GEORGIA DIVISION OF FAMILY AND CHILDREN SERVICES CHILD WELFARE POLICY MANUAL
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GEORGIA DIVISION OF FAMILY AND CHILDREN SERVICES
CHILD WELFARE POLICY MANUAL
Chapter: (13) Independent Living Program
Effective
Policy July 2021
Transition from Foster Care Date:
Title:
Policy Previous
13.4 N/A
Number: Policy #:
CODES/REFERENCES
O.C.G.A. § 15-11-201 DFCS Case Plan; Contents
O.C.G.A. § 29-4-3 Order of Preference in Selection of Guardians; Written Request
Nominating Guardian; Requirements of Writing
O.C.G.A. § 29-4-10 Petition for Appointment of Guardian; Requirements for Petition
O.C.G.A. § 49-5-8 Powers and Duties of Department
O.C.G.A. § 49-5-41 Persons and Agencies Permitted Access to Records
Fostering Connections to Success and Increasing Adoptions Act of 2008, P.L. 110-351
John H. Chafee Foster Care Program for Successful Transition to Adulthood (Foster
Care Independence Act of 1999) P.L. 106-169
42 U.S.C § 677
Code of Federal Regulations (CFR) §1356
Family First Prevention Services Act of 2018
Title IV-E of the Social Security Act Section 475(1)(D), 475(5)(D), 475(5)(H) and
475(5)(I)
REQUIREMENTS
The Division of Family and Children Services (DFCS) shall:
1. Ensure the Social Services Case Manager (SSCM), and as appropriate, other
representatives of the youth, provide assistance and support to youth in foster care
in developing a Transition Plan that is personalized at the direction of the youth
that supports the youth in attaining successful adulthood.
2. Utilize the Transition Meeting (TM) to:
a. Develop the Transition Plan within 30 calendar days of the youth’s 16th birthday;
b. Review the Transition Plan every six months thereafter;
c. Finalize the Transition Plan within the 90-day period immediately prior to the
youth’s 18th birthday and their eventual exit after age 18 if they participate in
extended foster care (EFC); and
d. Complete the Scattered Site Placement Readiness Assessment for Participant
in Extended Foster Care to determine the prospective youth’s readiness for an
Independent Living Placement within 90 days prior to the youth’s 18th birthday.
3. Ensure the Transition Plan includes:
a. Housing Options
b. Education
c. Workforce Supports and Employment Services
d. Money Management and Finances
e. Credit Report
f. Transportation
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Transition from Foster Careg. Essential Documents (see Forms and Tools: Foster Care Exit Documents
Checklist)
h. Health (Physical, Mental, Dental and Sexual Health if appropriate)
i. Health Insurance
j. Information about the importance of designating another individual to make
health care decisions on behalf of the youth, if the youth becomes unable to
participate in such decisions and the youth does not have or does not want a
relative who would otherwise be authorized under state/tribal law to make such
decisions and provides the youth options to execute a health care power of
attorney, health care proxy, or the Georgia Advanced Health Care Directive
(GADHC); and is as detailed as the youth elects.
NOTE: Georgia has opted out of the IV-E kinship guardianship program.
k. Permanency and Supportive Relationships
l. Personal Growth and Social Development
m. Life Skills
n. Local Opportunities for Mentors and Continuing Support Services
o. Parenting and Family Planning
p. Immigration Needs
4. Include the following individuals/entities in the TM based on the youth’s
individualized circumstances:
a. Youth
b. Youth’s family (parents/kin)
c. Youth supports (at least two individuals selected by the youth)
d. Current placement resource
e. Child Placing Agency (CPA)/Child Caring Institution (CCI) staff, if the youth is
placed with a CPA/CCI
f. Psychiatric Residential Treatment Facility (PRTF) staff, if the youth is in a PRTF
g. Regional Independent Living Program Specialist (ILS)
h. Education Programming, Assessment and Consultation (EPAC)
i. Youth’s School Counselor/Social Worker
j. Youth’s Therapist
k. Probation Officer (if Applicable)
l. Amerigroup Care Coordinator
m. Guardian Ad Litem (GAL)/Court Appointed Special Advocate (CASA)
n. The following additional individuals/entities for youth that may be unable to
make decisions on their own behalf:
i. Special Assistant Attorney General (SAAG)
ii. Regional Treatment Field Program Specialist (FPS)
iii. Care Coordination Team Unit (CCTU)
iv. Well-Being Programming Assessment and Consultation (WPAC)
v. Division of Aging Services/Adult Protective Services/ (DAS/APS)
vi. Department of Behavior Health and Developmental Disabilities (DBHDD)
5. Engage DBHDD prior to the initial and subsequent TM regarding any evaluation
and services needed for youth with suspected or diagnosed developmental
disabilities to support their transition to adulthood.
6. Engage DAS/APS prior to the initial and subsequent TM if the youth has complex
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Transition from Foster Careneeds to discuss how they can help in determining future needs of the youth and
possible options for services available to adults (see Practice Guidance:
Collaboration with Division of Aging Services).
7. For youth that may be unable to make decisions on their own behalf:
a. Determine by the youth’s 17th birthday in conjunction with the appropriate
transition planning team whether:
i. The youth will need ongoing support, the community supports and the
least restrictive decision-making alternatives for that could be available to
meet the youth’s needs.
ii. The youth may qualify under the law for the appointment of a guardian in
Probate Court if the least restrictive alternatives are not appropriate to
meet the needs of the youth when they turn 18.
NOTE: If the youth entered care after age 17, ensure the decision is made as
soon as possible after their entry into care.
b. Consult with the Special Assistant Attorney General (SAAG) regarding:
i. The least restrictive alternatives to meet the youth’s needs.
ii. Whether the youth may qualify for adult guardianship through Probate
Court;
iii. The filing of the petition for adult guardianship with the Probate Court
within six months prior to the youth turning age 18 if it is determined adult
guardianship is the best option for the youth.
8. Apply for Supplemental Security Income (SSI) for the youth if not already
completed to ensure continuity of services into adulthood (see policy 9.3 Eligibility:
Applying for Initial Funding).
NOTE: The SSI application approval generally takes several months, therefore
early planning and action is essential.
9. Monitor youth’s progress on their Transition Plan during monthly purposeful and
collateral contacts.
10. Conduct a Foster Care Exit Meeting when youth in foster care turns 18, to:
a. Provide them with the required documents outlined in the Foster Care Exit
Documents Checklist.
b. Obtain their signature on the Voluntary Placement Agreement for Extended
Foster Care (VPA-EFC) if the youth has agreed to participate in EFC. The VPA-
EFC must be signed by the youth within five business days after their 18th
birthday.
NOTE: If the youth has been determined to be otherwise unable to make
decisions on their own behalf, someone authorized or appointed on their behalf
will need to sign the VPA-EFC.
c. If they youth is opting out of EFC, obtain the youth’s signature on the Notice to
Opt-Out or Terminate Extended Foster Care.
11. Provide the following documents to each youth leaving foster care at 18 years of
age or older who has been in foster care for at least six months:
a. Official documentation that proves that the youth was previously in foster care;
b. Official or certified copy of their United States birth certificate;
c. Social security card issued by the Commissioner of the Social Security
Administration;
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Transition from Foster Cared. Education records;
e. Health insurance information;
f. A copy of his/her medical records; and
g. Driver’s license or state identification card issued in accordance with the
requirements of section 202 of the REAL ID Act of 2005 (see policy 13.8
Independent Living Program: Driver Education, Licensure and State
Identification).
NOTE: Youth shall be provided with their health and education records at no cost
at the time they leave foster care (regardless of how long they were in foster care),
if they are leaving foster care because of having attained the age of majority under
State law.
12. Adhere to confidentiality and the Health Insurance Portability and Accountability
Act (HIPAA) during transition planning. This includes the use of a valid
Authorization for Release of Information when appropriate (see policies 2.5
Information Management: Health Insurance Portability and Accountability Act
(HIPAA) and 2.6 Information Management: Confidentiality/Safeguarding of
Information).
13. Document all transition planning activities in Georgia SHINES within 72 hours of
occurrence.
PROCEDURES
Develop the Transition Plan
The Social Services Case Manager (SSCM) will:
1. Within 90 days prior to the youth’s 16th birthday, prepare for the initial TM by:
a. Initiating a staffing with the Social Services Supervisor (SSS) to plan for the
meeting.
b. Reviewing the case record to determine:
i. The youth’s permanency plan;
ii. The results of the youth’s Casey Life Skills Assessment (CLSA) (see
policy 13.2 Independent Living Program: Casey Life Skills Assessment);
iii. The youth’s Written Transitional Living Plan (WTLP);
iv. The youth’s identified supports;
v. Any other pertinent information needed to develop the Transition Plan;
vi. Whether the following documents for the youth are in the case record:
1. An official or certified copy of their United States birth certificate
2. The social security card
3. Health insurance information
4. A copy of their medical records
5. A copy of their Georgia driver's license or identification card
NOTE: If the documents have not been obtained, begin efforts to obtain
them.
c. Conducting a face-to-face visit with the youth to prepare for the initial TM:
i. Explain the transition planning process to the youth;
ii. Ask the youth what their individual goals are when they leave foster care;
iii. Explore their thoughts regarding their permanency plan;
iv. Discuss the benefits and requirements of EFC, as applicable based on
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Transition from Foster Caretheir permanency plan;
v. Discuss the plan for the meeting including:
1. The purpose
2. The youth’s role
3. The TM format
4. What to expect at the meeting
5. The expected outcomes
6. Individuals the youth would like to invite as a support
7. Other individuals that will be attending and their role
8. Information and resources included in the Transition Plan
d. Initiating staffings, in conjunction with the SSS with applicable state agencies
for more in-depth evaluation of possible future services, including but not
limited to:
i. DAS/APS, for youth with complex needs, for them to consult on what
adult services may be available to that youth as they exit foster care.
NOTE: DAS/APS may request a detailed social history, medical history
and any other documents that would be helpful in evaluating the future
needs of the youth prior to the staffing.
ii. DBHDD regarding any needed evaluation or services/supports needed
for youth with suspected or diagnosed behavioral health, mental health,
or developmental disabilities.
NOTE: Enlist the assistance of CCTU in engaging DBHDD and
providing assistance in assessing the needs of the youth.
e. Scheduling the initial TM inviting the appropriate individuals/entities based on
the youth’s individual circumstances.
2. Conduct the TM:
a. Discuss the purpose of the TM and the role of the participants in the meeting
and ongoing transition planning;
b. Engage the participants to develop the Transition Plan in partnership with the
youth (see Practice Guidance: Transition Plan);
c. Identify supportive individuals to help the youth with each item identified in the
Transition Plan;
d. Develop the Transition Plan during the meeting;
e. Provide a copy of the Transition Plan to the youth;
f. Document the TM in Georgia SHINES including uploading the Transition Plan
to External Documentation within 72 hours of occurrence.
3. Update the WTLP as needed.
Review the Transition Plan
The SSCM will:
1. Consult with the SSS to discuss and determine progress, adjustments and
additional supports that may be needed on the Transition Plan.
2. Prepare the youth prior to each ongoing TM by reviewing the Transition Plan with
them to determine progress made and any adjustments needed.
3. Include the attendees identified from the initial TM, and others as needed based
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Transition from Foster Careon the youth’s individual circumstances to the ongoing TMs.
4. Conduct the TM every six months following the initial TM.
NOTE: The TMs may be conducted in conjunction with the review of the case
plan/WTLP, as appropriate.
5. Add or modify the Transition Plan to support the youth in their successful transition
to adulthood.
6. Document the TMs in Georgia SHINES including uploading the updated Transition
Plan to External Documentation within 72 hours of the TM.
Monitor the Transition Plan
The SSCM will:
1. Conduct purposeful contacts in accordance with policy 10.18: Foster Care:
Purposeful Contacts in Foster Care, in addition:
a. Discuss the Transition Plan with the youth:
i. The status of each item;
ii. Specific services and resources and the effectiveness of those services;
iii. The progress made, including celebrating the progress and efforts;
iv. Any adjustments or revisions needed.
b. Discuss the Transition Plan with the caregiver:
i. The status of each item;
ii. Specific services and resources and the effectiveness of those services;
iii. They support they are providing to the youth to ensure the items on the
Transition Plan are being addressed.
iv. Any adjustments or revisions needed.
2. Engage collateral contacts in accordance with policy 19.16 Case Management:
Collateral Contacts to assess status of the youth’s Transition Plan.
3. Monitor services being provided to address the items on the Transition Plan in
accordance with policy 19.17 Case Management: Service Provision.
4. As necessitated by the specific needs of the youth, maintain appropriate contact
with DHS/DAS, DHBDD, Amerigroup Care Coordinator, CCTU and WPAC to:
a. Initiate and follow up on required applications or assessments for youth with
intellectual or developmental disabilities are completed (i.e., Medicaid Waivers,
applications, etc.) and that action items from the Transition Plan are being
completed.
b. Determine service needs and other supports for youth for a successful
transition to adulthood.
c. Obtain support/guidance on whether youth may need an alternative decision-
making support when they turn age 18.
d. Determine progress on items in the Transition Plan.
Finalize the Transition Plan
The SSCM will:
1. Prepare the youth for the TM:
a. Staff with the SSS to discuss the youth’s progress with the transition plan and
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Transition from Foster Careany adjustments that may need to be discussed in the upcoming meeting.
b. Meet with the youth and caregiver to review the Transition Plan to discuss
progress and any adjustments needed.
c. Engage appropriate entities to obtain information needed to determine the
status of the Transition Plan.
2. Include participants to the TM based on the youth’s individual circumstances.
3. Conduct a TM to finalize the Transition Plan for the youth within 90 calendar days
prior to the youth’s 18th birthday (and eventual exit if they are participating in EFC):
a. Review the final Transition Plan;
b. Complete the Scattered Site Placement Readiness Assessment for Participant
in Extended Foster Care if the youth is planning to participate in EFC (see
Forms and Tools);
NOTE: If it is determined that the youth is not ready for an ILP, develop the
Scattered Site Placement Readiness Action Plan (see Forms and Tools) to
support their future readiness.
c. Discuss the youth’s strengths and needs;
d. Confirm the commitments of the youth’s supports in the Transition Plan;
e. Confirm that the youth understands how to use their support system identified
in the Transition Plan;
f. Review the option to execute the Georgia Advanced Health Care Directive
(GAHCD) to the youth (see policy 13.10 Independent Living Program: Medical
Insurance for Youth 18 Years of Age and Older and the Georgia Advance
Directive for Health Care);
g. Explain the National Youth in Transition Database (NYTD) surveys and
complete the NYTD Contact Form (if applicable) (see policy 13.13 Independent
Living Program: National Youth in Transition Database);
h. Review the eligibility and benefits of EFC;
i. Celebrate the completion of the Transition Plan;
j. Provide the youth with the final Transition Plan;
k. Document the final TM in Georgia SHINES including uploading the final
Transition Plan to External Documentation within 72 hours.
NOTE: All youth must participate in the TM held within 90 days prior to the youth’s
18th birthday whether they intend to participate in EFC or opt out at age 18.
4. Conduct a Foster Care Exit Meeting when the youth turns 18:
a. Verify that the youth has a copy of the final Transition Plan.
b. Provide or ensure the youth has the following documents at no cost to the youth
(see Forms and Tools: Foster Care Exit Documents Checklist):
i. Official documentation stating that the child was previously in foster care
(Foster Care Verification Letter)
ii. Official or certified copy of their United States birth certificate
iii. Social security card
iv. Health insurance information (see policy 13.10 Independent Living
Program: Medical Insurance for Youth 18 Years of Age and Older and the
Georgia Advance Directive for Health Care).
v. A copy of their medical records
vi. A copy of their educational records
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Transition from Foster Carevii. Driver’s license or state identification card
viii. The final Transition Plan
NOTE: The youth must be provided the required documents when they exit foster
care even if they do not attend the Foster Care Exit Meeting.
c. Provide the youth with the contact information for their AmeriGroup
representative.
d. Obtain the youth’s signature on the Foster Care Exit Documents Checklist
acknowledging receipt of the documents.
e. Obtain contact information for the youth (i.e., address, phone number, email,
social media information, and at least one emergency contact information).
f. For youth turning 18 years old who have agreed to participate in EFC, discuss
and provide the VPA-EFC for the youth to review and sign. Provide a copy to
the youth and upload to External Documentation in Georgia SHINES.
g. For youth 18 opting out of EFC:
i. Explore the reason the youth is choosing to opt out of EFC and encourage
them to consider the benefits of continued participation in EFC if they are
eligible.
ii. Obtain the youth’s signature on the Notice to Opt-Out or Terminate
Extended Foster Care form.
iii. Document the discussion in Georgia SHINES include uploading a copy of
the form to External Documentation with 72 hours.
Youth Unable to Make Decisions on their Own Behalf
The SSCM will:
1. Explore with the transition planning team what level of decision-making supports
the youth will need ongoing:
a. Community supports available to meet the youth’s need; and/or alternative
decision-making support options, using the least restrictive options to meet the
youth’s needs (see Practice Guidance: Decision-Making Support Options).
b. Use the Decision-Making Support Needs Informal Assessment in Forms and
Tools as a guide.
c. Seek guidance from the SAAG, CCTU, WPAC and GARYSE in the
determination.
2. Determine by the youth’s 17th birthday whether the youth will need alternative
decision-making support as an adult; and if so, the least restrictive decision-making
support alternatives to meet the needs of the youth.
a. Consult with the SAAG, in conjunction with the SSS when making the
determination regarding the least restrictive decision-making support
alternatives or whether the youth may qualify under law for a guardian when
they turn 18, if the least restrictive options are not appropriate to meet the needs
of the youth. If the decision is to seek an adult guardianship in Probate Court:
i. Discuss whether there is an adult in the youth’s life that is willing and able
to serve as the youth’s guardian when they turn 18, i.e. kin, foster parent,
other committed adult(s); and
ii. Provide the SAAG with information on the efforts made to explore
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Transition from Foster Careand locate individuals to nominate as a guardian for the youth when they
turn age 18 (see Practice Guidance: Guardianship for the order of
preference in the selection of guardians from Georgia law).
NOTE: A guardian does not need to be either a blood relative or fictive kin.
b. If a guardian of last resort (public guardianship) will be pursued, inform the
DAS/Public Guardianship Office (PGO), of DFCS’ intent to proceed with filing
the guardianship petition.
3. In conjunction with the SAAG, ensure the petition for guardianship is ready to be
filed in Probate Court within 6 months prior to the youth’s 18th birthday (see Forms
and Tools: Checklist to File the Petition for Appointment of an Adult Guardian).
The ILS will:
1. Participate in all TM to develop, review and finalize the transition plan.
2. Collaborate with the SSCM to support the youth in addressing the transition
planning items needing attention.
The SSS will:
1. Conduct a staffing with the SSCM prior to the TM or foster care exit meeting to
assist the SSCM in directing, planning and conducting the meetings.
2. During ongoing supervisor staffings, include:
a. A review of the youth’s progress with their transition plan;
b. Proactive planning with other agencies for youth with complex needs including
intellectual or developmental disabilities or who may need decision-making
support, to ensure they receive appropriate services; and
c. Discussion of adjustments that may be needed in the youth’s transition plan.
3. Provide guidance to the SSCM regarding the level of decision-making supports the
youth with need ongoing, including community supports available to meet the
youth’s need; and/or alternative decision-making support options, using the least
restrictive to meet the youth’s needs.
4. Participate in the consultation with the SAAG regarding the least restrictive options
for the youth or the filing a guardianship in Probate Court if it appears the youth
will qualify for a guardian when they turn 18.
5. Attend the TM or foster care exit meeting (if possible).
6. Review the documentation from the meeting to ensure the required items were
discussed. Review and approve the Transition Plan.
7. Review the case record to ensure required documents are available for issuance
to the youth prior to exit from foster care.
PRACTICE GUIDANCE
Transition Planning
The Fostering Connections to Success and Increasing Adoptions Act of 2008 outlines
provisions for a transition plan for youth within the 90 days preceding their 18th birthday
and eventual exit from foster care. Transition planning should begin on day one of a child’s
placement into foster care and occur over the life of the case. Transition plans help youth
in foster care make a successful transition to adulthood. Successful transition plans
consider the youth’s age, skills and abilities. It should be developed in a manner that
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Transition from Foster Careallows the youth to see the value of the plan as they transition out of foster care, and to
ensure the youth understands it and will refer to it as a resource.
The transition plan is personalized and youth-directed and include services and resources
that help ensure youth are prepared to make healthy decisions about their future. Youth,
like adults, are more likely to assume ownership of a plan they participated in developing.
Therefore, SSCMs should actively engage youth in the development and implementation
of their transition plan to ensure its success. The transition plan must be as detailed as
the youth chooses. All identified needs must be resolved or near resolution by the 90th
day prior to the youth’s exit from foster care.
While case planning/permanency planning is DFCS’ ongoing efforts to transition youth
out of foster care to a permanent living situation, transition planning is the youth’s plan for
after foster care if they have not achieved permanency. It describes where youth will live,
how they will support themselves and other immediate daily living goals that must be met,
beginning day one of their exit from foster care.
Special consideration must be given to undocumented immigrant youth in foster care
approaching age 18. In accordance with the Georgia Immigration and Security Act, no
state or local government funding is available for undocumented immigrant children once
they reach 18 years of age unless/until they obtain a legal immigration status. Therefore,
unless the youth has a legal status, they will not be able to participate in EFC.
TRANSITION PLAN
Item Considerations for the Transition Plan
Housing • What does the youth need to achieve their housing goals?
• Where does the youth currently live?
• Do they plan to move?
• Would the current placement still be available once DFCS services end?
• Where would they live if their current housing fell through?
• Does the youth have a backup housing plan?
• How will the youth handle start-up costs for housing if moving?
• What about furniture, linens, and other housing essentials?
• Does the youth understand leases, rental applications, and the legal
rights of landlords and tenants?
• For those young adults in college dormitories, where will they live when
dorms are closed?
Education • Is the youth attending school? If so, high school or college?
• What are the youth’s educational goals?
• Does the youth receive special education services/have an Individual
Education Plan (IEP)?
• Is the young adult working toward their GED or interested in pursuing
this?
• What college/technical program campuses has the youth visited?
• What financial aid will they access?
• Does the youth have a timeframe to take the SAT or ACT, file the Free
Application for Federal Student Aid (FAFSA), and complete college
applications?
• Is the youth maintaining eligibility for educational services?
• How many credits does the youth have toward completing their
education? What is the expected graduation date?
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Transition from Foster Care• Is the youth on track to complete their program by the expected
graduation date?
• Does the youth need tutoring or other support services?
Workforce Supports and • Does the youth have a job or is he/she taking steps to get a job?
Employment Services • What does the youth need to meet their employment goals?
• Are any job skills still needed?
• What supports does the youth need to maintain their employment?
• Does the youth have a resume?
• What does the youth want to do for a job?
• What kind of career does the youth hope to have?
• Have they taken a career/ interest inventory to identify what career they
would like to pursue?
• If the youth is in school, what type of summer employment does the
youth plan to have?
• If the youth is unable to work, is DFCS assisting with an SSI application?
Money Management and • What does the youth need in order to achieve their financial goals?
Finances • Has the youth received assistance in preparing a monthly budget based
on their proposed housing plans and other financial responsibilities?
• Does the youth know how to access public assistance i.e. food stamps,
Temporary Assistance to Needy Families (TANF)?
• Does the youth have a checking and/or savings account?
• Does the youth know how to open a bank account?
• Has the youth saved any money, or does he/she have a savings plan?
• Does the youth know how to use a banking institution and understand
bank fees?
• Will the youth be able to access any trust funds, settlements, or cash
benefits (child support, SSI or RSDI)?
• Does the youth understand the importance of developing and maintain
a sound credit history and credit rating?
Credit Report • Does the youth understand what is a credit report?
• Does the youth know what the three major credit reporting agencies are
and how to access their credit report?
• Does the youth understand the purpose of conducting annual credit
checks?
• Has the youth received training/education in understanding credit
reports?
• Has the youth received a copy of their credit report from the three major
credit reporting agencies annually?
• Does the youth understand how to address discrepancies on their credit
report?
Transportation • What does the youth need in order to achieve their transportation goals?
• What are the youth’s goals for accessing reliable transportation?
• Will the youth live near public transportation?
• Does the youth know how to use public transportation, if available?
• Has the youth completed a driver’s education program?
• Does the young adult have a driver’s license? If not, what steps are
needed for them to obtain a driver’s license?
• Does the youth have a vehicle and vehicle insurance?
• Does the youth understand the costs of buying, registering, and
maintaining a vehicle?
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Transition from Foster CareEssential Documents • Does the youth know what essential documents are and purpose of
having them? (A list of documents should be provided and discussed
with the youth when they are leaving foster care (e.g., birth certificate,
social security card, state identification card, etc.)
• Does the youth know the importance of proper and secure storage of
documents?
• Does the youth know where to report/replace document if lost or stolen?
Health, Health Insurance • Does the youth understand the importance of maintaining routine health
and Health Care Proxy and dental examinations?
(includes Sexual Health) • Does the youth know how to make their own healthcare appointments?
• Does the youth know their own physical, mental, and dental health
needs?
• Does the youth know what is required to achieve good physical, mental
or dental health?
• Does the youth know the date of last health check and dental visit and
the next one scheduled?
• Does the youth know about their chronic health conditions and what it
takes to manage them?
• Does the youth know which medications they take, how to take their
medication, what the medication is for, understand side effects, etc.?
• Does the youth know how to maintain good oral hygiene?
• Is the youth in need of behavioral health services?
• Is the youth receiving counseling or other behavioral health services?
• Are there barriers to the youth receiving behavioral health services?
And if so, are the barriers being addressed?
• Does the youth have health insurance? If not, what is needed for the
youth to receive health insurance?
• Has the youth identified a health care proxy and completed the Georgia
Advance Directive form?
• Has the young adult received education in pregnancy prevention and
maintaining good reproductive health?
• Does the youth know how to protect themselves from sexually
transmitted infections (STI)?
Permanency and • What does the youth need in order to achieve their permanency goals?
Supportive • Who does the youth consider their family and important adult
Relationships connections?
• Does the youth have a relationship with their siblings, and if separated,
are they visiting regularly?
• Has the youth developed positive adult supports beyond the agency?
• Are there steps being taken to identify supportive adults? If so, what are
the steps?
• Where does the youth spend or plan to spend holidays when they leave
care?
• Who does the youth call when they need help/advice or to share positive
experiences?
Mentoring and • Does the youth have a mentor?
Continuing Support • Are there local mentoring programs that the youth can be referred?
Services • Are there adults in the youth’s life that he/she can talk to?
• Are there services and supports that the youth can access or continue
to use after leaving foster care?
Personal Growth and • Does the youth have goals for personal growth (i.e. Empathy,
Social Development Confidence, Facing Fear, Active Listening, Getting Along with Others,
Improve Body Language, Being Proactive, Stop Procrastinating,
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Transition from Foster CareWaking up Early, Master Conflict Resolution, Read More Often,
Managing Stress, Better Decision-making, Practicing Self-Care).
• What strategies are the youth using to work on personal growth?
• Have resources been identified to help the youth with their goal?
Parenting and Family • Has the youth received information and resources on family planning?
Planning • Does the youth have a child or children living with him/her?
• What does the youth need to achieve their parenting goals?
• Is the youth exhibiting good parenting skills?
• What parenting support does the youth have or need?
• Does the youth understand child development?
• Is the youth keeping all well-baby checks and other infant/child health
appointments?
• Does the youth know how to apply for the Special Supplemental
Nutrition Program for Women, Infants, and Children (WIC)?
• Does the youth have a plan for caring for their infant/child when the
youth is in school or working?
Life Skills • What life skills does the youth still need to address as an adult?
• Is the youth registered for the Selective Service?
• Is the youth registered to vote?
• Does the youth understand the process of registering to vote, and
keeping their voter registration active?
• What essential documents does the youth have (see Essential
Documents above?
• Are essential documents stored in a safe location?
• Which documents are still needed?
• Does the youth have skills to handle daily tasks on their own, such as
grocery shopping, preparing meals, self-care, paying bills, and
transportation?
Immigration Status • Does the youth have legal immigration status? What are the barriers to
obtaining legal immigration status?
• If not, is applying for special immigrant juvenile classification
appropriate? And has an application been completed? What is the
status?
• Does the youth qualify to apply for legal resident status? What is the
status of any application?
• If the youth will not be able to participate in EFC due to immigration
status, what is the plan for the youth?
Transition Meeting (TM)
The purpose of the TM is to develop the Transition plan for youth to ensure they are
prepared and are successful in adulthood. Before each TM, youth should be prepared for
the meeting and encouraged to identify significant people in their lives or permanent
connections who can participate in the meeting. The location of the TM should be
convenient for the youth and their supports.
TRANSITION PLANNING TIMELINE
Meeting Type Timeframe Related timeframe
Initial Transition Meeting Within 30 calendar days of the youth • Begin planning for Initial
turning age 16 Transition Plan Meeting
90 calendar days prior to
youth turning 16
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Transition from Foster CareOngoing Transition Meeting Every 6 months after the initial • Determine by age 17
transition planning meeting what supports or
services the youth will
need on-going and
whether guardianship is
necessitated as a last
resort
• File for guardianship
within 6 months of the
youth turning 18 years
old if it is determined
they may need a
guardian when they turn
age 18
Final Transition Meeting Within 90 Days prior to the youth
turning age 18
Foster Care Exit Meeting When the youth turns age 18
Scattered Site Placement Readiness Assessment for Participant in Extended
Foster Care
The purpose of this assessment tool is to determine youth readiness for placement in an
Independent Living Scattered Site Placement setting on their 18th birthday. The
assessment must be completed by the Independent Living Specialist assigned to the
participant’s legal region. This assessment should be completed with the participant, the
participant’s case manager, and other members of the participant’s support network. The
assessment may take up to 45 minutes to complete. It is recommended that the
assessment is completed at the transition planning meeting held within 90 days of a youth
turning age 18 if the youth is planning to participate in EFC, to support their transition.
Transition Planning for Youth Assessed Unable to Make Decisions on their Own
Behalf
The CCTU, WPAC, DAS, DBHDD, Amerigroup among other appropriate entities should
be engaged to assess whether youth may need decision making support when they
become an adult. If so, it is each department’s responsibility to plan, in advance, to ensure
that the youth’s identified needs are met without a gap in services when they turn 18 years
old. To accomplish this transition, all agencies will need to collaborate to develop the best
plan for the youth based on his/her individual needs, beginning as early as possible. As
the legal custodian of the youth, DFCS should take the lead and serve as the facilitator
for the youth’s transition team.
Care Coordination Treatment Unit
Provides consultation for youth with high-end mental/behavioral health needs,
intellectual/developmental disabilities, and complex medical issues via regionally
assigned Therapeutic Support Specialists (TSSs). If a youth is identified as having an
intellectual/developmental disability, or medical condition which may impact their
decision-making capacity, the TSS should be contacted to attend the initial TM
staffing. TSSs offer the ability to support the county by reviewing key documentation/files,
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Transition from Foster Careidentifying service gaps, providing case consultation, coordination of follow-up meetings
as needed, referrals to the appropriate resources, guidance on necessary
assessments, and assistance with connections to affiliate agencies.
Wellness Programming Assessment and Consultation (WPAC)
Participates in the transitional planning for youth by assisting in identifying appropriate
assessments that would aid in transition planning, addressing barriers in accessing
medical services/coverage, provide guidance in planning youth’s medical transition from
pediatric care to adult care providers, and reviewing health information in Georgia
SHINES to ensure appropriate documentation.
Collaboration with Division of Aging Services
APS investigates allegations of reports of abuse, neglect, and exploitation of disabled
adults age 18 years or older and elder persons 65 years of age or older who are not
residents of a licensed or long-term care facility. Investigations of allegations of abuse or
exploitation of persons (any age) residing in facilities are reported to and conducted by
the Department of Community Health, Healthcare Facility Regulation Division. APS also
evaluates and arrange for services needed to prevent or alleviate further maltreatment
(abuse, neglect or exploitation).
NOTE: APS can only file for guardianship when there is abuse/neglect or
exploitation involved in the case of an adult subject to their authority. In such cases, APS
will consult with PGO.
APS can assist DFCS on complex cases by participating in case staffings or transition
planning meetings and provide information regarding available services and supports.
Complex cases include but are not limited to medically fragile youth and youth who cannot
self-advocate. It is preferred to engage APS when youth reach 16 years old for future
planning purposes. Before the staffing/transition planning meeting, DFCS should provide
APS with a detailed social history, medical history, and any other documents to help in
determining the future needs of the youth.
Georgia DHS Division of Aging Services (APS/PGO)
Two Peachtree Street, NW 33rd Floor
Atlanta, GA 30303-3142
Phone:1-866-55-AGING (1-866-552-4464) Press Option “3” for APS
Georgia’s Department of Behavioral Health & Developmental Disabilities (DBHDD)
2 Peachtree Street, NW 24th Floor
Atlanta, GA 30303-3142
Phone: 404-657-2252 (Commissioner’s Office)
http://dbhdd.georgia.gov
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Transition from Foster CareDECISION MAKING SUPPORT OPTIONS
Type Description
Supported Decision- Allows individuals with disabilities to make choices about their own lives
Making (SDM) with support from a team of people they choose. Individuals with disabilities
choose people they know and trust to be part of a support network to help
with decision-making. Supported decision-making is an alternative to
guardianship. Instead of having a guardian make a decision for the person
with the disability, SDM allows the person with the disability to make his or
her own decisions.
Power of Attorney (POA) A legal document that gives one adult legal authority to act for another
adult. The person giving the authority is called the “principal.” The person
who is given the authority to make decisions on behalf of the principal is
called the “agent.” The agent can give as little or as much power as they
want to give to the principal. This means the principal may limit a POA to a
very specific transaction or grant full power to someone over all of their
affairs. A POA can cover tasks like writing and signing checks to more
complex matters likes selling a person’s home or property. With a POA, the
principal can choose who they want to act as their agent. Types of POA:
1. General POA: grants agents’ powers that end at the principal’s
incapacity.
2. Durable POA: grant agents’ powers that are not terminated by the
principal’s incapacity. A POA becomes a Durable Power of
Attorney (DPOA) when it states that the agent’s power continues
when the principal is unable to communicate his or her
wishes. Types of durable POA are:
a. Limited Durable POA
b. General Durable POA
3. Special or Limited POA (for specific purpose limited)
4. Springing POA (effective upon incapacity)
Advance Directives for Authorizes the agent to make health care decisions for the individual,
Healthcare consistent with the terms of the document and based on the wishes of the
individual. A person can name someone as an agent to make healthcare
decisions. It can also include statements of the person’s wishes concerning
medical treatment.
Representative Payee A representative payee is a person, or an organization appointed as a
payee to receive the Social Security or SSI benefits for anyone who can’t
manage or direct the management of their benefits. A payee’s main duties
are to use the benefits to pay for the current and future needs of the
beneficiary, and properly save any benefits not needed to meet current
needs. A payee must also keep records of expenses. When a report is
requested, the payee must provide an accounting of expenses to SSA of
how the benefits were used or saved.
Fiduciary/Conservator A fiduciary is an agent in whom complete confidence is placed by another
in regard to either a particular transaction or all of one's general affairs or
business. The relationship is not necessarily formally or legally established
as in a declaration of trust but can be one of moral or personal
responsibility, due to the superior knowledge and training of the fiduciary
as compared to the one whose affairs the fiduciary is handling.
Adult Guardianship A legal process where a court decides if a person lacks the capacity to
make decisions for themselves and there are no less restrictive alternatives
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Transition from Foster Carethan guardianship. A guardian is granted custody and control (including
decision-making) over the ward by the court. Guardians can be given
limited or broad authority over the ward. Guardians are responsible for
making sure the ward has adequate medical attention, an acceptable place
to live, adequate food, etc. No guardian, including DHS as guardian of last
resort, is required to use any of their own funds to acquire or pay for the
needs of the ward including housing or medical care; rather the guardian
assists the ward in utilizing the ward’s own resources and income to meet
their needs to the extent possible.
Limits on Guardianship Authority
The court may impose limits on the duties of a guardian of the person in its order. The
court also may limit the duration of the guardianship. In addition, a guardian of the person
must respect the expressed wishes and preferences of the individual to the greatest
extent possible. The guardian also must encourage the individual to participate in all
decision to the maximum extent of the individual’s abilities in all decisions that affect him
or her and must encourage the ward to regain the capacity to handle their own
affairs. The guardian cannot restrict with whom the ward communicates or visits and
cannot monitor or supervise the personal visitations of the ward. A guardian cannot force
a ward to take medication or undergo medical care against the will of the ward.
The guardian of the person must submit annual reports to the court concerning the
services the individual is receiving, the number and length of times the guardian visited
the person during the year, and any major medical or mental health problems the
individual experienced during the year.
Guardianship - Rights Retained by the Ward
The ward retains the right to have a guardian who is qualified to serve as guardian, acts
in their best interest, and is reasonably accessible. They also maintain the right to file
motions or actions relating to the guardianship, have their property used to provide for
their support, care, education, health, and welfare, have the least restrictive form of
guardianship, tailored to the person’s functional limitations, personal needs, and
preferences; for the guardianship to end or be terminated at the earliest possible time;
and to communicate and visit freely and privately with persons other than the guardian
(unless a court has issued an order prohibiting or limiting contact). The ward does not
lose other rights that are not mentioned in the guardianship law. This includes the right to
refuse psychotropic medications, refuse in-patient psychiatric treatment, maintain
physical integrity. Generally, the ward can still refuse invasive surgeries, such as
amputations, organ removals, etc. The guardian should obtain the permission of the court
to override the person’s refusal to undergo procedures this drastic.
Guardianship - Rights Removed from the Ward
A full guardianship removes from the ward the following rights:
• To get married and to get divorced;
• To make, modify, or terminate any and all contracts, which includes examples such
as hiring or firing professional supports or care, enrolling in college, signing a
lease, starting or stopping cell phone, TV, or internet service or adding apps to
smart devices, joining a gym, buying an airplane ticket or concert ticket, purchasing
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Transition from Foster Careproducts for home delivery from an online retailer, getting a shopper’s
discount/reward card or account for a pharmacy, grocery store, or fast-food
restaurant, getting or cancelling a credit card or debit card, adding or dropping
insurance for a car
• To consent to medical treatment, which includes therapies (occupational, speech,
etc.), medications, procedures, and surgeries
• To decide where to live
• To change legal address/residence
• To revoke a revocable trust established by the respondent
• To bring or defend any court case, administrative agency decision, or other legal
claims, whether in arbitration, mediation, an agency, or in court, except:
o In probate court, anything related to the guardianship,
o Civil commitment,
o Involuntary administration of psychotropic medications,
o Some medical procedures, and
o Criminal cases.
Any limited or full guardianship removes the right of the person to obtain a weapon carry
permit.
Guardianship Proceeding
In a guardianship proceeding, the court must first determine if the individual is in fact in
need of a guardian under the law, then who is the appropriate party to be appointed as
guardian. The court appoints a guardian to assist in making personal decisions on behalf
of the individual deemed to lack capacity (ward). A person will be deemed to lack
capacity if their ability to receive and evaluate information effectively and to communicate
decisions is so impaired that he or she cannot meet the essential requirements for his or
her physical health or safety. The authority of a guardian to make decisions on behalf of
an incapacitated person depends in large part on the scope of the court's order.
The court can appoint a person to act as a "plenary" guardian of the person or as a
"limited" guardian of the person. If the court appoints a "limited" guardian of the person,
it must designate the guardian's specific duties, such as general care and maintenance
of the individual; deciding where the individual will live; assuring that the individual
receives necessary services and health care. A person who is the plenary guardian of the
person can make all such decisions on behalf of the individual and many other significant
personal decisions.
Prior to appointing any guardian, the petitioners must present evidence as to
whether alternatives to guardianship have been pursued to ensure the continued
protection and preservation of the rights of the person under guardianship. Alternatives
to guardianship may include informal or formal support structures that exist without court
action or the removal of constitutional rights, i.e. Supported Decision Making, having a
financial or healthcare Power of Attorney to assist with specific needs, or having a
Representative Payee to handle limited financial needs. The SSCM should make and
document efforts to explore the least restrictive alternatives before making the decision
to take the matter to court.
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Transition from Foster CareThe Probate Court determines the guardian pursuant to Georgia law which provides the
following order of preference in the selection of guardians:
1. The individual last nominated by the proposed ward;
2. The spouse of the proposed ward or an individual nominated by the proposed
ward’s spouse;
3. An adult child of the proposed ward or an individual nominated by an adult child;
4. A parent of the proposed ward or an individual nominated by a parent of
the proposed ward;
5. A guardian appointed during the minority of proposed ward;
6. A guardian previously appointed in Georgia or another state,
7. A friend, relative or any other individual;
8. Any other person, including a volunteer to the court, found suitable and appropriate
who is willing to accept the appointment; or,
9. The county guardian.
The Probate Court Guardianship Process
1. Any interested adult, including the proposed ward, may file a petition for the
appointment of a guardian in the Probate Court. The petition shall be:
a. Sworn to by two people as petitioners; or
NOTE: The SAAG cannot be the petitioner, however, can file the petition on
behalf of DFCS.
b. Supported by one petitioner and a notarized affidavit of the professional
working with the youth (i.e. a psychiatrist, psychologist, licensed clinical social
worker).
NOTE: Any affidavit shall be based on personal knowledge and shall state that
the affiant has examined the proposed ward within 15 days prior to the filing of
the petition and that, based on the examination, the proposed ward was
determined to lack sufficient capacity to make or communicate significant,
responsible decisions concerning the proposed ward's health or safety. The
affidavit shall state the foreseeable duration of the guardianship and may set
forth the affiant's opinion as to any other limitations on the guardianship.
2. Upon the filing of the petition and affidavit, if any, the court will determine if there
is probable cause to believe the proposed ward is in need of a guardian. If there is
no probable cause, the case is dismissed.
3. If the Probate Court finds probable cause:
a. The proposed ward will be personally served with notice informing them:
i. A court action has been initiated to have a guardian appointed for them;
ii. The Probate Court will conduct an evaluation and the date and time to
submit to the court’s evaluation; and
iii. Of their right to counsel, which will be appointed by the court within two
days of service unless the proposed ward indicates he or she has retained
counsel in that timeframe.
NOTE: The Probate Court may appoint a GAL for the subject of the petition.
4. The Probate Court will:
a. Conduct a hearing.
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Transition from Foster Careb. Determines if the petitioners have presented clear and convincing evidence at
the hearings that the proposed individual meeting the qualification for needing
a legal guardian and appoints a guardian if the court finds the proposed ward
lacks sufficient capacity to make or communicate significant responsible
decisions concerning their health or safety.
c. Determines the fitness of the proposed guardian. (This includes using
information from background checks (criminal history, credit check), etc.).
d. Ask why other individuals cannot serve as a guardian when an appointment of
DHS as guardian of last resort is being sought.
5. The order for guardianship must be obtained before the appointed guardian can
take the oath of guardianship.
6. Fees vary depending on the jurisdiction of the Probate Court. Each jurisdiction may
have add-on fees based on what is allowable by law.
Guardian of Last Resort (Public Guardian)
In Georgia, DHS DAS/Public Guardianship Office (PGO) may serve as the guardian of
an adult when there is no one qualified, suitable, or available to serve. This is referred to
as “guardian of last resort.” The court appoints DHS as an entity. Prior to appointing DHS
as guardian, the court must first determine that guardianship is necessary and second,
that no other alternate guardians as listed in the priority section are willing or appropriate
to serve in that role. Before considering DHS as a guardian the SSCM should make and
document efforts to locate an interested and appropriate individual in the youth’s life to
serve as a guardian and rule out these options before seeking a last resort guardian.
Before filing the petition for a guardian of last resort, the SSCM should inform the
DAS/PGO of the intent to file the petition to facilitate a DAS/PGO case manager’s
attendance at the hearing.
NOTE: The DAS/PGO was created and split from APS. PGO has its own staff,
supervisory structure, and training protocols.
FORMS AND TOOLS
Checklist to File the Petition for Appointment of an Adult Guardian
Decision-Making Support Needs Informal Assessment
Foster Care Exit Documents Checklist
Foster Care Verification Letter
ILP Transition Packet
Notice to Opt-Out or Terminate Extended Foster Care
NYTD Contact Form
Scattered Site Placement Readiness Assessment for Participant in Extended Foster
Care
Scattered Site Placement Readiness Action Plan
Voluntary Placement Agreement for Extended Foster Care (VPA-EFC)
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