Application Three

Assessing Present Danger Threats at Access

Use the “Assessing Present Danger Threats” worksheet to review thisCPS Report. You will be asked to make an independent assessment of Present Danger Threats and justify your judgment. If there are multiple Present Danger Threats, you will need to copy and paste the justification section. You will then compare your assessment with that of the worker completing the CPS Report.

Email your worksheet to your trainer in keeping with the schedule.

Application Three

Assessing Present Danger Threats

Case Name: Washington

Who is in the family/household that is the focus for assessment?

For any Present Danger Threat you identify:

(Include justification of threats you considered, but ruled out)

Threat Identified:

  • Clearly observable family condition:
  • Significant:
  • Immediate (actively occurring or in process of occurring):
  • Likely to result in severe harm (consider child vulnerability):

For any Possible or Likely Impending Danger Threat you identify:

(Use list of Impending Danger Threats from Appendix 6 of Safety Intervention Standards)

Threat Identified:

Justify your judgment:

Compare your assessment with that of the worker completing the CPS Report

How do your judgments fit with the worker's decisions?

If the worker identified a threat with which you disagree, justify your stance:

How would you help this worker understand and address any discrepancies in judgment?

CHILD PROTECTIVE SERVICE REPORT

Case Name / Worker Safety Concerns / Report Number
Washington, Jasmine / Yes / X / No / XXXX
Date and Time Report Received / CPS Report Type / County
10/25 9:15 AM / Primary / Glen
Name - Worker / Name - Supervisor
Aaron Champlain / Sharon Herman
I. / Family Information
Name - Family / Telephone Number - Home
Washington, Jasmine / 123-4567
Address - Street / Apt. No. / City / Town / State / Zip Code
1107 Pine Street / Middletown / WI / 55522
Primary Language: / English / Interpreter Needed: / Yes / X / No
Directions to House
A. / Household Members

Name

/ Role / Relationship / DOB / Age / Gender / Race

START_DYNAMIC_TABLE=ADULT

Delicia Washington
Reginald Washington
Kiesha Washington
Jasmine Washington
DeShaun Washington / AV-HM
HM-PR
HM
HM-PR-RN
HM / Biological Child
Present Spouse
Biological Child
Reference Person
Biological Child / 12
45
10
41
15 / F
M
F
F
F / B
B
B
B
B

END_DYNAMIC_TABLE=ADULT

AV / = / Alleged Victim / A / = / Asian or Pacific Islander
HM / = / Household Member / B / = / Black
NM / = / Non-Household Member / I / = / American Indian / Alaskan Native
PN / = / Parent / Parental Role / P / = / Native Hawaiian / Other Pacific Islander
RN / = / Report Name / U / = / Unable to Determine
W / = / White

START_DYNAMIC_TABLE=CHILD

Information that the childchildren may have American Indian heritage, including names of tribe(s) if known.
Reporter is not aware of American Indian heritage

END_DYNAMIC_TABLE=CHILD

B. / Parent(s) Not in Home / Other Non-Household Members
Name / Relationship /

Address

/ Telephone No. / DOB / Gender / Race

START_DYNAMIC_TABLE=PARENT

END_DYNAMIC_TABLE=PARENT

C. / Alleged Maltreatment
Alleged Victim / Relationship to Victim / A/N Code / Description / F

START_DYNAMIC_TABLE=VICTIM

Delicia Washington / Biological Parent(s) / Physical Abuse / Bruising

END_DYNAMIC_TABLE=VICTIM

F / = / Fatality
D. / Location of Incident
Address - Street / Apt. No. / City / Town / State / Zip Code
1107 Pine Street / Middletown / WI / 55522
Telephone Number - Home / Telephone Number - Work / Date and Time of Alleged A / N
123-4567 / 234-5678 / 10/24
E. / Contacts / Others with Information About Family
Reporter has no contact information
II. / Narrative
  1. Describe alleged maltreatment: current and past; the surrounding circumstances; and the frequency or intervention or services needed for the child.
Reporter states on 10/25, 12 yo Delicia stated, “don’t touch my shoulder”. Delicia was observed to have 2 scratches on her left shoulder that were approx. two inches long. Delicia disclosed that last night (10/24) her father was drinking and her parents were arguing and her father was hitting her mother and Delicia got in the middle of the altercation and her dad accidently hit Delicia causing the injury to her shoulder.
On 10/24, Delicia reported that she was on the computer and her dad told her to get off then pushed her and her arm hit the filing cabinet. Delicia has a oval shaped yellowish blue color bruise that is 3 inches long on her right forearm from this.
The father is verbally abusive to Delicia telling her he hates her and calls her a slut, whore and wishes she was dead. He usually says these things when he is intoxicated. Delicia reported her father drinks alcohol every other day. The child was crying when she spoke with a social worker as she is scared she is going to be in trouble for telling what happened.
  1. Describe the child(ren)’s injury or conditions as a result of the alleged maltreatment or services needed.
Physical abuse related to a DV incident between parents.
12 yo Delicia has 2 scratches on her left shoulder that are approximately two inches long and an oval shaped yellowish blue color bruise that is 3 inches long on her right forearm that were caused by her father.
  1. Describe the child(ren)’s current location, school/daycare including dismissal time, functioning, including special needs, if any, and highlighting current vulnerability.
Delicia attends Kennedy School (Dismiss 2:45) and does not have any special needs or behavioral issues in school.
Kiesha attends 4th grade at Kennedy School. She does not have any special needs.
DeShaun attends 10th grade at Johnson H.S. DeShaun has an IEP for special needs related to learning delays. DeShaun does not have behavior issues in school. DeShaun has had behavioral issues in the home such as becoming violent and aggressive with his sisters. He has threatened to hurt himself and others.
DESCRIBE ANY PRESENT DANGER THREATS, INCLUDING A DESCRIPTION OF POSSIBLE OR LIKELY EMERGENCY (EXIGENT ) CIRCUMSTANCES
No Present Danger Threats
  1. Document relevant information from CPS history, CCAP and Sex Offender Registry-Reverse Address checks (if no relevant information found, document that checks were completed).
CPS HX: One past CPS report 7 years ago that was screened out. Kiesha came to Birth to Three program with bad case of head lice. The mother seems uninterested in this.
Reginald CCAP:
7 years ago-Eviction
15 years ago-3 counts of Resisting or Obstructing an Officer, Class A misdemeanor
18 years ago-Domestic Abuse Temporary Restraining Order-crt issued injunction
20 years ago-Disorderly Conduct Misdemeanor-dismissed on Prosecutor’s Motion
Jasmine CCAP:
6 years ago-Forgery-Uttering, Class H Felony
7 years ago-Theft-Movable Property, less than $2500, Class A Misdemeanor
  1. Describe when the alleged maltreater will have access to the child.
The child lives in the home with the mother and father
  1. Describe any changes in circumstances that may make it difficult to fulfill CPS responsibilities.
Reporter is not aware of any changes.
  1. Describe presence of domestic violence, if applicable, including the demonstration of power and control and entitlement within the home.
The father is abusive to the mother in the home and there was a DV incident on 10/24 where the child Delicia was injured from getting involved in the parents’ DV altercation.
  1. Describe how the family may respond to intervention by the agency, including the parental protective capacities.
The reporter is unsure how the father will respond. Reporter has never met or spoke with the father. Reporter is concerned how Delicia will be treated at home and will be blamed for CPS involvement.
THE FOLLOWING SECTION MUST BE COMPLETED FOR ALLEGED MALTREATMENT BY PRIMARY CAREGIVER OR PARENTAL CONTRIBUTION TO THE MALTREATMENT:
  1. Describe the parents or adults in the parental role: current location, functioning, and parenting practices and views of child(ren).
The father Reginald is unemployed and has a drinking problem. He was in jail for a period of time last year for unpaid child support from a child with another woman. Reginald appears to be emotionally unstable due to his drinking issues. It is unknown if Reginald has mental health issues.
The mother Jasmine may be doing in-home nursing as employment. She does not appear to have delays or mental health issues. She is a caring mother and tries her best with the children.
  1. Describe the family functioning, strengths and current stressors.
The mother is very involved in her children’s school and volunteers at the school a lot. The mother provides most basic care to her children.
The mother has been given resources for family therapy and AODA for the father but the mother has not followed through with this.
DESCRIBE THE POSSIBLE OR LIKELY IMPENDING THREATS TO CHILD SAFETY
One or both parents/caregivers are violent.
12 yo Delicia disclosed that last night (10/24) her father was drinking alcohol and her parents were arguing. Her father was hitting her mother and Delicia got in the middle of the altercation and her dad accidently hit Delicia causing injury to her shoulder. Delicia was observed to have 2 scratches on her left shoulder that were approx.. two inches long. On 10/24, the father told Delicia to get off the computer and he pushed her and she hit her arm on the cabinet and she has a 3inch bruise on her forearm from this.
One or both parents’/caregivers’ behavior is dangerously impulsive or they will not/cannot control their behavior.
The father is chemically dependent and unable to control the dependency’s effects. The father is reported to drink alcohol every other day and is reported to become violent and verbally abusive when he drinks. On 10/24, the father was intoxicated and became violent causing injury to his 12 yo child on two different occasions.
  1. Document the name of the alleged maltreater and relationship to child.
Father-Reginald Washington
III. / Agency Response
A. / Supervisor Screening Decision
Decision / Date / Time Decision was Made
Response Time / Reason
Explain
B. / Yes No Law Enforcement Notified
Yes No After Hours Report
IV. / Signatures
SIGNATURE - Worker / Date Signed
SIGNATURE - Supervisor / Date Signed

WCWPDS-Supervising Safety THIS IS A TRAINING CASEPage 1