Independent Living Program - Florida's Center for Child Welfare

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Complete the white cells below and in the sample tables. For more than thirty children in a sample, start a new file.Provider Name: Provider City: Contract Number: Service Description: Independent LivingCOU Team Member: Site Visit Date: Assigned COU: Below enter the actual date of the record review, or enter the last date of the review period.This date will be used to calculate children's ages and the length of time since removal.Pre IL (Age 13-14) Sample 1-5 Child 1 Child 2 Child 3 Child 4 Child 5Child Last Name, First InitialChild Record NumberChild Date of BirthChild Most Recent Date of Entry into Licensed CareCalculated: Child's Age in Years #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!Calculated: Child's Age in Months #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!Child's Age at Time of Review #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!Calculated: Child's Age in Years - Time of Removal 0 0 0 0 0Calculated: Child's Age in Months - Time of Removal 0 0 0 0 0Child's Age at Time of Removal 0 yrs 0 mths 0 yrs 0 mths 0 yrs 0 mths 0 yrs 0 mths 0 yrs 0 mthsCalculated Date: 30 Days Prior to 13th Birthday 12/1/1912 12/1/1912 12/1/1912 12/1/1912 12/1/1912Calculated Date: 30 Days After Removal 1/30/1900 1/30/1900 1/30/1900 1/30/1900 1/30/1900Due Date of IL Referral 12/1/1912 12/1/1912 12/1/1912 12/1/1912 12/1/1912Calculated Date: 30 Days After 13th Birthday 1/30/1913 1/30/1913 1/30/1913 1/30/1913 1/30/1913Calculated Date: 60 Days After Removal 2/29/1900 2/29/1900 2/29/1900 2/29/1900 2/29/1900Due Date of Assessment 1/30/1913 1/30/1913 1/30/1913 1/30/1913 1/30/1913
Pre IL (Age 13-14) Sample 6-10 Child 6 Child 7 Child 8 Child 9 Child 10Child Last Name, First InitialChild Record NumberChild Date of BirthChild Most Recent Date of Entry into Licensed CareCalculated: Child's Age in Years #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!Calculated: Child's Age in Months #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!Child's Age at Time of Review #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!Calculated: Child's Age in Years - Time of Removal 0 0 0 0 0Calculated: Child's Age in Months - Time of Removal 0 0 0 0 0Child's Age at Time of Removal 0 yrs 0 mths 0 yrs 0 mths 0 yrs 0 mths 0 yrs 0 mths 0 yrs 0 mthsCalculated Date: 30 Days Prior to 13th Birthday 12/1/1912 12/1/1912 12/1/1912 12/1/1912 12/1/1912Calculated Date: 30 Days After Removal 1/30/1900 1/30/1900 1/30/1900 1/30/1900 1/30/1900Due Date of IL Referral 12/1/1912 12/1/1912 12/1/1912 12/1/1912 12/1/1912Calculated Date: 30 Days After 13th Birthday 1/30/1913 1/30/1913 1/30/1913 1/30/1913 1/30/1913Calculated Date: 60 Days After Removal 2/29/1900 2/29/1900 2/29/1900 2/29/1900 2/29/1900Due Date of Assessment 1/30/1913 1/30/1913 1/30/1913 1/30/1913 1/30/1913Pre IL (Age 13-14) Sample 11-15 Child 11 Child 12 Child 13 Child 14 Child 15Child Last Name, First InitialChild Record NumberChild Date of BirthChild Most Recent Date of Entry into Licensed CareCalculated: Child's Age in Years #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!Calculated: Child's Age in Months #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!Child's Age at Time of Review #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!Calculated: Child's Age in Years - Time of Removal 0 0 0 0 0Calculated: Child's Age in Months - Time of Removal 0 0 0 0 0Child's Age at Time of Removal 0 yrs 0 mths 0 yrs 0 mths 0 yrs 0 mths 0 yrs 0 mths 0 yrs 0 mthsCalculated Date: 30 Days Prior to 13th Birthday 12/1/1912 12/1/1912 12/1/1912 12/1/1912 12/1/1912Calculated Date: 30 Days After Removal 1/30/1900 1/30/1900 1/30/1900 1/30/1900 1/30/1900Due Date of IL Referral 12/1/1912 12/1/1912 12/1/1912 12/1/1912 12/1/1912
Page 1 and 2: 2010IndependentLiving ProgramA Guid
Page 3 and 4: Chapter 01Resource List
Page 5 and 6: FormsForms are available online at:
Page 7 and 8: StatewideChapter 02IndependentLivin
Page 9 and 10: State of Florida Independent Living
Page 24 and 25: Windows into PracticeThe Regional Q
Page 26 and 27: CBC IN-DEPTH REVIEW: SYSTEMIC FACTO
Page 28 and 29: Independent Living Quality Assuranc
Page 30 and 31: Quality of Practice StandardsIndepe
Page 32 and 33: Quality of Practice StandardsIndepe
Page 34 and 35: Quality of Practice StandardsOngoin
Page 36 and 37: Quality of Practice Standardscase p
Page 38 and 39: Independent Living Case SpecificInt
Page 40 and 41: Home - Quality AssuranceCenter Home
Page 42 and 43: This page intentionally left blank
Page 46 and 47: Calculated Date: 30 Days After 13th
Page 48 and 49: 2009-2010 Life Skills (Age 15-17) M
Page 50 and 51: 2009-2010 Life Skills (Age 15-17) M
Page 52 and 53: Complete the white cells below and
Page 54 and 55: Date of six months prior to 18th bi
Page 58 and 59: Calculated: Child's Age in Years #V
Page 60 and 61: 2009-2010 Road to Independence (18-
Page 68 and 69: Youth Date of BirthCalculated: Yout
Page 70 and 71: FEBRUARY 2005 REPORT NO. 2005 - 119
Page 78 and 79: Exhibit 2Schedule of Budgeted Expen
Page 93 and 94: MEMORANDUMDATE: March 30, 2010PHONE
Page 95 and 96:
certificate and is admitted for ful
Page 97 and 98:
Progress Report Report No. 10-30•
Page 99 and 100:
Progress Report Report No. 10-30you
Page 101 and 102:
Progress Report Report No. 10-30DCF
Page 103 and 104:
The Florida LegislatureOffice of Pr
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IndependentChapter 06Living Spendin
Page 107 and 108:
PLAN FOR IMPLEMENTATION OF SERVICES
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PLAN FOR IMPLEMENTATION OF SERVICES
Page 112 and 113:
This page intentionally left blank
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2009 INDEPENDENT LIVING SERVICESADV
Page 117 and 118:
(c) Members of the advisory council
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Department Response: The Department
Page 121 and 122:
ecommendation by providing the high
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Require the Medicaid Reform countie
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Subgroup to ensure Florida’s comp
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IndependentChapter 08Living Redesig
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Planning for transition and self su
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3. Guardianship Assistance: for you
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All young adults who exit state cus
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Support Services: Young adults who
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Florida currently makes significant
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Estimated AnnualTitle IV-Revenue $1
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Costs based on these assumptions be
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Programs FY 2010 FY 2011 FY 2012 FY
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George Sheldon, SecretaryDon Winste
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Service delivery must be driven by
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National YouthChapter 09in Transiti
Page 151 and 152:
2) Youth Piece - The second compone
Page 153:
Florida SafeChapter 10Families Netw
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Independent Living Program - Florida's Center for Child Welfare

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