and Education
Education & Resources
Privacy Practices
Forms
News & Events
Press Releases
Agency News
Auxiliary News
Event Calendar
Photo Gallery
Get Involved
Calendar
Privacy Practices
Pay Bill
Forms
Contact Us
Donate
Give By Check
Give Online
Planned Giving
Reunification and Therapeutic Family Time Plan
RTFT Plan
REUNIFICATION AND THERAPEUTIC FAMILY TIME PLAN
Name of Parent/Guardian
*
First
Last
Name of Child
*
First
Last
Are there other children?
Yes
No
Name of Child (2)
First
Last
Name of Child (3)
First
Last
Name of Child (4)
First
Last
Date of Referral
*
Date Format: MM slash DD slash YYYY
Date of Initial Meeting
*
Date Format: MM slash DD slash YYYY
Names of Attendees
*
Current Contact
Is phone communication currently occurring?
*
Yes
No
If yes, with whom?
*
Is written correspondence occurring?
*
Yes
No
If yes, with whom?
*
Therapeutic Family Time Schedule, location and transportation arrangements:
*
Risk concern(s) and plans to address any identified concerns:
*
Is there anyone who may not have contact with the child(ren) and why?
*
Who will participate in Therapeutic Family Time?
*
Name of contact person for rescheduling visits
First
Last
Phone number of contact person for rescheduling visits
*
Rescheduling procedures
*
Scheduling barriers to consider?
*
Special conditions affecting Therapeutic Family Time?
*
(e.g., health, court orders, cultural issues, etc).
Parent/Guardian signature (1)
*
Parent/Guardian signature (2)
Resource parent signature
DCF SW signature
RTFT worker signature
*
Today's date
*
Date Format: MM slash DD slash YYYY
Donate Now