90-DAY DISCHARGE PLAN
Michigan Department of Health and Human Services
Youth Name	Birth Date	Person ID
Directions: The 90-Day Discharge meeting must be held between 60 and 90 days prior to a youth exiting care, in order to develop a discharge plan. The youth must be involved in every aspect of developing the plan. The meeting must be held regardless of a youth’s maturity level or disability. All youth, regardless of placement, should be offered appropriate accommodation to participate, including by phone if necessary. It must be personalized to the individual youth at his or her own discretion. Participants may include CASA workers, foster parents, biological parents, relatives, therapists, the youth’s friends, teachers, employers, or anyone the youth considers to be a supportive contact and wishes to invite. A copy of the completed plan is to be given to the youth at the end of the meeting and the original must be kept in the case file. Youth Confidentiality Statement I understand that sensitive and confidential information regarding my case (including, but not limited to treatment and records of substance abuse, mental health and/or medical issues) may be discussed at this meeting for purposes of case planning. I give my permission for this information to be discussed and understand that I can revoke my consent to these discussions and/or request the exclusion of individuals from certain conversations or can end my participation in this meeting. I also understand, that any new information regarding possible allegations of child abuse or neglect must be reported to Child Protective Services.
Print Youth Name	Youth Signature	Date
Team Member Confidentiality Statement In accordance with the policies of Michigan Department of Health and Human Services (MDHHS) and any applicable provisions of the Michigan law, I understand that as a member of this Family Team Meeting (FTM) I will have access to confidential information about an individual’s or a family’s involvement with MDHHS. I understand that my access to this information is limited strictly to the information necessary to carry out my role as part of the family team. I will not share information received at a team meeting concerning a youth or family member with anyone including other family members, friends of the family or professionals who are not a part of the FTM. Any new information regarding possible allegations of child abuse or neglect must be reported to Child Protective Services.
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90-DAY DISCHARGE PLAN
Michigan Department of Health and Human Services
Last Name	First Name	Middle Initial
Birthdate	Age	Gender	Case ID	Person ID
County of Jurisdiction
Address	City	Zip Code
Phone	Email	Alternative Phone (cell, relative, etc.)
Legal Status
Temporary Court Ward	Permanent Court Ward	Young Adult Voluntary Foster Care
MCI Ward	Dual Ward
Permanency Goal
The option of Young Adult Voluntary Foster Care (YAVFC) was discussed at this meeting.
Youth Initials
If leaving care to adoption or subsidized juvenile guardianship, was the option of extension of adoption or
guardianship payments discussed?	Yes	No
Meeting Date and Time	Meeting Location
MDHHS Worker or Monitor Name	MDHHS Worker/Monitor Phone	MDHHS Worker/Monitor Email
Tribal Worker Name	Tribal Worker Phone	Tribal Worker Email
MDHHS Supervisor Name	MDHHS Supervisor Phone	MDHHS Supervisor Email
PAFC Worker Name	PAFC Worker Phone	PAFC Worker Email
PAFC Supervisor Name	PAFC Supervisor Phone	PAFC Supervisor Email
Worker Name	Worker Phone	Worker Email
GAL Name	GAL Phone	GAL Email
INDEPENDENT LIVING SKILLS
1.	What IL skills and services has the youth completed and what is still needed?
Need	Date Completed
Education
HS Graduation
GED Preparation
GED Testing
College Preparation
Career Testing
Need	Date Completed
Employment/Training
Daily Living
Meal Planning/Cooking
Buying Groceries
Laundry
Housekeeping
Preventive Health Services
Personal Hygiene
Basic First Aid
Parenting
Budgeting/Financial Literacy
Rental Responsibilities
Housing Maintenance (minor repairs, exterior upkeep)
Other (explain)
2.	Who will be assisting the youth with additional IL skills needed prior to closure?
3.	Does the youth need a Michigan Identification card?	Yes	No
If yes, who will be assisting the youth with his prior to closure?
4.	Has the youth registered to vote (if at least 18)?	Yes	No	NA
If no, who will be assisting the youth with registering prior to closure?
5.	Has the youth registered for the Selective Service (if a male at least 18)?	Yes	No	NA
If no, who will be assisting the youth with registering prior to closure?
HOUSING
1.	Upon transitioning out of care, what is the youth’s plan for housing?
Biological/Adoptive Parent
Biological/Adoptive Relative
Legal Guardian
Own Apartment
Has the lease been signed?	Yes	No
If yes, when was it signed?
If no, is there a date/time set up to sign the lease?
If youth is at least 18 years old, is he/she aware of Youth in Transition (YIT) funds available
for first month’s rent/security?	Yes	No
Has the security deposit been made?	Yes	No
Are YIT funds being used?	Yes	No	Application Date
Has the first/last month’s rent been paid?	Yes	No
Are YIT funds being used?	Yes	No	Application Date
What is the plan to ensure ongoing rent is paid?
College Dorm
Has all required paperwork been submitted?	Yes	No
Is campus housing available year-round?	Yes	No
Remain in current foster home
Supportive Adult (name)
Will the youth be provided with his/her own bedroom?	Yes	No
If no, where will he/she sleep?
Friends
Will the youth be provided with his/her own bedroom?	Yes	No
If no, where will he/she sleep?
Adult Foster Care
Military Housing
Other (explain)
2.	Is youth aware of emergency shelters in the area?	Yes	No
3.	Who will assist the youth with these final tasks prior to closure?
EDUCATION
1.	Will the youth graduate from high school prior to transitioning out of foster care?	Yes	No
If no, does the youth have a plan for completing high school or a GED?	Yes	No
If yes, what is the plan?
If no, who will assist with making the plan?
Number of current credits
Will youth participate in Adult Education?	Yes	No
2.	The youth has been diagnosed with the following disabilities:	None
Mentally Impaired	Specific Learning Disability	Other Medically Diagnosed Condition
Emotionally Impaired	Visually Impaired	Hearing Impaired
Physically Disabled	Speech and Language	Not Yet Determined
3.	Is the youth currently in special education?	Yes	No
If yes, explain what services the youth receives.
4.	Does the youth have post-secondary plans? (This includes vocations/trade school.)	Yes	No
If yes, where?
5.	Have the following post-secondary resources been discussed with the youth?
Date Provided	Date
Tuition Incentive Program	Yes	No
Education and Training Voucher program	Yes	No
Campus based support programs	Yes	No
Federal student aid (FAFSA)	Yes	No
Fostering Futures scholarship	Yes	No
Other scholarship information	Yes	No
Vocational/trade school options	Yes	No
6.	Who will be assisting the youth with post-secondary planning prior to closure?
EMPLOYMENT
1.	Is the youth currently working?	Yes	No
If yes, identify the employer’s name.
Is the youth working with a community resource/employment agency?	Yes	No
If yes, what agency?

If no, who will be making the referral for the youth to begin participating with an agency prior to closure?
2.	Is the plan for the youth to be working?
Full Time	Part Time	Contingent
3.	Does the youth have a need for a referral to Michigan Rehabilitation Services?	Yes	No
If yes, who will assist with making this referral prior to closure?
4.	If the youth loses, quits, or gets fired from a job, what is the back-up plan?
TRANSPORTATION
1.	What is the youth’s plan for transportation?
Public Transportation
Bike
Walking
Has own vehicle
Does the youth have care insurance?	Yes	No
If yes, what is the youth’s source of funds for insurance? (family, friends, job, etc.)
If no, how will the youth get insurance and pay for it?
Plans to purchase own vehicle
What is the plan to pay for ongoing maintenance/insurance?
Other (explain)
2.	Does the youth have a driver’s license?	Yes	No
If no, does the youth need driver’s education?	Yes	No
If yes, what is the plan and date for enrolling and paying for driver’s education?
Who will be assisting the youth with transportation needs prior to closure?
YOUTH IN TRANSITION (YIT)
1.	Is youth aware of Youth in Transition Funding and what it can be utilized for?	Yes	No
Is youth aware of how to access YIT once case is closed (if still eligible)?	Yes	No
2.	Is the youth a participant in MYOI?	Yes	No
If no, was information about MYOI provided to the youth?
3.	Does the youth have one or more of the following?
Checking account	Savings account	Individual Development Account (IDA)
FINANCES
1.	Has the youth participated in financial literacy training?	Yes	No	NA
If no, how will he/she be provided with financial training or why NA?
2.	Upon transitioning out of care, what is the youth’s plan to financially support himself/herself?
3.	Has a credit check been completed for the youth in the last 12 months?	Yes	No
If yes, what were the results?

If no, specify the plan for this to be completed prior to the youth’s discharge.
Who will complete this prior to closure?
4.	Has information been provided or is youth receiving the following: (check all that apply)
Submitted	Receiving	Monthly Amount
Cash Assistance/Family Independence Program (FIP)
Child Day Care
Employment
Food Assistance Program (FAP)/Bridge Card
Foster Care Transitional Medicaid
RSDI/SSI
Spousal Support/Child Support
Tribal Trust Funds
Trust Funds
Other Medicaid
Other (explain)
5.	Who will assist the youth with applying for these services, if needed, prior to closure?
HEALTH/MEDICATION
1.	Does the youth have a primary physician?	Yes	No
If yes, identify the physician’s name and phone number.
If no, where will the youth access healthcare?
2.	Does youth have any ongoing medical needs?	Yes	No
If yes, identify all conditions/needs
3.	Does the youth have a Durable Power of Attorney for Health Care?	Yes	No	NA
4.	Current medications (list all and dosage).
5.	Where does the youth get their prescriptions?
6.	How will the youth pay for the prescription(s)? Source of funds
7.	How does the youth plan on renewing the prescriptions?
8.	Who will assist the youth with the above Health/Medication needs prior to closure?
Dentist’s Name & Phone Number
Nearest Urgent Care or ER & Phone Number
MENTAL HEALTH
1.	Does the youth have an identified mental health need?	Yes	No
If yes, what is the plan to meet that need?

2.	Does the youth currently have mental health support?	Yes	No
Community Mental Health
Private/contracted counselor
Clergy/Youth Pastor
Other (explain)
Who will assist the youth with any mental health needs prior to closure?
SUBSTANCE ABUSE
1.	Is substance abuse an identified need for the youth after he/she is discharged from foster care?	Yes	No
If yes, are there identified funds to provide for services?	Yes	No
If no, what referrals have been made?
If the answer to #1 is no, skip to Emotional/Social Support Section.
2.	Is the youth receiving substance abuse counseling services?	Yes	No	NA
If yes, identify the agency and counselor.
If no, specify the plan for the youth to obtain services.
3.	Is the youth aware of substance abuse resources in the community where he/she will reside?	Yes	No	NA
If no, specify the plan for the youth to obtain this information.
Who will be assisting the youth with substance abuse needs prior to closure?
EMOTIONAL/SOCIAL SUPPORT
1.	Does the youth have a plan for emotional support after transitioning from care?	Yes	No
If no, who will assist the youth with the accessing this prior to closure?
2.	Has the youth received information regarding family planning?	Yes	No
3.	Has the youth received information regarding dating/domestic violence services?	Yes	No
4.	Has the youth received information regarding lesbian, gay, bi-sexual, transgender, questioning (LGBTQ) supports?	Yes	No
5.	Is the youth able to go to the church of his/her choice?	Yes	No
6.	Is the youth aware of recreational facilities such as community centers, YMCA, YWCA, etc.?	Yes	No
7.	Who will assist the youth with these supports prior to closure?	Yes	No
PARENTING
1.	Is the youth an expectant parent?	Yes	No
If yes, when is the due date?
Is the youth receiving prenatal care?	Yes	No
2.	Is the youth a parent?	Yes	No
If yes, the number of children and their ages:
If the answer to #2 is no, skip to Mentor/Supportive Adult Section.

3.	Are the children residing with the youth?	Yes	No
If yes, is child care needed?	Yes	No
If yes, has a referral been made to the Child Care Coordinator?	Yes	No
Referral date and referral source:
If no, with whom are the children living?
4.	Is CPS involved?	Yes	No
If yes, identify the worker’s name and phone number:
5.	Is the youth involved in a Teen Parenting Program?	Yes	No
If yes, identify the agency:
If no, identify available local programs:
Date of referral:
6.	Is the youth receiving WIC?	Yes	No
If yes, what is the worker’s name and phone number, and referral date?
If no, specify the plan for obtaining a referral or why NA.
Who will assist the youth in completing this task prior to closure?
7.	Is the youth participating with Early On?	Yes	No	NA
If yes, what is the worker’s name and phone number, and referral date?
If no, specify the plan for obtaining youth participation or why NA.
Who will assist the youth in completing this task prior to closure?
8.	Is the youth’s child(ren) receiving Infant Mental Health services?	Yes	No	NA
If yes, what is the worker’s name and phone number, and referral date?
If no, specify the plan for obtaining these services or why NA.
Who will assist the youth in completing this task? (Identify by name and title)
MENTOR/CASE PLAN TEAM MEMBER
1.	Does the youth have an identified mentor/case plan team member?	Yes	No
If no, has the youth requested a mentor/case plan team member?	Yes	No
Who will assist with identifying a mentor/case plan team member?
If yes, who is the mentor for the youth? (Identify by name and title and check all that apply)
Supportive adult:
Teacher:
Relative:
Friend:
Other (explain):

SUPPORTIVE ADULT/SUPPORT SYSTEM
1.	After discharge, who will the youth call for support?
a.	Name and Phone Number:
b.	Name and Phone Number:
c.	Name and Phone Number:
2.	Does the youth have a plan in the event of an emergency?	Yes	No
If no, who will be assisting the youth to develop an emergency plan?
DISCHARGE DOCUMENTS
1.	Which of the following required documents have been provided to the youth? (check all that apply)
Original Birth Certificate/Certified Copy	Immunization Records
State/Driver’s Identification Card	Education Records
Insurance Card (Medicaid)	Medical Passport
DHS 945, Verification for College Financial Aid	YAVFC Fact Sheet, if case will be closing after 18
Financial Records (IDA, Banking, etc.)	Publication 161, Durable Power of Attorney
Social Security Card	Publication 193, FCTMA, if case will be closing after 18.
Publication 858, Important Information for Youth Transitioning out of Foster Care	MDHHS-5748, Verification of Placement in Foster Care
2.	How will MDHHS provide all of the documents to the youth prior to release?
ADDITIONAL NEEDS (not covered in other areas)
Identified Needs Prior to Discharge
1.
2.
3.
Plan to address each identified need:
SIGNATURES
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The Michigan Department of Health and Human Services (MDHHS) does not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, genetic information, sex, sexual orientation, gender identity or expression, political beliefs or disability.