Memo of Justification Supplement Service Per Diem (Sample)

Sample Memo of Justification R.
10/1/05
Memo of Justification
Supplement Service Per Diem
To: Hanna-Barbera, Service Region Administrator

From: Steven R. Clinician, SRCA
Date: 9/15/05
Subject: Memo of Justification for a Supplement Service for Jonny Quest, Case #1967
Background
A Family Team Meeting conference was conducted on April 20, 2005 in the McLean County DPP
office for the purpose of discussing a Foster Care Services Supplement to meet the
extraordinary service needs of Jonny Quest. Those who participated were:
1. Sally Social Service Worker, SSW
2. Ralph Rn’Cworker, R&C
3. Steven R. Clinician, SRCA
4. Jonny Quest, Child
5. Fred and Wilma Foster-Flintstone, Resource Home Parents
Due to the extraordinary care needs described below, Mr. and Mrs. Foster-Flintstone are
requesting a supplemental reimbursement.
A copy of SOP 3.A.9 was given to each participant for their review. As facilitator, the SRCA
read verbally each section with the participants and attempted to answer each question asked
concerning the various sections of SOP 3.A.9.
Resource Home
Mr. and Mrs. Foster-Flintstone have been a Resource Home since June 3, 1997.
Capacity of Resource Home: The Resource Home currently has 2 foster children in their Care
Plus home, with an additional biological child. The Resource Home capacity is within SOP
requirements.
Training: A review of the Resource Home finds that the Resource Home parent’s have both
met their required training hours each year since becoming foster parents.
Employment: Mr. Foster-Flintstone works as a crane operator in a stone quarry. Mrs. Foster-
Flintstone is a stay at home mother.
Child Care: A neighbor occasionally assists with child care as needed. The neighbor has met
the requirements in the Respite SOP.
Record Keeping: Appropriate records are maintained by the foster parents. The medical
passport, behavioral log, medication log, and all school records are up to date.
Case Plan: The Case Plan is current and thorough. Specific issues are the Jonny's anger,
violence, and destructive behavior. Jonny also has difficult with women in authority and has
extreme behavior issues when only supervised by Mrs. Foster-Flintstone.
Sample Memo of Justification R. 10/1/05
Child’s Needs
Therapeutic: When Jonny entered the home in late 2002, he informed the foster parents that
he would “burn down the house and shoot them with poison darts like his father had shown
him how to do when they traveled to New Guinea.” Jonny did not set fires for the first 2 years
in the home, then after fire behaviors became much more prevalent Jonny was hospitalized for
treatment at Bedrock Community Hospital from 10/2/02 to 11/31/02.
Since then, Mr. and Mrs. Foster-Flintstone have to spend a great deal of additional time
monitoring Jonny since these incidents, as well as increased damage to the home. Jonny is
oppositional and exhibits extremely poor impulse control and can be extremely violent when
either provoked or doesn’t get his way. Jonny talks to and answers himself a great deal and
the therapist indicates that Jonny may have used psychotropic elixirs from a medicine man in
his travels with his father that may be the cause of some of his problems. Jonny appears to be
a in trance much of the time and his friends call him “pigmy” due to his height and his
threatening people that he will blow poison darts at them. Jonny seems to like the nickname.
Jonny is very paranoid and thinks that people are out to get him. Jonny is also very
oppositional specifically to women and notes that he learned in his travels that men are in
charge and women are only here to please a man. This has caused some difficulties and
violent outbursts as Mrs. Foster-Flintstone is the primary caretaker.
Educational: Jonny attends Bedrock High School and is performing just slightly below his
actual grade level. Jonny is mainstreamed from the EBD classroom, but sometimes just gets
up and leaves the room. The only teacher he responds to is Roger Bannon, a strong male
figure. Jonny has developed a strong bond and trust with Mr. Bannon. Mr. and Mrs. Foster-
Flintstone spend at least 5 hours per week at the school meeting with teachers and/or de-
escalating issues that arise with Jonny. The school has threatened to expel Jonny on several
occasions.
Familial: Jonny is an only child but has a bond since birth with his friend Hodgy. While there
is no blood relation, Hodgy is a calming influence on Jonny and regular weekly visits were
established. Jonny’s father, Dr. Quest, has been in prison for smuggling drugs and child
endangerment since Jonny was with him in New Guinea. Dr. Quest has recently been released
and Jonny has been showing a great deal of concern and apprehension about contact with his
father.
Medical: Jonny is taking medication for his behaviors and attitudes. Local medical care is
managed Dr. Bombay in Bedrock and Jonny complains of new medical symptoms almost daily.
The foster parents reassure him that all is okay and Jonny is usually calmed.
Jonny takes the following medications:

Lithium 300 mg twice daily
Wellbutrin 50 mg daily
Tenex 1 mg twice daily
Dental/Vision: Jonny has no ongoing dental needs other than regular checkup. Jonny has
been diagnosed as needing glasses, but refuses to wear them saying “Pigmy’s don’t wear
glasses.”
Use of Supplemental Funds:

The Resource Parent's are spending significant additional time participating in family therapy
an attempt to stabilize the placement, as well as additional time tutoring Jonny. Additional
supervision has also been required due Jonny's fire starting. Due to these issues, a temporary
service supplement is requested to assist in stabilizing the placement.

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Sample Memo of Justification R.

To: Hanna-Barbera, Service Region Administrator

Jonny takes the following medications:

Use of Supplemental Funds:

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