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Massachusetts Department of Children and FamiliesYOUTH READINESS ASSESSMENT TOOLYouth’s Name:DOB:Person(s) Assisting Youth with Plan:Name:Review Date:Role:Name:Role:I. PERMANENCY AND LIFE LONG CONNECTIONS1. Family Members and Other Adults Who Have Committed to a Life Long Supportive Relationship with the Youth: [To include additionalnames, you can use the Permanency Addendum on the last page of this document]NameRelationshipContact InformationPlans/Efforts to SupportRelationship2. Describe the plan(s) to identify additional family members or adults to support the youth into adulthood:1.2.3.4.Doc. ID: XXXXXX1Issued 7/2013
II. EDUCATIONCurrent Educational Setting and Grade:Has current IEP?Secondary Education Goal:Expected Date of Completion:Post-Secondary Education Goal:Expected Date Of Completion:YesYesNot YetYesAttend school regularly and making progressPassed MCAS testsEngage in school-based activitiesEducational records/transcripts current688 Referral made for Adult Services, if appropriateAchieved high school diploma or GEDGoal:Date:Tasks to Achieve Goal:Who Will Assist?Goal:Date:Tasks to Achieve Goal:Who Will Assist?Date:Date Updated:Progress, New Tasks:Date Updated:Progress, New Tasks:Date Updated:Progress, New Tasks:Doc. ID: XXXXXXNot YetTasks to Achieve Goal:Who Will Assist?Goal:No2Issued 7/2013
III. POST-SECONDARY EDUCATIONYesNot YetYesExplore post-secondary educational optionsHave educational/vocational training planTake necessary tests and apply for admission tocollege/vocational training programResearch scholarshipsApply for scholarships/financial aid, complete theFAFSA (State Tuition & Fee Waiver, Education andTraining Voucher, Foster Child Grant, if eligible)Attend vocational training program or collegeregularly and making progressGoal:Tasks to Achieve Goal:Who Will Assist?Goal:Date:Tasks to Achieve Goal:Who Will Assist?Goal:Date:Tasks to Achieve Goal:Who Will Assist?Date:Date Updated:Progress, New Tasks:Date Updated:Progress, New Tasks:Date Updated:Progress, New Tasks:Doc. ID: XXXXXXNot Yet3Issued 7/2013
IV. EMPLOYMENTYesNot YetYesKnow my interests, skills, and abilities that could helpme find a job and enjoy my workReceived job readiness training [includinginterviewing tips & job maintenance strategies(time management, conflict resolution)]Know what services my local Career Center/Employment office offers and how to access thoseservicesHave completed job applications with contactinformation for references & previousemployersHave practiced interviewing for jobsHave an employment/career planWorking (part or full-time)Know how to write a resume & have a currentresumeUnderstand pay check deductionsUnderstand basic labor lawsGoal:Tasks to Achieve Goal:Who Will Assist?Goal:Date:Tasks to Achieve Goal:Who Will Assist?Goal:Date:Tasks to Achieve Goal:Who Will Assist?Date:Date Updated:Progress, New Tasks:Date Updated:Progress, New Tasks:Date Updated:Progress, New Tasks:Doc. ID: XXXXXXNot Yet4Issued 7/2013
V. PERSONAL CARE AND WELL-BEINGYesNot YetYesCan identify own strengthsKnow what I need help withHave identified own personal goalsHave a community support networkHave a healthy awareness of racial & ethnic identityUnderstand the risks of cigarettes, alcohol &drugsAvoid high risk behaviorsCan manage stress in healthy waysKnow where to get help for personal safety concerns:physical/emotional abuse, dating violence, etc.Know where & how to access mental healthservicesNot YetUnderstand how to use the internet safelyGoal:Tasks to Achieve Goal:Who Will Assist?Goal:Date:Tasks to Achieve Goal:Who Will Assist?Goal:Date:Tasks to Achieve Goal:Who Will Assist?Date:Date Updated:Progress, New Tasks:Date Updated:Progress, New Tasks:Date Updated:Progress, New Tasks:Doc. ID: XXXXXX5Issued 7/2013
VI. SEXUAL HEALTHYesNot YetYesKnow where to get support for any concernsregarding sexuality, sexual orientation, genderidentity/expressionUnderstand how to prevent sexuallytransmitted infections, including HIV, & knowthe local resources for testing, treatment, etc.Understand how to prevent pregnancy – abstinence& birth control options & how to access themUnderstand the implications of teenagepregnancyNot YetCan describe the qualities of a good parentGoal:Tasks to Achieve Goal:Who Will Assist?Goal:Date:Tasks to Achieve Goal:Who Will Assist?Goal:Date:Tasks to Achieve Goal:Who Will Assist?Date:Date Updated:Progress, New Tasks:Date Updated:Progress, New Tasks:Date Updated:Progress, New Tasks:Doc. ID: XXXXXX6Issued 7/2013
VII. HEALTH CAREYesNot YetYesKnow the names & contact information for owndoctor(s) and dentistKnow own medical history, includingimmunizationsHave own Mass Health card & know how to accesscoverage when Mass Health endsUnderstand purpose & dosage for prescribed& over-the-counter medicationsKnow which foods are nutritious & eat healthful foodsUnderstand the need for preventative healthcareKnow that exercise is important to health & is a goodstress relieverUnderstand what a Medical Proxy is & how toobtain one (youth 18 )Goal:Tasks to Achieve Goal:Who Will Assist?Goal:Date:Tasks to Achieve Goal:Who Will Assist?Goal:Date:Tasks to Achieve Goal:Who Will Assist?Date:Date Updated:Progress, New Tasks:Date Updated:Progress, New Tasks:Date Updated:Progress, New Tasks:Doc. ID: XXXXXXNot Yet7Issued 7/2013
VIII. MONEY MANAGEMENTYesNot YetYesUnderstand the value of money – necessities vs.luxuries & give examples of eachCan save money using coupons, comparinggeneric vs. brand name items, waiting for salesCan set up & follow a simple budget & follow asavings planResearch bank offers of savings accounts &open a savings accountUnderstand how to purchase & use money ordersResearch different types of checking accounts& open a checking accountCan demonstrate how to write checks, use a checkregister, balance a checking account & use onlinebankingUnderstand the importance of paying bills ontime (avoiding late fees & penalties)Understand the proper use of ATM/debit cards(avoiding overdraughts)Understand how loans work – interest rates,terms & conditionsUnderstand the importance of protecting personalinformation (Social Security number, credit cardnumber, bank account numbers and PIN numbers)Know how to establish good credit, avoidproblem debt & access personal credit reportKnow when to file a tax return & where to get freehelp to complete the formsSave money for post-DCF living expensesGoal:Tasks to Achieve Goal:Who Will Assist?Goal:Date:Tasks to Achieve Goal:Who Will Assist?Goal:Date:Tasks to Achieve Goal:Who Will Assist?Date:Date Updated:Progress, New Tasks:Date Updated:Progress, New Tasks:Date Updated:Progress, New Tasks:Doc. ID: XXXXXXNot Yet8Issued 7/2013
IX. FOOD/HOME MANAGEMENTYesNot YetYesKnow how to read nutrition labels on packaged foods(calories, percent of fat, protein, fiber)Can compare a grocery list & comparison shopto save moneyCan cook simple meals & follow recipesKnow how to wash/dry clothes – checking caredirections on fabricsKeep living space clean by using appropriatecleaning suppliesKnow how to perform basic householdmaintenance tasksUnderstand the function & importance of smoke andCO2 detectorsSave the needed household items prior toleaving careGoal:Tasks to Achieve Goal:Who Will Assist?Goal:Date:Tasks to Achieve Goal:Who Will Assist?Goal:Date:Tasks to Achieve Goal:Who Will Assist?Date:Date Updated:Progress, New Tasks:Date Updated:Progress, New Tasks:Date Updated:Progress, New Tasks:Doc. ID: XXXXXXNot Yet9Issued 7/2013
X. COMMUNITY LIVINGYesNot YetYesHave Social Security card and/or state identificationKnow where & when to get affordable legal aidKnow the resources of the community & what theyoffer (library, churches, YMCA, etc.)Participate in community recreationalactivities/sportsUse free time to better myselfPursue opportunities to make a differencethrough civic engagement/community serviceNot YetKnow when & where to register for Selective Service(males only)Goal:Tasks to Achieve Goal:Who Will Assist?Goal:Date:Tasks to Achieve Goal:Who Will Assist?Goal:Date:Tasks to Achieve Goal:Who Will Assist?Date:Date Updated:Progress, New Tasks:Date Updated:Progress, New Tasks:Date Updated:Progress, New Tasks:Doc. ID: XXXXXX10Issued 7/2013
XI. TRANSPORTATIONYesNot YetYesKnow how to read train & bus schedulesKnow how to use a map to find a destinationKnow how to use public transportationUnderstand how to obtain a driver’s permit &licenseCan estimate cost of car insurance, taxes &maintenanceUnderstand the consequences of motorvehicle violationsNot YetSave/budget for a car or other transportationexpensesGoal:Tasks to Achieve Goal:Who Will Assist?Goal:Date:Tasks to Achieve Goal:Who Will Assist?Goal:Date:Tasks to Achieve Goal:Who Will Assist?Date:Date Updated:Progress, New Tasks:Date Updated:Progress, New Tasks:Date Updated:Progress, New Tasks:Doc. ID: XXXXXX11Issued 7/2013
XII. HOUSINGYesNot YetYesResearch housing options & costsConsider roommate options – pros/consEstablish a budget for apartment, including start-upcosts of security deposit, first/last months’ rentUnderstand the costs of heat, telephone &other utilitiesUnderstand tenants rightsUnderstand how to read a leaseNot YetKnow where & how to apply for financial assistance(food stamps, subsidized housing, fuel assistance)Goal:Tasks to Achieve Goal:Who Will Assist?Goal:Date:Tasks to Achieve Goal:Who Will Assist?Goal:Date:Tasks to Achieve Goal:Who Will Assist?Date:Date Updated:Progress, New Tasks:Date Updated:Progress, New Tasks:Date Updated:Progress, New Tasks:Doc. ID: XXXXXX12Issued 7/2013
XIII. SUPPLEMENTAL QUESTIONSDo you have any questions or concerns that have not been addressed in this assessment?Do you have any problems or worries that you would like help with?SIGNATURESYouth:Date:Social Worker:Date:Outreach Worker:Date:Doc. ID: XXXXXX13Supervisor:Date:Issued 7/2013
TRANSITION PLAN CHECKLISTth[To be completed 90 days prior to youth’s 18 birthday or 90 days prior to a youngstadult’s discharge from DCF but no later than 90 days prior to youth’s 21 birthday]Planned Living Situation upon discharge:[Specify: return home; own apartment;apartment with roommate; etc.]Monthly Rent:Address:Email Address:Home Telephone: Cell Telephone:Family Member(s) and/or Caring Adult(s) I Can Rely on and Their Contact Information:Source of Monthly IncomeAmountPersonal Documents Provided to YouthEducationWorking full-time Original Birth CertificateHighest Grade CompletedWorking part-time Original Social Security CardMA Tuition & Fee WaiverSSDA/SSI/PNA Mass Health CardFinancial Aid Information SheetTANF Driver’s License/Mass IDFood stamps Immigration Documents (Green Card, A#, etc.)Inheritance, trust, settlement Educational Records & TranscriptSavings prior to discharge Medical & Immunization RecordsHealth Care ProxyPersonal Pictures/Letters (from Case Record)Updated Credit ReportDoc. ID: XXXXXX14Issued 7/2013
Resources available to youth upon discharge: (For example: Mass Rehab, MRVP housing voucher, DMH, Career Center, etc.)I have been informed and understand the DCF policy for young adults age 18 and older and know that I may request continued services beyond age 18ndand may return to DCF at any time prior to my 22 birthday to request voluntary services.I understand that a DCF staff person may contact me each year for the next 4 years to see how I am doing.I know that I can check the DCF website (mass.gov/dss) for information about services and supports.SIGNATURESYouth:Date:Social Worker:Date:Outreach Worker:Date:Doc. ID: XXXXXX15Supervisor:Date:Issued 7/2013
PERMANENCY ADDENDUMFamily Members and Other Adults Committed to Providing Support for Youth into Adulthood:NameDoc. ID: XXXXXXRelationshipContact Information16Plans/Efforts to SupportRelationshipIssued 7/2013
Resources available to youth upon discharge: (For example: Mass Rehab, MRVP housing voucher, DMH, Career Center, etc.) I have been informed and understand the DCF policy for young adults age 18 and older and
