FLORIDA SAFETY DECISION MAKING METHODOLOGY
Information Collection and Family FunctioningAssessment
Case Name: / Intake Received Date:Worker Name: / Date Completed: //
FSFN Case #: / Intake FSFN ID: ______
SECTION A: FAMILY ASSSESSMENT AREAS AND CHILD SAFETY THREATS
Maltreatment and Nature of Maltreatment –1. What is the extent of the maltreatment?
2. What surrounding circumstances accompany the alleged maltreatment, precipitating events, history?
YesNo
/ 1.Caregiver is not meeting child’s basic and essential needs for food, clothing and/or supervision, AND child is/has already been seriously armed or will likely be serious harmed.
/ 2. Caregiver’s intentional and willful act caused serious physical injury to the child, or the caregiver intended to seriously injury the child
/ 3. Caregiver is violent, impulsive, or acting dangerous in ways that have seriously harmed the child or will likely seriously harm the child.
/ 4. Caregiver is threatening to seriously harm the child, is fearful he/she will seriously harm the child.
/ 5. Caregiver views child and/or acts toward the child in extremely negative ways AND caregiver behavior is indicative of the child being seriously harmed emotionally and/or physically or the child has been seriously harmed emotionally or physically.
6. Child shows serious emotional symptoms requiring immediate intervention and/or lacks behavioral control that results in self-destructive behavior that caregivers are unwilling or unable to provide necessary care. Child provokes dangerous reactions / behaviors in caregivers and caregivers are unwilling or unable to arrange or provide or manage/control.
7. Child has a serious illness or injury (indicative of child abuse) that is unexplained, or the caregiver’s explanations are inconsistent with the illness or injury that is indicative of child abuse.
8. The child’s physical living conditions are hazardous and a child has already been seriously injured or will likely be seriously injured.
9. There are reports of serious harm and the child’s whereabouts cannot be ascertained and/or there is a reason to believe that the family is about to flee to avoid DCF intervention and/or refuses access to the reported concern is significant and indicates serious harm.
10. Other. Explain. ______
Child Functioning –
3. How does the child function on a daily basis? Behavior, activities, with family and others, etc.
4. Adult Functioning –
How does the adult function on a daily basis? Overall life management.
Parenting –
5. General – What are the overall, typical, parenting practices used by the parents/legal guardians?
6. Discipline/Behavior Management – What are the disciplinary approaches used by the parents/legal guardians, and under what circumstances
SECTION B: SAFETY DETERMINATION SUMMARY
No Threats of Danger identified.
Threat(s) of Danger identified.
SECTION C: CHILD VULNERABILITY
The vulnerability of each child needs to be considered throughout the information collection and assessment.
Factors which may inrease Child Vulnerability to safety/danger threat(mark all that apply to any child):
Young age of child(ren)Child’s inability to self-protect
Young age of caregiverChild’s diminished mental capacity (developmental delay, nonverbal)
Significant diagnosed medical/mental disorder Child’s physical disability
School aged, but not attending school
Briefly describe assessment of the child’s vulnerability to the safety threat(s) identified, if applicable.
Now, what is it within the parents functioning that allows them to be protective or that they’re lacking to deal with that child’s vulnerability?
SECTION D: CAREGIVER PROTECTIVE CAPACITIES and ANALYSIS
Caregiver Protective Ability / Caregiver #1: / Caregiver #2:Yes No Unknown / Yes No Unknown
Behavioral / Takes Non-violent Action / /
Physically Able / /
Clean and sober when caring for children.
This was demonstrates impulse control / /
Uses Resources to Meet Basic Needs / /
Intellectually Able/Capable / /
Emotional / Meets Own Emotional Needs / /
Copes with stress and adversity / /
Social / Has mutually supportive network of friends and/or family / /
Has mutually supportive relationships with adults in household / /
Parenting: Behavioral / Acts to meet child’s basic needs / /
Provides safe, effective discipline / /
Provides developmentally appropriate opportunities for child growth / /
Demonstrates actions that strengthen child’s sense of connection, self-worth / /
Parenting:
Cognitive / Recognizes Child’s Needs / /
Understands Protective Role / /
Accurate/Realistic Expectations of child’s abilities / /
Caregiver Protective Capacity Determination Summary:
Protective capacities are sufficient to manage identified threats of danger in relation to child’s vulnerability.
Protective capacities are not sufficient to manage identified threats of danger in relation to the child’s vulnerability.
SECTION E: CHILD SAFETY DETERMINATION AND SUMMARY
Child / Safe UnsafeChild 1: /
Child 2: /
At the completion of the investigation and assessment, based upon the information currently available, reviewed, collected, assessed and analyzed:
The Child(ren) is/are determined to be Safe. (Check which apply)
Noimpending danger safety threats that meet the safety threshold
Impending danger threats are being effectively controlled and managed by a caregiver in the home.
The Child(ren) is/are determined to beUnsafe.
One or more impending danger safety threats that meet the safety thresholdand child is vulnerable to the threat
A safety plan must be implemented, monitored and managed by the department.
The case will be opened for safety management and case management services
IF CHILD(REN) ARE ASSESSED AS SAFE, PROCEED TO SECTION G and H.
IF CHILD(REN)ARE ASSESSED ASUNSAFE, PROCEED TO SECTION F TO DETERMINE IF CHILD MAY REMAIN IN THE HOME WITH AN IN-HOME SAFETY PLAN. This may be non-judicial or judicial.
SECTION F: SAFETY ANALYSIS AND PLANNING
YesNo / The caregivers are willing for an in-home safety plan to be developed and implemented and have demonstrated that they will cooperate with all identified safety service providers.
/ The home environment is calm and consistent enough for an in-home safety plan to be implemented and for safety service providers to be in the home safely.
/ Safety services are available at a sufficient level and to the degree necessary in order to manage the way in which impending danger is manifested in the home.
/ An in-home safety plan and the use of in-home safety services can sufficiently manage impending danger without the results of scheduled professional evaluations.
/ The caregivers have a residence in which to implement an in-home safety plan.
If “Yes” to all of SECTION F above – Child will remain in the home at this time
Thechild(ren) is/are “Conditionally Safe” (Unsafe, but a Safety Plan is executed which allows a child to remain in the home with the use of in-home safety services in orderto manage the way in which impending danger is manifested in the home while treatment and safety management services can be determined and initiated.)
A safety plan must be implemented, monitored,and actively managed by the department.
The case will be opened for safety management and case management services
If “No” to any of SECTION F above – out of home placement is the only protective intervention possible for one or more children.
Out-of-home safety plan
The case will be open for safety management, case management, and reunification services
If an Out-of-home safety plan is selected, summarize reason for removal and conditions for return. Conditions for return should be related to reasons for removal and behaviorally based. These are caregiver actions and behaviors that must be demonstrated over time to sufficiently address the impending danger and allow for the child to safely return home.SECTION G: MALTREATMENT/ALLEGATION FINDING AND DISPOSITION – Apply Child Maltreatment Index Criteria
No Indicators
Not Substantiated
Verified Incident or Finding Date:______Parent/Caregiver Responsible: ______
SECTION H: RISK ASSESSMENT DETERMINATION
Complete Risk Assessment instrument at close of investigation.
Safety / Low/moderate risk / High/very high riskSafe / Close / Evaluate for family support services
“Conditionally” Safe with Safety Plan or
Unsafe / Refer for safety management and ongoing case managementservices.
Child has in-home safety plan or is in placement. / Refer for safety management and ongoing case management services.
Child has in-home safety plan or is in placement.
Worker: Date: //
Supervisor: Date: //
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