Multi-disciplinary staffing & Assessment

of child-on-child referral

ote: n Koerick at 954.585.3736.
ker at 954.214-5703.t that identifies the funding provided by the legislature. the hrNote: This multi-disciplinary staffing on the below referenced referral is for purposes of case planning and determination of treatment needs. It is being conducted through an approach involving the child protective investigative staff, law enforcement, representatives of the child protection team of the Department of Health or Children Advocacy Center, and community-based care providers funded by the department, county, or legislature to provide ameliorative and treatment services as appropriate. The core source for the format of this information is derived from requirements of Florida Administrative Code Rule 65.C-29.007. This information is confidential pursuant to FS 39.202.

FSFN Intake Report Number:

Child Protective Investigator:

Listed victim child (first/last initials only):

Listed alleged aggressor (first/last initials only):

Date of COC Multi-disciplinary staffing & Assessment:

  1. Assessment elements considered in determining a need for services and case planning included:

1)Offense Characteristics –considerations: the victim is substantially younger than the offender rather than peer age; the victim is known to the offender; the use of coercion, violence, and bribes by the offender; there are elements of secrecy involved; there are multiple victims; the number of abusive incidents; there is history of non-sexual aggravated assault.

Conclusions:

2)Child Maltreatment History – considerations: the offender has a history of sexual victimization, physical abuse, neglect, or family/domestic violence.

Conclusions:

3)Social and Interpersonal Skill and Relationships – considerations: the offender’s family has a history of instability; there is a history of physical or emotional separation from one or both parents; the offender has inadequate social skills, poor peer relationships, and/or is socially isolated.

Conclusions:

4)Sexual Knowledge and Experience – considerations: the offender has knowledge of advanced sexual practices and/or exposure to pornography.

Conclusions:

5)Academic and Cognitive Functioning – considerations: the offender has academic difficulties, reduced empathy and blames the victim.

Conclusions:

6)Mental Health Issues – the offender has a history of impulse control problems, anxiety, depression, suicidal ideation, substance abuse.

Conclusions:

7)Household Demographics:

Aggressor child - home conclusions:

Victim child – home conclusions:

  1. Treatment Needs:
  1. Assessment Outcome & Recommendations:
  1. Service Compliance Issues:

Participants multi-disciplinary staffing:

My signature below indicates that I attended & participated in the above noted multi-disciplinary staffing and assessment. The Confidentiality of all information, discussions and/or records referenced in this staffing is pursuant to FS 39.202. No notations or recordings from this staffing may be taken, unless the entity has prior authorization by the CPI and supervisor based on their permitted access due to being an authorized provider who has been granted charge of intervention or prevention services in the case.

Agency / Print Name: / Signature:

COC Multi-disciplinary Staffing & Assessment Report [July 2012]Page 1