a child 4

50
COUNTY OF SUFFOLK STEVE LEVY SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF SOCIAL SERVICES GREGORY J. BLASS COMMISSIONER To: Sullivan County Government Center Attn: Family Court Clerk of the Court I would like to formally request all family court orders on record pertaining to Timothy Grant DOB 1-30-89. Our agency currently has a neglect petition pending in Suffolk County Family Court. Our petition is against Timothy's biological mother, Winona Palmiotti on behalf of her youngest child. During the course of our investigation we learned of Sullivan County's court proceedings regarding Timothy. Unfortunately, I do not have a docket number. I hope the follow can assist you in finding the case. Court involvement spanned from 2004 through 2007. I believe Sullivan County filed their initial petition in 2004. There should also be TPR petition from 2005 Order terminating rights in 2006/07 and an Order of Protection from possibly July 2006. I believe the Judge's name was Meddaugh. Any documentation you can provide would be greatly appreciated. Please fax the last order and petition to 631-854-3358 attn: Team 63/102 All information can be mailed to: Suffolk County Department of Social Services Child Protective Services PO Box 18100 Hauppauge,NY 11788-8900 Attn: T63/102 Thank you for your prompt attention to this matter. Sincerely Lisa Scaf Suffolk County Child Protective Services Senior Caseworker Investigations BOX 18100 HAUPPAUGE, N.Y. 11788-8900 (631) 854-9935

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Page 1: A CHILD 4

COUNTY OF SUFFOLK

STEVE LEVYSUFFOLK COUNTY EXECUTIVE

DEPARTMENT OF SOCIAL SERVICES GREGORY J. BLASSCOMMISSIONER

To: Sullivan County Government CenterAttn: Family Court

Clerk of the Court

I would like to formally request all family court orders on record pertaining to TimothyGrant DOB 1-30-89.Our agency currently has a neglect petition pending in Suffolk County Family Court.Our petition is against Timothy's biological mother, Winona Palmiotti on behalf of heryoungest child. During the course of our investigation we learned of Sullivan County'scourt proceedings regarding Timothy. Unfortunately, I do not have a docket number.I hope the follow can assist you in finding the case.Court involvement spanned from 2004 through 2007.I believe Sullivan County filed their initial petition in 2004.There should also be TPR petition from 2005Order terminating rights in 2006/07 and an Order of Protection from possibly July 2006.I believe the Judge's name was Meddaugh.

Any documentation you can provide would be greatly appreciated.

Please fax the last order and petition to 631-854-3358 attn: Team 63/102

All information can be mailed to:Suffolk CountyDepartment of Social ServicesChild Protective ServicesPO Box 18100Hauppauge,NY 11788-8900Attn: T63/102

Thank you for your prompt attention to this matter.

Sincerely

Lisa ScafSuffolk CountyChild Protective ServicesSenior Caseworker Investigations

BOX 18100 HAUPPAUGE, N.Y. 11788-8900 (631) 854-9935

Page 2: A CHILD 4

FCSA DATA BASE INFORMATION SHEET

CASE NAME:,

Q-\ INITIAL: - UPDATE:

PRIMARY SECONDARY,

TEAMS C?^>

WORKER'S NAME / NUMBER :

ANCILLARY

CLESNITIAUS

%AL AUTHORITY FOR SERVICE CASE: CID

PREVENTIVE OT1 (SPECIFY ORIGIN OF REQUEST)

VOLUNTARY CPS COURT ORDERED CPS

ICPC (SPECIFY ORIGIN OF REQUEST)

COMPLETE BELOW SECTION FOR CHILDREN NOT IN PARENTAL CUSTODY (N-DOC. FOSTER CARE. JD. PINS)

CHILD'S NAME. D.O.B. CUSTODIAN/RESOURCE ADDRESS

i_iJ

REMOVAL RETURNTYPE (N-DOC, FC, JD, PINS) DATE HOME

AKxj Uxi MY f r9 (07

COMMENTS:

IAJAS^-^^-

Page 3: A CHILD 4

MENTAL HEALTH CLINICS (cont)

Opti-Care Mental Health Centers 366-5800Smithtown Center99 Hollywood Drive, Smithtown, NY, 11787

Riverhead Center 284-5500877 E. Main Street, Riverhead, NY, 11901

Pederson Krag Mental Health Centers:

Smithtown 920-830011 Route 111, Smithtown, NY, 11787

Huntington 920-800055 Horizon Drive, Huntington, NY, 11743

Patchogue Geriatric Center 475-71383 Grove Avenue, Patchogue, NY, 11772

Peconic Center - Riverhead 369-1277540 E. Main Street, Suite 2, Riverhead, NY, 11901

Riverhead Mental Health Center 852-1852Jail Unit - Suffolk County Correctional Facility100 Center Drive, Riverhead, NY, 11901

Riverhead Mental Health Center 852-1440300Center DriveCounty Center, Riverhead, NY, 11901

Skills Unlimited MHC - Oakdale 567-3320405 Locust Avenue, Oakdale, NY, 11769

Western Suffolk Center 761-2082Pilgrim Psychiatric Center, Bldg. 56998 Crooked Hill Rd., W. Brentwood, NY, 11717

Yaphank Center 924-441131 Industrial Blvd., Medford, NY, 11763

15

Page 4: A CHILD 4

PARENTING REFERRAL LIST

ALTERNATIVES COUNSELING CENTER......... ........ - --------- „ ________ 369-120Q

ANTOINETTE L. MICHAEL'S HOPE COUNCELING CENTER ....... 859-025022 RAILROAD AVE., SAYV1LLE, NY 11782

CATHOUC CHARITIES. .............. . ................... . ............... , ...... 665-3434269 W. MAIN STR. BAYSHORE, NY 11706

COMMON SENSEEARENTING^.. .... . ..„».£•, -I . ..... -------------------- -., ...... .673-7836* f .lS ^/• . - , . , , . ..".;-*^- .•-.:•. ' • , . - • : • ..-:. '. t •..-.-' • ' • ' • ; - • . . . - * , . ; • • " - , . :"'••" ";

^-:^^ T>?mR^^JV"-j*- >i-^"--/ -:-: •; ^. . . . . . " . • • • . • '•*. '* ' ' . i ' * * - . . .

.-^.^.v^ V : " ";:*i ^- ' : ;

'

GOOD SAMARTFA .:. .;:...i' . . ... . ..:.- ... . : . . . . 1.... ..... ..376*4159KARENKAPLAN , ; >'. :••

'Parenting Your YounigCmad^ using S;T.E.Pf

ISUP TOWNSHIP. ...... . ......... ' : . ™ . _ . . . ^PARENT RESOURCE CENTER

665-1900ADULTS & CHILDREN W/LEARNiNG&rDEVELOPMENTAL.DISABILITY s; ^

REFERRAL LINE.. ------------ i.;... ............. ....... .. ..... . ....... . ....................... ...... ...;. 265-3311,

PARENTING SKIia^VORKSHOPa. ';L.,^^.^^. 1 1 ...... ^' '

PEDERSON KRAG,...

Page 5: A CHILD 4

PEDERSON KRAG .................................. ..................... ....... ........ ...265-3311SMITHTOWN

SUNRISE COUNSELING ............................................................. ..... 666-1615BAYSHORE $45 -$55 PERSESSION

SUMY PSYCHOLOGICAL CENTEER ..... .......... _ ...... .... ...... ... ....... .. .632-7830

TOWN OF BABYLON.~...v^..~.-....,. .....~... ..... .... ...... , ________________ ...... ,...

SMTTHTOWN TOWNHALL-WEEKDAY

PedersonKrag Center North

C.«uL*-k;1s4 sra^^nfett^& i K'Jht; »,&.;... M i nrw) «. ,>?•! V" -? ~ : ' - • ' . , ' . : • ' " • ' - ' ' " •: ' ' ': ' '"' ' "' ' ' 'Free child cairf or «>e fiifst 5

. Family Service Leagne^1 ••, • ; * • • < "

ahd«curtseiinfMedicaid • . • • » i . '

Sylvia Cabrera Smith :

360^730\ acdte-., Spanish shafting paretiti""

" ' '"

' *

66543229 evening*?(Cifl*51€297i V / -V - 4, -

Excepts most insurances kichKfing HMO me^caid

Pablo Guevara289-5353Patchogue^

Page 6: A CHILD 4

COMMUNITY RESOURCES

ParentingMadonna Heights, Dix HillsSagamore Psychiatric CenterFamily Service LeagueFamily Service League/Home BaseEarly Head Start

Pederson-KragResource CenterPassagesJim.LacknerSunshine Prevention (Selden)Point of Woods (Stony Brook)Hope House Ministries (Pt. Jeff)South Brookhaven Health Cntr.Parent.

643-8800673-7836

85*£$zn i (Ronkonkoma)758-5200 Ext. 112 (perinatal,

newboms)265-3311360-7517878-2080345-5645476-3099632-7874928-2377852-1028

-665-3434

Smithtown

MorichesHome

OthersPlanned Parenthood

YMCA

Huntington 427-7154Westlslip 893-0150

Bay Shore 665-1173Centereach 558-6676

Women's Counseling Service Commack 462-5222

Mothers of Super Twins (multiples) East Isl ip 859-1110

LIPA-REAPP (Residential energy affordability partnership program)For lowering electric bills, new refrigerators, lightbulbs, roofingRepairs, insulation, windows. Contact Lynette Curly 1-800 263-6786.

Page 7: A CHILD 4

Topics specifically dealt withi iis group format include:

.' Styles of parenting

y -Active communication

o Responsibility

. Handling Anger

• • Power of Encouragement

•• ) espect

. Think-Feel-Dp Cycle

k . ,, ^ ~19 North .Ocean Avenue1 * , , 'Ratchogue, NY 11772

* - A. » X

Phone: 631-475-8641

Fax: 631-475-8642

C L I N I C A L C A R EA S S O C I A T E S &

T U R N I N G P O I N TC O U N S E L I N G

QjELS

P A R E N T I N G

S K I L L S

R O G R A 3

Page 8: A CHILD 4

August 18, 2008

Parenting, Programs on Long;...Island.

Suffolk County

1. EA C Lone Island Parenting Institute (631- 73 7-1454/Ronkonkoma) weeklyparenting education workshops on various topics, in addition to the 6 or 7-week"Common Sense Parenting" workshops, the 6Vweek parent-child "Bright Beginnings " <woricshtipsyanrftheS^ stf

2. Brookh&venMenwrial Hospital ExMCtwtParenfc

3. Cornell Cooperative Extension of Suffolk County (63 1-727-7850/Riverhead) ottersparenthig education workshops on a variety of topicsyineludingr nutrition; di^e^^child developmenti managing children'sianger, parenting

^ ^ '-^

Parent Resource Center i631->224-"9' ~

offers parenting awatieriesV ;'"workshops on suchtopies as:i)arentingt«ens, discipline, and-sibling rivalry.

7 Peder$Q&-iCommon Sense Parenting for parmts of i^ildren ages 5-18v as

\ in-home parenting for parmts with childfeh who are severely icmotioaaJly distttfbed.^! '«•'.

8. Planned Parenthood ffudscm-Peconic (63 J-240-1152/Smittitown) Offers parent .' ' '

9: Reach for the Stairs Tutorins Family Coaching Service f631*642-7876/Coratn) 'VI.offers individualized parenting education information on such topics as: pptQf 'training, discipKne, i^tmes andisdiedMes, pareht-child^bntract development, family

IQ.Roeers Memorial Library Children and Family Services (631-283-0774/South -

Page 9: A CHILD 4

August 18, 2008

11. SaKamaxeChildren's-Ps^nrtite Center ffiWaverrv Ave. Clinic (631-370-1676/Patchoeue) offers Common Sense Parenting for parents of children 5-18 yearsof age.

12. Smithtown Parent Resource Center / Smithlown Youth Bureau (6M-360- '7595/Smithtown) offers 2-hour workshops on various parenting topics such as:discipline, child development, encouragement/praise, and parenting adolescents.Additionally, trainers will go off-site to offer workshops.

13. SNAP Lone Island fPatchoeue) - offers parent education workshops specifically forparents of teens as well as for teen parents.

14. Si Charles Hospital Family Education Proeram (63,1'434^700/Poet Jefferson)offers workshops to expectant parents on such topics; as preparing for children, and;;

pre-;and.post-nataTexercise* Additional groups araoffered^for new rooms

15. Hauppauee Puttie Library Children and Family Services (63>l-9<79~1600/HaiwDaUee): offers Parent-Child workshops for parents>of r-3Vear olds? - These .-.5 week;sessions include a differott topic«achweek;«w^l^

;'•• : conunuiJity*e0*eseHtid^ttatrve to kpeak.to part«ts-whf

^offet^Ayork^ps ror parents' -,' *" ' "

M.':'y: •Hm0*^KeJmirttteH7/EaslHarttt

parent edueati0frwd^&

Nassau County /ft-,

ft^a^, patenting adolescents;: ThInstiteteistiBErently •'''•

offering "Raising a Thinking Chil^" for parents of 4-year ts{d Children as'wdl as ; -ongoing parent support groups for single parents andare offered at various times.

19. W#Cettri0rifttmtt^classes on aH parenting topics based children's ages* in additionio "mtpray and me"classes and parent care workshops^ All workshops are offered at-various imeaK: .

offers Parent-Chfid workshops forparents of l-3yearolds. These 5 week sessionsinclude a different topic each week', as well as a, social worker or community- = *

. representati ve40 speak? 1® parents 'wWletfieirchfldren^piayv

Page 10: A CHILD 4

'-— > August 18. 2008

2 1. HunMHs&e Consultants Mfavo^ Program (516-741-5141} offers parent education workshops on such topics as child development,positive discipline, and parent self-awareness. •

22. The National Assoc. of Mother's Centers (516-399-MOMS)* with locationsthroughout Nassau and Suffolk, offers support groups as well as parent educationworkshops on various topics.

23 . North Shore LI Jewish Health System Center for ParentEducation (516-465-2500/various Nassau County locations)offers workshops on such topics asi car. seal safety, Lamaze, infant CPU, ^ 'breastfeeding, Bafiycarev and baby safety. '• ;

24. The Parent Resource Centern

25;offers small group workshops on such topics as: developmental' milestones, parentingpractice, behavior"'problems:. Additibhally; trainers will go off-site to offer » ;workshops^" " ^ " ' • • • " • • • • . ' • ' ' • ' • • : " • • . . . ' . ' "•'•:' , ' - • • • • ' ' ' .' ' •

Page 11: A CHILD 4

12/09/2009 00:11 16312241201* ACCESS PAGE 01/09

TEMI17

Date /l/Y/7?

To L SOranization *J~

Fax# fry-m?From

Organization ACCESS. TOWN OF ISLIPFax# f 63 n 224-1206

SubjectPages: (including cover sheefl 7

Comments Cfi , * e. •A.

PROHIBITION ON RE-PISCLOSUREOF CONFIDENTIAL INFORMATION

CONCERNING SUBSTANCE ABUSE PATIENT

NOTICE TO ACCOMPANY DISCLOSURE MADE WITH CLIENTS CONSENT

This information has been disclosed to you from records protected by Federal confidentiality rules (42 CER part 2 and HIPP A). Thefederal rules prohibit you from making further disclosure of this information unless further disclosure is expressly permitted by thewritten consent of tbe person to whom it pertains or as otherwise permitted by 42 CFRpart 2 and/or HIPP A. A generalauthorization for the release of medical or other information is NOT sufficient for this purpose. The federal rules restrict any use ofthe information to criminally investigate or prosecute any alcohol or drug abuse patient.

Any unauthorized further disclosure in violation of these laws may result in a fine of jail sentence or both

Page 12: A CHILD 4

12/09/2009 00:11 16312241206ACCESS

PAGE 02/09

DETERMINATION OF NEED FOR PHYSICAL EXAMINATIONPart 822 PROGRAM

NAME OF CLIENT

wr

ID NUMBER ADMISSION DATE

NOTE: THIS FORM MAY BE USED AS AN ADDENDUM TO THE MEDICAL ASSESSMENT.*

A, SUMMARY DETERMINATION) .The client's medical assessment provides insufficient information about the health status of the individual,

or indicates that further medical review is required. Therefore, a physical examination 'wffl be performed which must take place within 2 1 days of the client's admission and must in&Judelaboratory tests and other diagnostic procedures determined necessary by the examining physician asprescribed in Section 8 below

physical examination is not needed as documented in Section C below.

J3. PJ^SICAtEXAMJDNATION ARRANGEMENTS(. ) On-s'ite by a physician, registered physician's assistant, or nurse practitioner who is on staff or un der

contract wfeh the provider. ' 'i - ' •*

( _ ) At the site of any OASAS licensed program by a physician, registered physician's assistant or aarsepractitioner who is on staff or under contract with the provider.

( ) Referral to an outside physician with whom the provider has entered into a qualified service agreement(per 42 CFR part 2).'

Referral to the client's primary care physician, with appropriate consents to release confidentialinformation which allows for the sharing of information between die provider and the physician;* * * * * i f i

C, EXPLAKAHON OF DETERMINATION NOT TO CONDUCT A PHYSICAL EXAMBASIS FOR DECISION (DOCUMENT CLEARLY): ' •

./V^/^/KDSfCNATU^E CREOENTJAL

*The Medical Assessmwt must fae made via a 6ce-to-fece contact with proftssfonaJ medical stsfTof the program fLe.nurse practitfoner, registered nurse. Wcensed practical nitrsc, or other health care professions! licensed end certified by the StateDepartment of Education to examine, evaluate, diagnose and treat the physical and psychiatric conditions' of tha client

Page 13: A CHILD 4

12/09/2009 00:11 16312241206 ACCESS _ ' PAGE

TOWN OF (SLIP DEPARTMENT OF HUMAN SERVICESACCESS/ACCESODivision of Drug and Alcohol Counseling and Education Services

401 MAIN STREET • ISLtP, NEW YORK 11751 • (631) 224-5330452SUFFOLKAVENUE-BRENTWOODINEWYORK11717 • (631)436-6065

PSYCHIATRIC PROGRESS NOTE

DATE

CLIENT NAME KW^ r^^^^f CLIENT #

SESSION TYPE W/JJ tJL I JLJrSESSION LENGTH

IT /rJLJ

DOCTORS SIGNATURE

Page 14: A CHILD 4

12/09/2009 00:11 16312241206ACCESS

PAGE 04/09

PART 822 GOTMttCAL DEPENDENCE!OUlPAilCEinitial Detenninatioii / Level of Care Determination / Admission Decision

• , WiV\o<\"\ VPatiei

M/n^tt •rtName

,. . . .;.....::;. ^^•.^-,.-." ' 3»aaent£>#

Initial Determination

This individual appears to be is need of chemical dependence services.

individual appears to be free of serious communicable disease that can be transmittedthrough ordinary contact .

tois individual appeats to be not in need of acote hospital care, acute psychiatric care orother intensrve services which cannot be provided in ooajmictioii with, otttpatient care. • .

: *If no, make appropriate referral on reverse side of fMs form,

. _ _^ _ ' _ Non-Crtsi> Level of Care Petermination

Yea _, No*r , .,' .' ,•Yes ' .No*

No*

LOCAJPTk Criteria ladicatedLevel of Care: .•

I. Dependence condition or abuse condition,continue

[]ao,got6#15

2. Utablei6 participate in or compfyrith treatment [. outside 24^our structured treatment setting '. [

3. Imminent health ristfrom continued alcohol or [] yes-drug use . . •

['] yes, continue

5. Complications or contorbidities requiringmedico! management/monitoring dtufy

6. Established opiate dependence condition

7. Chooses to participate in Methadone Treatment

8. Substantial deficits tn functional stalls

9. Physical health care needs

10, Inadequate social support system

11. Substantial risk of relapse

• []no -3 . • ' - Jn.patieatKdiabifila.tion. ; - . . .

[jyes •> ^"a^eritRehabiEtation ; • ' • • •,• . . ' [ ] no. & • lateiisiveR^dentMReliabiUtation .

[] ye^^daue" ' ' " ' . 'y^o>Eoto^[]yes -^ ..SsiSal to M^badoneTreatrienlv continue

[]no, coatiaue .; [Jisresjgcj^fllftO ' ' • ' • • ' ' ' . "• -\-

ii^A™ /£ K£^ f fe.?^p[].no,goto#ii ; . : , , ; • . . . . . . . . . .[Jyes OntpatientiReiiabiSation (goto#^l)

[Jj»sJ5onrirme\M& * £tensive6t%atieat (gotoWT)

[ ) iao, continue ' , ' ,

12. Jbtoderate to severe dependence condition[]no

Ihteasive Qu^jatieat . (go to #13)Outpatient noii-iiitettsivo. (go to

13. Inadequate LMng Environment [ ] yes, continuet] no, end.

\4. Requires 24~hour a day 'residential services endongoing clinical and peer support

15. Significant other

[jyesSttppoxtiveiivittg •...."-, —-A—-—-—.-—-•Ou^ialient non-iatensive^ .'•

[]no,ejad

Page 15: A CHILD 4

PAGE 05/0912/09/2009 00:11 16312241206 "ACCESS

/ /I J f ' C<S?a of Care: f\/-P&4^ A/ &TM L~t^\ ' if~^

Are flisre patieait fefitors fcat aigae against to level of caie? [ix*^ [] Yes Cspeoify1 betew)

CIfnj[cB% Rjecocomended Level of Care (if dififereaQ: ^ . .__

Additional Factws Relevant to Placement

AdMssionPedsion/^ . N ' ,.- • • • • • , • • ' • • • • ••:«••••'- ..- .

. I have reviewed the 'saieenfag informal^ in^^ . ,/ Aiive determined that thisperson can be a&nittetf to isser^^^^,e ' ' ' : ^ ' ''"'' ' '

lift individual has been detctminfidto be able to achieve or fflaintain , , . • • • • •abstinence and racovcty goals Tntia ths ^jpHcatioa of onqjktient services.

chemical abfase'ar depeodence.'

. ,*«?/..•.

(For prtrvtltt certified to provide CD OutyatUnt ReJiabH&i&Ht Services, please diteckwkick admission criteriaccppfy. f lease tie reminded (Hat Criteria id AND EITHER Crtierb #2 OR. Criteria %3 MUST apply.) ' .

•tflTfoiadivSdTiBliias.aa inadequate ?ooiaIsTrppQrtsyBtepi.. , Yes

: AND . . .'_ .- •'. : "_" "; ;•" ; ' • . ' " ""''"#2. Either tie fedrvidual has substantial deficits in .foncdonalakflls, OR .-_,_ Yisa

. #3 The individaal has health caie needs requiring !ialteniioa or monitoring by .

If fhis petson is not ad^nttad, it is &a the following reasonfs) fadude referral to More appropriate care, tfapplicable): .

•.A ;./v^ ._OF AUTHORIZED REKtESENTATIVlI OKE»OP(SIBLE QHI)

Page 16: A CHILD 4

12/09/2009 00:11 16312241206ACCESS

PASE 06/09

TOWN OF ISL1P DEPARTMENT OF HUMAN SERVICESAQCESS/ACCESODrvteion of Drug and Alcohpl Counseling and Education Services

401 MAN STREET-1SLB NEW YORK T1751-(631) 224^5330 ... '' ' ' •452 SUFFOLK AVENUE • 8RENIWOCQ NEW YORK 11717 • £631; 436-4065

Psychiatric EvaluationElizabeth Lorenz,

"Client Name

Rate of Birth:

Namfc of the client's Primary Counselor:

son for Referral:

Client #:

Gender:

Date:

Historyjof Psychiatric Illness: J

&

Pa*t Medical/surgical History:

t Psychiatric Histtry: «x" Yes No • If yes, condition being treated:_

Where:Reason:

-S . (JW tP~A, zPresently under care ofa Psychiatrist Yes If yes, condition being treated:

Family History:

Histo'ry 6f past medications (including.adyerse reactions to specific medications)r Current Medications or orders for all medications: y] (

Psychiatrist's name, address and telephone ftfifqkesure a release of information is signed):-^j .' .. ,

Review of systems: /M/ SI n .

Psychiatric Evaluation:Orientation:Level of Awareness;Affect:Posture;Speech:

Mood:

Perceptions:

FcrsonDrowsy

_ Relaxed/ Rapid ^Slow

Monotone _SoftNormal Rate and rhythmJLabile DepressedEuphoric .^x^CTflTrn

'__ . Hallucinations Jilusions.^.^Appropriate Derealizatioii

JDepressedSlouchedShared

1OUS

_Stuporous.Nonnal^Posturing_Pressxa:eil^coherent

Irritable

__Depersonalizatiori.

Page 17: A CHILD 4

12/09/2009 00:11 16312241206

Client Name:

ACCESSPAGE 07/09

Client #

Motor Activity;Thought Process:

Thought Contents:

Judgement:.'Immediate Recall;Recent Memory:Remote M>ino*yDiagnosis:

^Appropriate-'Loose Association.

,/^Intact^Appropriate.Obsessions

^Restless • Tremors' '. , ^ RetardationTangential ^ Retardation -Blockings Paranoid Ideation

: Delusions • • Phobias'•__ __Ideas of Reference/fofiuence

Fair JPoorssf

GoodGood . .Good .. •,

Eair ' • ' Poor''•Fair - • PoorFair Poor

Axis I: bf^eAsvJ rvUu — ->t Is^'OO' . ' ' . • ' • • • • ' . -

*

Axis' II: Wo

Axis.ni fa•AxisIV '"AxisV .ipervision:XpmJTifltinn;

Pri/^u v^l^^iA' ff/U,

r^-YesYes

i

C r.^j/ e-Cv-^v/K-*rvi^W'- ) •X1 f» . - ' • • •

No^-No

Clinical Assessment: -(To include symptoms of alcohol/drug abuse or dependences level of motivation, denial pertinejnedical, p^cMatric, fanaily, parenting, relationship jega!3 and vocation needs. Describe areas of vanerabiMes,

'clients strengfliSj preferences,and abilities): /^Lt \~£~

eatment Recommendations (To include level of cate^ec^jSilendedlpased ontEent'jait's medical and/or psychiatric history, the'clieijt's ability to maintain abstinence, risk of relapse HTVing/educational requirements and strength of sobe^ support ystem:

Cr

itional Referrals:

Page 18: A CHILD 4

12/89/2009 00:11 16312241206ACCESS

PAGE 08/09

.ASSESSMEClient Name v J .* '.

V \v\* Date /y/y/x,..Client#

Does dieateuiTeotiy s&flfer&Ma aiy of flte fbZZowing:(SwnrtiJe udditfanalinfonnatfcm, trbere apipropriate (<i,g. date of diagnosis, freqneacy cf probtem*,

Shortstess of Breath '• ^

Heart Disease

s/Accidents

Page 19: A CHILD 4

12/09/2003 00:11 16312241206ACCESS

PAGE 09/09

Female: Age of fast period

Date of last period

Menses: negater. inegnlar

feuM .dig# caareoffy begtegaaot? '

Date of last ob^gya exam

^-

Has oKerrt been tested for HBV/IB ?

OTHER;

Signature of Medical Diiecton

Page 20: A CHILD 4

COUNTY OF SUFFOLK

STEVE LEVYSUFFOLK COUNTY EXECUTIVE

DEPARTMENT OF SOCIAL SERVICES GREGORY J. BLASSCOMMISSIONER

December 7, 2009

Access401 Main StreetIslip, NY 11751 ...... _ _ . . _

RE: Winona Palmiotti

To Whom It May Concern:

The above named person is currently receiving services from Suffolk County Department of Social Services. Itis important that we have a copy of her mental health evaluation and your recommendations for our file. It isbelieved that Ms. Palmiotti registered for an intake with your office on October 5, 2009. She was provided afollow up appointment on October 15, 2009 at 5:30 (Please see attached letter from your agency). Pleaseforward a copy of her mental health evaluation to my attention at Suffolk County Department of SocialServices, PO Box 18100, Hauppauge, NY 1 1788-8900 Attn. MacArthur Bid. Team 17-108. This informationcan also be faxed to my attention at 631-854-9347. 1 have enclosed a signed release of information.

Please feel free to contact me at 631-854-9397 with any questions.

Sincerely,

Lori Towns, CaseworkerChild Placement Bureau, Team 17

BOX 18100 HAUPPAUGE, N.Y. 11788-8900 (631) 854-9935

Page 21: A CHILD 4

COUNTY OF SUFFOLK

STEVE LEVYSUFFOLK COUNTY EXECUTIVE

DEPARTMENT OF SOCIAL SERVICES JANET DEMARZOCOMMISSIONER

PERMISSION FOR RELEASE OF INFORMATION

I hereby authorize

at and

Suffolk County Dept. of Social Services at 3455 Veterans Highway, NY 11779to communicate and release information to each other regarding:

I understand that the information to be released is confidential and protectedfrom disclosure.

I understand that I have the right to cancel this Permission for Release of Information atanytime before it is released.

I also understand that this Permission for Release of Information will expire when actedupon, or six months, whichever comes first.

Signed:_

Relationship:^

Address:

Date

BOX 181OO HAUPPAUGE, N.Y. II788-89OO (631)85-

Page 22: A CHILD 4

SUFFOLK COUNTYDEPT. OF SOCIAL SERVICES

P.O. BOX 18100HAUPPAUGE, NEW YORK 11788-8900

\

uC

Mt

Winona M Palmiotti1355 Locust AveBohemia, NY 11716-2182

Dear Winona Palmiotti

7DDT IbflD DDDD B5^7 - "^- ™- - >s - n "^w

000209470? CCT23 2003FvlAILEDFROM ZIP CODE 1 1 788

FIRST NOTICEHKbl N U U b t y-SECOND NOTICE \\\.WRETURNED-XOC^

^^fv.fg\i\\^^f^"?',A\N,a i&2, Vf^JiVl.r-'••"•••-'"

.r> -•• '~>

NIXIE OO 11/27/OSiRETURN TO SENDER

•UHCL. AIMEDUWASL.E TO

Page 23: A CHILD 4

SENDER: COMPLETE THIS SECTION

Complete Items 1,2, and 3. Also completeitem 4 If Restricted Delivery is desired.Print your name and address on the reverseso that we can return the card to you.Attach this card to the back of the mailpiece,or on the front if space permits.

1. Article Addressed to:

UJl tWtl •atb

COMPLETE THIS SECTION ON DELIVERY

A. Signature

X

B. Received by (Printed Name)

ID Agent

D Addressee

C. Date of Delivery

D. Is delivery address different from item 1 ? D YesIf YES, enter delivery address below: Q No

3. Service TypeB*6ertifled MailD Registered

D Insured Mail

D Express MailD Return Receipt for MerchandiseD C.O.D.

4. Restricted Delivery? (Extra Fee) DYes

2. Article Numoer(Transfer from service label)

PS Form 3811, February 2004

7DD1 IbflD DDDD BSH7 HSfllDomestic Return Receipt 102595-02-M-1540

Page 24: A CHILD 4

JOUNTY OF SUFFOLK

STEVE LEVYSUFFOLK COUNTY EXECUTIVE

DEPARTMENT OF SOCIAL SERVICES Date: 12/03/2009

Winona Palmiotti1355 LOCUST AVEBOHEMIA, NY 11716-2182

Gregory J. BlusCommissioner

Dear Winona Palmiotti,

You are invited to participate in a Service Plan Review, which is a conference to review the plan for the safety,permanency, and well being of the following children.

Children Date of Birth AgePiscitelli.Winona July 06,2005 4

The Service Plan Review is scheduled on: . .

Date December 11,2009

Time 11:15 AM

Location SUFFOLK COUNTY DSS Room 101 Floor 1

Address 3455 VETERANS MEMORIALRONKONKOMA NY 11779-7629

The purpose of the meeting is to bring together the child, family, and service providers to discuss thechild(ren)'s and family's strengths and needs, to review their progress, and to plan for the future.

It is necessary that you participate in this meeting to develop and review the plan, as importantdecisions will be made at this meeting. We need your participation in making these decisions. Weinvite you to bring with you anyone who can help with such planning, for example, family members,friends, a member of the clergy, or any other representative of your choice.If you are the parent or guardian of a child in foster care, or if you are a child in foster care, it isimportant that you know the following. Under State and federal law, if a child remains in foster care for15 of the most recent 22 months, there is an obligation on this agency to file a petition to terminateparental rights, unless there is a legally acceptable reason for not doing so. This is a significant topicfor discussion at each Service Plan Review meeting.

If you have any questions or problems regarding the scheduled conference, please contact yourassigned worker or the contact person listed below.

Sincerely,

Case Planner: Phone: - Ext:Case Manager: Towns,Lori Phone: 631-854-9397 Ext:Contact Person: Timothy Ferguson Phone: 631-854-3475

BOX1S100 HAUPPAUGE, N.Y. U788 - 8900 (631)854-9935

Page 25: A CHILD 4

COUNTY OF SUFFOLK

STEVE LEWSUFFOLK COUNTY EXECUTIVE

DEPARTMENT OF SOCIAL SERVICES Date: 12/03/2009

Paul Piscitelli318 ELLISON AVEWESTBURY, NY 11590-1835

Gregory J. BlastCommissioner

Dear Paul Piscitelli,

You are invited to participate in a Service Plan Review, which is a conference to review the plan for the safety,permanency, and well being of the following children.

Children Date of Birth AgePiscitelli.Winona July 06,2005 4

The Service Plan Review is scheduled on:

Date December 11, 2009

Time 11:15 AM

Location SUFFOLK COUNTY DSS Room 101 Floor 1

Address 3455 VETERANS MEMORIALRONKONKOMA NY 11779-7629

The purpose of the meeting is to bring together the child, family, and service providers to discuss thechild(ren)'s and family's strengths and needs, to review their progress, and to plan for the future.

It is necessary that you participate in this meeting to develop and review the plan, as importantdecisions will be made at this meeting. We need your participation in making these decisions. Weinvite you to bring with you anyone who can help with such planning, for example, family members,friends, a member of the clergy, or any other representative of your choice.If you are the parent or guardian of a child in foster care, or if you are a child in foster care, it isimportant that you know the following. Under State and federal law, if a child remains in foster care for15 of the most recent 22 months, there is an obligation on this agency to file a petition to terminateparental rights, unless there is a legally acceptable reason for not doing so. This is a significant topicfor discussion at each Service Plan Review meeting.

If you have any questions or problems regarding the scheduled conference, please contact yourassigned worker or the contact person listed below.

Sincerely,

Case Planner: Phone: - Ext:Case Manager: Towns,Lori Phone: 631-854-9397 Ext:Contact Person: Timothy Ferguson Phone: 631-854-3475

BOX 18100 HAUPPAUGE, N.Y.I 1788-8900 (631)854-9935

Page 26: A CHILD 4

JOUNTY OF SUFFOLK

STEVE LEVYSUFFOLK COUNTY EXECUTIVE

DEPARTMENT OF SOCIAL SERVICES Date: 12/03/2009

Gregory J. BhusCommissioner

Dear Lisa Carbone,

You are invited to participate in a Service Plan Review, which is a conference to review the plan for the safety,permanency, and well being of the following children.

Children Date of Birth Age

Piscitelli.Winona July 06,2005 4

The Service Plan Review is scheduled on: .

Date December 11, 2009

Time 11:15 AM

Location SUFFOLK COUNTY DSS Room 101 Floor 1

Address 3455 VETERANS MEMORIALRONKONKOMA NY 11779-7629

The purpose of the meeting is to bring together the child, family, and service providers to discuss thechild(ren)'s and family's strengths and needs, to review their progress, and to plan for the future.

It is necessary that you participate in this meeting to develop and review the plan, as importantdecisions will be made at this meeting. We need your participation in making these decisions. Weinvite you to bring with you anyone who can help with such planning, for example, family members,friends, a member of the clergy, or any other representative of your choice.If you are the parent or guardian of a child in foster care, or if you are a child in foster care, it isimportant that you know the following. Under State and federal law, if a child remains in foster care for15 of the most recent 22 months, there is an obligation on this agency to file a petition to terminateparental rights, unless there is a legally acceptable reason for not doing so. This is a significant topicfor discussion at each Service Plan Review meeting.

If you have any questions or problems regarding the scheduled conference, please contact yourassigned worker or the contact person listed below.

Sincerely,

Case Planner: Phone: - Ext:Case Manager: Towns,Lori Phone: 631-854-9397 Ext:Contact Person: Timothy Ferguson Phone: 631-854-3475

BOX 18100 . HAUPPAUGE.N.Y. 11788-8900 (631)854-9935

Page 27: A CHILD 4

JOUNTY OF SUFFOLK

STEVE LEVYSUFFOLK COUNTY EXECUTIVE

DEPARTMENT OF SOCIAL SERVICES Date: 12/03/2009

MichelePilo320 CARLETON AVESTE 3800CENTRAL ISLIP, NY 11722-4510 Gregory J. Blasi

CommissionerDear Michele Pilo,

You are invited to participate in a Service Plan Review, which is a conference to review the plan for the safety,permanency, and well being of the following children.

Children Date of Birth AgePiscitelli,Winona July 06,2005 4

The Service Plan Review is scheduled on:

Date December 11,2009

Time 11:15 AM

Location SUFFOLK COUNTY DSS Room 101 Floor 1

Address 3455 VETERANS MEMORIALRONKONKOMA NY 11779-7629

The purpose of the meeting is to bring together the child, family, and service providers to discuss thechild(ren)'s and family's strengths and needs, to review their progress, and to plan for the future.

It is necessary that you participate in this meeting to develop and review the plan, as importantdecisions will be made at this meeting. We need your participation in making these decisions. Weinvite you to bring with you anyone who can help with such planning, for example, family members,friends, a member of the clergy, or any other representative of your choice.If you are the parent or guardian of a child in foster care, or if you are a child in foster care, it isimportant that you know the following. Under State and federal law, if a child remains in foster care for15 of the most recent 22 months, there is an obligation on this agency to file a petition to terminateparental rights, unless there is a legally acceptable reason for not doing so. This is a significant topicfor discussion at each Service Plan Review meeting.

If you have any questions or problems regarding the scheduled conference, please contact yourassigned worker or the contact person listed below.

Sincerely,

Case Planner: Phone: - Ext:Case Manager: Towns,Lori Phone: 631-854-9397 Ext:Contact Person: Timothy Ferguson Phone: 631-854-3475

BOX 18100 HAUPPAUGE, N.Y. 11788-8900 (631)154-9935

Page 28: A CHILD 4

REQUEST FOR PRIOR APPROVAL OF SPECIAL NEEDS

TO: Linda Swartz, AD Child Placement Bureau

FR: Lori Towns, Caseworker

Sally O'Donnell, Supervisor

DATE: 11/27/09

RE: Foster ChildWinona Piscitelli DOB 7/6/05

Case # S00900898 Child's CIN #DW78162ENext Recert Date

Total Amount Requested $ 37.50 Estimates Attached

REASON FOR REQUEST:Foster mother purchased a car seat booster for child.

AMOUNT FORTHCOMING FROM OTHER SOURCES: $ IDENTIFY SOURCE

DEADLINE FOR DEPOSIT OR PAYMENT:

AMOUNT APPROVED $ J? 7 Date: /'/*"7

Supervisor's Signature^Jjjj^i & '

FOR APPROVAL OF PROPOSED EXPENDITURE $ 100 - $200

ASSISTANT DIRECTOR'S REVIEW

AMOUNT APPROVED $ Date:Ass't Dir. Signature

FOR APPROVAL OF PROPOSED EXPENDITURE OVER $200

DIRECTOR'S REVIEW

AMOUNT APPROVED $ Date:Director's Signature

NOTEForward two copies for approval. One copy will be returned for the record.

CSA-824 (10/00) Request for Prior Approval of Special Need

Page 29: A CHILD 4
Page 30: A CHILD 4

11/23/2009 09:51 531 -SSS -i SCDOHDSCSN

COUNTY OF SUFFOLK

STEVE LEVYSUFFOLK COUNTY EXECUTIVE

DEPARTMENT OF HEALTH SERVICES

PAGE 02/02

LJNDA MERMELSTEIN, M , MPHActing Commissioner

November 23, 2009

Dear Ms, Towns,

IjjtaMHFfor Children with Special Needs. Lisa currently works Monday-Friday from 8:30 a.m. to 4:30 p.m.Please feel free to contact me if you need any further information.

Sincerely,

Sheila VentriceAssistant Coordinator of Special Instruction(631)853-2334

DIVISION OF SERVICES FOR CHILDREN WITH SPECIAL NEEDS50 Laser Court, Hauppauge, NY 11788(631)853-3130 Fax (631) 853-2300

Page 31: A CHILD 4

CSLGS

Case Name: Winona PalmiottiCase Number: S00900898Court Ordered: Yes IE1 No Q

TRANSPORTATION SERVICESREQUISITION/RECORD

Requisition Date: 11/17/09Child/Children and DOB: Winona Piscitelli

Type of Activity: 1 1 Supervised Visit with transportationQ Supervised Visit without transportationn Transportation Only

[~l Deliver itemsQ Drop off records

Visit or Activity to Commence on: Thursday Nov 19Frequency of Visit: E>3l time dweekly Obi-weekly dmonthlyLength of Visit: open hoursTime of visit: (check) [3am dafternoon CHevening QSaturday(IF VISIT MUST BE A SPECIFIC TIME OR DAY, PLEASE INDICATE):

NOV 1 7 2009Foster Parent or Custodian:Address:Home Phone:

TEAMSChild Placement Bureau

Suffolk County Social ServicesPerson(s) Authorized to have visit and relationship to children: Father- Paul PiscitelliiHome Phone: 516-414-8076 Cell: 516-348-4524

PICK UP location(s) (list all):Daycre4

Visitation Site/Address: Drop off child at BF's home- 318 Ellison Ave, Westbury, NY 11590

RETURN location(s): No return BF will drive child back to FH

Please check all that apply:

BOrder of Protection (Attach copy)Letter from custodian giving permission for DSS to transport (Attach copy)

^Individuals not permitted at visit:

MEDICAL INFORMATION (check all that apply, please note individual with condition/allergy):HHAllergy (list allergy) [HAsthmaCUSeizure disorder QOtherCUSpecial equipment EUNone

Comments: Non respondent father has court ordered unsupervised visits with child. He resides in Westbury. He isrequesting a visit with child on Thursday 11/19. Transportation for child is requested one way anytime in the morning

Caseworker: Lori Towns

Assigned to:

Team# 17 Extension: 4-9397

Start Date: Time:

Transportation Unit cannot handle request at this time:

d. aims~Transporfatiert^pV)rdinator

Page 32: A CHILD 4

Wiaona's Healthy Nutrition Plan

My most important concern with Winona is her eating habits. She is a size 7-8 whenshe should be a 4-5. Winona is a good eater, but is used to fatty fast foods, salt and sugaradded drinks and foods. I'm not a nutritionist but I know the difference from eatinghealthy and Winona has not been provided with healthy choices. I'm very worried abouther health, and proper development. I believe a well balanced diet is essential forWinona, with combined physical activity throughout the day. I will also consult herpediatrician as to what's recommended for Winona's diet and adjust it accordingly. Sheshould have 3 meals a day, breakfast, lunch and dinner, with plenty of grains, vegetables,and fruits, low calorie, low fat, low salt, meals, and about 2 healthy snacks in between.

Her sleep time is very important for a continued nutritional plan, with daily physicalactivities, and she should have about 10-12 hours of sleep at night, and maybe a daily napof about 1 hour, working with her sleeping habits at first as they get adjusted. Winona'snutritional plan will be challenging, but will be enforced by allowing experimentationwith a variety of healthy foods, and to not punish her for not eating well, but to encourageher with a healthy plan for myself, reward her, by telling her "good job" for eating. Evenif she ate very little, I would save her food for later, as she's hungry or add those missednutrients to her diet the following day accordingly. Also adding fun to her food such as alow fat dressing to veggies or a few Fruit Loops, or fresh fruit such as strawberries or abanana to her Cheerios, and also give her a few choices as to what she wants to eat andlet Winona decide. This will encourage her to eat more and also will help build her selfesteem as she feels she's in control. I believe with some experimenting and some fun, shecan be on a well balanced nutritional diet she needs.

Milk-Great source of Calcium, Vitamin D, Protein. Avoid fats from milk, serving lowfat milk or skim milk, Soy Milk, Calcium Forfeited Orange Juice, or low fat Yogurt w/oadded sugar. Make Yogurt fun with fresh fruit such as Strawberries. About 3 - 8ozservings of milk a day.

Cereal - Whole Grain, or Multi Grain cereals such as Cheerios, have many Vitamins andMinerals, with no sugar. Cereals can be combined with fruit, such as strawberries orbananas, or add a few pieces of sweeten cereals such as fruit loops to give it a little moreflavor, and fun. Served with reduced fat, or low fat milk, and a small portion will make agreat meal, as she finishes her meal and praised with a good job for doing so, she will beencouraged to finish her future meals, and building her self esteem at the same time.

Vegetables - High in fiber, Vitamin A, C, Potassium and others. Try all differentvarieties of vegetables, Cooked Carrots, Corn, Peas, Backed Potato, Broccoli, StringBeans, Mashed Potato's, Celery, Lettuce and Tomatoes. Combine vegetables with eggomelets, wraps, or some light dressing. Not to over cook vegetables as they will becrunchy and fun to eat. Serve in small portions so she can finish, and will be rewardedwith a "good job", which will also help build her self esteem.

Page 33: A CHILD 4

Fruits - Fresh Fruits are essential in Winona's diet as they contain many vitamins andminerals naturally. Apples, Oranges, Peaches, Strawberries, Bananas, and other fruitscan be served in many ways to make them fun to eat. Fruits can be served in a meal or asa healthy snack. I would give her a few choices of fruits, such as Strawberry or Banana,but not too many choices otherwise she would be confused and overwhelmed. 1 -2 cups aday of fresh fruit

Juice - Winona likes Juice Drinks, such as Capri Sun. I noticed her drink as much as 3servings at one time. Juice Drinks are not a good source of a healthy diet, as they containsugar that can promote cavities, and they don't contain many nutrients, and will fillWinona, and she will not be hungry at meal time. A great alternative is 100% pasteurizedFruit Juice, Milk or Water, but fresh fruit as a snack is better. If she drinks Juice, Itshould be 100% fruit juice, or watered down Juice, with low or no sugar. I think its betterserved at no more man 602 a day, and served in a sports bottle, which will limit herintake, rather than a glass or a sippy cup, so hunger will set in later at meal time. I willexperiment with Winona as to what she likes to drink and provide healthy choices for her.

Eggs - Eggs do have cholesterol, but no saturated fat. Many minerals and vitamins are ineggs, such as Protein, Iron, and more, so eggs make a good meal every so often. An eggis sufficient 2-3 times a week. Eggs can also be combined with vegetables, as an omlet,French Toast, and can be served a number a ways to make it fun to eat. I will experimentwith her to see how Winona likes eggs.

Oatmeal - Oatmeal is full of whole grains, and can be served numerous way so Winonawill like it. Oatmeal can be a healthy meal, or served as a snack. A small portion willencourage her to finish it, as she's praised for a good job.

Peanut Butter - Peanut Butter can be high in fat, but is full of vitamins and minerals.Vitamin A, E, B6, Iron, and Protein. A low fat, vitamin forfeited, peanut butter is a goodalternative. Peanut Butter combined with a small portion of fruit spreads with low sugarcontent, combined with Whole Grain bread, cut hi shapes will make it fun to eat andenjoy.

Pasta - Pasta is a good source of grains. Low hi calorie, fat, cholesterol free and sodiumfree. Pasta can be served hi many ways and shapes to make it fun to eat. It can also becombined with vegetables for more needed nutrients. A low salt cheese sauce or tomatosauce can be served with pasta. I will experiment as to what Winona likes best. Pastadoes contain carbohydrates, but this should give Winona the energy through out the day,combined with physical activity. Multi-grain pasta is a great alternative as it is less hicarbohydrates and offers more needed nutrients.

Page 34: A CHILD 4

Fish - Tuna Fish is a great food full of Omega-3 fatty acids. Great source for braindevelopment and overall normal growth development. Fish does contain mercury, butlow mercury Albacore Tuna served in small portions and in infrequent intervalscombined with low fat mayonnaise, some vegetables, such as celery and Whole Wheatbread should be sufficient for Winona's diet Again, sandwiches can be made in differentshapes to make it fun to eat I will have to experiment with Winona and see how she likesit

Meats -1 would need to experiment with her as to what meats she likes. All she knowsnow is hamburger. I don't know, but I think that she was eating too much fast food forthe past 3 years. I will try a few healthy meats with her in different healthy varieties suchas chicken, beef and turkey. Low salt cold cuts or cooked meats, maybe combine meats,such as lean ground beef with Pasta.

These are just a few of many ways, how I believe Winona should be eating. I will alwaysexperiment with her as to what healthy food she likes and dislikes, and will give herchoices as required. Although there will be times that a few food she eats will beunhealthy, I will always encourage healthy choices all the time. Winona is very activeand with attention to her proper diet, working with her, and giving her much attention,choices and praise, combined with involvement with physical activities, making it funand at the same time, encouraging her, she should be on the road to a healthier little girl.

I Miss You -1 Love You So Much Always and Forever.My Little Sweet P (Princess)

-Daddy

Page 35: A CHILD 4

^"-V-'•J*.

AMERICAN GREETINGS

J515"51737""54095699 2308

1.99 AH23088-01TAMERICAN GREETINGS CLEVELAND. OHIO 4414

OAQC. LLC MADE IN U.S.A.

Page 36: A CHILD 4
Page 37: A CHILD 4
Page 38: A CHILD 4

onemebmedA

u\ (\\cfl.\ \

Case Name: Winona PalmiottiCase Number: S00900898Court Ordered: Yes £3 No Q

TRANSPORTATION SERVICESREQUISITION/RECORD

Requisition Date: 10/29/09Child/Children and DOB: Winona Piscitelli

Type of Activity: ^ Supervised Visit with transportationQ Supervised Visit without transportationd Transportation Only

Visitor Activity to Commence on: Week of Nov 9Frequency of Visit: (S31 tiSiei [Zlweekly [Ubi-weekly OmonthlyLength of Visit: 2 hows--''Time of visit: (check) Qam Qafternoon Oevening dSaturday(IF VISIT MUST BE A SPECIFIC rr™*v "n " * v m v * ¥1vir"

Q Deliver itemsE] Drop off records

\ O \-0

Foster Parent or Custodian:Address:

Home Phone: Cell:

Person(s) Authorized to have visit and relationship to children: Mother Winona PalmiottiHome Phone: 516-238-0371 Cell:

PICK UP location(s) (list all)^

Visitation Site/Address: dss

RETURN location(s): daycare

Please check all that apply:QOrder of Protection (Attach copy)OLetter from custodian giving permission for DSS to transport (Attach copy)Qlndividuals not permitted at visit:

OCT 2 9 2009

TEAMSCHiW PlaCSment Bureau

Suffolk County SOCfaf SeiVfceS

MEDICAL INFORMATION (check all that apply, please note individual with condition/allergy):QAllergy (list allergy) DAsthmaQSeizure disorder DOther

equipment C]None

Comments: One time make up visit for agency closure on Wed 11/11/09.Mother is seveFlyjnentaHy ill. CSW must watch

Caseworker: Lori Towns

Assigned to:

Team# 17 Extension: 4-9397

Start Date: _ Time:

Transportation Unit cannot handle request at this time^\ (TUPC! ^ l>_\ pQijinPy ^ \ \

Transportation Coordinator Date

Page 39: A CHILD 4

TOWN OF (SLIP DEi 7tTMENT OF HUMAN SERVICESACCESS/ACCESODivision of Drug and Alcohol Counseling and Education Services

401 MAIN STREET • ISLIP, NEW YORK 11751 -(631) 224-5330 •• .452 SUFFOLK AVENUE • BRENTWOOD, NEW YORK WM > (631) 436-6065

Phil Nolan, SupervisorElizabeth Lorenz, Commissioner

Date:

[ I " rJ (' " i /I/O \ i^VSt^v ^[ oVh ( C\~H— has come to the ACCESS office today to registerfor an intake appointment. Initial information has been taken and a referral-in hasbeen written up.

The client will be notified and assigned their intake appointment as soon aspossible. A release of information has been signed by this client and will be kept onfile. If you have any questions about the status of this case, do not hesitate to call theACCESS office at 224-5330.

Sincerely,

Counselor

Page 40: A CHILD 4

TO:

FROM:

CASE TRAM? "R )STER CARE PLACEMENT QUALITY A. JR E COVER SHEET

JLLu CA^W»«_H DATE: fO - ^ - O°|O 17 ,

Unit/worker: Co^3> \ to 5^

, Supervisor.Team

Case name:

, Supervisor Q_,, Team

: Qx\ W Case number:PLEASE ATTACH FORMS IN ORDER LISTED FOR SUPERVISOR

WMS) SERVICES (SOO) CASE OPENING (FOR MSU) (1 OR 2)'DSS-2921 Application for Services'CSA-906 CSA/WMS Transmittal - Note name of foster parent

SS-3373 UCR/CCRS Assessment Plan Grid- NOTE: MSU staff will access through Connections

Date sent to M&U£r"' J&It - •

c\, ^

&/*<LOSS 461 1 (revision date 8/04) Family Checklist for Eligibility & Authorization for EAF

WMS SERVICES AUTHORIZATION (CASE OPEN—CHILD IN CASE) (FOR MSUj*CSA-906A CSA/WMS Transmittal - Note name of foster parent NOTE: Worker must state on 906 whT

progress note the info, is documented on.

Note: MSU STAFF ARE RESPONSIBLE FOR ADDING INDIVIDUALS TO CONX. To add a child to an open case(newborn, etc.) add:D *DSS-3502 Services WorksheetD 'DSS-3316 CCRS Supplemental Information (Must Indicate Ethnicity)D 'DSS-3373 UCR/CCRS Assessment Plan Grid

. MEDICAID ELIGIBILITY TO IV E UNIT (3, 4, 5, 6 or 7) Date sent to IV-E*DSS-2921 Application for Medicaid for each child with Third Party Health Insurance information and verification of

birth (certificate or copy of letter requesting it)LOSS 4809 (revision date 8/04)

*Verification of child's Social Security number .

*4. CSA-67Q *FACE SHEET: All fields must be completed - NOTE: FAMILY INCOME MUST BE INCLUDEDALL PARENTS must appear on Face Sheet (copy to IVE, orig. to case record)

*5. CHILD SUPPORT (See Desk Guide) DO NOT REFER IF CHILD LEFT FOSTER CAREW *CSA-954 Notice of Determinajtiofl of Responsibility for Child Support

If referred to CSEB: B" CSA-956 Referral of Parents to CSEB (EACH PARENT MUST BE REFERRED)D DSS-2860 Child Support Enforce/Ref. (if on PA) (EACH PARENT)

OR EfDSS-2521 App. For Child Support Svcs (if non-PA) (EACH PARENT)

6. "LEGAL AUTHORITY - VOLUNTARY - in Legal Activity RecordD *CSA-397 Voluntary Transfer Agreement (copy)D *DSS-3416 Religious Designation of ChildQ "CSA-396 Affidavit of PaternityD *CSA*983 Consent for Child's Medical/Dental Care (NOTE - In Case Record)D 'Consent for Out of County & Out of State Travel (NOTE - In Case Record)

7> * LEGAL AUTHORITY - COURT PLACEMENTS - in Legal Activity RecordS 'Article 10 Remand/Transfer of CustodyD 'Article 1 0 Adjudication/Transfer of CustodyD *JD PINS/DFY Adjudication/Transfer of Custody

8. D* APPROVED (A.D.'s SIGNATURE) FOSTER CARE PLACEMENT REVIEW

XL i..(/-YviJrCt cl9. ]$l*DSS-2999, School District Notification for School Age Child Placed into Foster Home

Child enrolled date _ _=___=__ _ _10. FOR ALL CHILDREN ENTERING INSTITUTIONAL OR DIAGNOSTIC PLACEMENT

D'Juition Reimbursement Information Sheet NOTE; MUST BE INCLUDED WITH OPENING PACKAGE1 1 . [^Transfer Summary (in CONX CPRS) ~"

B^Birtfi certificate or Q requestZL#Bchool records or D requestH'ffMedical records or H"request32#SSN verification or D SS5^#Neglect/Abuse Petition (in Legal Activit'

jS^Court Order (in Legal Activity Recorlvy

D Other-

^Paternity Statement (in legal record).

Date

Date

Supervisor's Signature (sending) _

Supervisor's Signature (receiving)_^ , _ . _ . . .„ t . . ,_ -— / ,

Asterisk (*) indicates material necessary to process Medicaid or Services case. If absent or incomplete case will be returned for correction.Pound sign (#) indicates material necessary to be Included on all transferred cases."•Instructions for use- For initial case opening use sections 1 & 11 - For transferring between two teams checK all that apply- For Foster Care placements use entire sheet

Rev. OWG an

Page 41: A CHILD 4

COUNTY OF SUFFOLK

STEVE LEVYSUFFOLK COUNTY EXECUTIVE

DEPARTMENT OF SOCIAL SERVICES GREGORY J. BLASSCOMMISSIONER

October 21,2009

- Re: Case ID 24158873Intake Stage ID 26384552Date of Intake 9/9/2009

Winona M Palmiotti1355 Locust AveBohemia, NY 11716-2182

Dear Winona Palmiotti

On 10/21/2009, you were notified that you were the subject or other person named in a report of suspected childabuse or maltreatment received by the New York State Child Abuse and Maltreatment Register (State CentralRegister). At that time, you were informed of the investigation process conducted by the SUFFOLK County ChildProtective Service and your rights in regard to this matter.

We must now inform you that this report has been "indicated" and that you are the subject of the report. This meansthat some credible evidence has been found to support the determination that you maltreated or abused the child(ren)named in the report. In addition to this letter, I, the undersigned caseworker, am willing to discuss in more depth thereasons for this determination and your feelings concerning this matter. Services may also be offered to assist youand your family.

Since this report has been determined to be indicated, it will remain in the New York State Child Abuse andMaltreatment Register. As you were previously informed in your notification letter, you are entitled to request acopy of all information regarding the report contained in the State Central Register. However, the Commissioner ofthe New York State Office of Children and Family Services and social services district official must withholdinformation identifying the person who made the report unless that person has consented in writing to the release ofsuch information. In addition, the Commissioner and social services district official may withhold informationidentifying a person who cooperated in the investigation of the report if the Commissioner reasonably determinesthat the release of the information would be detrimental to that person's safety or interest.

As a subject of a report, that is a person determined to be responsible for causing or allowing to be inflicted injury,abuse or maltreatment to the child(ren) named in the report, you have the right to request the Commissioner of theNew York State Office of Children and Family Services to amend (change) the record of the report if you believethat the information in the report is inaccurate. Such a request could include a request that the report be amendedfrom being "indicated" to being "unfounded". This request must be made by you within 90 days of receiving this

BOX 18100 HAUPPAUGE, N.Y. 11788-8900 (631)854-9935

Page 42: A CHILD 4

notice. Do not wait to receive copies of the information contained in the State Central Register if you wish torequest an amendment. As a result of your request, a complete review of the record and the factors upon which an"indicated" determination was made will take place. Upon completion of this review, you will be notified by theNew York State Office of Children and Family Services, in writing, of the decision made in response to yourrequest. If the Office does not amend the record in accordance with your request or if the Commissioner does notact upon your request for an amendment of the report within 90 days of receiving this request, you will be notifiedof the date when a fair hearing on your request will be held.

If you fail to request that the report be amended within 90 days, or, if upon your request, the report is not amendedto be "unfounded", the information will remain in the Register until your youngest child's 28th birthday. Anindicated report in the Register may be disclosed to an inquiring licensing or provider agency, pursuant to Section424-a of the Social Services Law, if the substance of the report is found to be both supported by a fairpreponderance of the evidence and relevant and reasonably related to employment or licensure in the child caringarea for which you have applied. Such an indicated report may affect your ability to work or be licensed in the childcare field or adopt a child or become a foster parent. The Office has developed guidelines regarding whetherindicated instances of child abuse and maltreatment are relevant and reasonably related to such employment orlicensure. You have the right to request these "Guidelines of Relevant and Reasonably Related" at any time. Youwill automatically receive them if you request amendment of the report.

If you have not yet requested a copy of the information contained within the State Central Register and desire suchinformation, and/or if you wish to request amendment of the information regarding the report contained in the StateCentral Register, you may do so by sending a written request to:

New York State Office of Children and Family ServicesChild Abuse and Maltreatment RegisterP.O. Box 4480Albany, New York 12204-0480

This written request should include your full name, the full name(s) of the child(ren) named in the report, youraddress, the address of the children, the Case ID, and the Intake Stage ID number given in the upper right-handcomer of this letter.

Lisa Scafide Robert LetoCaseworker Caseworker Supervisor

(631)854-9139 Ext.Telephone Number

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COUNTY OF SUFFOLK

STEVE LEVYSUFFOLK COUNTY EXECUTIVE

DEPARTMENT OF SOCIAL SERVICES GREGORY J. BLASSCOMMISSIONER

October 21,2009

Re: Case ID 24158873Intake Stage ID 26384552Date of Intake 9/9/2009

Paul Piscitelli318 Ellison AveWestbury.NY 11590-1835

Dear Paul Piscitelli

On 10/21/2009, you were notified that you were the subject or other person named in a report of suspected childabuse or maltreatment received by the New York State Child Abuse and Maltreatment Register (State CentralRegister). At that time, you were informed of the investigation process conducted by the SUFFOLK County ChildProtective Service and your rights in regard to this matter.

We must now inform you that this report has been "indicated." This means that some credible evidence has beenfound to support the determination that the child(ren) named in the report has/have been maltreated or abused.However, you have been found not to be responsible for causing injury, abuse or maltreatment to the child(ren) orfor allowing such injury, abuse or maltreatment to be inflicted on such child(ren). In addition to this letter, I, theundersigned caseworker, am willing to discuss in more depth the reasons for this determination and your feelingsconcerning this matter. Services may also be offered to assist you and your family.

Since this report has been determined to be indicated, it will remain in the New York State Child Abuse andMaltreatment Register. As you were previously informed in your notification letter, you are entitled to request acopy of all information regarding the report contained in the State Central Register. However, the Commissioner ofthe New York State Office of Children and Family Services and social services district official must withholdinformation identifying the person who made the report unless that person has consented in writing to the release ofsuch information. In addition, the Commissioner and social services district official may withhold informationidentifying a person who cooperated in the investigation of the report if the Commissioner reasonably determinesthat the release of the information would be detrimental to that person's safety or interest.

If you have not yet requested a copy of the information regarding the report contained within the State CentralRegister and you desire such information, you should send a written request to:

BOX 18100 HAUPPAUGE, N.Y.I 1788-8900 (631)854-9935

Page 44: A CHILD 4

New York State Office of Children and Family ServicesChild Abuse and Maltreatment RegisterP.O. Box 4480Albany, New York 12204-0480

This written request should include your full name, the full name(s) of the child(ren) named in the report, youraddress, the address of the children, the Case ID, and the Intake Stage ID number given in the upper right-handcorner of this letter.

Lisa Scafide Robert LetoCaseworker Caseworker Supervisor

(631)854-9139 Ext.Telephone Number

Page 45: A CHILD 4

COUNTY OF SUFFOLK

STEVE LEVYSUFFOLK COUNTY EXECUTIVE

DEPARTMENT OF SOCIAL SERVICES October 21,2009GREGORY J. BLASS

COMMISSIONER

Re: Case ID: 24158873Call ID: 26384552Report Date: 9/9/2009

Dea:

This letter is in response to your request, pursuant to Section 422(4) of the Social Services Law, to thefindings of the investigation concerning your report of suspected child abuse or maltreatment. You made such areport in your professional or official capacity as a person required to report child abuse or maltreatment.

Office of Children and Family Services records show that the report has been deemed 'indicated', as childprotective services has found some credible evidence of abuse and /or maltreatment.

Should you have any questions or concerns regarding this, please do not hesitate to contact me at theaddress listed above.

Thank you for your cooperation.

Very truly yours,

Robert LetoSupervisor

Lisa ScafideSenior Caseworker

BOX 18100 HAUPPAUGE, N.Y. 11788-8900 (631)854-9935

Page 46: A CHILD 4

Adclphi University

Institute.forParenting

CONSENT FOR RELEASE OF INFORMATION

Date: \O\V*

Counselor: Mlfheill t(H W

Extend of nature of information to be disclosed:

Purpose or need for the disclosure: I nCVTOK UWIr KTtHnC IPHrt£ r.PS &K-6 •+• r^I/mftrft-cHn lrtn. J

From: (Name, address and phone number of person or organization disclosinginformation):

UicWiU-eruJa>

To: (Name, address and phone number of person or organization to which disclosure is tobe made):

I understand that 1 have the right to revoke this consent at any time except to the extent that action has beentaken thereon. 1 also understand that my consent will expire when acted upon, or six (6) months from thisdate, whichever occurs first

I understand that such disclosure is bound by Title 42 of the Code of Federal Regulations governing theconfidentiality of patifint records, when applicable. Title 42 prohibits you from making any futuredisclosure of this information without my specific written consent, or as otherwise permitted by suchregulations. A general authorization for the release of medical or other information is NOT Sufficient forthis purpose.

Print Name of Witness

Page 47: A CHILD 4

COMPANY:

FAX NUMBER:

Adelphi University

I nstitute.forParenting

SENDER PHONE NUMBP.Ri

RE;

FAX COVER SHEET

FROM: Michel kDATE:

TOTAL NO. OF PAGES IMCLUUlNti COVER:

SENDRU FAX KlIlM'RRn-

516-237-8512

853!

ONE SOUTH A V l i N U E P.O. BOX 701 G A R D E N CITY, NY 11S3'0

Page 48: A CHILD 4

CONNECTIONS

CHILD PROTECTIVE

RECORD SUMMARY

V"'"WARNING*****

CONFIDENTIAL INFORMATION

AUTHORIZED PERSONNEL ONLY

CASE ID: 24158873

CASE NAME: Palmiotti.Winona M

STAGE CD:

INV STAGE ID: 26384647

INV STAGE NAME: Palmiotti.Winona M

INT REPORT DATE: 9/9/2009

HOUSEHOLD COMPOSITION

ID NAME PERSON ID REUINT D.O.B. SEX

1 Palmiotti.Winona 28610736 Mother 4/7/1973 F

2 Piscitelli.Paul 28610737 Bio.

Father5/27/1972 M

3 Piscitelli.Winona 28610740 Child 7/6/2005 F

ROLE ETH, RACEConfirmed

Subject

Confirmed

Maltreated

NH White

No Role NH White

NH White

LANG SSN REL

English 067-70-3251

English

English 110-94-0570

ID ADDRESS

1 1355 LOCUST AVE

2 318 ELLISON AVE

3 PO BOX 1800

CITY

BOHEMIA NY

WESTBURY NY

HAUPPAUGE NY

ZIP

11716-2182

11590-1835

11788-8600

CNTY

047

028

047

CD PHONE

(516)238-0371

(516)333-2672

(631)503-7765

Date Printed: 10/9/2009 12:06:48 PM Page:

Page 49: A CHILD 4

10/16/09 FRI 17:51 FAX 631854335" CPS MACARTHUR PARK ilOOl

ft:}:****.•}:#*« «***:£##«*** TX REPORT ***ae*********** *********

TRANSMISSION OK

TX/RX NOCONNECTION TELCONNECTION IDST. TIMEUSAGE TPCS. SENTRESULT

1390918457940199

10/16 17:5000'432

OK

DEPARTMENT OF SOCIAL SERVICES

FaxTo:. 31

COUNTY OF SUFFOLK

STEVE LEVYSUFFOLK COUNTY EXECUTIVE

4T

Gregory J. BlassCommissioner

O U T From: Lisa Scat te 631-854-9139 •

Pages:

Date: IO-IL-0?Re; -G-or- CJQW 4- CC:

1 alent D For Review D Please Comment D Please Reply D Please Recycle

• Comments:

SC^4-B/f ruj//L* .ix. e__.

Page 50: A CHILD 4

COUNTY OF SUFFOLK

STEVE LEVYSUFFOLK COUNTY EXECUTIVE

DEPARTMENT OF SOCIAL SERVICES Gregory J. BlassCommissioner

From: Lisa Scafide 631-854-9139

Pages:

Phone: £U C- ~Vd- 3OCO Date:

Re; p,o^ jLjg3X"T -£cft~ CjQJU/"^" *****

CTUrgent D For Review O Please Comment D Please Reply D Please Recycle

• Comments:

Thank youjpt ur prompt attention to this matter

A 'Since/ely

Lisa Scafide Team 63/102

Confidentiality Notice: The documents, which accompany this telefax transmission sheet, containinformation which is confidential and/or legally privileged, and which is intended only for the use of theperson or entity named above. If you have received this transmission in error you are hereby notifiedthat any disclosure, copying distribution, or the taking of any action in reliance of the contents of thisinformation is strictly prohibited and that the documents must be returned to this office immediately.

If you have received this transmission in error, or if any parts of it are missing or illegible, please notifyus at 631-854-9139

BOX 18100 HAUPPAUGE, N.Y.I 1788-8900 (631)854-9935