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 NumberWashington, 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 / RaceSTART_DYNAMIC_TABLE=ADULT
Delicia WashingtonReginald 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 IslanderHM / = / 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 MembersName / Relationship /
Address
/ Telephone No. / DOB / Gender / RaceSTART_DYNAMIC_TABLE=PARENT
END_DYNAMIC_TABLE=PARENT
C. / Alleged MaltreatmentAlleged Victim / Relationship to Victim / A/N Code / Description / F
START_DYNAMIC_TABLE=VICTIM
Delicia Washington / Biological Parent(s) / Physical Abuse / BruisingEND_DYNAMIC_TABLE=VICTIM
F / = / FatalityD. / 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
- Describe alleged maltreatment: current and past; the surrounding circumstances; and the frequency or intervention or services needed for the child.
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.
- Describe the child(ren)’s injury or conditions as a result of the alleged maltreatment or services needed.
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.
- Describe the child(ren)’s current location, school/daycare including dismissal time, functioning, including special needs, if any, and highlighting current vulnerability.
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
- Document relevant information from CPS history, CCAP and Sex Offender Registry-Reverse Address checks (if no relevant information found, document that checks were completed).
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
- Describe when the alleged maltreater will have access to the child.
- Describe any changes in circumstances that may make it difficult to fulfill CPS responsibilities.
- Describe presence of domestic violence, if applicable, including the demonstration of power and control and entitlement within the home.
- Describe how the family may respond to intervention by the agency, including the parental protective capacities.
THE FOLLOWING SECTION MUST BE COMPLETED FOR ALLEGED MALTREATMENT BY PRIMARY CAREGIVER OR PARENTAL CONTRIBUTION TO THE MALTREATMENT:
- Describe the parents or adults in the parental role: current location, functioning, and parenting practices and views of child(ren).
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.
- Describe the family functioning, strengths and current stressors.
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.
- Document the name of the alleged maltreater and relationship to child.
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