Foster Parents Support Services Referral Form

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Foster Parents Support Services Referral Form

MSPCC Foster Parent Support Services

Please note, this referral form replaces the original google form for the Behavioral Health Support Program and has been updated to include the Encompass Program, a support service available in the Central Region of MA.

Behavioral Health Support Program - Statewide

The Behavioral Health Support Program is a service that leverages peer-to-peer mentoring to provide stabilization for foster families. Behavioral Health Partners (BHPs) develop customized action plans for each family they partner with and work closely with DCF, educational, clinical, and community stakeholders to create robust support systems for the families they serve. The BHSP is designed to assist those who are navigating a growing level of need or crisis in their homes. This program is available to all DCF foster families across the state of MA.

Encompass - Central Region Offices and Framingham Area Office - ONLY

Encompass matches foster, kinship, and pre-adoptive caregivers with a Peer Trauma Coach to develop trauma-informed parenting skills and to support caregivers in their foster care journey. Caregivers also have access to monthly meal delivery, as well as the opportunity to network with other foster parents as part of a virtual group designed to provide families with training and new tools to utilize with their families in day to day life. Encompass strives to help caregivers feel comfortable, confident, and well-equipped in their vital roles as foster parents, and this program is available for all foster families in Central MA.

Which program are you submitting this referral to? *

Behavioral Health Support Program -- Statewide

Encompass -- Central Region and Framingham Area Office - ONLY

UNSURE -- Central Region and Framingham Area Office - ONLY (assessment will be done during screening call)

Foster Parent's Name *

Foster Parent's email *

Foster Parent's phone number *

Foster Parent's Street Address, City/Town, Zip code *

Language spoken by foster parent *

Race of foster parent *

Race of additional foster parent (if applicable)

Total number of children in the home (aged 0-18)

Number of foster children in the home (aged 0-18)

Ages of foster children in the home

How long has the caregiver been fostering?

Type of placement *

Reason for referral *

DCF Area Office (for foster parent) *

DCF Area Office (for foster child) *

Name of person submitting this referral *

Phone number of person submitting this referral *

Email of person submitting this referral *

Relationship to the foster parent *

I am the foster parent

I am a DCF social worker who works with the child in care

I am the Foster Family or Kinship Social Worker who works with the foster family (FFSW/KSW)

I am a Family Resource Liaison who works with the foster family (FRL)

I am part of the child's in-home clinical team

I am part of the child's outpatient clinical team

Other:

Name of Foster Family Social Worker (FFSW) or Kinship Social Worker (KSW) if this information has not been collected in previous fields
*

Name & contact information was collected above (if it has not been collected, please provide it below next to "other")

Other:

Email of Foster Family Social Worker (FFSW) or Kinship Social Worker (KSW) if this information has not been collected in previous fields
*

Name & contact information was collected above (if it has not been collected, please provide it below next to "other")

Other:

Phone number of Foster Family Social Worker (FFSW) or Kinship Social Worker (KSW) if this information has not been collected in previous fields
*

Name & contact information was collected above (if it has not been collected, please provide it below next to "other")

Other:

Have you submitted a referral to either of these programs in the past? *

This is my first time submitting a referral

I have submitted a referral to the BHSP

I have submitted a referral to Encompass

Required

Has the family ever been admitted into either of these programs in the past? *

Yes, the Behavioral Health Support Program

Yes, Encompass

Unknown

Required

Is the foster parent aware of this referral? *

Yes

I'm not sure

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