State & Local Programs

CASA Effectiveness Manual Part 3

Tracking Forms
This section describes tracking forms to be filled out by CASA volunteers, supervisors and directors. The first pages briefly describe the purpose of the forms, who should fill it out, how often, and other basic instructions. Sample forms are then provided. All forms have been made as simple as possible and should take only a few minutes to fill out. Completion of these forms will allow programs to measure accomplishment of goals. Part 5 provides directions about how to use the information in reports.

CASA Volunteer Tracking Form

Purpose: To track child outcomes, processes and CASA volunteer activities.

Completed by: CASA Volunteers.

Frequency: Monthly, every 6 months.

Instructions: Most CASA programs have some type of monthly report forms filled out by volunteers. The sample volunteer tracking form provided may be used as the monthly report or modified to meet individual program needs. The same form is used for summarizing information every six months and may be helpful in preparing court reports.

Child Exit Form

Purpose: To track child outcomes and processes.

Completed by: CASA volunteers.

Frequency: When child(ren) is dismissed from court and/or CASA program.

Instructions: The Exit Form provides additional tracking information on children as they exit the system. It may also be used when children change CASA volunteers to help programs track the frequency that children are assigned a new CASA.

Supervisor’s Tracking Form

Purpose: To track child outcomes, processes and CASA volunteer activities.

Preparation: CASA supervisors.

Frequency: Monthly, semi-annually, annually.

Instructions: The Supervisor’s Tracking Form is filled out based on information from the CASA Volunteer Tracking Forms. It is used to tally information about children from the volunteers. The information from the Supervisor’s Tracking form is then used to fill out the Director’s Tracking Form.

Director’s Tracking Form

Purpose: To track child outcomes, processes and CASA volunteer activities.

Preparation: Program Director or assigned staff.

Frequency: Monthly, Semi-annually, Annually.

Instructions: The Director’s Tracking Form is used to tally the information from the Supervisor’s Tracking Form. Upon completion, this form will provide the agency with information on child outcomes, processes, and CASA activities that can be used for Annual Reports.

CASA Volunteer Tracking Form

Volunteer's name ____________________________________ Date _______

Supervisor _________________________________________________

Names of child(ren) and d.o.b. _______________ Case number(s)

________________________________________ _____________

________________________________________ _____________

________________________________________ _____________

Length of time in foster care system _______

Length of time you’ve been the CASA _______

Child welfare worker __________ GAL __________ Judge________
Has there been a change? o yes o no o yes o no o yes o no

Current placement of child(ren) (check one)

o own home
o with relative
o foster home
o group home
o adoptive home
o therapeutic foster home
o detention center
o shelter
o hospital
o residential facility
o independent living
o other ____________

Has there been a change in placement this month? o yes o no

If yes, from ___________________ to _________________ (from above list).

(placement) (placement)

Are siblings placed together? (only applies when siblings are also in care) o yes o no

Is child(ren) place in county of home listed as the permanent plan? o yes o no

Have there been any incidents of abuse/neglect during the month? o yes o no

Contacts Face to Face Phone Mail Time Spent Mileage
Child
Biological Parents
Foster Parents

                     

Relatives
Collaterals
Hearings
Supervisor
In-Services

Other time spent
(reports, travel, etc.)

Totals

Case Planning: (filled out every 6 months)

Was there a child welfare review during the past 6 months? o yes ________ o no
(date)

Was there a court review hearing during the past 6 months o yes o no

Was there a disposition hearing during the past 6 months? o yes _________ o no
(date)

Did judge make "reasonable efforts determination"? o yes o no

Were there court continuances? o yes ____________ o no
(how many)

Were services provided as specified in the last case plan? o yes o no o partially

Were significant parties present at the case planning? o yes o no o partially

Does case plan specify visitation? o yes o no

Has visitation been occurring as planned? o yes o no o partially

Does case plan specify a permanent plan? o yes o no

The permanent plan is: (circle)

reunification/reintegration
relative placement
adoption

long-term foster care
independent living
other

Do you agree with permanent plan? o yes o no
Did judge follow your recommendations? o yes o no o partially

Personal Notes:

(Describe a success you have had this month)

(Describe any obstacles you are encountering)

Child Exit Form

(Filled out by CASA when case is dismissed from CASA program or transferred to another CASA or had court closure)

CASA name _________________________________________________ Date _________

Names of child(ren) and d.o.b.
________________________________________________

________________________________________________

________________________________________________

________________________________________________

Case number(s) ___________________Length of time in foster care system __________

Date of court custody _______________Length of time you were the CASA ___________
(in months)

Total time child had a CASA_________________ (in months)
Has case been transferred to another CASA? o yes o no
Has court custody been dismissed? o yes o no

Reason for court dismissal

o permanency achieved
o death of child
o child turned 18
o adopted
o returned to family
o placed with legal guardians

How long was child(ren) in custody? ___________________________ (in months)

Placement at court/CASA dismissal (check one)

o own home
o with relative
o foster home
o group home
o adoptive home
o therapeutic foster home
o detention center
o shelter
o hospital
o residential facility
o independent living
o other____________

Has there been a recent change in placement? o yes o no

If yes, from __________________ to ____________________ (from above list).

(placement) (placement)

Are siblings placed together? (only applies when siblings are also in care) o yes o no

Is child(ren) placed within 30 miles of the home listed as the permanent plan? o yes o no

Have there been any confirmed findings of abuse/neglect during the month? o yes o no

If yes, explain.

Supervisor’s Tracking Form

Supervisor ________________________________________________________________

Number of active CASA volunteers  (you currently have assigned) ___________________________

Number of children being served (by CASAs you supervise) ________________________

Number of children in each type of placement:

____ own home
____ with relative
____ foster home
____ group home
____ adoptive home
____ therapeutic foster home
____ detention center
____ shelter
____ hospital
____ residential facility
____ independent living
____ other __________

Number of children who changed placements __________

Number moved to a:
more restrictive setting ________
same restrictive _______
less restrictive _____

Number of children placed with siblings __________ number not with siblings ____________

Number of children within 30 miles of the home specified as permanent plan ____________

Number of children not within 30 miles of the home specified as permanent plan ____________

Number of children experiencing abuse/neglect this month ____________

Number of court case closures this month ________

Reason for court case closures

o permanency achieved
o adopted
o returned to family
o placed with legal guardians
o other ____________________

Number of new CASA volunteers assigned this month _____________

Number of CASA volunteers dismissed this month _____________

Contacts Face to Face Phone Mail Time Spent Mileage
Child
Biological Parents
Foster Parents

                     

Relatives
Collaterals
Hearings
Supervisor
In-Services

Other time spent
(reports, travel, etc.)

Totals

Case Planning: (filled out every six months)

Number of children who had a child welfare agency review during the past 6 month period ______

Number of children who had a court review hearing in the past 6 months ______

Number of cases where judge made reasonable efforts determination ______

Number of cases where judge followed all or part of CASA volunteer's recommendations ______

Number of cases where services were provided as specified all or part services in the case plan ______

Number of cases where services were not provided as specified in the case plan ______

Number of cases where visitation is occurring as planned ______

Number of cases where visitation is not occurring as planned ______

Number of cases where significant parties were present at the case planning ______

Number of cases where the significant parties were not present at the case planning ______

Director’s Tracking Form

(To be filled out monthly from supervisor’s tracking forms)

Number of active CASA volunteers _________________ Number of children being served _________

Number and percent of children in each placement.

(Percent = number in each placement/total number of CASA children)

own home ____, ____%
with relative ____, ____%
foster home ____, ____%
group home ____, ____%
adoptive home ____, ____%
therapeutic foster home ____, ____%
detention center ____, ____%
shelter ____, ____%
hospital ____, ____%

residential facility ____, ____%
independent living ____, ____%
other ____, ____%

Moves:

Number of children who changed placements _______, _______% (Percent = number who changed/total number of CASA children)

Number who moved to a more restrictive setting _______, _______%

Less restrictive _______, _______% (Percent = number who moved to more or less restrictive/number who changed placements)

Number of children placed with siblings _______, _______%

Number not with siblings _______, _______%

Number of children within 30 miles of the home specified as permanent plan _____, _____% (Percent = number of children in county or permanent plan/total number of CASA children)

Number of children not within 30 miles of the home specified as permanent plan _____, _____%

Number of children experiencing abuse/neglect this month _______, _______% (Percent = number of children maltreated/total number of CASA children)

Dismissals:

Number of court closures this month ________

Reason for court closure

____, ____% permanency achieved
____, ____% adopted
____, ____% returned to family
____, ____% placed with legal guardians

Number of new CASA volunteers assigned this month ________

Number of CASA volunteers dismissed this month ________

Contacts Face to Face (average) Phone (average) Mail (average) Time Spent (average) Mileage
Child
Biological Parents
Foster Parents

                     

Relatives
Collaterals
Hearings
Supervisor
In-Services

Other time spent
(reports, travel, etc.)

Totals

Training:

Number of volunteers beginning initial training _______

Number completed training program and assigned a case _______

Percent completing training _______% (Percent = number completing/number beginning)

Volunteer retention rate: volunteers still active after

6 months _______ 12 months _______ 18 months _______ 24 months _______

Case Planning:

Number and percent of children who had at least one child welfare case plan review _______, _______%

Number and percent of children who had at least one court review hearing_______, _______%

Percent of cases where judge followed CASA recommendations _______%

Number and percent of cases where services were provided as specified on the case plan ______, _____%

Number and percent of cases where services were not provided as specified _______, _______%

Number and percent of cases where visitation is occurring as planned _______, _______%

Number and percent of cases where visitation is not occurring as planned _______, _______%

Number and percent of cases where significant parties were present at the case planning _______, _______%

Number and percent of cases where the significant parties were not present at the case planning _______, _______%

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