Structured Decision Making Policy and Procedure Manual

Structured Decision Making Policy and Procedure Manual

Case Example 2

CHILD ABUSE AND NEGLECT SCREEN-IN CRITERIA RESPONSE PRIORITY SAFETY ASSESSMENT FAMILY RISK ASSESSMENT CASE DECISION GUIDELINES MATRIX FAMILY STRENGTHS AND NEEDS ASSESSMENT CASE CONTACT GUIDELINES FAMILY RISK REVIEW FAMILY STRENGTHS AND NEEDS REVIEW FAMILY REUNIFICATION REVIEW

New Hampshire Division of Children, Youth and Families Child Protective Services Structured Decision Making (SDM) Training CRC, NCCD/CRC slide 1 Goals of Training Increase knowledge of the SDM model; Increase specific knowledge of SDM tools, criteria, policy and procedures; Have an opportunity to apply SDM tools to case examples. CRC, slide 2 Overview of SDM Comprehensive case management model Structures the critical decision points in the life of a case from intake to case closure Utilizes assessment tools that are research-based Has demonstrated ability to reduce subsequent harm to children and expedite permanency when implemented properly CRC, slide 3 1

How decisions should not be made Gut feeling Bias Idiosyncratic Inconsistent CRC, slide 4 Goal of Structured Decision Making (SDM) Reduce subsequent harm to children η Subsequent referrals η Re-substantiations η Injury η Removals to foster care Expedite Permanency CRC, slide 5 Objectives of SDM Identify key decision points CRC, slide 6 2

Referral received Screen-In How quickly to respond? Response Priority Is child safe in the home? Safety Decision: open or close? Risk Case Planning Decision: keep open or close? Placement Cases: Reunification Review S/N Review Family Strength & Needs Reassessment In-home Cases: Risk Review S/N Review contact guidelines Objectives of SDM Increase consistency of decisions Increase validity of decisions Target resources to families at highest risk Use case level data to inform decisions throughout agency CRC, slide 8 Michigan Evaluation Results Outcomes for all cases in study 12 month follow-up CRC, slide 9 3

Subsequent Substantiations by risk level and investigation findings CRC, slide 10 New Mexico, 1995 New Referral Rates case opened vs. closed after investigation 2 year follow-up CRC, slide 11 Wisconsin Urban Caucus, 1999 New Referral Rates case opened vs. closed after investigation 2 year follow-up CRC, slide 12 Wisconsin Urban Caucus, 1999 4

Subsequent Substantiations by risk level and investigation findings CRC, slide 13 New Mexico, 1995 Building toward SDM s goal Reduced harm Using tools to guide decisions Completing tools accurately, supported by narrative evidence Completing tools CRC, slide 14 Screen-In Criteria (pg 2 P&P Manual) By utilizing New Hampshire statutes, agency policies and protocols, the Screen-In Criteria assess whether a report meets the criteria for abuse and neglect assessment. CRC, slide 15 5

Screen-In Criteria Which Referrals The Child Abuse and Neglect Screen-in criteria is completed on all credible reports. This includes telephone and all other means of report, and includes new reports of child abuse and neglect on open cases. CRC, slide 16 Screen-In Criteria Cont. When Within 24 hours, excluding holidays and weekend, of receipt of the report. Who The Intake CPSW CRC, slide 17 Screen-In Criteria cont. Appropriate Completion (pg 3&4 P&P Manual Complete the appropriate NH Bridges/SDM screens by marking the specific maltreatment type and report criteria. Reports that do not meet any of the screen-in criteria must not be accepted for assessment CRC, slide 18 6

Response Priority A set of decision trees that correspond to specific types of maltreatment Each decision tree asks a set of questions related to the most critical characteristics of the report to determine how quickly to respond Guides how quickly an assessment must be initiated CRC, slide 19 Response Priority (Pg5 P&P Manual) Level 1= Immediate, but no later than 24 hours, Level 2= Within 48 Hours Level 3= Within 72 Hours CRC, slide 20 Response Priority Results CRC, slide 21 N=10,201 California Combined Counties, January 1-June 30, 2000 7

CRC, slide 22 Response Priority (pg 5 P&P Manual Which referrals Completed on every new CPS credible report that is accepted for assessment, including every new assessment on open cases When Completed within 24 hours, excluding holidays and weekends from receipt by intake of a credible report of child abuse or neglect Who Intake CPSW Response Priority is not completed on Law Enforcement requests Response Priority-Sexual Abuse No SEXUAL ABUSE Does the alleged offender have access or is the child afraid to go home? Yes Is the non-offender caregiver' response appropriate and protective of the child? No Is the caregiver unaware of abuse or is response to abuse unknown? Yes No Yes No Level 2 Level 1 Level 2 Level 3 CRC, slide 23 Response Priority Cont. Appropriate Completion Complete the decision tree for each type of alleged maltreatment on the appropriate NH Bridges/SDM screens. For each tree, begin at the first question and mark yes or no, using the criteria to determine the appropriate response. Follow the branch of the tree determined by the yes or no response until reaching a determined response time. CRC, slide 24 8

Response Priority Cont. Overrides Decision trees are designed to guide decisions, not replace the judgment of the CPSW. When there is a unique circumstance that is not captured by the tool, or there is other information that is known, the response priority may be assigned a lower or higher response priority. CRC, slide 25 Screen in Criteria and Response Priority Practice Activity Read p. 1 of the Hernandez case Complete p. 2 4 Use definitions for the Response Priority p. 9 12, P & P Manual CRC, slide 26 Safety Assessment (p. 13-20 P&P Manual) Are safety factors present that place a child in danger of immediate harm? If so, can safety interventions be implemented now that would allow the child to remain in the home as the assessment proceeds? Or, if not, must the child be placed? CRC, slide 27 9

Safety Assessment Section 1: Safety Assessment Section 2: Safety Response Section 3: Safety Decision CRC, slide 28 Safety Assessment Cont. Which Assessments Completed on all child abuse and neglect assessments, including new referrals on open cases that are assigned for assessment Any time new information becomes available that indicates a threat of safety to the child(ren) CRC, slide 29 CRC, slide 30 Safety Assessment Cont. When Assessing child safety begins immediately upon initial contact with the family. Safety Assessment is completed before leaving a child in the home and before returning a child to the home during the assessment. Safety factors should be reviewed during the assessment process and the tool completed within 24 hours of face to face contact with the child Whenever new information is available that indicates threat of safety to child(ren) 10

Safety Assessment Cont. Who The assigned Assessment CPSW For new referrals on ongoing cases, the safety assessment is completed by the Assessment CPSW or the Family Services CPSW CRC, slide 31 Safety Assessment Cont. How Using criteria established consider each of the 10 Safety Factors in section 1, answering yes or no as it relates to the most vulnerable child. For each safety factor identified, consider the resources available in the family and the community that might help to keep the child(ren) safe and in section 2, check each response taken to protect the child(ren). CRC, slide 32 Safety Assessment Cont. How Section 3 Safe: No safety factors were identified in section 1 Conditionally Safe: One or more safety factors were present however, safety interventions were put in place and children can remain in home Unsafe: One or more safety factors were present any one child was removed from the home CRC, slide 33 11

Safety Assessment Practice Read p. 5 6 of the Hernandez case Complete p. 7 Use Criteria p. 18 20 STOP Read top of p. 9 of Hernandez case Complete p. 8 CRC, slide 34 Discrete decisions, different tools Question Is the child in danger of immediate harm? Safety Risk Need What is the likelihood of future harm? What are the priority needs? Basis Consensus Research Consensus Decisions Should the child be placed or remain in the home while the investigation continues? Should the case be opened after the investigation and if so, at what service level? What priority needs should be addressed in the case plan? CRC, slide 35 Risk Assessment Risk Assessment identifies families who have very high, high, moderate or low probabilities of abusing or neglecting their children in the future Risk Level indicates the likelihood of future maltreatment and is used to determine if the assessment should be opened for services or closed CRC, slide 36 12

Research Based Risk Assessment Related to actual case outcomes Available at the end of the assessment Concrete and observable CRC, slide 37 California Risk Study Results CRC, slide 38 N=2,511 investigations conducted in 1995, followed for two years Risk Assessment compared to Safety Assessment CRC, slide 39 N=8,236 Combined California Counties, January 1-June 30, 2000 13

Risk Assessment Prediction:Declares in advance, on the basis of observation, experience, or scientific reason vs. Classification: The systematic arrangement in groups or categories according to established criteria CRC, slide 40 Risk Assessment (p. 21-29 P&P Manual) Which Assessments Completed on all child abuse and neglect assessments, including all assessments received on open cases. When Completed at the conclusion of the assessment, but no later than 60 days from receipt of the referral by the DO Who Assessment CPSW assigned assessment, or Family Services CPSW for assessments on existing cases CRC, slide 41 Risk Assessment Cont. Only one household can be assessed Should be completed on the household that provides the majority of childcare; if equal, on household where maltreatment occurred Using the criteria, complete Both the abuse and neglect scales regardless of the alleged maltreatment type CRC, slide 42 14

Risk Assessment Cont. CRC, slide 43 Overrides If the scored risk level is something other than very high, the worker must consider the Policy Overrides listed. These are conditions in which the agency has determined warrant a very high risk level regardless of the scored risk level Discretionary overrides may also be used when there is a unique circumstance that is not captured by the tool, or there is other information that is known. The risk level may be increased one level. Risk Assessment Practice Read p. 9 10 of Hernandez Case Complete p. 11 Use criteria on p. 25 29 in P&P Manual CRC, slide 44 Family Strengths and Needs Assessment/Review (p. 32-40 in P&P Manual Systematically assesses the strengths and needs of families across broad domains of functioning Ensures that all CPSW s and family members consistently consider each families strengths and needs Provides an important case planning reference and provides a mechanism to assess reduction in needs and progress toward case plan CRC, slide 45 15

Michigan Evaluation Results Percentage of High Risk CPS Cases that Received Specific Services CRC, slide 46 Family Strengths and Needs Assessment Which Assessments Completed on all founded assessments. When Completed no later than 60 days from the receipt of the referral by the DO Who The Assessment CPSW completes the FSNA, when assessment is received on an existing case, the Family Service CPSW completes the FSNA CRC, slide 47 Family Strengths and Needs Assessment Cont. How The CPSW identifies the need areas for the family through scoring the primary, and if present, the secondary caregiver. Select one score only under each item which reflects the highest level of need for any caregiver in the household Priority needs are those with a negative value, priority strengths have a positive value After scoring the strengths and needs, list the three greatest needs and strengths identified CRC, slide 48 16

Family Strengths and Needs Practice Complete p. 13 & 14 of Hernandez case Use Criteria on p. 36 40 in P&P Manual CRC, slide 49 Referral received Screen-In How quickly to respond? Response Priority Is child safe in the home? Safety Decision: open or close? Risk Case Planning Decision: keep open or close? Placement Cases: Family Strength & Needs Reassessment In-home Cases: contact guidelines Reunification Review S/N Review Risk Review S/N Review Reviewing Risk and Strengths & Needs Every 90 days from date of dispositional or date of Non-Court Agreement In-home cases: Family Risk Review Strengths & Needs Review Placement cases: Family Reunification Review Strengths & Needs Review 17

Family Risk Review (p. 44-49 in P&P Manual) Guides the decision about whether to close a case or keep a case open, and/or revise the case plan. Low and moderate risk cases should be considered for closure Which Cases Completed on all in-home family services cases CRC, slide 52 Risk Review Cont. When For court cases it is completed 90 days following disposition and every 90 days (three months) thereafter For non-court cases it is completed 90 days from the non-court agreement and every 90 days thereafter Is also completed prior to closing any inhome case, regardless of court involvement Who Completed by the Family Services CPSW CRC, slide 53 Risk review Cont. How On the appropriate NH Bridges/SDM screens mark the number that indicates which review this represents for the family Score all Items based on the status since the last Family Risk Assessment or Review Indicate final risk level and case status CRC, slide 54 18

CRC, slide 55 Risk Review Cont. Overrides If the scored risk level is something other than very high, the worker must consider the Policy Overrides listed. These are conditions in which the agency has determined warrant a very high risk level regardless of the scored risk level (only use if the event has occurred since the last Family Risk Assessment or Risk Review) Discretionary overrides may also be used when there is a unique circumstance that is not captured by the tool, or there is other information that is known. The risk level may be increased or decreased. Family Strengths and Needs Review (p. 50-58 in P&P Manual) Same as Family Strengths and Needs Assessment Done to systematically assess the strengths and needs of families and used to build case plan Which Cases Completed on all ongoing cases (both in-home and placement) CRC, slide 56 Family Strengths and Needs Review Cont. When For in-home cases, completed 90 days following disposition (for court cases) or date of the non-court agreement (for non- court cases) and every 90 days thereafter, in conjunction with the Family Risk Review For placement cases, completed 90 days following disposition and every 90 days thereafter, in conjunction with the Family Reunification Review CRC, slide 57 19

Family Strengths and Needs Review Cont. Who Completed by the Family Services CPSW How All items must be scored considering the conditions that existed during the review period only Indicate number of review being completed Completed using the same policy and procedures as the Strengths and Needs Assessment CRC, slide 58 Risk Review Practice Read p. 15 of Hernandez case Complete p. 16 Use criteria on p. 47 49 in P&P Manual CRC, slide 59 Risk Review Practice #2 Read p. 17 in Hernandez case Complete p. 18 Use criteria p. 47-49 in P&P Manual CRC, slide 60 20

Referral received Screen-In How quickly to respond? Response Priority Is child safe in the home? Safety Decision: open or close? Risk Case Planning Decision: keep open or close? Placement Cases: Family Strength & Needs Reassessment In-home Cases: contact guidelines Reunification Review S/N Review Risk Review S/N Review Intake and Assessment Tools Practice with Smith Case Example Read p. 1 18 of Smith case, completing Screen In Criteria, Response Priority, Safety Assessment, Risk Assessment and Family Strengths and Needs Assessment Stop at p. 18 CRC, slide 62 Smith Case Critical Decision Points: Screen-In Criteria: Neglect/Lack of Supervision & Inadequate Basic Care/ housing conditions/lack of adequate food Safety: #3 unsafe, all children removed Risk: Very High FSNA Needs: 1) Substance Abuse, 2) Resource Management, 3) Parenting Skills CRC, slide 63 21

Reunification Principals Children should be reunified when parents have A. reduced risk of future maltreatment and B. maintained quality visitation with their children and C. demonstrated a safe home environment When the above factors have not been achieved within specified time frames, the permanency plan goal should be changed CRC, slide 64 Reunification Review (p. 59-67 in P&P Manual) Which Cases Completed on any ongoing case in which at least one child is placed out of the home and there is a goal of reunification When Completed 90 days following disposition and every 90 days thereafter Completed any time a child(ren) is being considered for return home CRC, slide 65 Reunification Review Cont. Who Completed by the Family Services CPSW How Complete Section A through F Section A: Reunification Risk Review Section B: Visitation Plan Evaluation Section C: Reunification Safety Review Section D: Permanency Plan Guidelines Section E: Permanency Plan Recommendations Summary Section F: Case Status CRC, slide 66 22

When do I complete Section C.? Is risk low or moderate? Yes Is compliance with the visitation plan fair or better? Yes Complete Section C. Reunification Safety Review? No No Do not complete Section. C.* (Go to D.) * if overriding the permanency plan recommendation to return home, you must complete Section C. Reunification Review Practice Read p. 19 of the Smith Case Complete p. 20-21 Use criteria on p. 65-67 in P&P Manual CRC, slide 68 Reunification Review Practice #2 Read p. 23 of Smith Case Complete tool on p. 24 Use criteria on p. 65-73 in P&P Manual CRC, slide 69 23

Referral received How quickly to respond? Screen-In Response Priority Is child safe in the home? Safety Decision: open or close? Risk Case Planning Decision: keep open or close? Placement Cases: Reunification Review S/N Review Family Strength & Needs Reassessment In-home Cases: Risk Review S/N Review contact guidelines 24

TABLE OF CONTENTS Page # Overview of SDM Policy and Procedures...1 SECTION I: Child Abuse and Neglect Screen-In Criteria Child Abuse and Neglect Screen-In Criteria Policy and Procedures...2 Child Abuse and Neglect Screen-In Criteria...3 SECTION II: Response Priority Response Priority Policy and Procedures...5 Response Priority...8 Response Priority Criteria...9 SECTION III: Safety Assessment Safety Assessment Policy and Procedures...13 Safety Assessment...16 Safety Assessment Criteria...18 SECTION IV: Family Risk Assessment Family Risk Assessment of Abuse and Neglect Policy and Procedures...21 Family Risk Assessment of Abuse and Neglect...24 Family Risk Assessment of Abuse and Neglect Criteria...25 SECTION V: Case Decision Guidelines Matrix Case Decision Guidelines Matrix Policy and Procedures...30 Case Decision Guidelines Matrix...31 SECTION VI: Family Strengths and Needs Assessment Family Strengths and Needs Assessment Policy and Procedures...32 Family Strengths and Needs Assessment...34 Family Strengths and Needs Assessment Criteria...36 SECTION VII: Case Contact Guidelines Case Contact Guidelines Policy and Procedures...41 Case Contact Guidelines...42 SECTION VIII: Family Risk Review Family Risk Review Policy and Procedures...44 Family Risk Review...46 Family Risk Review Criteria...47 SECTION IX: Family Strengths and Needs Review Family Strengths and Needs Review Policy and Procedures...50 Family Strengths and Needs Review...52 Family Strengths and Needs Review Criteria...54 T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc

SECTION X: Family Reunification Review Family Reunification Review Policy and Procedures...59 Family Reunification Review...62 Family Reunification Review Criteria...65 Reunification Safety Review Policy and Procedures...68 Reunification Safety Review...70 Reunification Safety Review Criteria...71 SECTION XI: Case Examples T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc

OVERVIEW OF SDM POLICY AND PROCEDURES SDM TOOL TYPES OF REFERRAL(S)/CASES RESPONSIBLE STAFF PERSON(S) Child Abuse and Neglect Screen-In Criteria Response Priority Safety Assessment Family Risk Assessment of Abuse and Neglect Case Decision Guidelines Matrix Family Strengths and Needs Assessment (Initial) DECISION All credible referrals Intake CPSW Determines whether the referral meets criteria for child abuse and neglect assessment All credible reports accepted for assessment, including new credible reports on open cases All child abuse and neglect assessments, including assessments on new referrals received on open cases, and any case in which a new Safety Assessment is warranted All child abuse and neglect assessments, including assessments on new referrals received on open cases Intake CPSW Assessment CPSW* Assessment CPSW* Guides how quickly an assessment must be initiated Guides decisions about whether a child may remain in the home or should be removed, and if a child can be returned to the home Determines the likelihood of future child maltreatment; establishes the basis for differential service standards All child abuse and neglect assessments Assessment CPSW Guides the decision to close or open the assessment for ongoing services. All founded child abuse and neglect Assessment CPSW* Determines the priority strengths and assessments, including founded needs of each family that must be assessments on new referrals on open cases addressed in the Case Plan Case Contact Guidelines All cases opened for Family Services Family Services CPSW Family Risk Review Family Reunification Review All Family Services cases where all children are in the home (in-home) All Family Services cases where any child is in out-of-home placement Family Services CPSW Family Services CPSW Determines the minimum number of contacts with the child(ren) and family. Guides decisions about whether to close a case or keep a case open. Guides decisions about reunification and permanency plan goal recommendations. TIME FRAMES FOR COMPLETION Within 24 hours, excluding holidays and weekends, from receipt by Intake. Within 24 hours, excluding holidays and weekends, from receipt by Intake. Within 24 hours of first face-to-face contact with the alleged child victim. No later than 60 days from receipt by the District Office. No later than 60 days from receipt by the District Office. No later than 60 days from receipt by the District Office. Upon receipt of the case in Family Services and throughout the life of a case as risk level changes. For court cases: 90 days following disposition and every 3 months thereafter; For non-court cases: 90 days following the date of the Voluntary Service Agreement, and every 3 months thereafter; Prior to closing any case. 90 days following disposition and every 3 months thereafter, and any time a child is being considered for return home. Family Strengths and Needs Review All Family Services cases (in-home and placement cases) Family Services CPSW Assesses changes in family strengths and needs and whether changes to the Case Plan are required. For placement cases: 90 days following disposition and every 3 months thereafter in conjunction with the Reunification Review. For all in-home cases: 90 days following disposition or the date of the Voluntary Service Agreement, and every 3 months thereafter, in conjunction with the Risk Review Prior to closing any case. * For assessments on new referrals received on open cases, the Assessment CPSW or the Family Services CPSW completes the tool as agreed upon by the Assessment and Family Services Supervisors. T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 1

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES CHILD ABUSE AND NEGLECT SCREEN-IN CRITERIA POLICY AND PROCEDURES The purpose of the Child Abuse and Neglect Screen-in criteria is to assess whether reports meet DCYF criteria for child abuse and neglect assessment. Types of Referrals/ Cases: Responsible Staff Person(s): Decision: Time Frames: Completion: The Child Abuse and Neglect Screen-In Criteria is completed on all credible reports. This includes telephone and all other means of report, and includes new reports of child abuse and neglect on open cases. The Intake CPSW completes the Child Abuse and Neglect Screen-in Criteria. The Child Abuse and Neglect Screen-In Criteria determines whether a report meets DCYF criteria for child abuse and neglect assessment. The Screen-In Criteria is completed within 24 hours, excluding holidays and weekends, of receipt of the report (includes supervisor review and approval). Complete the appropriate NH Bridges/SDM screens by marking the specific maltreatment type and report criteria. The Intake Supervisor reviews and approves the screen in decision. Reports that do not meet any of the screenin criteria must not be accepted for assessment. T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 2

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES CHILD ABUSE AND NEGLECT SCREEN-IN CRITERIA Family Case Name: Referral ID #: CPS Referral Date: / / County Name: District Office: CPSW: Neglect includes a child who has been abandoned by his parents, guardian, or custodian; or who is without proper parental care or control, subsistence, education as required by law, or other care or control necessary for his or her physical, mental, or emotional health, when it is established that his or her health has suffered or is very likely to suffer serious impairment; and the deprivation is not due primarily to the lack of financial means of the parents, guardian, or custodian; or whose parents, guardian or custodian are unable to discharge their responsibilities to and for the child because of incarceration, hospitalization or other physical or mental incapacity. Abandonment: child is without an apparent caregiver, and is without provision for his or her care. Parental Incapacity: caregiver is unable to discharge his or her caretaking responsibilities due to incarceration, hospitalization, mental or physical illness, or alcohol or drug use. Educational: caregiver interferes with the child s mandatory educational requirements, and there is documentation by an education authority. Failure to Protect: child is experiencing any of the abuse or neglect conditions defined in DCYF policy, and the caregiver fails to take actions that would protect the child from this abuse or neglect, or a substantial risk of this abuse or neglect (includes subjecting a child to witnessing domestic violence). Lack of Supervision: child is left alone for any length of time and is developmentally, emotionally, or physically unable to care for himself or herself, and/or for younger siblings. Inadequate Basic Care (food, clothing, hygiene, shelter, medical or dental, mental health): Child s housing conditions, lack of heat or lack of shelter are hazardous to the safety of a child and conditions could lead to injury or illness of the child if not resolved. A caregiver has failed to meet a child s basic needs for hygiene to the extent that it impairs the child s functioning or has medical indications such as sores, infection, or physical illness. Child is without adequate food or is malnourished as a result of commission or omission by a caregiver. Caregiver is failing to seek, obtain or follow through with medical attention for a specific medical or dental injury, illness, or condition for a child, including failure to use prescribed drugs and failure to thrive. Complete the Medical Neglect Response Priority Decision Tree. Caregiver is unable or unwilling to obtain mental health services and intervention for a child in need of treatment or evaluation (includes suicidal threats or attempts, severe emotional disorders, etc.). Complete the Medical Neglect Response Priority Decision Tree. T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 3

Physical Abuse includes: bone fractures; brain damage or skull fractures; retinal hemorrhage; cerebral hemorrhage; burns or scalding; significant cuts, bruises or welts; human bites; internal injuries; sprains or dislocations; subdural hematoma or skeletal injuries; torture; wounds; tying or close confinement; poisoning or noxious substances; and death (when caregiver has access to other children in his or her custody or control). Psychological abuse includes symptoms of emotional problems generally recognized to result from consistent mistreatment. Non-accidental or suspicious injury to a child by a caregiver or other household member. Old, healed, or healing injuries, which have gone untreated and appear suspicious as reported by a medical professional. Injury or physical contact suffered by a child as a result of domestic violence. Munchausen s Syndrome by Proxy or suspicion of it is reported by a medical or mental health professional and the reporting professional provides written documentation supporting the allegation. Emotional or Psychological: behavior toward a child by a caregiver that has caused emotional maltreatment or impaired functioning to a child, or is generally recognized as leading to mental or psychological injury (i.e., berating, name-calling, domestic violence, etc.). Professional reporters must submit written documentation. Threat of physical abuse or harm toward a child by a caregiver or other household member. Evidence of injuries need not be present. (Examples may include: increased severity and/or frequency of domestic violence, report from medical professional of a drug positive infant, a breast-feeding mother who is using illicit drugs, caregiver states a fear of harming the child, cruel or bizarre treatment of children, etc.) Sexual Abuse means the following activities under circumstances which indicate that the child s health or welfare is harmed or threatened with harm: the employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or having a child assist any other person to engage in, any sexually explicit conduct or any simulation of such conduct for the purpose of producing any visual depiction of such conduct; or the rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children. Sexual contact or exploitation involving a child (under age 18) by a caregiver or other household member. Disclosure by a child of an incident of sexual abuse but specific offender not identified. Physical finding of a suspicion of sexual abuse reported by a medical professional, even without disclosure. Child exhibits behavior beyond normal psychosexual development. Law Enforcement/Court Requests DCYF Assessment (does not include requests for home studies): Neglect Physical Abuse Sexual Abuse Supervisor Review/Signature / / Date T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 4

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES RESPONSE PRIORITY POLICY AND PROCEDURES The purpose of the Response Priority Decision Trees is to assess how quickly the assessment must be initiated. The decision trees structure this analysis to determine a response priority level. Types of Referrals/ Cases: Responsible Staff Person(s): Decision: The Response Priority Decision Trees are to be completed on every new Child Protective Services (CPS) credible report that is accepted for assessment, including every new credible report accepted for assessment on open cases. The Intake CPSW completes the tool, and the Intake Supervisor approves or modifies the decision. Response Priority Decision Trees guide how quickly an assessment must be initiated. Response times are: Level 1: Level 2: Level 3: Immediately, but no later than within 24 hours of receipt of the report by the District Office, face-to-face contact with the alleged child victim(s) and parent(s) is required. The timeframe for face-to-face contact with other household members is determined by the Assessment Supervisor. Within 48 hours of receipt of the report by the District Office, face-to-face contact with the alleged child victim(s) and parent(s) is required. The timeframe for face-to-face contact with other household members is determined by the Assessment Supervisor. Within 72 hours of receipt of the report by the District Office, every effort must be made to ensure child safety through faceto-face contact with both the alleged child victim(s) and parent(s). When the child s safety is not jeopardized and with supervisory approval, telephone or collateral contacts may be made within 72 hours. Written correspondence to the family is not an acceptable method of contact. Time Frames: Completion: The Response Priority process is completed within 24 hours, excluding holidays and weekends, from receipt by intake of a credible report of child abuse or neglect. Complete the decision tree for each type of alleged maltreatment on the appropriate NH Bridges/SDM screens. For each tree, begin at the first question box and mark yes or no, using the criteria to determine the appropriate response. To determine whether yes or no is the most appropriate response for each question, the Intake CPSW should ask T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 5

questions of the referent until the response becomes clear or the referent has no further information. If the response to a question is not known, the Intake CPSW must respond in the most protective way. Follow the branch of the tree determined by the yes or no response until reaching a termination point and mark it. The termination point indicates whether Structured Decision Making (SDM) recommends a priority level 1, 2, or 3 response. If a level 1 response has been indicated on one tree, it is not necessary to complete any additional maltreatment trees. Indicate the recommended response by marking one response level. Overrides The decision trees are designed to guide decisions, not to replace the judgement of the Intake CPSW. If, after consultation with the Intake Supervisor, it is agreed that appropriate completion of the tree leads to a decision that does not apply to a particular case due to unique circumstances not captured by the tool, or because critical information is unknown, the Intake Supervisor may approve an alternate decision using a discretionary override. Discretionary Overrides Occasionally there will be unique circumstances not captured within the questions and criteria of the decision trees. The Intake CPSW, after obtaining the Intake Supervisor s approval, may select a response priority different from that indicated by the decision trees to provide a higher or lower response priority. Note that an override may be necessary when critical information needed to assess the case is unknown. The Intake CPSW should mark Yes if a discretionary override has guided the response. All overrides must be approved by the Intake Supervisor. Supervisory approval is indicated when the Intake Supervisor dates and initials appropriate New Hampshire Bridges/SDM screens. Indicate whether or not the Intake Supervisor overrode the recommendation by marking either yes or no. The Assessment Supervisor may change a Response Priority level only when there is information known and documented by the District Office which supports the level of change, or if law enforcement requests a specific response time frame. Indicate the assigned response by marking one response level. If an override was exercised, assigned will differ from recommended response. If no override was used, assigned and recommended response will be the same. Special Case Circumstances For each report that comes from law enforcement requesting assistance regarding out-of-home perpetrators, the Response Priority is not completed. T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 6

For each report that comes from a NH court requesting a home study, the Response Priority is not completed. Rollbacks The Assessment Supervisor may request a rollback of a referral if one of the following criteria exists: a. The family and the alleged incident are already known to the district office. (Intake would then change the referral to add information status.) A rollback is not allowed for another incident or a different type of maltreatment; or b. Withdrawal of request for assistance by law enforcement; or c. Additional information is known and documented by the District Office that clarifies that there is no abuse or neglect. The Intake Supervisor makes the final decision whether to accept the rollback. T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 7

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES RESPONSE PRIORITY Family Case Name: Referral ID #: CPS Referral Date: / / County Name: District Office: CPSW: Current Referral (Use All Applicable - Mark Appropriate Answer) PHYSICAL/PSYCHOLOGICAL ABUSE Is physical injury evident or is medical or psychiatric care required? Yes No SEXUAL ABUSE Does alleged offender have access or is child afraid to go home? Yes No Is child under age seven years or limited by disability? Yes Level 1 Yes Level 1 No Will alleged offender have access to child in next 48 hours? No Level 2 Is child under age three years? Will alleged offender have access to child in next 48 hours, or is child afraid to go home? Yes Yes Level 1 Were severe or bizarre disciplinary measures used? No Yes No No Have there been prior assessed reports of abuse involving any child in the household?* Yes No Level 1 Level 2 Level 2 Level 3 Is non-offender caregiver's response appropriate and protective of child? Level 2 Level 1 Level 2 Is caregiver unaware of abuse or is response to abuse unknown? Yes No Yes No Level 3 * If unable to determine prior investigated allegation type, mark yes. NEGLECT Is the home situation immediately dangerous or unhealthy, or is any child currently left unsupervised who is under seven or limited by disability? Yes No MEDICAL/PSYCHIATRIC NEGLECT Does child appear seriously ill or injured; In need of immediate care? Yes No Level 1 Is any child under age eleven years or limited by disability? Level 1 Level 3 Yes No Are AODA or domestic violence issues currently present? Are AODA or domestic violence issues currently present? Yes No Yes No Level 1 Have prior reports of Is child afraid Level 3 neglect been founded? of going home? Yes No Yes No Level 2 Level 3 Level 1 Level 2 Level 1 Immediate/Within 24 hours Level 2 Within 48 hours Level 3 Within 72 hours Recommended Response (mark one): Level 1 Level 2 Level 3 Intake Supervisor Override? Yes No / / Supervisor Initials Date Override Reason: Assigned Response (mark one): Level 1 Level 2 Level 3 Assessment Supervisor Modification? Yes No / / Supervisor Initials Date Reason: Information documented by the District Office that supports the change. Law Enforcement requests specific time frame. New Response (mark one): Level 1 Level 2 Level 3 Other: T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 8

PHYSICAL/PSYCHOLOGICAL ABUSE RESPONSE PRIORITY CRITERIA Is physical injury evident or is medical or psychiatric care required? Are visible signs of abuse indicated, or are there bone fractures, brain damage or skull fractures, retinal hemorrhage, cerebral hemorrhage, burns or scalding, significant cuts, bruises or welts, human bites, internal injuries, sprains or dislocations, subdural hematoma or skeletal injuries, torture, wounds, tying or close confinement, poisoning or ingestion of noxious substances, or death (when caregiver has access to other children in his or her custody or control)? Does the child(ren) require immediate medical or psychiatric treatment and/or hospitalization? Are there possible internal injuries, broken bones, fractures or injuries to the head or abdominal area? Are there apparent burns requiring medical treatment or evaluation? Does the child display severe emotional or behavioral symptoms such as suicidal/homicidal attempts or ideation, somatic complaints, enuresis/encopresis not due to medical conditions, chronic, withdrawal/isolation from family or school activities, depression, severe acting out, aggressive behavior, or cruelty toward animals that results from emotional abuse incidents that were severe, extreme, bizarre or due to consistent mistreatment? Examples of severe, extreme or bizarre mistreatment include: parent threatening to harm self in child(ren) s presence; child singled out for detrimental treatment; parent constantly belittling child(ren) or has unrealistic expectations of child(ren); or murder/torture of pets in the presence of children. This DOES NOT include a child who has already received medical attention. Is the child under age three years? Self-explanatory. Is the child(ren) under age seven years or limited by a disability? Does the child(ren) have a physical, emotional, or cognitive disability that increases vulnerability? Were severe or bizarre disciplinary measures used? Were there severe or bizarre disciplinary measures used which could lead to injuries? These measures may include tying, close confinement, poisonous or noxious substances, torture, etc. Will alleged offender have access to the child(ren) in the next 48 hours? Will the alleged offender have unsupervised, in-person contact, including visitation, with the child(ren)? OR Is the child(ren) afraid to go home? The fear expressed is based on credible threats made by the caregiver(s); child(ren) exhibits severe behavioral indicators of fear; there is a history of abusive behavior that is similar to the current allegation, and may suggest a higher chance of reoccurrence. [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 9

Have there been prior assessed reports of physical or sexual abuse? There is a history of physically or sexually abusive behavior that may be similar to the current allegation, and may suggest a higher chance of reoccurrence. If unable to determine allegations in prior assessments, mark Yes. SEXUAL ABUSE Does the alleged offender have access or is child(ren) afraid to go home? Does the alleged offender live in the home or have immediate contact with the child(ren) (i.e. babysitter)? The fear expressed is based on credible threats made by the caregiver(s); child(ren) exhibits behavioral indicators of fear. Is the non-offender caregiver s response appropriate and protective of the child(ren)? Is the non-offending caregiver supporting the child(ren) s disclosure and demonstrating the ability to prevent the alleged offender from having access to the child(ren)? Will the non-offending caregiver not pressure the child(ren) to change statement? Will the non-offending caregiver obtain medical treatment for the child(ren) if needed? If unknown, answer is no. Is caregiver unaware of abuse or is response to abuse unknown? Self-explanatory. [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 10

NEGLECT Is the home situation immediately dangerous or unhealthy, or is any child currently left unsupervised who is under age seven years old or limited by disability? Based on the child(ren) s age and developmental status, the child(ren) s physical living conditions are hazardous and immediately dangerous. For example: Leaking gas from stove or heating unit; No food in home or indications that child(ren) are not being fed; Substances or objects accessible to the child(ren) that may endanger their health or safety; Lack of water or utilities (heat, plumbing, electricity) and no alternate, safe provisions made; Open windows; broken or missing windows; Exposed electrical wires; Excessive garbage, or rotted or spoiled food which threatens health; Serious illness or significant injury has occurred due to living conditions and these conditions still exist (i.e., lead poisoning, rat bites); Evidence of excessive human or animal waste in the living quarters; Guns and other weapons are accessible. The child(ren) is not receiving supervision from his or her caregiver(s) and there is no alternative plan for supervision. For example: Child(ren) is currently alone (time period varies with age and developmental stage); Caregiver(s) does not attend to child(ren) to the extent that need for care goes unnoticed or unmet (i.e., caregiver(s) is present but child(ren) can wander outdoors alone, play with dangerous objects, play on unprotected window ledge, or be exposed to other serious hazards; a child with some suicidal ideation is not closely monitored); Child(ren) is presently receiving inadequate and/or inappropriate child care arrangements (i.e., ten-year-old who supervises four children under the age of five all day); Caregiver is incapacitated due to AODA or domestic violence, incarceration, hospitalization, or physical, emotional or cognitive disability. Is any child under age eleven years or limited by disability? Does the child(ren) have a physical, emotional, or cognitive disability that increases vulnerability? Are AODA or domestic violence issues currently present? Has the reporter indicated that alcohol and/or other drugs are being used now? Are domestic violence issues reported as occurring at this time? Have prior reports of neglect been founded? There is a history of neglectful behavior that may be similar to the current allegation, and may suggest a higher chance of reoccurrence. If unable to determine the type of founded allegations, answer Yes. Is the child(ren) afraid to go home? Has the child(ren) expressed serious concerns about his or her safety if he or she returns home? [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 11

MEDICAL/PSYCHIATRIC NEGLECT Does the child(ren) appear seriously ill or injured; in need of immediate care? Does the child(ren) require immediate medical or psychiatric treatment and/or hospitalization? This includes failure to thrive, refusal of caregiver(s) to meet child(ren) s medical or psychiatric needs or treat a serious or significant injury or condition. [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 12

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES SAFETY ASSESSMENT POLICY AND PROCEDURES The purposes of the Safety Assessment is to: 1) determine whether any child(ren) is currently in immediate danger of serious physical harm which may require a safety intervention; and 2) determine what interventions should be initiated to provide protection. Safety versus Risk Assessment: It is important to remember the difference between safety and risk when completing this tool. Safety Assessment differs from Risk Assessment because it assesses the child s present danger and the interventions currently needed to protect the child. In contrast, risk assessment looks at the likelihood of future maltreatment. Types of Referrals/ Cases: The Safety Assessment is completed on all child abuse and neglect assessments, including new referrals on open cases that are assigned for assessment, and any case whenever new information becomes available that threatens the safety of a child(ren). Note: For placement cases, when a non-removal household is being considered as a reunification resource, a Safety Assessment may be completed to help guide decisions regarding placement, however, this information must not be entered into the SDM database. Responsible Staff Person(s): Decision: For new cases, the Assessment CPSW assigned the initial assessment completes the Safety Assessment. For new referrals on ongoing cases, the Safety Assessment is completed by either the Assessment CPSW or the assigned Family Services CPSW as agreed upon by the Assessment and Family Services Supervisors. The Safety Assessment is used to guide decisions about whether or not the child(ren) may remain in the home, the need for interventions to eliminate the threat of immediate harm, and/or if the child(ren) must be protectively placed (or remain in placement). A safety plan is required when any safety factor has been identified. Time Frames: For a new referral, the Safety Assessment is completed before leaving a child in the home and before returning a child to the home during the assessment. The safety factors should be reviewed during the assessment process and the tool completed within 24 hours of face-to-face contact with the child. The tool reflects the conditions that exist at the time of the initial visit with the child. Throughout the assessment period, and for open cases, whenever new information becomes available that threatens the safety of the child(ren), a Safety Assessment is completed immediately upon receipt of the new information. [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 13

Completion: The Safety Assessment has three sections: Section 1, the Safety Assessment; Section 2, the Safety Response; and Section 3, the Safety Decision. The vulnerability of each child is considered throughout the assessment. Young children cannot protect themselves. For older children, inability to protect themselves could result from diminished physical, emotional, or cognitive capacity or repeated victimization. Section 1 has two parts: Part A, Safety Factor Identification, and Part B, Safety Factor Description. Part A requires that the CPSW consider each of the 10 behaviors and/or conditions listed and identify the presence or absence of each factor by marking either yes or no on the appropriate NH Bridges/SDM screens. Answer each item as it relates to the most vulnerable child. Part B is completed whenever one or more safety factors have been identified in Part A. The CPSW notes the specific safety factor number and provides a brief description of the specific individual behavior, conditions, and/or circumstances associated with the safety factor indicated on the appropriate NH Bridges/SDM screens. Section 2, Safety Response, is completed by the CPSW on the appropriate NH Bridges/SDM screens whenever one or more safety factors have been identified in Section 1. For each factor identified, the CPSW considers the resources available in the family and the community that might help to keep the child safe. This section is intended to assist the CPSW in exploring the alternatives to removal of the child and upon completion, to document the state and federal requirement that DCYF made reasonable efforts to safely maintain a child at home whenever possible. If any child is being protectively placed, mark 8. Legal action must be taken to place the child outside the home. The CPSW documents the safety decision in Section 3 as it pertains to the most vulnerable child, on the appropriate NH Bridges/SDM screens. The safety decision is the result of careful consideration of the safety factors present and any available safety interventions taken or immediately planned by DCYF, family, or community resources to protect the child. Consideration of these factors will affect any decision regarding removal of the child(ren). When safety factors are present, the CPSW may put safety interventions in place designed to protect the child in the home, or may seek emergency temporary physical custody. If a child(ren) is removed during the assessment or at any time following the assessment, the Safety Assessment is used to guide decision-making on return of the child(ren). A child must be safe or conditionally safe prior to return home. The CPSW makes a determination of unsafe, conditionally safe, or safe based on whether safety interventions can mitigate any unsafe factor(s) identified. Mark unsafe if any child was removed and protectively placed out of the home. Mark conditionally safe if all children remain in the home with [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 14

controlling safety interventions in place. Mark safe only when no safety factors have been identified for any child in the household. The Safety Assessment is reviewed and approved by the CPSW s Supervisor. [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 15

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES SAFETY ASSESSMENT Family Case Name: Referral ID #: County Name: District Office: CPSW: CPS Referral Date: / / Current Date: / / Initial, or Review Part A. Safety Factor Identification Section 1: Safety Assessment Directions: The following list of factors is behaviors or conditions that may be associated with a child being in imminent danger of serious harm. Identify the presence or absence of each factor by marking either "yes" or "no." Note: The vulnerability of each child needs to be considered throughout the assessment. Children under seven years of age cannot protect themselves. For older children, inability to protect themselves could result from diminished physical, emotional, or cognitive capacity or repeated victimization. 1. Yes No Caregiver's or household member s behavior is violent or out of control. 2. Yes No Caregiver or household member describes or acts toward child in predominantly negative terms or has extremely unrealistic expectations. 3. Yes No Caregiver or household member caused serious physical harm to the child or has made a plausible threat to cause serious physical harm. 4. Yes No The caregiver s explanation of an injury to a child is inconsistent with the nature of the injury and/or there are significant discrepancies between explanations given by caregivers, other household members, or collateral contacts. 5. Yes No The family refuses access to the child, or there is reason to believe that the family is about to flee, and/or the child's whereabouts cannot be determined. 6. Yes No Caregiver has not, will not, or is unable to provide supervision necessary to protect child from potentially serious harm. If yes, is the caregiver s or household member s lack of supervision due to: Alcohol or other drug use Hospitalization Physical, emotional or cognitive incapacity Domestic Violence Incarceration Other 7. Yes No Caregiver is unwilling, or is unable, to meet the child's imminent needs for food, clothing, shelter, and/or medical or mental health care. If yes, are the child s basic needs unmet by the caregiver or household member due to: Alcohol or other drug use Incarceration Child s physical, emotional or cognitive incapacity Hospitalization Caregiver s physical, emotional or cognitive incapacity Other 8. Yes No Child is fearful of caregiver(s), other family members, or other people living in or having access to the home. 9. Yes No The child's physical living conditions are hazardous and imminently threatening. 10. Yes No Child sexual abuse is suspected and circumstances suggest that child safety may be an imminent concern. 11. Yes No Other (specify) IF NO SAFETY FACTORS ARE PRESENT, GO TO SECTION 3: SAFETY DECISION IF SAFETY FACTORS ARE PRESENT, PROCEED WITH PART B Part B. Safety Factor Description Directions: For all safety factors which are marked "Yes," note the applicable safety factor number and then briefly describe the specific individuals, behaviors, conditions, and/or circumstances associated with that particular safety factor. [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 16

Section 2: Safety Response For each condition identified in Section 1, consider the resources available in the family and the community that might help to keep the child safe. Check each response taken to protect the child and explain below. Describe all safety interventions taken or immediately planned by you or anyone else and explain how each intervention protects (or protected) each child. Note: If any child is being removed from the home, mark #8. 1. Direct intervention by CPSW. 2. Use family, neighbors, or other individuals in the community as safety resources. 3. Use community agencies or services as safety resources. 4. Have the alleged offender leave the home, either voluntarily or in response to legal action. 5. Have the non-offending caregiver move to a safe environment with the child. 6. Caregiver(s) places the child outside the home. 7. Other: 8. Legal action must be taken to place the child(ren) outside the home. Note: child(ren) is considered unsafe in the home; it is contrary to the child(ren) s welfare to remain in the home. If DCYF is initiating legal action and placing the child: 1) explain why responses 1-7 could not be used to keep the child(ren) safe; and 2) describe your discussion with the caregiver(s) regarding the placement. Section 3: Safety Decision Directions: Identify your safety decision by checking the appropriate line below. Check one line only. This decision should be based on the assessment of all safety factors as it relates to the most vulnerable child, and any other information known about this case. A. Unsafe: One or more children will be in imminent danger of serious harm. Remove child(ren) from the home. (Note: check this decision if safety intervention #8 above was used.) List all children who are being removed: B. Conditionally Safe: Controlling safety interventions have been taken since the report was received, and those interventions have resolved the unsafe situation for the present time. C. Safe: There are no children likely to be in imminent danger of serious harm. Supervisor Review/Signature / / Date [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 17

SAFETY ASSESSMENT CRITERIA 1. Caregiver's or household member s behavior is violent or out of control. - Extreme physical or verbal, angry or hostile outbursts at the child; - Use of brutal or bizarre punishment (i.e., scalding with hot water, burning with cigarettes, forced feeding); - Domestic violence likely to negatively impact on the child; - Use of guns, knives, or other instruments in a violent or threatening way; - Violently shakes or chokes baby or child; - Behavior that seems out of touch with reality, fanatical, or bizarre; - Behavior that seems to indicate a serious lack of self-control (i.e., reckless, unstable, raving, explosive). 2. Caregiver or household member describes or acts toward child in predominantly negative terms or has extremely unrealistic expectations. - Describes child as evil, stupid, ugly, or in some other demeaning or degrading manner, or objectifies child (i.e., calling child "it" or "them"); - Repeatedly curses and/or belittles child; - Scapegoats a particular child in the family; - Expects a child to perform or act in a way that is impossible or improbable for the child's age (i.e., babies and young children expected not to cry, expected to be still for extended periods, be toilet trained or eat neatly, expected to care for younger siblings, expected to stay alone); - Child is seen by either parent as responsible for the parents' problems; - Uses sexualized language to describe child or name calling (i.e., whore, slut, etc.). 3. Caregiver or household member caused serious physical harm to the child or has made a plausible threat to cause serious physical harm. - Intentionally or by other than accidental means caused serious abuse or injury (i.e., fractures, poisoning, suffocating, shooting, burns, significant bruises or welts, bite marks, choke marks, etc.); - An action, inaction, or threat that would result in serious harm (i.e., kill, starve, lock out of home, etc.); - Plans to retaliate against child for DCYF assessment; - Use of torture or physical force that bears no resemblance to reasonable discipline, or punished child beyond the duration of the child's endurance; - One or both parents fear they will maltreat child and/or request placement. 4. The caregiver s explanation of an injury to a child is inconsistent with the nature of the injury and/or there are significant discrepancies between explanations given by caregivers, other household members, or collateral contacts. - Caregiver s explanation for the observed injuries is inconsistent with the type of injury. - Caregiver s description of the causes of the injury minimizes the extent of harm to the child. - Medical evaluation indicates injury is a result of abuse; parent denies or attributes injury to accidental causes. [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 18

5. The family refuses access to the child or there is reason to believe that the family is about to flee and/or the child's whereabouts cannot be determined. - Family has previously fled in response to a DCYF assessment; - Family has removed child from a hospital against medical advice; - Family has history of keeping child at home, away from peers, school, other outsiders for extended periods. 6. Caregiver or household member has not, will not, or is unable to provide supervision necessary to protect child from potentially serious harm. - Caregiver or household member does not attend to child to the extent that need for care goes unnoticed or unmet (i.e., although caregiver or household member is present, child can wander outdoors alone, play with dangerous objects, play on unprotected window ledge, or be exposed to other serious hazards); - Caregiver or household member leaves child alone (time period varies with age and developmental stage); - Caregiver or household member makes inadequate and/or inappropriate baby-sitting or child care arrangements or demonstrates very poor planning for child's care; - Parents' whereabouts are unknown; - Caregiver or household member has not, will not, or is unable to protect child from violence against other family members. Note: If the item is identified as a safety factor, indicate if the caregiver s or household member s lack of supervision is due to: Alcohol or other drug use Hospitalization Physical, emotional or cognitive incapacity Domestic Violence Incarceration Other 7. Caregiver or household member is unwilling or unable to meet the child's imminent needs for food, clothing, shelter, and/or medical or mental health care. - No food provided or available to child, or child starved or deprived of food or drink for prolonged periods; - Child without minimally warm clothing in cold months; - No housing or emergency shelter; child must or is forced to sleep in the street, car, etc.; housing is unsafe, without heat, etc; - Caregiver or household member does not seek treatment for child's imminent and dangerous medical condition(s) or does not follow prescribed treatment for such condition(s); - Child appears malnourished; - Child has exceptional needs which parents cannot or will not meet; - Child is suicidal and parents will not take protective action; - Child shows effects of maltreatment, such as serious emotional symptoms and lack of behavior control or serious physical symptoms. Note: If the item is identified as a safety factor, indicate if the child s basic needs are unmet by the caregiver or household member due to: Alcohol or other drug use Incarceration Child s physical, emotional or cognitive incapacity Hospitalization Caregiver s physical, emotional or cognitive incapacity Other [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 19

8. Child is fearful of caregiver(s), other family members, or other people living in or having access to the home. - Child cries, cowers, cringes, trembles, or otherwise exhibits fear in the presence of certain individuals or verbalizes fear; - Child exhibits severe emotional, physical or behavioral symptoms (i.e., nightmares, insomnia) related to situation(s) associated with a person(s) in the home; - Child has fears of retribution or retaliation from caregivers or household members. 9. The child's physical living conditions are hazardous and imminently threatening. Based on child(ren) s age and developmental status, the child(ren) s physical living conditions are hazardous and immediately dangerous. For example: - Leaking gas from stove or heating unit; - Dangerous substances or objects stored in unlocked lower shelves or cabinets, under sink or easily accessible; - Lack of water or utilities (heat, plumbing, electricity) and no alternate provisions made, or alternate provisions are inappropriate (i.e., stove, unsafe space heaters); - Open windows or broken or missing windows; - Exposed electrical wires; - Excessive garbage, or rotted or spoiled food which threatens health; - Serious illness or significant injury has occurred due to living conditions and these conditions still exist (i.e., lead poisoning, rat bites); - Evidence of excessive human or animal waste throughout living quarters; - Guns and other weapons are accessible. 10. Child sexual abuse is suspected and circumstances suggest that child safety may be an imminent concern. - Access by possible or confirmed offender to child continues to exist; - Circumstances suggest that caregiver or household member has committed rape, sodomy, or has had other sexual contact with child; - Circumstances suggest caregiver or household member has forced or encouraged child to engage in sexual performances or activities. 11. Other (specify): Possible examples: - Current circumstances, in addition to information that the caretaker(s) has or may have previously maltreated a child(ren) in their care, suggests that the child(ren) s safety may be of immediate concern based on the severity of the previous maltreatment and/or the caretaker(s) response to the previous incident; - Abuse or neglect related to a child death, or unexplained child death; - Caregiver or household member refuses to cooperate or is evasive; - Criminal behavior occurring in the presence of the child or the child is forced to commit a crime(s) or engage in criminal behavior. [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 20

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES FAMILY RISK ASSESSMENT OF ABUSE AND NEGLECT POLICY AND PROCEDURES Risk Assessment identifies families that have very high, high, moderate or low probabilities of abusing or neglecting their children in the future. By completing the Risk Assessment, the Assessment CPSW obtains an objective appraisal of the likelihood that a family will maltreat their children in the next 12 to 18 months. The difference between the risk levels is substantial. High risk families have significantly higher rates than low risk families of subsequent referral and founded determinations and are more often involved in serious abuse or neglect incidents. When risk is clearly defined, the choice between serving one family or another family is simplified: DCYF resources are targeted to higher risk families because of the greater potential to reduce subsequent maltreatment. The Risk Assessment is based on research of abuse and neglect cases that examined the relationships between family characteristics and the outcomes of subsequent confirmed abuse and neglect. The Risk Assessment does not predict recurrence, but simply assesses whether a family is more or less likely to have another abuse or neglect incident without intervention. One important result of the research is that a single scale should not be used to assess the risk of both abuse and neglect. Different family dynamics are present in abuse and neglect situations. Hence, separate scales are used to assess the future probability of abuse and neglect, though both scales are completed for every family under assessment for child maltreatment. The risk level is determined by scoring each of the scales, totaling the score, and taking the highest level from the abuse and neglect scales. Types of Referrals/ Cases: Responsible Staff Person(s): Decisions: The Family Risk Assessment is completed on all initial child abuse and neglect assessments including all assessments of new referrals received on open cases. For new referrals, the Assessment CPSW assigned the initial assessment completes the Family Risk Assessment. For new referrals on ongoing cases, it is completed by either the Assessment CPSW or the assigned Family Services CPSW as determined by the supervisor. The risk level indicates the likelihood of future maltreatment, and is used to determine if the assessment should be transferred for ongoing services or be closed. This determination is made by consulting the "Case Decision Guidelines Matrix" described separately in this manual on page 30. For assessments opened for ongoing services, the risk level is used to determine the contact requirements for the case (service level). See the section on Case Contact Guidelines on page 41 for the specific frequency of contact associated with each risk classification. [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 21

Time Frames: Completion: The Family Risk Assessment is completed at the conclusion of the assessment, but no later than 60 days from receipt of the referral by the District Office. On the appropriate NH Bridges/SDM screens: 1. Complete both scales and determine risk level, based on the highest level on either scale. 2. Review policy overrides to determine if any apply. 3. Consider discretionary override. 4. Indicate final risk level. If an override has been used, the final risk level should differ from the initial risk level. If an override has not been used, the final risk level will be the same as the initial risk level. The Family Risk Assessment is completed based on conditions that exist at completion of the assessment. Only one household can be assessed on the Family Risk Assessment tool. In some cases (for example, joint custody cases), it may be difficult to identify the household in which the child(ren) resides. The household which provides the majority of the child care should be selected. If the child(ren) resides equally in both households, select the household in which the maltreatment occurred. Both scales (abuse and neglect) are completed regardless of the type of allegation(s) reported or assessed. All items on the Family Risk Assessment scales are completed. The CPSW must make every effort throughout the assessment to obtain the information needed to answer each question. If information cannot be obtained to answer a specific item, the item must be scored as 0. Score all items on each scale and total the score. Using the chart in the initial risk level section, identify the corresponding risk level for the score on each scale. Indicate the overall risk level by placing a check next to the higher of the two levels. Note that item N6 requires that the CPSW check each characteristic of the primary caregiver and total the score. Items A6 and A10 require that the CPSW indicate the type of problem but there is only one score for the items. The item criteria must be used when answering each question. Policy Overrides After completing the risk scales, the CPSW then determines if any of the policy override reasons exist. Policy overrides reflect incident seriousness and child vulnerability concerns, and have been determined by DCYF to be cases that warrant the highest level of service regardless of the risk scale scores. If any policy override reason exists, check the appropriate policy override reason. The risk level is then increased to very high. [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 22

Discretionary Overrides The CPSW determines if there are any discretionary override reasons (for example, prior TPRs). A discretionary override is applied by the Assessment CPSW to increase the risk level in any case where the CPSW believes the risk level set by the scales is too low. Discretionary overrides may only increase the risk level by one unit (for example, from low to moderate, or moderate to high, BUT NOT low to very high). Discretionary overrides must be approved by the CPSW s supervisor. Mark the appropriate final risk level. If an override has been entered, the final risk level will differ from the initial risk level. If an override has not been used, the final risk level will be the same as the initial risk level. Supervisor review and approval is indicated on the applicable NH Bridges/SDM screens. [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 23

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES FAMILY RISK ASSESSMENT OF ABUSE AND NEGLECT Family Case Name: Referral ID #: County Name: District Office: CPSW: Assigned Date: / / Today s Date: / / Neglect Score Abuse Score N1. Current Assessment is for Neglect A1. Current Assessment is for Physical, Sexual, or Emotional Abuse a. No...0 a. No...0 b. Yes...1 b. Yes...1 N2. Number of Prior Assessments a. None...0 b. One...1 c. Two or more...2 N3. Number of Children in the Home a. Two or fewer...0 b. Three or more...1 N4. Number of Adults in Home at Time of Assessment a. Two or more...0 b. One or none...1 N5. Age of Primary Caregiver a. 30 or older...0 b. 29 or younger...1 N6. Characteristics of Primary Caregiver (check & add for score) a. Not applicable...0 b. Parenting skills are a major problem...1 c. Lacks self-esteem...1 d. Apathetic or feeling of hopelessness...1 N7. Primary Caregiver Involved in Harmful Relationships a. No...0 b. Yes, but not a victim of domestic violence...1 c. Yes, as a victim of domestic violence...2 N8. Primary Caregiver Has a Current Substance Abuse Problem a. No...0 b. Alcohol only...1 c. Other drug(s) (with or without alcohol)...3 N9. Household is Experiencing Severe Financial Difficulty a. No...0 b. Yes...1 N10. Primary Caregiver's Motivation to Improve Parenting Skills a. Motivated and realistic...0 b. Unmotivated...1 c. Motivated but unrealistic...2 N11. Caregiver(s) Response to Assessment and Seriousness of Complaint a. Attitude consistent with seriousness of allegation and complied satisfactorily...0 b. Attitude not consistent with seriousness of allegation (minimizes)...1 c. Failed to comply satisfactorily...2 d. Both b and c...3 TOTAL NEGLECT RISK SCORE A2. Prior Abuse Assessments a. None...0 b. Physical or emotional abuse assessment(s)...1 c. Sexual abuse assessment(s)...2 d. Both b and c...3 A3. Prior DCYF Family Services History a. No...0 b. Yes...1 A4. Number of Children in the Home a. One...0 b. Two or more...1 A5. Caregiver(s) Abused as Child(ren) a. No...0 b. Yes...1 A6. Secondary Caregiver has a Current Substance Abuse Problem a. No, or no secondary caregiver...0 b. Yes (check all that apply) Alcohol abuse problem Drug abuse problem...1 A7. Primary or Secondary Caregiver Employs Excessive and/or Inappropriate Discipline a. No...0 b. Yes...2 A8. Caregiver(s) has a History of Domestic Violence a. No...0 b. Yes...1 A9. Caregiver(s) is an Over-Controlling Parent a. No...0 b. Yes...1 A10. Child in the Home has Special Needs or History of Delinquency a. No...0 b. Yes (check all that apply) Diagnosed special needs History of delinquency or CHINS...1 A11. Secondary Caregiver Motivated to Improve Parenting Skills a. Yes, or no secondary caregiver in home...0 b. No...2 A12. Primary Caregiver s Attitude is Consistent with the Seriousness of the Allegation a. Yes...0 b. No...1 TOTAL ABUSE RISK SCORE INITIAL RISK LEVEL Assign the family s risk level based on the highest score on either scale, using the following chart: Neglect Score Abuse Score Risk Level 0-4 0-2 Low 5-7 3-5 Moderate 8-12 6-9 High 13-20 10-16 Very High OVERRIDES Policy: Override to Very High. Mark the appropriate reason. FINAL RISK LEVEL: Low Moderate High Very High Supervisor s Review/Approval 1. Sexual abuse cases where the offender is likely to have access 2. Cases with non-accidental physical injury to a child under age three years. 3. Serious non-accidental physical injury requiring hospitalization or medical treatment. 4. Death (previous or current) of a sibling as a result of abuse or neglect. Discretionary: Override and increase one level. 5. Explain: / / Date T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 24

FAMILY RISK ASSESSMENT OF ABUSE AND NEGLECT CRITERIA The primary caregiver is the adult (typically the parent) living in the household who has legal responsibility and who assumes the most responsibility for child care. When two adult caregivers are present and both have legal responsibility, select the one who handles most of the child care responsibilities. When two caregivers are present and only one has legal responsibility, select the one who is legally responsible for the children (even if he or she does not assume the most responsibility for child care). If this rule does not resolve the question, the legally responsible adult who was an offender must be selected. Only one primary caregiver can be identified. The secondary caregiver is defined as an adult living in the household who has routine responsibility for child care, but less responsibility than the primary caregiver. A live-in partner may be a secondary caregiver even though they have minimal responsibility for care of the child(ren). Only one household is evaluated on the Family Risk Assessment. NEGLECT SCALE N1. Current Assessment is for Neglect Answer "yes" if the current assessment is for neglect or both abuse and neglect. This includes any allegation under assessment not identified in the original report. Answer no if neglect is not part of the current assessment. N2. Number of Prior Assessments - Count all prior child abuse and neglect assessments, whether founded or unfounded. Include prior assessments for any type of abuse or neglect. Do NOT include the current assessment. N3. Number of Children in the Home Identify the number of individuals under 18 years of age (or under 21 if developmentally delayed or disabled) residing in the home at the time of the current assessment. If a child is removed as a result of the assessment or is on runaway status, count the child as residing in the home. N4. Number of Adults in Home at Time of Assessment - Identify the number of individuals 18 years of age or over residing in home at time of current assessment. (Exclude any person 18-21 who is developmentally delayed or disabled and was counted as a child in the prior question.) N5. Age of Primary Caregiver Record the age at the time of assessment completion. N6. Characteristics of Primary Caregiver - Check all applicable boxes and add the indicated scores for each primary caregiver characteristic: a. Not applicable b. Parenting skills are a major problem The primary caregiver demonstrates an inability or unwillingness to care for or supervise children, uses excessive physical punishment resulting in significant bruises or injury or use of mechanical restraints, deprives the child of basic needs as punishment, has minimal knowledge of child development and age-appropriate expectations for children, repeatedly uses disciplinary methods not appropriate to the child s age, and/or fails to keep guns or weapons inaccessible. [T:\DCYF\GROUP\DOLLOFF\RELATED TRAINING HOS & POWERPOINT\SDM\P&P MANUAL 9-01CRC.DOC] 25

c. Lacks self-esteem The primary caregiver reports or displays chronic and/or extreme lack of confidence, self-doubt or disparagement, or is withdrawn. d. Apathetic or feels hopeless - The primary caregiver reports or appears overwhelmed to the point of not caring about self or children. Indicators may include a recent substantial decline in hygiene, energy level and/or physical appearance. N7. Primary Caregiver Involved in Harmful Relationships a. No b. Yes, but not a victim of domestic violence - The primary caregiver has adult relationships outside the home (i.e. friends involved in drug lifestyle or criminal activities) that are harmful to domestic functioning or child care, or has harmful adult relationships inside the home that are not at the level of domestic violence. c. Yes, as victim of domestic violence - The primary caregiver has relationships characterized by domestic conflicts, often involving physical violence, that require intervention by police, family or others. (See also A8. definition.) N8. Primary Caregiver has a Current Substance Abuse Problem - The primary caregiver has a current alcohol or drug abuse problem, evidenced by the child abuse and neglect assessment, ongoing conflict in home, extreme behavior, financial difficulties, frequent illness, job absenteeism, job changes or unemployment, driving under the influence, traffic violations, criminal arrests, or a life organized around substance use. Use should not be considered a problem unless there have been negative consequences such as those listed above. a. No problems b. Alcohol only - The primary caregiver abuses alcohol but there is no indication of problems with other drugs. c. Other drug(s) (with or without alcohol) - The primary caregiver is abusing drugs other than alcohol such as cocaine, marijuana, heroin, barbiturates, or prescription medication. He or she may be poly-addicted and may also abuse alcohol. N9. Household is Experiencing Severe Financial Difficulty Caregiver(s) cannot consistently pay for one or more basic household necessities (rent, heat, light, food, clothing). This may be due to lack of income or because the household is not living within its means due to caregiver actions. Homeless families must also be scored "yes." N10. Primary Caregiver's Motivation to Improve Parenting Skills Scoring is based on the CPSW s judgment made by observing the primary caregiver s response to a tentative safety plan or other offers of DCYF assistance made during the assessment, and is based on the caregiver s motivation at the end of the assessment. a. Motivated and Realistic There is no need to improve parenting skills, or there is a need and the primary caregiver is willing and able to work with DCYF. b. Unmotivated - The primary caregiver is able, but has not demonstrated a willingness to address parenting skills issues. c. Motivated but Unrealistic - The primary caregiver is willing to make agreed upon changes, but his or her physical, emotional, or cognitive ability precludes making those changes. [T:\DCYF\GROUP\DOLLOFF\RELATED TRAINING HOS & POWERPOINT\SDM\P&P MANUAL 9-01CRC.DOC] 26

N11. Caregiver(s) Response to Assessment and Seriousness of Complaint a. Attitude consistent with seriousness of allegation and complied satisfactorily - All caregivers show a level of concern that is consistent with the nature of the allegation; their focus is on the well-being of the child(ren); they comply by answering questions, making the child(ren) available, and making safety plans for the child(ren), etc. b. Attitude not consistent with allegation - One caregiver views the allegation less seriously than warranted or minimizes the level of harm to the child(ren). c. Failed to comply satisfactorily - One caregiver refuses involvement in the assessment and/or refuses access to the child(ren) during the assessment, etc. d. Both b and c - One caregiver s attitude is not consistent with the seriousness of the allegation and he or she did not cooperate during the assessment. ABUSE SCALE A1. Current Assessment is for Physical, Sexual, or Emotional Abuse Answer "yes" if the current assessment is for abuse or both abuse and neglect. This includes any allegation under assessment not included in the original report. Answer no if physical, sexual, or emotional abuse is not part of the current assessment. A2. Prior Abuse Assessments - Include all assessments, founded or unfounded, for any type of abuse prior to the current assessment. a. None-There are no prior abuse assessments. b. Physical or emotional abuse assessment(s)-there is at least one prior assessment of any type of abuse except sexual abuse. c. Sexual abuse assessment(s)-there is at least one prior sexual abuse assessment. d. Both b and c-there are prior assessments of both sexual abuse and other types of abuse. A3. Prior DCYF Family Services Service History Answer yes if a family had an open Family Services case as a result of a prior assessment for abuse and/or neglect or had an open Family Services case at the time of the current assessment. Answer no if there has never been an open Family Services Case. A4. Number of Children in the Home Identify the number of individuals under 18 years of age (or 18-21 if DD) residing in the home at the time of the current assessment, including those removed as a result of the assessment or on runaway status. A5. Caregiver(s) Abused as Child(ren) Answer yes or no based on DCYF records or credible statements by the caregiver(s) or others that either or both caregivers were abused as children. Abuse includes physical, sexual and any other type of abuse (exclude neglect). A6. Secondary Caregiver has a Current Substance Abuse Problem The secondary caregiver has a current alcohol or drug abuse problem as evidenced by the child abuse and neglect report, frequent conflict in home, extreme behavior, financial difficulties, frequent illness, job absenteeism, job changes or unemployment, or driving under the influence, traffic violations, criminal arrests, or life organized around substance use (if yes, mark appropriate boxes). [T:\DCYF\GROUP\DOLLOFF\RELATED TRAINING HOS & POWERPOINT\SDM\P&P MANUAL 9-01CRC.DOC] 27

A7. Primary or Secondary Caregiver Employs Excessive and/or Inappropriate Discipline - Either caregiver employs excessive and/or inappropriate disciplinary practices to punish children in the home. The circumstances of the current incident and past practices may be considered. Examples include: discipline that routinely involves use of an instrument (belt, board, etc.) that results in marks, bruises, contusions; restraining the child with rope, duct tape or other mechanical means; denial of food or other necessities as punishment; or use of disciplinary practices that are inappropriate for the child's age or development. A8. Caregiver(s) has a History of Domestic Violence - Either caregiver has a history (past two years) of domestic violence - as an offender or victim - defined as adult mistreatment of one another, evidenced by hitting, slapping, yelling, berating, verbal or physical abuse, physical fighting (with or without injury, or with or without a weapon), continuing threats, intimidation, ultimatums, frequent separation or reconciliation, involvement of law enforcement and/or domestic violence programs, restraining orders or criminal complaints. A9. Caregiver(s) is an Over-Controlling Parent - Either caregiver over-controls child(ren), evidenced by unreasonable and/or excessive rules, being overly demanding or overbearing; overreaction, or berating or demeaning responses to relatively minor infractions. Overcontrolling parents may be referred to as tyrannical: they use cruel and unjust power and authority. Parents who are simply strict and firm in their disciplinary practices must not be considered over-controlling. A10. Child in the Home has Special Needs or a History of Delinquency - Score 1 if either or both exist. a. No There is no history of either special needs or delinquency. b. Yes, Diagnosed Special Needs- There is evidence that a child has a special need(s) including serious medical conditions, mental retardation, attention deficit disorder, learning disability, conduct disorder or other diagnosed emotional or psychiatric disorder; and/or, Yes, History of Delinquency or CHINS -Any child has been arrested and/or referred to juvenile court for delinquent or status offenses (truancy, runaway, incorrigible). Offenses not brought to a court s attention but which create stress within the household should also be scored here (i.e., drug or alcohol problems) If yes, mark the appropriate boxes. A11. Secondary Caregiver Motivated to Improve Parenting Skills Scoring is based on the CPSW s judgment made by observing secondary caregiver response to a tentative safety plan and/or other offers of DCYF assistance made during the assessment, and is based on the caregiver s motivation at the end of the assessment. a. Yes, or no secondary caregiver in home There is no need to improve parenting skills or there is no secondary caregiver. If there is a need, the secondary caregiver is willing and able to work with DCYF to improve parenting skills. b. No - The secondary caregiver needs to improve parenting skills but is not motivated and/or not able to work with DCYF. [T:\DCYF\GROUP\DOLLOFF\RELATED TRAINING HOS & POWERPOINT\SDM\P&P MANUAL 9-01CRC.DOC] 28

A12. Primary Caregiver s Attitude is Consistent with the Seriousness of Allegation - Scoring should be based on the primary caregiver s attitude at the end of the assessment period. a. Yes - The primary caregiver views the alleged incident as seriously or more seriously than the CPSW; his or her primary concerns are the well-being of the child(ren). b. No -The primary caregiver views the incident less seriously than warranted by the nature or seriousness of the allegation. Indicators may include refusing to be involved in service planning for self or children, and/or refusing services and/or minimizing the level of child abuse. [T:\DCYF\GROUP\DOLLOFF\RELATED TRAINING HOS & POWERPOINT\SDM\P&P MANUAL 9-01CRC.DOC] 29

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES CASE DECISION GUIDELINES MATRIX POLICY AND PROCEDURES The Case Decision Guidelines Matrix is used to structure decisions about which cases are to be opened for Family Services. Two primary criteria are used to structure the open or close decision: 1) the assessment finding; and 2) the family s risk level. Types of Referrals/ Cases: Responsible Staff Person(s): Decision: Time Frames: The Case Decision Guidelines Matrix applies to all initial child abuse and neglect assessments. The Assessment CPSW uses the Case Decision Guidelines Matrix. The Case Decision Guidelines Matrix structures the decision to open or close the assessment. The Case Decision Guidelines Matrix is used at the completion of the assessment, but no later than 60 days from receipt of the referral by the District Office. The Case Decision Guidelines Matrix is used after determination of the assessment disposition and completion of the Safety Assessment and Family Risk Assessment. Use: Using the risk level from the Family Risk Assessment, and the assessment disposition, identify the appropriate cell in the matrix at which they intersect to obtain the recommended open or close decision. Unfounded assessments must be closed. For unfounded very high, high, and moderate risk assessments, the names of appropriate community resources are given to the family upon closure of the assessment and are documented in the case record. Guidelines recommend that founded low risk assessments be closed. Founded moderate risk cases may be opened and transferred to Family Services, or closed with or without referrals to community services as determined by the Assessment Supervisor. Guidelines recommend that founded assessments that are very high or high risk be opened and transferred to Family Services. [T:\DCYF\GROUP\DOLLOFF\RELATED TRAINING HOS & POWERPOINT\SDM\P&P MANUAL 9-01CRC.DOC] 30

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES CASE DECISION GUIDELINES MATRIX The following case opening and closing decisions are recommendations based on the assessment disposition and the risk level: ASSESSMENT DISPOSITION RISK LEVEL Founded Unfounded Very High High Moderate Open a Family Services Case Open a Family Services Case Open a Family Services Case, Close DCYF assessment with referral to community services,* or Close DCYF assessment Recommend community services Close DCYF assessment Recommend community services Close DCYF assessment Recommend community services Close DCYF assessment Low Close DCYF assessment Close DCYF assessment *The Assessment CPSW must send correspondence to the family, specifying names and addresses of appropriate community resources. [T:\DCYF\GROUP\DOLLOFF\RELATED TRAINING HOS & POWERPOINT\SDM\P&P MANUAL 9-01CRC.DOC] 31

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES FAMILY STRENGTHS AND NEEDS ASSESSMENT POLICY AND PROCEDURES The Family Strengths and Needs Assessment is used to systematically identify critical family needs and help develop effective Case Plans. The Family Strengths and Needs Assessment serves several purposes: $ It ensures that all CPSWs and family members consistently consider each family's strengths and needs in an objective format; $ It provides an important case planning reference for CPSWs and Supervisors; $ It serves as a mechanism for monitoring service referrals made to address identified family needs; and $ The initial Family Strengths and Needs Assessment, when followed by regular Strengths and Needs Reviews, permits CPSWs and Supervisors to easily assess change in family functioning and evaluate the impact of services on the case. Types of Referrals/ Cases: Responsible Staff Person(s): Decision: The Family Strengths and Needs Assessment is completed on all founded child abuse and neglect assessments. (It may also be completed on unfounded cases for the purpose of making referrals to appropriate community resources.) For new cases, the Assessment CPSW assigned the initial assessment completes the Family Strengths and Needs Assessment. For new assessments on ongoing cases, the Family Strength and Needs Assessment is completed by the Assessment CPSW or the Family Services CPSW, as determined by the supervisor. The Family Strengths and Needs Assessment is used to identify family needs that must be addressed in the family s case plan. The CPSW identifies the need areas for the family through scoring the primary and, if present, the secondary caregiver. Priority need areas are those with negative point values as scored by the CPSW for either the primary or secondary caregiver. The CPSW also identifies family strengths, as scored on the scale and any other strengths identified through the assessment process. After scoring the strengths and needs items, the CPSW lists the three greatest needs and strengths identified. (Consider both the primary and secondary caregiver when identifying these priority needs.) Priority items must then be incorporated into the Case Plan and addressed immediately. Time Frames: The Family Strengths and Needs Assessment must be completed no later than 60 days from receipt of the referral by the District Office. [T:\DCYF\GROUP\DOLLOFF\RELATED TRAINING HOS & POWERPOINT\SDM\P&P MANUAL 9-01CRC.DOC] 32

Completion: Only one household can be assessed on the Family Strengths and Needs Assessment. The household assessed must be the same household for which the Family Risk Assessment was completed. Whenever possible, the family should be involved in the process of gathering information used to complete the Family Strengths and Needs Assessment. The household is assessed by completing all items on the appropriate NH Bridges/SDM screens. Select one score only under each item which reflects the highest level of need for any caregiver in the household and enter in the "Score" column. List in order of greatest to least the top three needs identified. List in order the top three strengths identified. A negative score (i.e. -3) indicates a need, while a positive score (i.e. +3) indicates a strength. Item SN8 is used to assess characteristics of children. For this item, score the child(ren), not the caregiver(s). Scoring must be done in accordance with the item criteria provided. It is the use of the criteria that helps provide consistency in the assessment process. [T:\DCYF\GROUP\DOLLOFF\RELATED TRAINING HOS & POWERPOINT\SDM\P&P MANUAL 9-01CRC.DOC] 33

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES FAMILY STRENGTHS AND NEEDS ASSESSMENT Family Case Name: Family Case #: County Name: District Office: CPSW: Date Case Opened to FS: / / Date Completed: / / Initial or Review # 1 2 3 4 SN1. Substance Use or Abuse Score (Substances: alcohol, illegal drugs, inhalants, and prescription or over-the-counter drugs.) a. Teaches and demonstrates healthy understanding of alcohol and drugs... +3 b. Alcohol or prescribed drug use or no use...0 c. Alcohol or drug abuse... -3 d. Alcohol or drug dependency... -5 If C or D, mark all that apply: Alcohol Barbiturates Cocaine or Crack Heroin Inhalants Marijuana or Hashish Methamphetamine Non-Prescription Methadone PCP Tranquilizers (Benzodiazepine) Over-the-Counter drugs Other Amphetamines Other Opiates and Synthetics Other Sedatives or Hypnotics Other Stimulants Other Tranquilizers Other (specify): SN2. SN3. SN4. SN5. SN6. Emotional Stability a. Positive emotional stability... +3 b. No evidence or symptoms of emotional instability...0 c. Mild to moderate emotional instability... -3 d. Chronic or severe emotional instability... -5 Resource Management and Basic Needs a. Resources sufficient to meet basic needs and are adequately managed... +2 b. Resources are limited but are adequately managed...0 c. Resources are insufficient or not well-managed... -2 d. No resources or resources severely limited and/or mismanaged... -4 Parenting Skills a. Strong skills... +2 b. Adequately parents and protects child(ren)...0 c. Inadequately parents and protects child(ren)... -2 d. Destructive or abusive parenting... -4 Household Relationships a. Supportive... +2 b. Minor or occasional discord...0 c. Frequent discord... -2 d. Chronic discord... -3 Caregiver(s) Abuse or Neglect History a. Abuse or neglect as a child, demonstrates good coping ability... +2 b. No abuse or neglect as a child...0 c. Minor problems related to abuse or neglect as a child... -2 d. Serious problems related to abuse or neglect as a child... -3 Primary Caregiver Secondary Caregiver Abuse or neglect as a child In foster care as a child due to abuse or neglect Perpetrator of abuse or neglect in last seven years [T:\DCYF\GROUP\DOLLOFF\RELATED TRAINING HOS & POWERPOINT\SDM\P&P MANUAL 9-01CRC.DOC] 34

SN7. SN8. SN9. SN10. Social or Community Support System a. Strong support system... +1 b. Adequate support system...0 c. Limited support system... -1 d. No support system... -3 Child Characteristics a. Age-appropriate and no difficulties... +1 b. Minor difficulties...0 c. One child has severe or chronic difficulties... -1 d. Children have severe or chronic difficulties... -3 Physical Health a. Preventive health care is practiced... +1 b. Health issues do not affect family functioning...0 c. Health concerns or disabilities affect family functioning... -1 d. Serious health concerns or disabilities result in inability to care for child(ren)... -2 Communication Skills a. Strong skills... +1 b. Functional skills...0 c. Limited skills... -1 d. Severely limited skills... -2 PRIORITY NEEDS AND STRENGTHS Enter item number and description of up to three highest priority needs and strengths. Priority Areas of Need Priority Areas of Strength 1. 1. 2. 2. 3. 3. Does family identify areas of needs or strengths that are not included in the categories assessed by this tool? 1. No 2. Yes, describe: Supervisor Review/Approval / / Date [T:\DCYF\GROUP\DOLLOFF\RELATED TRAINING HOS & POWERPOINT\SDM\P&P MANUAL 9-01CRC.DOC] 35

FAMILY STRENGTHS AND NEEDS ASSESSMENT/REVIEW CRITERIA SN1. Substance Use or Abuse (Substances: alcohol, illegal drugs, inhalants, prescription or over-the-counter drugs) a. Teaches and demonstrates healthy understanding of alcohol and drugs. The caregiver(s) may use alcohol or prescribed drugs, however, his or her use does not negatively affect parenting skills and functioning, and the caregiver(s) teaches and demonstrates an understanding of the choices made about use or abstinence and the effects of alcohol and drugs on behavior and society. b. Alcohol or prescribed drug use or no use. The caregiver(s) may have a history of substance use and/or may currently use alcohol or prescribed drugs however, such use does not negatively affect parenting skills and functioning, or the caregiver(s) does not use alcohol or prescribed drugs. c. Alcohol or drug abuse. The caregiver(s) uses alcohol and/or drugs resulting in negative consequences in some areas such as family, social, health, legal, or financial; and/or the caregiver(s) needs help to alleviate negative consequences to the family. d. Alcohol or drug dependency. The caregiver(s) uses alcohol and/or drugs resulting in behaviors that impede his or her ability to meet his or her own and/or their child(ren) s basic needs; or caregiver(s) experiences impairment in most areas including family, social, health, legal, and financial; or caregiver(s) needs intensive structure and support to achieve abstinence from alcohol or drugs. SN2. Emotional Stability a. Positive emotional stability. The caregiver(s) demonstrates the ability to deal with adversity, crises, and conflicts in a positive, proactive, and/or constructive manner. b. No evidence or symptoms of emotional instability. Based on available evidence, it does not appear that the caregiver's emotional stability interferes with his, her, or the family's functioning. The caregiver(s) demonstrates emotional responses that are consistent with his or her circumstances. c. Mild to moderate emotional instability. Based on available evidence, the caregiver's emotional stability appears problematic in that it interferes to a mild or moderate degree with family functioning, parenting, or employment or other aspects of daily living. May include: repeated observations or multiple reliable reports of low self-esteem, apathy, withdrawal from social contact, flat affect, somatic complaints, changes in sleeping or eating patterns, difficulty in concentrating or making decisions, low frustration tolerance or hostile behavior; frequent conflicts with co-worker s or friends; speech is sometimes illogical or irrelevant; frequent loss of work days due to unsubstantiated somatic complaints; diagnosis of a mild to moderate disorder; difficulty coping with crisis situations such as loss of a job, divorce or separation or an unwanted pregnancy. d. Chronic or severe emotional instability. The caregiver(s) appears to have severe problems that prohibit adequate functioning, and are seriously disruptive to family functioning, or are incapacitating. May include: [T:\DCYF\GROUP\DOLLOFF\RELATED TRAINING HOS & POWERPOINT\SDM\P&P MANUAL 36 9-01CRC.DOC]

observed, reported or diagnosed chronic depression, paranoia, excessive mood swings, impulsive or obsessive or compulsive behavior, or other severe mental, emotional or psychological disorders; inability to keep a job or friends; suicide ideation or attempts; recurrent violence; stays in bed all day; completely neglects personal hygiene; grossly impaired communication (i.e., incoherent); reports hearing voices or seeing things; repeated referrals for mental health or psychological evaluations; recommended or actual hospitalization for emotional problems within the past year. SN3. Resource Management or Basic Needs a. Resources sufficient to meet basic needs and are adequately managed. The caregiver(s) has a history of consistently providing safe, healthy, and stable housing, nutritional food, and clothing. b. Resources are limited but are adequately managed. The caregiver(s) provides adequate housing, food, and clothing to meet basic needs. c. Resources are insufficient or not well-managed. The caregiver(s) provides housing but it does not meet the basic needs of the child(ren) due to such things as inadequate plumbing, heating, wiring, or housekeeping. Food and/or clothing do not meet basic needs of the child(ren). The family may be homeless, however there is no evidence of harm or threat of harm to the child(ren). d. No resources or resources severely limited and/or mismanaged. Conditions exist in the household that have caused illness or injury to family members such as inadequate plumbing, heating, wiring, and housekeeping. There is no food, food is spoiled, or family members are malnourished. Child(ren) chronically presents with clothing that is unclean, not appropriate for weather conditions, or in poor repair. The family is homeless, which results in harm or threat of harm to the child(ren). SN4. Parenting Skills a. Strong skills. The caregiver(s) displays good knowledge and understanding of ageappropriate parenting skills and integrates the use of skills on a daily basis. The caregiver(s) expresses hope for and recognizes child(ren) s abilities and strengths and encourages participation in the family and the community. The caregiver(s) advocates for the family and responds to changing needs. b. Adequately parents and protects child(ren). The caregiver(s) displays adequate parenting patterns that are age-appropriate for child(ren) in areas of expectations, discipline, communication, protection, and nurturing. The caregiver(s) has basic knowledge and skills to parent. c. Inadequately parents and protects child(ren). Improvement of basic parenting skills are needed by the caregiver(s). The caregiver(s) has some unrealistic expectations and gaps in parenting skills, demonstrates poor knowledge of age-appropriate disciplinary methods, and/or lacks knowledge of child development that interferes with effective parenting. d. Destructive or abusive parenting. The caregiver(s) displays destructive or abusive parenting patterns that result in harm to the child(ren). [T:\DCYF\GROUP\DOLLOFF\RELATED TRAINING HOS & POWERPOINT\SDM\P&P MANUAL 37 9-01CRC.DOC]

SN5. Household Relationships a. Supportive. Internal or external stressors (i.e., illness, financial problems, divorce, special needs) may be present but the household maintains positive interactions (i.e., mutual affection, respect, open communication, empathy), and shares responsibilities that are mutually agreed upon by the household members. Household members mediate disputes and promote non-violence in the home. Individuals are safe from threats, intimidation, or assaults by other household members. The caregivers may have past history of domestic violence and demonstrate an effective or adequate coping ability regarding any past abuse. b. Minor or occasional discord. Internal or external stressors are present but the household is coping despite some disruption of positive interactions. Conflicts may be resolved through less adaptive strategies such as avoidance, however, household members do not control each other or threaten physical or sexual assault within the household, or there is no history of domestic violence. c. Frequent discord. Internal or external stressors are present and the household is consistently experiencing increased disruption of positive interactions coupled with lack of cooperation and/or emotional or verbal abuse. Custody and visitation issues are characterized by frequent conflicts. The caregiver(s) pattern of adult relationships creates significant stress for the child(ren). Adult relationships are characterized by occasional physical outbursts that may result in injuries; and/or controlling behavior that results in isolation or restriction of activities. Both the offender and the victim seek help in reducing threats of violence. d. Chronic discord. Internal or external stressors are present and the household experiences minimal, or no positive interactions. Custody and visitation issues are characterized by harassment and/or severe conflict, such as multiple reports to law enforcement and/or child protective service. The caregiver(s) pattern of adult relationships place child at risk for maltreatment and/or contribute to severe emotional distress. One or more household members use regular and/or severe physical violence. Individuals engage in physically assaultive behaviors toward other household members. Violent or controlling behavior has or may result in injury. SN6. Caregiver(s) Abuse or Neglect History a. Abuse or neglect as a child, demonstrates good coping ability. The caregiver(s) has experienced physical or sexual abuse or neglect as a child, and demonstrates effective or adequate coping ability regarding his or her abuse or neglect history. b. No abuse or neglect as a child. No caregiver(s) has experienced physical or sexual abuse or neglect as a child. c. Minor problems related to abuse or neglect as a child. The caregiver(s) was abused and/or neglected as a child and this history is related to problems in family functioning or impairs positive familial relationships. d. Serious problems related to abuse or neglect as a child. The caregiver(s) was abused or neglected as a child and this history severely interferes with family functioning, seriously impedes positive familial relationships, or is related to destructive parenting patterns. [T:\DCYF\GROUP\DOLLOFF\RELATED TRAINING HOS & POWERPOINT\SDM\P&P MANUAL 38 9-01CRC.DOC]

SN7. Social or Community Support System a. Strong support system. The family regularly engages with a strong, constructive, mutual-support system. The family interacts with extended family, friends, cultural, religious, and/or community support or services that provide a wide range of resources. b. Adequate support system. As needs arise, the family uses extended family, friends, cultural, religious, and community resources to provide support and/or services such as child care, transportation, supervision, role-modeling for parent(s) and child(ren), parenting and emotional support, guidance, etc. c. Limited support system. The family has a limited support system, is isolated, or is reluctant to use available support. The caregiver(s) perceives services and supports as unavailable or inaccessible. Individuals may experience conflict with cultural or community identity that creates difficulties and internal conflict. d. No support system. The family has no support system and does not utilize extended family and community resources. Connections with potential support networks are unavailable or perceived as unavailable due to the lack of understanding of cultural or community and/or language differences. Household members experience conflict with cultural or community identity that is reflected in behavior. SN8. Child Characteristics a. Age-appropriate and no difficulties. All children appear to be functioning at an ageappropriate level. b. Minor difficulties. Any child has minor physical, emotional, medical, or intellectual difficulties addressed with minimal or routine intervention. c. One child has severe or chronic difficulties. Any child has severe physical, emotional, medical, or intellectual difficulties resulting in substantial difficulties in school, home, or community that strain family finances and/or relationships. d. Children have severe or chronic difficulties. More than one child has severe physical, emotional, medical, or intellectual difficulties resulting in substantial difficulties in school, home, or community that strain family finances and/or relationships. SN9. Physical Health a. Preventive health care is practiced. The caregiver(s) manages health concerns, and teaches and promotes good health. b. Health issues do not affect family functioning. The caregiver(s) has no current health concerns that affect family functioning. The caregiver(s) accesses regular health resources for himself or herself (i.e., medical or dental care). c. Health concerns or disabilities affect family functioning. The caregiver(s) has health concerns or conditions that affect family functioning and/or family resources. d. Serious health concerns or disabilities result in inability to provide care. The caregiver(s) has serious or chronic health problem(s) or condition(s) that affects his or her ability to care for and/or protect the child. [T:\DCYF\GROUP\DOLLOFF\RELATED TRAINING HOS & POWERPOINT\SDM\P&P MANUAL 39 9-01CRC.DOC]

SN10. Communication Skills a. Strong skills. The caregiver(s) communication skills facilitate successful accessing of services and resources to promote family functioning. If the caregiver(s) requires translation services, he or she obtains such services whenever needed. b. Functional skills. The caregiver(s) communication skills are no barrier to effective family functioning, accessing resources, or assisting children in the community or school. If the caregiver(s) requires translation services, he or she uses such services when provided. c. Limited skills. The caregiver(s) has limited communication skills resulting in difficulty accessing resources which interferes with family functioning. If the caregiver(s) requires translation services, he or she experiences difficulty accessing such services or is reluctant to use services. d. Severely limited skills. The caregiver(s) has severely limited communication skills resulting in an inability to access resources which severely affects family functioning. If the caregiver(s) requires translation services, he or she is unwilling or unable to communicate even when provided with such services. [T:\DCYF\GROUP\DOLLOFF\RELATED TRAINING HOS & POWERPOINT\SDM\P&P MANUAL 40 9-01CRC.DOC]

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES CASE CONTACT GUIDELINES POLICY AND PROCEDURES The Family Risk Assessment provides reliable, valid information on the risk to children of continued abuse and neglect. Appropriate use of this assessment data is key to ensuring better protection of children. Therefore, for cases that have been opened for Family Services, the risk level is used to set the minimum amount of contact required with the family each month. These guidelines are considered "best practice" and help focus staff resources on the highest risk cases. There are two sets of guidelines, one for in-home cases and one for children in placement. The guidelines reflect policy regarding the minimum number of face-to-face contacts with the parent(s) and caregiver(s) and each child. CPSWs should use judgement in each case to best determine whether more contacts are needed. The definition and purpose of a face-to-face contact is: to monitor developments in the case, to observe interaction between the caregiver and the child(ren), to facilitate implementation of the Case Plan, and to assess progress with the plan. Types of Referrals/ Cases: Responsible Staff Person(s): Decision: Time Frames: Use: The Case Contact Guidelines apply to all Family Services cases. The Family Services CPSW uses the Case Contact Guidelines. The Case Contact Guidelines determine the minimum number of contacts the Family Services CPSW must have with the family. Case Contact Guidelines are used throughout the life of an open case in response to changes in the risk level. In-Home Case Contact Guidelines Find the column that corresponds to the assessed level of risk, and follow the matrix across to determine the minimum number of contacts required with the family. Child(ren) in Placement Case Contact Guidelines Guidelines for children in placement are described in levels according to placement type. Identify the appropriate service level according to the placement type to determine the minimum number of contacts required with the child. NOTE: If one or more child(ren) are in placement, and the goal is reunification, in-home case case contact guidelines describe activity that the Family Services CPSW has with family, and child(ren) in placement case contact guidelines describe activity the Family Services CPSW has with the child(ren). [T:\DCYF\GROUP\DOLLOFF\RELATED TRAINING HOS & POWERPOINT\SDM\P&P MANUAL 41 9-01CRC.DOC]

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES CASE CONTACT GUIDELINES In-Home Case Contact Guidelines Risk Level Low Overall Contact 1 face-to-face contact with the child(ren) and caregiver(s) at least once every 6 weeks; and, Family Services CPSW Minimum Contacts The Family Services CPSW must have face-to-face contact with all children and caregiver(s) at least once every 6 weeks. * Additional Guidelines Moderate High Very High 1 collateral contact per month by the CPSW. 2 face-to-face contacts with the child(ren) and caregiver(s) per month; and, 2 collateral contacts per month by the CPSW. 3 face-to-face contacts with the child(ren) and caregiver(s) per month; and, 3 collateral contacts per month by the CPSW. 4 face-to-face contacts with child(ren) and caregiver(s) per month; and, 4 collateral contacts per month by the CPSW. The Family Services CPSW must have face-to-face contact with all children and caregiver(s) at least once per month.* One face-to face contact with either the child(ren) or caregiver(s) by a service provider may be applied to the overall contact requirement. The Family Services CPSW must have face-to-face contact with all children and caregiver(s) at least once per month.* Two face-to face contacts with either the child(ren) or caregiver(s) by a service provider may be applied to the overall contact requirement. The Family Services CPSW must have face-to-face contact with all children and caregiver(s) at least once per month.* Three face-to-face contacts with either the child(ren) or caregiver(s) by a service provider may be applied to the overall contact requirement. Every effort should be made to meet with the child(ren) separate from the caregiver(s) during the visit. Every effort should be made to meet with the child(ren) separate from the caregiver(s) during the visit. * If the child(ren) and caregiver(s) are seen together in one visit, one face-to-face contact is satisfied. Note: If one or more child(ren) are in placement and the goal is reunification, In-Home Case Contact Guidelines describe activity that the Family Services CPSW has with the family, and the Child(ren) in Placement Case Contact Guidelines on the following page describe activity the Family Services CPSW has with the child(ren). [T:\DCYF\GROUP\DOLLOFF\RELATED TRAINING HOS & POWERPOINT\SDM\P&P MANUAL 42 9-01CRC.DOC]

Child(ren) in Placement Case Contact Guidelines Service Level Level 1 Placement Type Family Services CPSW Minimum Contacts Additional Guidelines Level 2 Level 3 Level 4 Relatives (in-state) Foster Home (in-state) Residential (in-state) or Residential (MA/VT/ME) State Child Placing Agency/ Therapeutic Foster Care The Family Services CPSW must have one face-to-face contact with the child and the family with whom the child resides every 6 weeks and, have one collateral per month The Family Services CPSW must have one face-to-face contact with the child per month and, have one collateral per month The Family Services CPSW must have three face-to-face contacts within the first year (1 st contact must be made within the 1 st month) and two face-to-face contacts yearly thereafter; and, have one collateral contact quarterly. It is the responsibility of the Child-Placing Agency Social Worker to maintain intensive faceto-face contacts with the child, based on case needs. For out-of-state relative placements, the minimum contacts remain the same but may be met by the receiving state agency, when approved by the direct supervisor. Documentation of all contacts with the child made by the out-of-state agency must be forwarded to the assigned CPSW. Face-to-face contact with the child must take place in the foster home where the child is placed. For out-of-state foster home placements, the minimum contacts remain the same but may be met by the receiving state agency, when approved by the Supervisor. Documentation of all contacts with the child made by the out-of-state agency must be forwarded to the assigned CPSW. Best efforts must be made by the assigned Family Services CPSW to visit the child, but visits may be made by other Family Services CPSWs or DCYF staff. For out-of-state residential placements other than MA/VT/ME, the minimum contacts remain the same, but the Family Services CPSW requests through Interstate Compact that the receiving state agency provide the required contacts. Documentation of all contacts with the child made by the out-ofstate agency must be forwarded to the assigned Family Services CPSW. Documentation of all contacts with the child made by the child-placing agency must be forwarded to the assigned Family Services CPSW. The required frequency of face-toface contacts with the child by the DCYF Family Services CPSW is determined in consultation with the Supervisor, based on case needs. [T:\DCYF\GROUP\DOLLOFF\RELATED TRAINING HOS & POWERPOINT\SDM\P&P MANUAL 43 9-01CRC.DOC]

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES FAMILY RISK REVIEW POLICY AND PROCEDURES The Family Risk Assessment and Family Strengths and Needs Assessment represent the first phase of the structured decision making process. Reviews are performed at established intervals as long as the case is open. Case review ensures that risk of maltreatment and family needs will be considered in later stages of the service delivery process and that case decisions will be made accordingly. At each review, Family Services CPSWs reevaluate the family using tools which help them systematically assess changes in risk and needs. Case progress will determine if a case should remain open or if the case can be closed. Periodic review also provides for on-going monitoring of important case outcomes such as: 1) new abuse or neglect incidents; 2) changes in each family's service utilization pattern; and 3) changes in the severity of previously identified problems. While the initial Family Risk Assessment has separate scales for abuse and neglect, there is only one risk scale for the Family Risk Review. The focus at review is the impact of services provided to the family during the review period and on whether certain events in the family have occurred since the last review. The first four items are those strongly related to the likelihood of subsequent abuse and neglect and generally do not change from the initial Family Risk Assessment. The next four items relate to events that did or did not occur since the last Family Risk Assessment or Risk Review. The final two items specifically relate to the caregiver s progress in relationship to the Case Plan, including participation in services. Types of Referrals/ Cases: Responsible Staff Person(s): Decision: Time Frames: The Family Risk Review is completed on all in-home Family Services cases. The Family Services CPSW completes the Family Risk Review. The Family Risk Review guides the decision about whether to close a case, keep a case open, and/or revise the Case Plan. It also guides changes in contacts required with the family as the risk level changes. Low and moderate risk cases must be considered for closure. For court cases, the Family Risk Review is completed 90 days following disposition, and every three months thereafter. For non-court cases, the Family Risk Review is completed 90 days following the date of the Voluntary Services Agreement, and every three months thereafter. The Family Risk Review is also completed prior to closing any in-home case, regardless of court involvement. [T:\DCYF\GROUP\DOLLOFF\RELATED TRAINING HOS & POWERPOINT\SDM\P&P MANUAL 44 9-01CRC.DOC]

Completion: On the appropriate NH Bridges/SDM screens, mark the number that indicates which review this represents for the family in the header information, and score all the items. All scoring is completed based on the status of the case since the last Family Risk Assessment or Risk Review. For example, when considering whether the primary or secondary caregiver employs excessive and/or inappropriate discipline, base the review only on events since the last Family Risk Assessment or Risk Review. If this item was scored as yes in the initial Risk Assessment, it may be scored as either yes or no depending on changes the family has made. Based on the total score, determine the risk level by finding the appropriate range on the risk level chart. Policy Override The Family Services CPSW determines if any of the policy override reasons exist. Policy overrides have been determined by DCYF as case situations that warrant the highest level of service regardless of the risk scale score at review. If any policy override reasons exist, mark the applicable reason and increase the final risk level to very high. Note that the conditions associated with the policy overrides must have taken place during the review period. A policy override is only used at review if the event has occurred since the last Family Risk Assessment or Risk Review. Discretionary Override The Family Services CPSW determines if there are any discretionary override reasons. At review, a discretionary override may be applied to increase or decrease the risk level by one level in any case where the Family Services CPSW feels the risk level set by the scale is too low or too high. All overrides must be approved by the Family Services Supervisor on the appropriate NH Bridges/SDM screens. Case Status Since all cases that are ready to be closed must have a Risk Review completed, there is a section to indicate whether the case is remaining open or being closed following the review and, if closing, the reasons for case closure. Mark yes if case will be closed and mark one reason for case closure. Mark no if case will remain open following the review. [T:\DCYF\GROUP\DOLLOFF\RELATED TRAINING HOS & POWERPOINT\SDM\P&P MANUAL 45 9-01CRC.DOC]

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES FAMILY RISK REVIEW Family Case Name: Family Case #: CPS Referral Date: / / County Name: District Office: CPSW: Review Date: / / Review #: 1 2 3 4 Complete for cases where all children are in the home. If any child is in placement, complete the Family Reunification Review. R1. Number of Prior Child Abuse and Neglect Assessments (do not count most recent assessment) Score a. None... 0 b. One... 1 c. Two or more... 2 R2. Prior Assessments for Physical, Emotional, or Sexual Abuse (do not count most recent assessment) a. None... 0 b. Physical and/or emotional abuse only... 1 c. Sexual abuse... 2 R3. Number of Children in the Home (at time of most recent assessment) a. Two or fewer... 0 b. Three or more... 1 R4. Current Age of Primary Caregiver a. 30 or older... 0 b. 29 or younger... 1 R5. Caregiver(s) has a Current Substance Abuse Problem a. No... 0 b. Alcohol only... 1 c. Other drug(s) (with or without alcohol)... 2 d. Yes, and refuses treatment... 4 R6. Household is Currently Experiencing Severe Financial Difficulty a. No... 0 b. Yes... 1 R7. Primary or Secondary Caregiver Currently Employs Excessive and/or Inappropriate Discipline a. No... 0 b. Yes... 2 R8. New Founded Determination of child abuse and neglect (Since the Last Family Risk Assessment or Risk Review) a. No referrals or report was unfounded... 0 b. Yes, a report was received and founded... 3 R9. Primary Caregiver(s) Progress Toward Case Plan Goals (since the last Family Risk Assessment or Risk Review) a. Successfully completed all programs recommended or actively participating in programs; pursuing Case Plan objectives; usually demonstrates desired behavior... 0 b. Moderate participation in pursuing Case Plan objectives; occasionally demonstrates desired behavior... 1 c. Minimal participation or refuses involvement; rarely or never demonstrates desired behavior... 3 R10. Secondary Caregiver s Progress toward Case Plan Goals (since the last Family Risk Assessment or Risk Review) a. Not applicable, only one caregiver in the home... 0 b. Successfully completed all programs recommended or actively participating in programs; pursuing Case Plan objectives; usually demonstrates desired behavior... 0 c. Moderate participation in pursuing Case Plan objectives; occasionally demonstrates desired behavior... 1 d. Minimal participation or refuses involvement; rarely or never demonstrates desired behavior... 3 TOTAL SCORE RISK LEVEL: CASE STATUS: Assign the family s risk level based on the following chart: Is case being closed: Yes No 0-3 Low (close unless an override is used) If yes, case closing 4-7 Moderate reason: 1. Low or moderate risk case 8-12 High 2. Satisfactory completion of case plan 13-22 Very High 3. Offender no longer has access to victim 4. Court-ordered OVERRIDES: 5. Child aged out Policy Overrides to Very High (1-4 apply to reviews based on new referral only): 6. Client moved out of state, referral made 1. Sexual Abuse cases where the perpetrator is likely to have access to child victim. 7. Location of clients unknown 2. Cases with non-accidental physical injury to a child under age three years. 8. Death of only child 3. Serious non-accidental physical injury requiring hospitalization or medical treatment. 9. Other: 4. Death (current) of a sibling as a result of abuse or neglect. Discretionary: 5. Explain: FINAL RISK LEVEL: Low Moderate High Very High Supervisor Review/Approval / / Date [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 46

FAMILY RISK REVIEW CRITERIA R1. Number of Prior Child Abuse and Neglect Assessments - Count all child abuse and neglect assessments, whether founded or unfounded, for any type of abuse or neglect, received prior to the most recent assessment. R2. Prior Assessments for Physical, Emotional, or Sexual Abuse - Count any assessment, founded or unfounded, for physical, emotional, or sexual abuse prior to the most recent assessment. a. None There are no prior physical, emotional, or sexual abuse assessments. b. Physical and/or emotional abuse only - There has been a prior assessment of physical and/or emotional abuse, but not sexual abuse. c. Sexual abuse - There has been a prior assessment of a sexual abuse complaint (there may or may not have been physical or emotional abuse assessments as well). R3. Number of Children in the Home Identify the number of individuals under 18 years of age (or under 21 if developmentally delayed) residing in the home at the time of the most recent child abuse and neglect assessment. If a child had been removed as a result of the assessment, a delinquency or CHINS referral, or was on runaway status, count the child as residing in the home. (Note: If a child was placed out of the home during the assessment and remains in placement, complete the Family Reunification Review.) R4. Current Age of Primary Caregiver Record the current age category of the primary caregiver. R5. Caregiver(s) or Household Member(s) has a Current Substance Abuse Problem Indicate if any caregiver(s) or household member(s) has a current problem of alcohol or drug abuse, resulting in a child abuse and neglect report, conflict in home, problems in providing appropriate care for children, extreme behavior or attitudes, financial difficulties, frequent illness, job absenteeism, job changes or unemployment, driving under the influence, traffic violations, criminal arrests, disappearance of usual household items (especially those easily sold), or a life organized around substance use. a. No There are no problems with substances or he or she has successfully completed treatment or may currently be in aftercare, and shows no evidence of a current problem. b. Alcohol only - A caregiver or household member abuses alcohol. This includes persons currently in alcohol abuse treatment programs and those in aftercare who show evidence of relapse. c. Other drug(s) (with or without alcohol) - A caregiver or household member is abusing drugs other than alcohol such as cocaine, marijuana, heroin, barbiturate, prescription drugs, etc; may be poly-addicted, and may abuse alcohol as well as other drugs. This includes persons currently in a drug abuse treatment program and those in aftercare who show evidence of relapse. d. Yes, and refuses treatment - A caregiver or household member has a current alcohol/drug abuse problem; treatment has been offered or recommended for the caregiver or household member and has been refused. [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 47

R6. Household is Currently Experiencing Severe Financial Difficulty The caregiver(s) or household member(s) cannot consistently pay for one or more basic household necessities (rent, heat, light, food, clothing) due to lack of income, or because the household is unable to live within its means due to the actions of the caregivers. Homeless families must be scored yes. R7. Primary or Secondary Caregiver Currently Employs Excessive and/or Inappropriate Discipline - Rate this item based on disciplinary practices, particularly methods employed to punish children in the home, by the primary or secondary caregiver since the Family Risk Assessment or Risk Review. One standard is whether the caregiver s disciplinary practices caused or threatened harm to a child because they were excessively harsh physically or emotionally and/or inappropriate given the child's age or development. Examples include discipline that routinely involves use of an instrument (belt, board, etc.) AND which results in bruises or contusions; restraining the child with a rope, duct tape or other mechanical means; or denial of food or other necessities as punishment. R8. New Founded Determination for Abuse or Neglect since the Last Family Risk Assessment or Risk Review - Rate this item based on whether reports alleging abuse or neglect have been founded since the last Family Risk Assessment or Risk Review. a. No, no referrals have been received or a report was unfounded since the last Family Risk Assessment or Risk Review. b. Yes, a new report was received since the last Family Risk Assessment or Risk Review and it was founded. R9. Primary Caregiver's Progress Toward Case Plan Goals - Rate this item based on the primary caregiver s participation in the case plan and whether he or she is applying skills learned from participation in program(s) since the last Family Risk Assessment or Risk Review. a. Successfully completed all programs recommended or actively participating in programs; pursuing objectives detailed in Case Plans; usually demonstrates desired behavior Observation or reports show the caregiver's application of learned skills in parent/child interaction(s), household relationships, self-care, home maintenance, financial management, and/or mastery of skills toward reaching the behavioral objectives agreed upon in the Case Plan. b. Moderate participation in pursuing Case Plan objectives; occasionally demonstrates desired behavior - The caregiver is participating in services, has made progress, but is not fully complying with the objectives in the Case Plan; or the caregiver is willing to participate in services, and is currently on a waiting list. c. Minimal participation or refuses involvement; rarely or never demonstrates desired behavior - The caregiver refuses services, sporadically follows the Case Plan, or is not demonstrating the necessary skills due to a failure or inability to participate as required. R10. Secondary Caregiver's Progress Toward Case Plan Goals - Rate this item based on the secondary caregiver s participation in the Case Plan and whether he or she is applying the skills learned from participation in program(s) since the last Family Risk Assessment or Risk Review. a. Not applicable - There is no secondary caregiver in the home. Mark box next to a. b. Successfully completed all programs recommended or actively participating in programs; pursuing objectives detailed in Case Plans; usually demonstrated desired behavior [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 48

Observation or reports show caregiver's application of learned skills in parent /child interaction(s), household relationships, self-care, home maintenance, financial management, and/or mastery of skills toward reaching the behavioral objectives agreed upon in the Case Plan. Mark box next to b. c. Moderate participation in pursuing Case Plan objectives; occasionally demonstrates desired behavior - The caregiver is participating in services, and has made progress but is not fully complying with the objectives in the Case Plan; or the caregiver is willing to participate in services and is currently on an active waiting list. d. Minimal participation or refuses involvement; rarely or never demonstrates desired behavior - The caregiver refuses services, sporadically follows the Case Plan, or is not demonstrating the necessary skills due to a failure or inability to participate as required. [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 49

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES FAMILY STRENGTHS AND NEEDS REVIEW POLICY AND PROCEDURES The Family Strengths and Needs Review examines the current condition of the family in terms of strengths and needs, and measures progress toward needs reduction. This is the same tool used during the initial assessment, however, it is important to assess behavior since the last Family Risk Assessment or Risk Review. The Family Strengths and Needs Review is conducted in conjunction with the Family Risk Review (in-home cases) or with the Family Reunification Review (out-ofhome cases). Types of Referrals/ Cases: Responsible Staff Person(s): Decision: The Family Strengths and Needs Review is completed on all ongoing cases (in-home and placement cases). The Family Services CPSW completes The Family Strengths and Needs Review. The results of the Family Strengths and Needs Review will influence scoring the case plan progress questions on the Family Risk Review (in-home) or the Family Reunification Review (out-of-home), and may affect decisions about reasons to continue reunification services. The results guide decisions about which areas must be included or maintained in the Case Plan. Time Frames: For placement cases, the Family Strengths and Needs Review is completed 90 days following disposition and every three months thereafter, in conjunction with the Family Reunification Review. For in-home cases, the Family Strengths and Needs Review is completed 90 days following disposition (for court cases) or the date of the Voluntary Service Agreement (for non-court cases); and every three months thereafter, in conjunction with the Family Risk Review. The Family Strengths and Needs Review must be completed on any case prior to closing. Completion: On the appropriate NH Bridges/SDM screens, indicate a review by marking Review in the header information, and specify the number of reviews this represents for the family. If more than four reviews have been conducted, indicate the review number in the space provided. The same procedures used on the initial Family Strengths and Needs Assessment are used at review to score the primary and secondary caregivers. [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 50

Select one score under each item which reflects the highest level of need for any caregiver in the household and enter in the "Score" column. Finally, list, in order, the top three needs and the top three strengths. All items must be scored considering conditions that existed during the review period only (i.e., was the problem present during the current review period and, if so, how severe was it?). Use the same set of criteria as for the initial Family Strengths and Needs Assessment. The key issue in determining whether a problem exists is whether there is currently a negative impact on family functioning. The Family Services CPSW must refer to the most recent Family Strengths and Needs Assessment (Initial or Review) and determine the impact of services on the needs areas identified as priority need areas, as well as identify any new needs and strengths areas. The identification of any significant problems that were not identified previously requires appropriate modifications to the Case Plan. [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 51

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES FAMILY STRENGTHS AND NEEDS REVIEW Family Case Name: Family Case #: County Name: District Office: CPSW: Date Case Opened to FS: / / Date Completed: / / Initial or Review # 1 2 3 4 SN1. Substance Use or Abuse Score (Substances: alcohol, illegal drugs, inhalants, and prescription or over-the-counter drugs.) a. Teaches and demonstrates healthy understanding of alcohol and drugs... +3 b. Alcohol or prescribed drug use or no use...0 c. Alcohol or drug abuse... -3 d. Alcohol or drug dependency... -5 If C or D, mark all that apply: Alcohol Barbiturates Cocaine or Crack Heroin Inhalants Marijuana or Hashish Methamphetamine Non-Prescription Methadone PCP Tranquilizers (Benzodiazepine) Over-the-Counter drugs Other Amphetamines Other Opiates and Synthetics Other Sedatives or Hypnotics Other Stimulants Other Tranquilizers Other (specify): SN2. SN3. SN4. SN5. SN6. Emotional Stability a. Positive emotional stability... +3 b. No evidence or symptoms of emotional instability...0 c. Mild to moderate emotional instability... -3 d. Chronic or severe emotional instability... -5 Resource Management and Basic Needs a. Resources sufficient to meet basic needs and are adequately managed... +2 b. Resources are limited but are adequately managed...0 c. Resources are insufficient or not well-managed... -2 d. No resources or resources severely limited and/or mismanaged... -4 Parenting Skills a. Strong skills... +2 b. Adequately parents and protects child(ren)...0 c. Inadequately parents and protects child(ren)... -2 d. Destructive or abusive parenting... -4 Household Relationships a. Supportive... +2 b. Minor or occasional discord...0 c. Frequent discord... -2 d. Chronic discord... -3 Caregiver(s) Abuse or Neglect History a. Abuse or neglect as a child, demonstrates good coping ability... +2 b. No abuse or neglect as a child...0 c. Minor problems related to abuse or neglect as a child... -2 d. Serious problems related to abuse or neglect as a child... -3 Primary Caregiver Secondary Caregiver Abuse or neglect as a child In foster care as a child due to abuse or neglect Perpetrator of abuse or neglect in last seven years [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 52

SN7. SN8. SN9. SN10. Social or Community Support System a. Strong support system... +1 b. Adequate support system...0 c. Limited support system... -1 d. No support system... -3 Child Characteristics a. Age-appropriate and no difficulties... +1 b. Minor difficulties...0 c. One child has severe or chronic difficulties... -1 d. Children have severe or chronic difficulties... -3 Physical Health a. Preventive health care is practiced... +1 b. Health issues do not affect family functioning...0 c. Health concerns or disabilities affect family functioning... -1 d. Serious health concerns or disabilities result in inability to care for child(ren)... -2 Communication Skills a. Strong skills... +1 b. Functional skills...0 c. Limited skills... -1 d. Severely limited skills... -2 PRIORITY NEEDS AND STRENGTHS Enter item number and description of up to three highest priority needs and strengths. Priority Areas of Need Priority Areas of Strength 1. 1. 2. 2. 3. 3. Does family identify areas of needs or strengths that are not included in the categories assessed by this tool? 1. No 2. Yes, describe: Supervisor Review/Approval / / Date [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 53

FAMILY STRENGTHS AND NEEDS ASSESSMENT/REVIEW CRITERIA SN1. Substance Use or Abuse (Substances: alcohol, illegal drugs, inhalants, prescription or over-the-counter drugs) a. Teaches and demonstrates healthy understanding of alcohol and drugs. The caregiver(s) may use alcohol or prescribed drugs, however, his or her use does not negatively affect parenting skills and functioning, and the caregiver(s) teaches and demonstrates an understanding of the choices made about use or abstinence and the effects of alcohol and drugs on behavior and society. b. Alcohol or prescribed drug use or no use. The caregiver(s) may have a history of substance use and/or may currently use alcohol or prescribed drugs however, such use does not negatively affect parenting skills and functioning, or the caregiver(s) does not use alcohol or prescribed drugs. c. Alcohol or drug abuse. The caregiver(s) uses alcohol and/or drugs resulting in negative consequences in some areas such as family, social, health, legal, or financial; and/or the caregiver(s) needs help to alleviate negative consequences to the family. d. Alcohol or drug dependency. The caregiver(s) uses alcohol and/or drugs resulting in behaviors that impede his or her ability to meet his or her own and/or their child(ren) s basic needs; or caregiver(s) experiences impairment in most areas including family, social, health, legal, and financial; or caregiver(s) needs intensive structure and support to achieve abstinence from alcohol or drugs. SN2. Emotional Stability a. Positive emotional stability. The caregiver(s) demonstrates the ability to deal with adversity, crises, and conflicts in a positive, proactive, and/or constructive manner. b. No evidence or symptoms of emotional instability. Based on available evidence, it does not appear that the caregiver's emotional stability interferes with his, her, or the family's functioning. The caregiver(s) demonstrates emotional responses that are consistent with his or her circumstances. c. Mild to moderate emotional instability. Based on available evidence, the caregiver's emotional stability appears problematic in that it interferes to a mild or moderate degree with family functioning, parenting, or employment or other aspects of daily living. May include: repeated observations or multiple reliable reports of low self-esteem, apathy, withdrawal from social contact, flat affect, somatic complaints, changes in sleeping or eating patterns, difficulty in concentrating or making decisions, low frustration tolerance or hostile behavior; frequent conflicts with co-worker s or friends; speech is sometimes illogical or irrelevant; frequent loss of work days due to unsubstantiated somatic complaints; diagnosis of a mild to moderate disorder; difficulty coping with crisis situations such as loss of a job, divorce or separation or an unwanted pregnancy. d. Chronic or severe emotional instability. The caregiver(s) appears to have severe problems that prohibit adequate functioning, and are seriously disruptive to family functioning, or are incapacitating. May include: T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 54

observed, reported or diagnosed chronic depression, paranoia, excessive mood swings, impulsive or obsessive or compulsive behavior, or other severe mental, emotional or psychological disorders; inability to keep a job or friends; suicide ideation or attempts; recurrent violence; stays in bed all day; completely neglects personal hygiene; grossly impaired communication (i.e., incoherent); reports hearing voices or seeing things; repeated referrals for mental health or psychological evaluations; recommended or actual hospitalization for emotional problems within the past year. SN3. Resource Management or Basic Needs a. Resources sufficient to meet basic needs and are adequately managed. The caregiver(s) has a history of consistently providing safe, healthy, and stable housing, nutritional food, and clothing. b. Resources are limited but are adequately managed. The caregiver(s) provides adequate housing, food, and clothing to meet basic needs. c. Resources are insufficient or not well-managed. The caregiver(s) provides housing but it does not meet the basic needs of the child(ren) due to such things as inadequate plumbing, heating, wiring, or housekeeping. Food and/or clothing do not meet basic needs of the child(ren). The family may be homeless, however there is no evidence of harm or threat of harm to the child(ren). d. No resources or resources severely limited and/or mismanaged. Conditions exist in the household that have caused illness or injury to family members such as inadequate plumbing, heating, wiring, and housekeeping. There is no food, food is spoiled, or family members are malnourished. Child(ren) chronically presents with clothing that is unclean, not appropriate for weather conditions, or in poor repair. The family is homeless, which results in harm or threat of harm to the child(ren). SN4. Parenting Skills a. Strong skills. The caregiver(s) displays good knowledge and understanding of ageappropriate parenting skills and integrates the use of skills on a daily basis. The caregiver(s) expresses hope for and recognizes child(ren) s abilities and strengths and encourages participation in the family and the community. The caregiver(s) advocates for the family and responds to changing needs. b. Adequately parents and protects child(ren). The caregiver(s) displays adequate parenting patterns that are age-appropriate for child(ren) in areas of expectations, discipline, communication, protection, and nurturing. The caregiver(s) has basic knowledge and skills to parent. c. Inadequately parents and protects child(ren). Improvement of basic parenting skills are needed by the caregiver(s). The caregiver(s) has some unrealistic expectations and gaps in parenting skills, demonstrates poor knowledge of age-appropriate disciplinary methods, and/or lacks knowledge of child development that interferes with effective parenting. d. Destructive or abusive parenting. The caregiver(s) displays destructive or abusive parenting patterns that result in harm to the child(ren). T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 55

SN5. Household Relationships a. Supportive. Internal or external stressors (i.e., illness, financial problems, divorce, special needs) may be present but the household maintains positive interactions (i.e., mutual affection, respect, open communication, empathy), and shares responsibilities that are mutually agreed upon by the household members. Household members mediate disputes and promote non-violence in the home. Individuals are safe from threats, intimidation, or assaults by other household members. The caregivers may have past history of domestic violence and demonstrate an effective or adequate coping ability regarding any past abuse. b. Minor or occasional discord. Internal or external stressors are present but the household is coping despite some disruption of positive interactions. Conflicts may be resolved through less adaptive strategies such as avoidance, however, household members do not control each other or threaten physical or sexual assault within the household, or there is no history of domestic violence. c. Frequent discord. Internal or external stressors are present and the household is consistently experiencing increased disruption of positive interactions coupled with lack of cooperation and/or emotional or verbal abuse. Custody and visitation issues are characterized by frequent conflicts. The caregiver(s) pattern of adult relationships creates significant stress for the child(ren). Adult relationships are characterized by occasional physical outbursts that may result in injuries; and/or controlling behavior that results in isolation or restriction of activities. Both the offender and the victim seek help in reducing threats of violence. d. Chronic discord. Internal or external stressors are present and the household experiences minimal, or no positive interactions. Custody and visitation issues are characterized by harassment and/or severe conflict, such as multiple reports to law enforcement and/or child protective service. The caregiver(s) pattern of adult relationships place child at risk for maltreatment and/or contribute to severe emotional distress. One or more household members use regular and/or severe physical violence. Individuals engage in physically assaultive behaviors toward other household members. Violent or controlling behavior has or may result in injury. SN6. Caregiver(s) Abuse or Neglect History a. Abuse or neglect as a child, demonstrates good coping ability. The caregiver(s) has experienced physical or sexual abuse or neglect as a child, and demonstrates effective or adequate coping ability regarding his or her abuse or neglect history. b. No abuse or neglect as a child. No caregiver(s) has experienced physical or sexual abuse or neglect as a child. c. Minor problems related to abuse or neglect as a child. The caregiver(s) was abused and/or neglected as a child and this history is related to problems in family functioning or impairs positive familial relationships. d. Serious problems related to abuse or neglect as a child. The caregiver(s) was abused or neglected as a child and this history severely interferes with family functioning, seriously impedes positive familial relationships, or is related to destructive parenting patterns. T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 56

SN7. Social or Community Support System a. Strong support system. The family regularly engages with a strong, constructive, mutual-support system. The family interacts with extended family, friends, cultural, religious, and/or community support or services that provide a wide range of resources. b. Adequate support system. As needs arise, the family uses extended family, friends, cultural, religious, and community resources to provide support and/or services such as child care, transportation, supervision, role-modeling for parent(s) and child(ren), parenting and emotional support, guidance, etc. c. Limited support system. The family has a limited support system, is isolated, or is reluctant to use available support. The caregiver(s) perceives services and supports as unavailable or inaccessible. Individuals may experience conflict with cultural or community identity that creates difficulties and internal conflict. d. No support system. The family has no support system and does not utilize extended family and community resources. Connections with potential support networks are unavailable or perceived as unavailable due to the lack of understanding of cultural or community and/or language differences. Household members experience conflict with cultural or community identity that is reflected in behavior. SN8. Child Characteristics a. Age-appropriate and no difficulties. All children appear to be functioning at an ageappropriate level. b. Minor difficulties. Any child has minor physical, emotional, medical, or intellectual difficulties addressed with minimal or routine intervention. c. One child has severe or chronic difficulties. Any child has severe physical, emotional, medical, or intellectual difficulties resulting in substantial difficulties in school, home, or community that strain family finances and/or relationships. d. Children have severe or chronic difficulties. More than one child has severe physical, emotional, medical, or intellectual difficulties resulting in substantial difficulties in school, home, or community that strain family finances and/or relationships. SN9. Physical Health a. Preventive health care is practiced. The caregiver(s) manages health concerns, and teaches and promotes good health. b. Health issues do not affect family functioning. The caregiver(s) has no current health concerns that affect family functioning. The caregiver(s) accesses regular health resources for himself or herself (i.e., medical or dental care). c. Health concerns or disabilities affect family functioning. The caregiver(s) has health concerns or conditions that affect family functioning and/or family resources. d. Serious health concerns or disabilities result in inability to provide care. The caregiver(s) has serious or chronic health problem(s) or condition(s) that affects his or her ability to care for and/or protect the child. T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 57

SN10. Communication Skills a. Strong skills. The caregiver(s) communication skills facilitate successful accessing of services and resources to promote family functioning. If the caregiver(s) requires translation services, he or she obtains such services whenever needed. b. Functional skills. The caregiver(s) communication skills are no barrier to effective family functioning, accessing resources, or assisting children in the community or school. If the caregiver(s) requires translation services, he or she uses such services when provided. c. Limited skills. The caregiver(s) has limited communication skills resulting in difficulty accessing resources which interferes with family functioning. If the caregiver(s) requires translation services, he or she experiences difficulty accessing such services or is reluctant to use services. d. Severely limited skills. The caregiver(s) has severely limited communication skills resulting in an inability to access resources which severely affects family functioning. If the caregiver(s) requires translation services, he or she is unwilling or unable to communicate even when provided with such services. T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 58

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES FAMILY REUNIFICATION REVIEW POLICY AND PROCEDURES The Family Reunification Review consists of six parts that are used to evaluate risk, visitation compliance, and safety issues; describe permanency plan guidelines; and record the permanency plan goal and case status. Results are used to reach a permanency plan recommendation and to guide decisions about whether to return a child(ren) home. The Family Reunification Review is conducted in conjunction with the Family Strengths and Needs Review. Types of Referral/ Cases: The Family Reunification Review is completed on any ongoing case in which at least one child is in out-of-home placement (including relative placements) and there is a goal of reunification to the removal home. The Reunification Review applies to the household from which the child was removed. Note: In cases where another parent is being considered as a reunification resource, a Safety Assessment is required. If the finding of the Safety Assessment is "safe," DCYF may decide to place the child(ren) in the home and close the case. However, if the finding is "unsafe" or "conditionally safe" and DCYF is continuing to consider the home as a reunification resource, it is necessary to complete a Family Risk Assessment, Family Strengths and Needs Assessment (Initial), and, at the time of next review, the Family Reunification Review. SDM assessment tools completed for nonremoval households must not be entered into the SDM database. Responsible Staff Person(s): Decision: Time Frames: The Family Services CPSW completes the Family Reunification Review. The Reunification Risk Review and Visitation Plan Evaluation results determine whether a case is eligible for a recommendation for reunification to the removal home, if the home is safe or conditionally safe. If families have effectively reduced risk to low or moderate and have achieved at least fair compliance with visitation, a Reunification Safety Review is conducted and the results are used to determine if the home environment is safe. The Permanency Plan Guidelines and recommendation sections guide decisions to return a child(ren) home or to change the permanency goal. The Family Reunification Review is completed: 90 days following disposition and every three months thereafter, and At any time a child(ren) is being considered for return home. T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 59

Completion: Using the appropriate NH Bridges/SDM screens: Complete the case identifiers at the top of the page. Section A. Reunification Risk Review Complete the Reunification Risk Review. Section B. Visitation Plan Evaluation For each child, indicate the level at which the parent(s) or caregiver(s) has participated in the visitation plan. If the parent(s) is unable to visit the child(ren), supply a reason in 1a. Proceed to Section D. If 1a does not apply, evaluate the parent(s)or caregiver(s) participation in visitation. Visitation Evaluation choices range from excellent to none. Rate the parental or caregiver compliance with the plan for each child. Section C. Reunification Safety Review If risk has been reduced to low or moderate AND the parents have achieved a fair or better visitation compliance rating, complete a Reunification Safety Review. Enter the results of the Reunification Safety Review in Section C. If risk has NOT been reduced to low or moderate or the parents receive a poor visitation rating or have not complied, do not complete a Reunification Safety Review. Proceed to Section D. Section D. Permanency Plan Guidelines The decision tree provided in Section D is used to determine if a child is to be recommended for reunification to the removal home, maintained in out-of-home care, or if a recommendation for a change in the permanency plan is warranted. Follow the tree to conclusion. Section E. Permanency Plan Recommendation Summary Complete Section E for all reunification reviews. Enter the name and date of placement for each child in placement and mark the recommended permanency goal. If "Change Permanency Plan is marked, you MUST enter the new permanency plan using the codes provided. Check the override column if an override will be used to change the permanency plan recommendation for any child and indicate the final permanency plan goal recommendation in the next column. If an override is being used, indicate the reason in the space provided. Note that if an override is being used to return a child to the removal home, a Safety Reunification Review must be completed if not already completed for the removal household. Supervisory approval of all overrides is indicated on the appropriate NH Bridges/SDM screens. T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 60

Section F. Case Status Indicate the case status at the conclusion of the reunification review. Mark only one. Note: If the Reunification Review is being completed in conjunction with a scheduled court hearing, the current case status should reflect the court s finding. T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 61

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES FAMILY REUNIFICATION REVIEW Family Case Name: Family Case #: CPS Referral Date: / / County Name: District Office: CPSW: Review Date: / / Review #: 1 2 3 4 Complete for cases where any child has been removed from the home and remains in placement. A. FAMILY REUNIFICATION RISK REVIEW R1. Initial CPS Risk Level (after overrides) Score a. Low... 0 b. Moderate... 3 c. High... 4 d. Very High... 5 R2. Household s Progress Toward Treatment Goals a. Successfully met all current Case Plan objectives; continuing cooperation with ongoing programs; significant progress in all of the applicable high need areas (as identified in the Family Strengths & Needs Assessment Initial or Review)... -2 b. Actively participating in programs; pursuing objectives detailed in the Case Plan; continuing progress in all of the applicable high need areas (as identified in the Family Strengths & Needs Assessment Initial or Review)... -1 c. Partial participation in pursuing objectives in the Case Plan; some progress in at least one of the applicable high need areas (as identified in the Family Strengths & Needs Assessment Initial or Review)... 0 d. Minimal level of participation in pursuing objectives of the Case Plan; marginal progress toward reducing needs... 2 e. Refuses involvement in programs; no progress toward reducing needs (as identified in the Family Strengths & Needs Assessment Initial or Review)... 4 R3. Has there been a New Founded Determination (in this household) Since the Last Family Risk Assessment, Risk Review, or Reunification Review? a. No... 0 b. Yes... 6 RISK LEVEL Assign the family s risk level based on the following chart. Score Risk Level -2 to 1 Low 2 to 3 Moderate 4 to 5 High 6 and above Very High OVERRIDES Total Score Policy Overrides: Override to Very High. Mark appropriate reason: 1. Prior sexual abuse; offender has access to child(ren) and has not successfully completed treatment. 2. Cases with non-accidental physical injury to a child under age three years and parent(s) have not successfully completed treatment. 3. Serious non-accidental physical injury requiring hospitalization or medical treatment and parent(s) have not successfully completed treatment. 4. Death (previous or current) of a sibling as a result of abuse or neglect. Discretionary Override: Override up or down one level. 5. Reason: FINAL RISK LEVEL: Low Moderate High Very High T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 62

B. VISITATION PLAN EVALUATION Check visitation compliance for each child. 1. Compliance with Plan Child # Child # Child # Child # a. No visitation plan, check the reason: 1) Parent(s) incarcerated 2) Parent(s) in treatment facility 3) Court order prohibits 4) Unable to locate 5) Other, specify: STOP. GO TO SECTION D. b. Excellent - parent(s) have met all objectives outlined in the visitation plan, no missed visits. c. Good parent(s) have met most objectives of plan. (Definition: Parent-child interaction positive during the visits. Visits may have been rescheduled in advance by parent with a legitimate reason. If visitation was supervised, visits are now unsupervised.) d. Fair parent(s) have met some objectives of plan. (Definition: Parent-child interaction appropriate or improving during visits but continued improvement required. No more than one missed visit without legitimate explanation or advance notice.) e. Poor parent(s) have met few objectives of plan or visitation has been changed from unsupervised to supervised. (Definition: More than one missed visit without legitimate explanation and/or advance notice and/or parent has demonstrated poor parenting techniques or parent-child interaction during visitation.) f. None parent(s) have failed to visit or visits have been suspended due to parental behavior. C. REUNIFICATION SAFETY REVIEW IF RISK LEVEL IS LOW OR MODERATE AND PARENTS HAVE ATTAINED AT LEAST A FAIR LEVEL OF COMPLIANCE WITH VISITATION PLAN, COMPLETE A REUNIFICATION SAFETY REVIEW. OTHERWISE GO TO SECTION D. Safety Decision (check one): Safe Conditionally Safe Unsafe (do not return home) T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 63

D. PLACEMENT/PERMANENCY PLAN GUIDELINES Complete for each child in out-of-home care and enter results below in Section E. Is Risk Level Low or Moderate? No Yes Has risk remained high or very high for two consecutive Reunification Reviews? No Yes Have parents maintained a fair or better level of compliance with visitation plan? No Yes Maintain in Out-of-Home Care Change Permanency Plan Goal Has the child been in placement 12 of the last 22 months? No Yes Is the household safe or conditionally safe (with intervention in place)? No Yes Maintain in Out-of-Home Care Change Permanency Plan Goal Has the household been rated unsafe for two consecutive Reunification Reviews? Return to Removal Home No Yes Maintain in Out-of-Home Care Change Permanency Plan Goal E. PERMANENCY PLAN RECOMMENDATION SUMMARY (Record recommendation for each child.) Child s Name (list in same order as in Section B) Date Placed Out of Home Permanency Plan Recommendation from Section D above (check one) Return Child to Removal Home Maintain OHP w/ Goal of Reunification Change Permanency Plan* New Goal (use codes below) Override Y/N (indicate reason below) CPSW s Final Perm Plan Recommendation 1. 2. 3. 4. 5. 6. * If change permanency plan is marked, you must enter the new goal using the codes below: Permanency Plan Goal Codes: A=Adoption C=Planned Permanent Living Arrangement E=Reunification to Other Parent B=Legal Guardianship D=Reunification to Removal Home F=Permanent Relative Placement Override reason: (Note: if a child is recommended for Return to the Removal Home by use of an override, a Reunification Safety Review must be completed.) F. CURRENT CASE STATUS (check one): 1. Case remains open with at least one child out-of-home. (Future Reunification Reviews required.) 2. Case remains open. All children reunited. (CPS services continue and future Risk Reviews required.) 3. Permanency plan approved by the court and/or TPR granted. (No future Reunification Reviews required.) 4. Permanency plan approved by the court and case closed. (No future Reunification Reviews required.) 5. Other, specify: / / / / CPSW Signature Date Supervisor Review/Approval Date T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 64

FAMILY REUNIFICATION REVIEW CRITERIA A. FAMILY REUNIFICATION RISK REVIEW R1. Initial Risk Level (after overrides) The initial risk level on the Risk Assessment tool is used to score this item R2. Household s Progress toward Case Plan Goals. Rate this item based on whether the members of the household have mastered or are mastering skills learned from participation in service(s). High need areas include major problems where a negative score may be identified on the Strengths and Needs Assessment (Initial or Review). a. Successfully met all current Case Plan objectives; continuing cooperation with ongoing programs; significant progress in all of the applicable high need areas - The family has successfully met all current Case Plan objectives. After meeting these objectives, they continue to cooperate with ongoing services. The family demonstrates significant progress in all applicable high need areas. b. Actively participating in programs; pursuing objectives detailed in the Case Plan; continuing progress in all of the applicable high need areas - The family is actively participating in all of the services and demonstrates an effort in pursuing the objectives detailed in the Case Plan. They continue to show progress in all of the applicable high need areas. c. Partial participation in pursuing objectives in the Case Plan; some progress in at least one of the applicable high need areas - The family is participating in some of the services. They also show some progress in at least one of the high need areas. d. Minimal level of participation in pursuing objectives in the Case Plan; marginal progress toward reducing needs - The caregiver is minimally participating in services, has made progress but is not fully complying with the objectives in the Case Plan. e. Refuses involvement in programs; no progress toward reducing needs - The caregiver refuses services, or has made no progress toward applying the necessary skills due to a failure or inability to participate. R3. Has there been a New Founded Determination (in this household) Since the Last Family Risk Assessment or Risk Review or Reunification Review? Rate this item based on whether a report has been received (for this household) since the last Risk Assessment or Risk Review or Reunification Review? a. No, no referrals have been received or a report was unfounded since the last Family Risk Assessment, Risk Review or Reunification Review. b. Yes, a new report was received and founded since the last Family Risk Assessment, Risk Review or Reunification Review. T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 65

B. VISITATION PLAN EVALUATION a. No Visitation. There is no visitation plan because the parents are unable to visit the child(ren). b. Excellent - Parent(s) has met all objectives outlined in the visitation plan, no missed visits. Self-explanatory. c. Good - Parent(s) has met most objectives of plan. Parent-child interaction is positive during the visits. Visits may have been rescheduled in advance by the parent(s) with legitimate reason. If visitation was supervised, visits are now unsupervised. d. Fair - Parent(s) has met some objectives of plan. Parent-child interaction is appropriate or improving during visits but continued improvement required. There has been no more than one missed visit without legitimate explanation or advance notice. e. Poor - Parent(s) has met few objectives of plan or visitation has been changed from unsupervised to supervised. There has been more than one missed visit without legitimate explanation and/or advance notice, and/or the parent(s) has demonstrated poor parenting techniques or parent-child interaction during visitation. f. None - Parent(s) has failed to visit or visits have been suspended due to parental behavior. Self-explanatory. C. REUNIFICATION SAFETY REVIEW See Reunification Safety Review form, criteria, and policy and procedures included in this manual, pages 70-75. D. PLACEMENT/PERMANENCY PLAN GUIDELINES Maintain in Out-of-Home Care. Do not return the child(ren) to the removal home. Continue reunification efforts with the household. Change Permanency Plan Goal. Change the permanency plan goal from Reunification to removal home to Adoption, Legal Guardianship, Planned Permanent Living Arrangement, Reunification to Other Parent, or Permanent Relative Placement. Stop efforts to return the child(ren) to the removal home. Return Home. Recommend that the child(ren) returns to the removal home. T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 66

E. PERMANENCY PLAN RECOMMENDATION SUMMARY Return the Child to the Removal Home. Based on the Reunification Review results, recommend that the child(ren) is eligible to return to the removal home. Maintain in Out-of-Home Placement. Based on the Reunification Review results, recommend to keep the child(ren) in out-of-home care and continue reunification efforts with the removal household. Change Permanency Plan. Based on the Reunification Review results, recommend a change in the child(ren) s permanency plan to Adoption, Legal Guardianship, Planned Permanent Living Arrangement, Reunification to Other Parent, or Permanent Relative Placement. F. CURRENT CASE STATUS Self-explanatory. T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 67

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES REUNIFICATION SAFETY REVIEW POLICY AND PROCEDURES The Reunification Safety Review is a component of the Family Reunification Review and is used to determine if any safety concerns exist in a household under consideration for reunification. Types of Referrals/ Cases: Responsible Staff Person(s): Time Frames: The Reunification Safety Review is completed on all Family Services cases in which at least one child is in out-of-home placement with a goal of "reunification when: 1) risk has been reduced to low or moderate and the parents have achieved a fair or better visitation compliance rating, OR 2) The permanency plan goal recommendation for a child is being overridden to Return Home. The Family Service CPSW completes the Reunification Safety Review. The Reunification Safety Review is completed: As part of the Family Reunification Review (90 days from disposition and every three months thereafter) when risk is low or moderate, and visitation compliance is fair or better; and At any time a child(ren) in out-of-home care is being considered for return home. Decision: Completion: The Reunification Safety Review guides the decision to return a child(ren) home. A child(ren) may be returned to a "safe or "conditionally safe home environment. Child(ren) must not be recommended to be returned to a home rated "unsafe. At the time of the Family Reunification Review, a decision must be made whether any child would likely be in imminent danger of serious harm if safety interventions were not provided in the household under consideration for reunification. On the appropriate NH Bridges/SDM screens, complete: SECTION 1: REUNIFICATION SAFETY REVIEW Review the safety factors and criteria to determine if any factors are currently present. If there are no safety factors present, mark A and complete Section 2; if safety factors are present and no changes are needed to the safety plan, mark B ; and if safety factors are present and/or a revision(s) needs to be made to the safety plan, mark C and complete Section 3. T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 68

Indicate the safety decision by marking A. Unsafe, B. Conditionally Safe, or C. Safe. A safety decision of "Safe is only marked if no safety factors are present. SECTION 2: SAFETY RESOLUTION DOCUMENTATION If safety factors had previously been identified but are no longer present, document how the safety issues have been resolved. SECTION 3: REVISED SAFETY PLAN When revisions to the safety plan are regarded as necessary, describe the revisions here. Consider interventions that need to be continued or initiated for previously identified safety factors as well as any new safety factors. Note the applicable safety factor number and then briefly describe the issues and how the issues will be addressed to protect the child from immediate and serious danger. T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 69

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES REUNIFICATION SAFETY REVIEW Family Case Name: Family Case #: Current Date: / / SECTION 1: Directions: REUNIFICATION SAFETY REVIEW Review the safety factors listed in the initial assessment to determine if any previously identified factors are still present, or if any new factors are currently present. 1. Yes No Caregiver's or household member s behavior is violent or out of control. 2. Yes No Caregiver or household member describes or acts toward child in predominantly negative terms or has extremely unrealistic expectations. 3. Yes No Caregiver or household member caused serious physical harm to the child or has made a plausible threat to cause serious physical harm. 4. Yes No The caregiver s explanation of an injury to a child is inconsistent with the nature of the injury and/or there are significant discrepancies between explanations given by caregivers, other household members, or collateral contacts. 5. Yes No The family refuses access to the child, or there is reason to believe that the family is about to flee, and/or the child's whereabouts cannot be determined. 6. Yes No Caregiver has not, will not, or is unable to provide supervision necessary to protect child from potentially serious harm. If yes, is the caregiver s or household member s lack of supervision due to: Alcohol or other drug use Hospitalization Physical, emotional or cognitive incapacity Domestic Violence Incarceration Other 7. Yes No Caregiver is unwilling, or is unable, to meet the child's imminent needs for food, clothing, shelter, and/or medical or mental health care. If yes, are the child s basic needs unmet by the caregiver or household member due to: Alcohol or other drug use Incarceration Child s physical, emotional or cognitive incapacity Hospitalization Caregiver s physical, emotional or cognitive incapacity Other 8. Yes No Child is fearful of caregiver(s), other family members, or other people living in or having access to the home. 9. Yes No The child's physical living conditions are hazardous and imminently threatening. 10. Yes No Child sexual abuse is suspected and circumstances suggest that child safety may be an imminent concern. 11. Yes No Other (specify) Safety Factors are: (mark one) Safety Decision: (mark one) A. No longer present (complete Section 2). B. Present, no changes needed to current safety plan (sign and date). C. Present, new safety plan or revisions to plan are needed (complete Section 3). A. Safe (No safety factors present for any child) B. Conditionally Safe (All children safe with controlling safety interventions in place) C. Unsafe (One or more children are unsafe) SECTION 2: Directions: SAFETY RESOLUTION DOCUMENTATION If safety factors had previously been identified but are no longer present, document how the safety issues have been resolved. SECTION 3: Directions: REVISED SAFETY PLAN Describe the revisions to the safety plan. If initial safety factors are still present or new safety factors have been identified, note the applicable safety factor number and then briefly describe the issues. / / / / CPSW Signature Date Supervisor Signature Date C: 12/99 T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 70

REUNIFICATION SAFETY REVIEW CRITERIA 1. Caregiver's or household member s behavior is violent or out of control. - Extreme physical or verbal, angry or hostile outbursts at the child; - Use of brutal or bizarre punishment (i.e., scalding with hot water, burning with cigarettes, forced feeding); - Domestic violence likely to negatively impact on the child; - Use of guns, knives, or other instruments in a violent or threatening way; - Violently shakes or chokes baby or child; - Behavior that seems out of touch with reality, fanatical, or bizarre; - Behavior that seems to indicate a serious lack of self-control (i.e., reckless, unstable, raving, explosive). 2. Caregiver or household member describes or acts toward child in predominantly negative terms or has extremely unrealistic expectations. - Describes child as evil, stupid, ugly, or in some other demeaning or degrading manner, or objectifies child (i.e., calling child "it" or "them"); - Repeatedly curses and/or belittles child; - Scapegoats a particular child in the family; - Expects a child to perform or act in a way that is impossible or improbable for the child's age (i.e., babies and young children expected not to cry, expected to be still for extended periods, be toilet trained or eat neatly, expected to care for younger siblings, expected to stay alone); - Child is seen by either parent as responsible for the parents' problems; - Uses sexualized language to describe child or name calling (i.e., whore, slut, etc.). 3. Caregiver or household member caused serious physical harm to the child or has made a plausible threat to cause serious physical harm. - Intentionally or by other than accidental means caused serious abuse or injury (i.e., fractures, poisoning, suffocating, shooting, burns, bruises or welts, bite marks, choke marks, etc.); - An action, inaction, or threat that would result in serious harm (i.e., kill, starve, lock out of home, etc.); - Plans to retaliate against child for DCYF assessment; - Use of torture or physical force that bears no resemblance to reasonable discipline, or punished child beyond the duration of the child's endurance; - One or both parents fear they will maltreat child and/or request placement. 4. The caregiver s explanation of an injury to a child is inconsistent with the nature of the injury and/or there are significant discrepancies between explanations given by caregivers, other household members, or collateral contacts. - Caregiver s explanation for the observed injuries is inconsistent with the type of injury. - Caregiver s description of the causes of the injury minimizes the extent of harm to the child. - Medical evaluation indicates injury is a result of abuse; parent denies or attributes injury to accidental causes. 71

5. The family refuses access to the child or there is reason to believe that the family is about to flee and/or the child's whereabouts cannot be determined. - Family has previously fled in response to a DCYF assessment; - Family has removed child from a hospital against medical advice; - Family has history of keeping child at home, away from peers, school, other outsiders for extended periods. 6. Caregiver or household member has not, will not, or is unable to provide supervision necessary to protect child from potentially serious harm. - Caregiver or household member does not attend to child to the extent that need for care goes unnoticed or unmet (i.e., although caregiver or household member is present, child can wander outdoors alone, play with dangerous objects, play on unprotected window ledge, or be exposed to other serious hazards); - Caregiver or household member leaves child alone (time period varies with age and developmental stage); - Caregiver or household member makes inadequate and/or inappropriate baby-sitting or child care arrangements or demonstrates very poor planning for child's care; - Parents' whereabouts are unknown; - Caregiver or household member has not, will not, or is unable to protect child from violence against other family members. Note: If the item is identified as a safety factor, indicate if the caregiver s or household member s lack of supervision is due to: Alcohol or other drug use Hospitalization Physical, emotional or cognitive incapacity Domestic Violence Incarceration Other 7. Caregiver or household member is unwilling or unable to meet the child's imminent needs for food, clothing, shelter, and/or medical or mental health care. - No food provided or available to child, or child starved or deprived of food or drink for prolonged periods; - Child without minimally warm clothing in cold months; - No housing or emergency shelter; child must or is forced to sleep in the street, car, etc.; housing is unsafe, without heat, etc; - Caregiver or household member does not seek treatment for child's imminent and dangerous medical condition(s) or does not follow prescribed treatment for such condition(s); - Child appears malnourished; - Child has exceptional needs which parents cannot or will not meet; - Child is suicidal and parents will not take protective action; - Child shows effects of maltreatment, such as serious emotional symptoms and lack of behavior control or serious physical symptoms. Note: If the item is identified as a safety factor, indicate if the child s basic needs are unmet by the caregiver or household member due to: Alcohol or other drug use Incarceration Child s physical, emotional or cognitive incapacity Hospitalization Caregiver s physical, emotional or cognitive incapacity Other 72

8. Child is fearful of caregiver(s), other family members, or other people living in or having access to the home. - Child cries, cowers, cringes, trembles, or otherwise exhibits fear in the presence of certain individuals or verbalizes fear; - Child exhibits severe emotional, physical or behavioral symptoms (i.e., nightmares, insomnia) related to situation(s) associated with a person(s) in the home; - Child has fears of retribution or retaliation from caregivers or household members. 9. The child's physical living conditions are hazardous and imminently threatening. Based on child(ren) s age and developmental status, the child(ren) s physical living conditions are hazardous and immediately dangerous. For example: - Leaking gas from stove or heating unit; - Dangerous substances or objects stored in unlocked lower shelves or cabinets, under sink or easily accessible; - Lack of water or utilities (heat, plumbing, electricity) and no alternate provisions made, or alternate provisions are inappropriate (i.e., stove, unsafe space heaters); - Open windows or broken or missing windows; - Exposed electrical wires; - Excessive garbage, or rotted or spoiled food which threatens health; - Serious illness or significant injury has occurred due to living conditions and these conditions still exist (i.e., lead poisoning, rat bites); - Evidence of excessive human or animal waste throughout living quarters; - Guns and other weapons are accessible. 10. Child sexual abuse is suspected and circumstances suggest that child safety may be an imminent concern. - Access by possible or confirmed offender to child continues to exist; - Circumstances suggest that caregiver or household member has committed rape, sodomy, or has had other sexual contact with child; - Circumstances suggest caregiver or household member has forced or encouraged child to engage in sexual performances or activities. 11. Other (specify): Possible examples: - Current circumstances, in addition to information that the caretaker(s) has or may have previously maltreated a child(ren) in their care, suggests that the child(ren) s safety may be of immediate concern based on the severity of the previous maltreatment and/or the caretaker(s) response to the previous incident; - Abuse or neglect related to a child death, or unexplained child death; - Caregiver or household member refuses to cooperate or is evasive; - Criminal behavior occurring in the presence of the child or the child is forced to commit a crime(s) or engage in criminal behavior. 73

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES CASE EXAMPLES Case Example #1 CPS Intake Report DATE: 9/10/00 ALLEGED CHILD VICTIM: AGE: REPORTING AGENCY: Jose Hernandez 3 Years Sunny Brook Day Care NARRATIVE: The initial call was from Nancy Adams, Director of the Sunny Brook Day Care Center. She reported that a teacher s aide at the day care center was asked by a three-year old boy for help using the bathroom. While the aide was assisting the child, she observed fresh welt marks on his legs and buttocks. The teacher then talked to the boy and asked him what had happened. The boy stated that his father had spanked him with a belt. The family was quite new to the center and the staff has had limited experience interacting with them. His 18-month-old sister was also in this facility, but no marks have been observed on her. There is a 14-year-old brother in the family who often comes to pick up the children. Record check revealed no prior CPS referrals. A police check found one DWI in the past year for Mr. Hernandez. Stop: Complete Screen-In Criteria and Response Priority 1

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES CHILD ABUSE AND NEGLECT SCREEN-IN CRITERIA Family Case Name: Referral ID #: CPS Referral Date: / / County Name: District Office: CPSW: Neglect includes a child who has been abandoned by his parents, guardian, or custodian; or who is without proper parental care or control, subsistence, education as required by law, or other care or control necessary for his or her physical, mental, or emotional health, when it is established that his or her health has suffered or is very likely to suffer serious impairment; and the deprivation is not due primarily to the lack of financial means of the parents, guardian, or custodian; or whose parents, guardian or custodian are unable to discharge their responsibilities to and for the child because of incarceration, hospitalization or other physical or mental incapacity. Abandonment: child is without an apparent caregiver, and is without provision for his or her care. Parental Incapacity: caregiver is unable to discharge his or her caretaking responsibilities due to incarceration, hospitalization, mental or physical illness, or alcohol or drug use. Educational: caregiver interferes with the child s mandatory educational requirements, and there is documentation by an education authority. Failure to Protect: child is experiencing any of the abuse or neglect conditions defined in DCYF policy, and the caregiver fails to take actions that would protect the child from this abuse or neglect, or a substantial risk of this abuse or neglect (includes subjecting a child to witnessing domestic violence). Lack of Supervision: child is left alone for any length of time and is developmentally, emotionally, or physically unable to care for himself or herself, and/or for younger siblings. Inadequate Basic Care (food, clothing, hygiene, shelter, medical or dental, mental health): Child s housing conditions, lack of heat or lack of shelter are hazardous to the safety of a child and conditions could lead to injury or illness of the child if not resolved. A caregiver has failed to meet a child s basic needs for hygiene to the extent that it impairs the child s functioning or has medical indications such as sores, infection, or physical illness. Child is without adequate food or is malnourished as a result of commission or omission by a caregiver. Caregiver is failing to seek, obtain or follow through with medical attention for a specific medical or dental injury, illness, or condition for a child, including failure to use prescribed drugs and failure to thrive. Complete the Medical Neglect Response Priority Decision Tree. Caregiver is unable or unwilling to obtain mental health services and intervention for a child in need of treatment or evaluation (includes suicidal threats or attempts, severe emotional disorders, etc.). Complete the Medical Neglect Response Priority Decision Tree. 2

Physical Abuse includes: bone fractures; brain damage or skull fractures; retinal hemorrhage; cerebral hemorrhage; burns or scalding; significant cuts, bruises or welts; human bites; internal injuries; sprains or dislocations; subdural hematoma or skeletal injuries; torture; wounds; tying or close confinement; poisoning or noxious substances; and death (when caregiver has access to other children in his or her custody or control). Psychological abuse includes symptoms of emotional problems generally recognized to result from consistent mistreatment. Non-accidental or suspicious injury to a child by a caregiver or other household member. Old, healed, or healing injuries, which have gone untreated and appear suspicious as reported by a medical professional. Injury or physical contact suffered by a child as a result of domestic violence. Munchausen s Syndrome by Proxy or suspicion of it is reported by a medical or mental health professional and the reporting professional provides written documentation supporting the allegation. Emotional or Psychological: behavior toward a child by a caregiver that has caused emotional maltreatment or impaired functioning to a child, or is generally recognized as leading to mental or psychological injury (i.e., berating, name-calling, domestic violence, etc.). Professional reporters must submit written documentation. Threat of physical abuse or harm toward a child by a caregiver or other household member. Evidence of injuries need not be present. (Examples may include: increased severity and/or frequency of domestic violence, report from medical professional of a drug positive infant, a breast-feeding mother who is using illicit drugs, caregiver states a fear of harming the child, cruel or bizarre treatment of children, etc.) Sexual Abuse means the following activities under circumstances which indicate that the child s health or welfare is harmed or threatened with harm: the employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or having a child assist any other person to engage in, any sexually explicit conduct or any simulation of such conduct for the purpose of producing any visual depiction of such conduct; or the rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children. Sexual contact or exploitation involving a child (under age 18) by a caregiver or other household member. Disclosure by a child of an incident of sexual abuse but specific offender not identified. Physical finding of a suspicion of sexual abuse reported by a medical professional, even without disclosure. Child exhibits behavior beyond normal psychosexual development. Law Enforcement/Court Requests DCYF Assessment (does not include requests for home studies): Neglect Physical Abuse Sexual Abuse Supervisor Review/Signature / / Date 3

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES RESPONSE PRIORITY Family Case Name: Referral ID #: CPS Referral Date: / / County Name: District Office: CPSW: Current Referral (Use All Applicable - Mark Appropriate Answer) PHYSICAL/PSYCHOLOGICAL ABUSE Is physical injury evident or is medical or psychiatric care required? Yes No SEXUAL ABUSE Does alleged offender have access or is child afraid to go home? Yes No Is child under age seven years or limited by disability? Yes Level 1 Yes Level 1 No Will alleged offender have access to child in next 48 hours? No Level 2 Is child under age three years? Will alleged offender have access to child in next 48 hours, or is child afraid to go home? Yes Yes Level 1 Were severe or bizarre disciplinary measures used? No Yes No No Have there been prior assessed reports of abuse involving any child in the household?* Yes No Level 1 Level 2 Level 2 Level 3 Is non-offender caregiver's response appropriate and protective of child? Level 2 Level 1 Level 2 Is caregiver unaware of abuse or is response to abuse unknown? Yes No Yes No Level 3 * If unable to determine prior investigated allegation type, mark yes. NEGLECT Is the home situation immediately dangerous or unhealthy, or is any child currently left unsupervised who is under seven or limited by disability? Yes No MEDICAL/PSYCHIATRIC NEGLECT Does child appear seriously ill or injured; In need of immediate care? Yes No Level 1 Is any child under age eleven years or limited by disability? Level 1 Level 3 Yes No Are AODA or domestic violence issues currently present? Are AODA or domestic violence issues currently present? Yes No Yes No Level 1 Have prior reports of Is child afraid Level 3 neglect been founded? of going home? Yes No Yes No Level 2 Level 3 Level 1 Level 2 Level 1 Immediate/Within 24 hours Level 2 Within 48 hours Level 3 Within 72 hours Recommended Response (mark one): Level 1 Level 2 Level 3 Intake Supervisor Override? Yes No / / Supervisor Initials Date Override Reason: Assigned Response (mark one): Level 1 Level 2 Level 3 Assessment Supervisor Modification? Yes No / / Supervisor Initials Date Reason: Information documented by the District Office that supports the change. Law Enforcement requests specific time frame. New Response (mark one): Level 1 Level 2 Level 3 Other: [P&P Manual 9-01CRC.doc] 4

OBSERVATION OF CHILD: On 9-10-00, the assessment worker went to the Sunny Brook Day Care Center to observe three-year old Jose Hernandez. The child appeared healthy and well cared for in both dress and hygiene. He was quiet initially and reluctant to talk to a stranger, but responded well to the day care teacher. The assessment worker observed two large, linear red welts on both his right and left buttocks and a welt on the back of his upper leg. No skin was broken and no other bruises or scars were observed on the child. When asked about the welts, the child stated that his father spanked him with the belt when he was bad. He talked freely about his older brother and how he played with his baby sister. He did not appear fearful to go home. OBSERVATION OF SISTER: The 18-month-old sister, Rosa, was observed at Sunny Brook Day Care on 9-10-00. There were no signs of any injuries. She seemed well cared for and appeared to be a healthy and happy child. OBSERVATION OF BROTHER: The 14-year-old half-brother, David Garcia, was interviewed at the High School of the Arts on 9-10-00. David is the mother s son from a previous relationship. He resides with his mother and step-father. He is a freshman in high school. David was very polite and respectful to the assessment worker, but was guarded in talking about his family. Despite his reluctance to talk, he was quick to defend his mother, denying any physical abuse by his mother to any of the children. He did admit that his parents used spanking as a form of discipline and on occasion his step-father would use a belt. David reported that his stepfather has hit him and his three-year-old brother and would sometimes threaten his mother. He was most likely to get hit when he would step in to protect his mother or his brother. He reported that his stepfather s temper is much worse when he has been drinking. He stated that the last time this happened was about a two months ago when his step-father came home drunk one night and started fighting with his mother. David said he saw his stepfather push his mom so he got between them and shoved his stepfather back and told him to leave his mom alone. Then, according to David, his stepfather took a swing at him and hit him in the face, then yelled something and went to bed. He reports that he likes school and gets pretty good grades. He stated that he would like to join a sports team, but they all practice after school and his mom often needs him to help out with his siblings and things around the house. The school counselor confirmed that David is considered a good student with no apparent problems. David s account for the alleged incident is as follows: The night before, Mr. Hernandez had not come home by the time the children went to bed. David woke up when he heard Jose crying. Mrs. Hernandez went to comfort Jose, who apparently had gotten out of bed. At that time, Mr. Hernandez arrived home, and was angry that Jose was not asleep as he was supposed to be. He took Jose from Mrs. Hernandez, and made Jose take down his pajama bottoms. Using the belt he was wearing, Mr. Hernandez counted out three strikes on Jose s bottom then told Jose to go to bed. David stated he did not know if his stepfather had been drinking before he arrived at home. [P&P Manual 9-01CRC.doc] 5

HOME VISIT: Mrs. Hernandez was at home upon the assessment worker s arrival and was upset about the report to the agency. She was very much in control of herself, despite being upset about the situation. The home was very clean and well furnished. The living room furniture was covered with plastic. There were statues of the Blessed Virgin Mary (Virginia de Guadeloupe) throughout the house and the mother stated that the family regularly attends the local Catholic church. There were many ageappropriate toys in the home and the home was child-proofed for the safety of the younger children. The parents both age 34, have been married for six years. Mr. Hernandez works at a white collar, middle class job. Mrs. Hernandez works part-time at a retail store. Mr. Hernandez arrived home shortly after the assessment worker s arrival and was extremely upset at the assessment worker s presence. Mrs. Hernandez became very quiet and allowed Mr. Hernandez to take over the conversation. After some discussion, Mr. Hernandez reluctantly agreed to cooperate with the assessment. Mr. Hernandez denied knowledge of how Jose was injured, and suggested he may have been playing hide and seek in the bushes and gotten scratched. However, he did not deny, and in fact proudly declared that he does use physical punishment. He said children these days especially need to be taught clear lessons. For example, he explained how Jose often requires three or four reminders to clean his room, and often does not clean his room to Mr. Hernandez s satisfaction. Jose is often loud, and does not always do as he is told. Jose is also, according to Mr. Hernandez, being spoiled by his mother, who gives him hugs when he cries rather than expecting him to stop crying. He also stated he sometimes uses a belt. He insisted that this is his right as a parent. He claims the family gets along fine and denied any physical altercations with Mrs. Hernandez. When asked about substance use, Mr. Hernandez admitted an occasional drink after work with coworkers but denied a problem. The assessment worker then discussed the agency s policy on doing record checks as a routine part of all assessments, and asked if there was anything either of them wanted to say before discussing anything further. Mr. Hernandez became angry and defensive, and then reluctantly disclosed his DWI charge. Mrs. Hernandez was visibly upset and stated she was unaware of this and asked Mr. Hernandez why he never told her. Mr. Hernandez ignored her and told the assessment worker this was a long time ago, that it was a bogus charge in the first place, and it was all over. Stop: Complete Safety Assessment [P&P Manual 9-01CRC.doc] 6

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES SAFETY ASSESSMENT Family Case Name: Referral ID #: County Name: District Office: CPSW: CPS Referral Date: / / Current Date: / / Initial, or Review Part A. Safety Factor Identification Section 1: Safety Assessment Directions: The following list of factors is behaviors or conditions that may be associated with a child being in imminent danger of serious harm. Identify the presence or absence of each factor by marking either "yes" or "no." Note: The vulnerability of each child needs to be considered throughout the assessment. Children under seven years of age cannot protect themselves. For older children, inability to protect themselves could result from diminished physical, emotional, or cognitive capacity or repeated victimization. 1. Yes No Caregiver's or household member s behavior is violent or out of control. 2. Yes No Caregiver or household member describes or acts toward child in predominantly negative terms or has extremely unrealistic expectations. 3. Yes No Caregiver or household member caused serious physical harm to the child or has made a plausible threat to cause serious physical harm. 4. Yes No The caregiver s explanation of an injury to a child is inconsistent with the nature of the injury and/or there are significant discrepancies between explanations given by caregivers, other household members, or collateral contacts. 5. Yes No The family refuses access to the child, or there is reason to believe that the family is about to flee, and/or the child's whereabouts cannot be determined. 6. Yes No Caregiver has not, will not, or is unable to provide supervision necessary to protect child from potentially serious harm. If yes, is the caregiver s or household member s lack of supervision due to: Alcohol or other drug use Hospitalization Physical, emotional or cognitive incapacity Domestic Violence Incarceration Other 7. Yes No Caregiver is unwilling, or is unable, to meet the child's imminent needs for food, clothing, shelter, and/or medical or mental health care. If yes, are the child s basic needs unmet by the caregiver or household member due to: Alcohol or other drug use Incarceration Child s physical, emotional or cognitive incapacity Hospitalization Caregiver s physical, emotional or cognitive incapacity Other 8. Yes No Child is fearful of caregiver(s), other family members, or other people living in or having access to the home. 9. Yes No The child's physical living conditions are hazardous and imminently threatening. 10. Yes No Child sexual abuse is suspected and circumstances suggest that child safety may be an imminent concern. 11. Yes No Other (specify) IF NO SAFETY FACTORS ARE PRESENT, GO TO SECTION 3: SAFETY DECISION IF SAFETY FACTORS ARE PRESENT, PROCEED WITH PART B Part B. Safety Factor Description Directions: For all safety factors which are marked "Yes," note the applicable safety factor number and then briefly describe the specific individuals, behaviors, conditions, and/or circumstances associated with that particular safety factor. T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 7

Section 2: Safety Response For each condition identified in Section 1, consider the resources available in the family and the community that might help to keep the child safe. Check each response taken to protect the child and explain below. Describe all safety interventions taken or immediately planned by you or anyone else and explain how each intervention protects (or protected) each child. Note: If any child is being removed from the home, mark #8. 1. Direct intervention by CPSW. 2. Use family, neighbors, or other individuals in the community as safety resources. 3. Use community agencies or services as safety resources. 4. Have the alleged offender leave the home, either voluntarily or in response to legal action. 5. Have the non-offending caregiver move to a safe environment with the child. 6. Caregiver(s) places the child outside the home. 7. Other: 8. Legal action must be taken to place the child(ren) outside the home. Note: child(ren) is considered unsafe in the home; it is contrary to the child(ren) s welfare to remain in the home. If DCYF is initiating legal action and placing the child: 1) explain why responses 1-7 could not be used to keep the child(ren) safe; and 2) describe your discussion with the caregiver(s) regarding the placement. Section 3: Safety Decision Directions: Identify your safety decision by checking the appropriate line below. Check one line only. This decision should be based on the assessment of all safety factors as it relates to the most vulnerable child, and any other information known about this case. A. Unsafe: One or more children will be in imminent danger of serious harm. Remove child(ren) from the home. (Note: check this decision if safety intervention #8 above was used.) List all children who are being removed: B. Conditionally Safe: Controlling safety interventions have been taken since the report was received, and those interventions have resolved the unsafe situation for the present time. C. Safe: There are no children likely to be in imminent danger of serious harm. Supervisor Review/Signature / / Date T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 8

The assessment worker explained to Mr. and Mrs. Hernandez that there were several immediate concerns: There is a pattern of discipline that involves use of an object, and reason to believe this may have left injuries in the past and present. There is reason to believe that if one parent has caused these injuries, the other parent is not acting or is unable to act to protect the children which may be related to interactions between the parents that become physical, and this creates danger for both parents and children. The injuries observed are inconsistent with the accounts given by the parents. The assessment worker indicates that given these concerns, something must be done to assure the safety of the children and asks the parents what they would be willing to consider doing at this time. At first Mr. Hernandez indicated that since he does not believe there is a problem he is unwilling to do anything, but Mrs. Hernandez stated that she would cooperate. Mr. Hernandez eventually indicated he d do whatever it took to get the agency off his back. He agreed to suspend use of belts or objects for the next 30 days, while the assessment continued. Both parents agreed that Jose would continue attending daycare and that the assessment worker could discuss attendance and behavior at day care with the day care provider. Both parents agreed that they would not engage in physical altercations over the next 30 days. Mrs. Hernandez indicated she would like to talk to her priest to get advice, and Mr. Hernandez reluctantly agreed. Both agreed to make themselves and the children available for further assessment. The abuse referral was founded. HERNANDEZ CASE-SUBSEQUENT INTERVIEWS SUBSEQUENT INTERVIEW WITH MOTHER: The assessment worker met with Mrs. Hernandez several days after the initial interview. She restated that she had not been informed about the father s DWI arrest. This information shocked her. She admits she is increasingly concerned over Mr. Hernandez s drinking. He does not usually drink at home, but she smells alcohol on him a few times a week, and that when he has been drinking, his temper is short and he can become unreasonable. While she states she often defers to his opinions, she states that she does try to talk things over with her husband when they disagree about family and household issues. She emphasized what a good father and husband he is: he is very responsible, hard-working, and has a good sense of right and wrong. She realizes he can be demanding, especially of David. He does not like a messy house, and likes things to be quiet when he is at home. This is sometimes hard for Jose, who is an energetic and outgoing child. Mrs. Hernandez states she is primarily the one who gets the kids ready for school and daycare, and takes care of household responsibilities. She spoke proudly of David and described him as a very responsible and good son who helps out a lot. Mrs. Hernandez acknowledged that while she is not opposed to corporal punishment, she does worry that Mr. Hernandez goes too far sometimes. She has noticed how Jose, in particular, becomes very quiet when his father comes home. He sometimes stops playing and sits very still and quiet. T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 9

Mrs. Hernandez tearfully recounted the incident that resulted in Jose s welt marks. Her account matched that of David s, and she carries much guilt that she did not intervene. She has been afraid to say anything for fear that Mr. Hernandez would be angry. This led to a discussion of her relationship with Mr. Hernandez. She states she is committed to the relationship, but wishes he would be more willing to compromise, and more aware of the needs of other family members. She stated that Mr. Hernandez is not a very good listener, and does not want to discuss things once he has stated his opinion. He has pushed and shoved her and on a few occasions, has slapped her, but says that the incidents were probably her fault for bothering him with household matters when he was tired from work. She did acknowledge that once or twice David tried to stop him, and was slapped in the face as a result. Mrs. Hernandez has not talked to anyone about her growing concerns. She has no close friends, and has been embarrassed to talk to her family. SUBSEQUENT INTERVIEW WITH FATHER: Mr. Hernandez continued to object to the intervention of DCYF, making it clear he was only participating to the extent required to satisfy minimal requirements. He continued to deny knowledge of how Jose received welt marks and does not believe that his parenting methods are harmful or abusive, but indicated he would continue with the safety plan until DCYF concluded their business with his family. Mr. Hernandez continued to deny physical abuse of his wife. He states that he is the decision maker in the family. He takes his responsibility seriously, and prides himself on being a good provider. He acknowledges spending time with his co-workers having a few beers before coming home, but continues to state that this is not a problem, and that his DWI arrest was another example of the state interfering unnecessarily into his family. PHONE INTERVIEW WITH FATHER S PROBATION AGENT: Mr. Hernandez s AODA assessment for his DWI indicated alcohol abuse. He was referred for outpatient alcohol education classes, but he has not attended. He has 30 days to come into compliance or will face possible jail time. Stop: Complete Risk Assessment T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 10

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES FAMILY RISK ASSESSMENT OF ABUSE AND NEGLECT Family Case Name: Referral ID #: County Name: District Office: CPSW: Assigned Date: / / Today s Date: / / Neglect Score Abuse Score N1. Current Assessment is for Neglect a. No...0 b. Yes...1 A1. Current Assessment is for Physical, Sexual, or Emotional Abuse a. No...0 b. Yes...1 N2. Number of Prior Assessments a. None...0 b. One...1 c. Two or more...2 N3. Number of Children in the Home a. Two or fewer...0 b. Three or more...1 N4. Number of Adults in Home at Time of Assessment a. Two or more...0 b. One or none...1 N5. Age of Primary Caregiver a. 30 or older...0 b. 29 or younger...1 N6. Characteristics of Primary Caregiver (check & add for score) a. Not applicable...0 b. Parenting skills are a major problem...1 c. Lacks self-esteem...1 d. Apathetic or feeling of hopelessness...1 N7. Primary Caregiver Involved in Harmful Relationships a. No...0 b. Yes, but not a victim of domestic violence...1 c. Yes, as a victim of domestic violence...2 N8. Primary Caregiver Has a Current Substance Abuse Problem a. No...0 b. Alcohol only...1 c. Other drug(s) (with or without alcohol)...3 N9. Household is Experiencing Severe Financial Difficulty a. No...0 b. Yes...1 N10. Primary Caregiver's Motivation to Improve Parenting Skills a. Motivated and realistic...0 b. Unmotivated...1 c. Motivated but unrealistic...2 N11. Caregiver(s) Response to Assessment and Seriousness of Complaint a. Attitude consistent with seriousness of allegation and complied satisfactorily...0 b. Attitude not consistent with seriousness of allegation (minimizes)...1 c. Failed to comply satisfactorily...2 d. Both b and c...3 TOTAL NEGLECT RISK SCORE A2. Prior Abuse Assessments a. None...0 b. Physical or emotional abuse assessment(s)...1 c. Sexual abuse assessment(s)...2 d. Both b and c...3 A3. Prior DCYF Family Services History a. No...0 b. Yes...1 A4. Number of Children in the Home a. One...0 b. Two or more...1 A5. Caregiver(s) Abused as Child(ren) a. No...0 b. Yes...1 A6. Secondary Caregiver has a Current Substance Abuse Problem a. No, or no secondary caregiver...0 b. Yes (check all that apply) Alcohol abuse problem Drug abuse problem...1 A7. Primary or Secondary Caregiver Employs Excessive and/or Inappropriate Discipline a. No...0 b. Yes...2 A8. Caregiver(s) has a History of Domestic Violence a. No...0 b. Yes...1 A9. Caregiver(s) is an Over-Controlling Parent a. No...0 b. Yes...1 A10. Child in the Home has Special Needs or History of Delinquency a. No...0 b. Yes (check all that apply) Diagnosed special needs History of delinquency or CHINS...1 A11. Secondary Caregiver Motivated to Improve Parenting Skills a. Yes, or no secondary caregiver in home...0 b. No...2 A12. Primary Caregiver s Attitude is Consistent with the Seriousness of the Allegation a. Yes...0 b. No...1 TOTAL ABUSE RISK SCORE INITIAL RISK LEVEL Assign the family s risk level based on the highest score on either scale, using the following chart: Neglect Score 0-4 5-7 8-12 13-20 Abuse Score 0-2 3-5 6-9 10-16 Risk Level Low Moderate High Very High T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 11 OVERRIDES Policy: Override to Very High. Mark the appropriate reason. 1. Sexual abuse cases where the offender is likely to have access 2. Cases with non-accidental physical injury to a child under age three years. 3. Serious non-accidental physical injury requiring hospitalization or medical treatment. 4. Death (previous or current) of a sibling as a result of abuse or neglect. Discretionary: Override and increase one level. 5. Explain: FINAL RISK LEVEL: Low Moderate High Very High Supervisor s Review/Approval / / Date

Stop: Complete Family Assessment of Strengths and Needs T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 12

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES FAMILY STRENGTHS AND NEEDS ASSESSMENT Family Case Name: Family Case #: County Name: District Office: CPSW: Date Case Opened to FS: / / Date Completed: / / Initial or Review # 1 2 3 4 SN1. Substance Use or Abuse Score (Substances: alcohol, illegal drugs, inhalants, and prescription or over-the-counter drugs.) a. Teaches and demonstrates healthy understanding of alcohol and drugs... +3 b. Alcohol or prescribed drug use or no use...0 c. Alcohol or drug abuse... -3 d. Alcohol or drug dependency... -5 If C or D, mark all that apply: Alcohol Barbiturates Cocaine or Crack Heroin Inhalants Marijuana or Hashish Methamphetamine Non-Prescription Methadone PCP Tranquilizers (Benzodiazepine) Over-the-Counter drugs Other Amphetamines Other Opiates and Synthetics Other Sedatives or Hypnotics Other Stimulants Other Tranquilizers Other (specify): SN2. SN3. SN4. SN5. SN6. Emotional Stability a. Positive emotional stability... +3 b. No evidence or symptoms of emotional instability...0 c. Mild to moderate emotional instability... -3 d. Chronic or severe emotional instability... -5 Resource Management and Basic Needs a. Resources sufficient to meet basic needs and are adequately managed... +2 b. Resources are limited but are adequately managed...0 c. Resources are insufficient or not well-managed... -2 d. No resources or resources severely limited and/or mismanaged... -4 Parenting Skills a. Strong skills... +2 b. Adequately parents and protects child(ren)...0 c. Inadequately parents and protects child(ren)... -2 d. Destructive or abusive parenting... -4 Household Relationships a. Supportive... +2 b. Minor or occasional discord...0 c. Frequent discord... -2 d. Chronic discord... -3 Caregiver(s) Abuse or Neglect History a. Abuse or neglect as a child, demonstrates good coping ability... +2 b. No abuse or neglect as a child...0 c. Minor problems related to abuse or neglect as a child... -2 d. Serious problems related to abuse or neglect as a child... -3 Primary Caregiver Secondary Caregiver Abuse or neglect as a child In foster care as a child due to abuse or neglect Perpetrator of abuse or neglect in last seven years T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 13

SN7. SN8. SN9. SN10. Social or Community Support System a. Strong support system... +1 b. Adequate support system...0 c. Limited support system... -1 d. No support system... -3 Child Characteristics a. Age-appropriate and no difficulties... +1 b. Minor difficulties...0 c. One child has severe or chronic difficulties... -1 d. Children have severe or chronic difficulties... -3 Physical Health a. Preventive health care is practiced... +1 b. Health issues do not affect family functioning...0 c. Health concerns or disabilities affect family functioning... -1 d. Serious health concerns or disabilities result in inability to care for child(ren)... -2 Communication Skills a. Strong skills... +1 b. Functional skills...0 c. Limited skills... -1 d. Severely limited skills... -2 PRIORITY NEEDS AND STRENGTHS Enter item number and description of up to three highest priority needs and strengths. Priority Areas of Need Priority Areas of Strength 1. 1. 2. 2. 3. 3. Does family identify areas of needs or strengths that are not included in the categories assessed by this tool? 1. No 2. Yes, describe: Supervisor Review/Approval / / Date T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 14

FIRST REASSESSMENT (within 90 days): The initial Case Plan for Mr. and Mrs. Hernandez included: Out-patient Substance Abuse Treatment for Mr. Hernandez, and Parenting Classes for both Mr. and Mrs. Hernandez In-home family counseling Initially, there was good cooperation from both parents. The parents attended their church parenting class and had several meetings with their parish priest to discuss parenting and their marriage. There were no new injuries to any of the children. Spankings had occurred, but parents had only used a hand. Developing realistic expectations for the children had been very difficult for Mr. Hernandez. He expected a great deal from the children and had little tolerance for their behavior. The family participated in family therapy and marital therapy with mixed results. David was less parentified in the family and had more activities at school. He is still worried about his stepfather s temper and is protective of his mother. The younger children are doing well. Mr. Hernandez has recently stopped attending family counseling sessions, stating that the therapist was turning his family against him. He had completed an alcohol intake assessment with the program he was referred to, but did not agree with the recommendation for treatment and stated he would not attend. The marital relationship is increasingly stressed. As Mrs. Hernandez has become more assertive, the conflict between her and her husband has escalated. About three weeks ago, Mr. Hernandez came home intoxicated and became verbally aggressive with his wife. Fearing a physical altercation, she called the police. Mr. Hernandez said he wasn t going to put up with this and stormed out of the house. He went to stay with a friend from his workplace. At the time of the incident, the children were at a church function. She has told her husband that she will file for a legal separation if he does not comply with treatment. Stop: Complete Risk Review [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 15

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES FAMILY RISK REVIEW Family Case Name: Family Case #: CPS Referral Date: / / County Name: District Office: CPSW: Review Date: / / Review #: 1 2 3 4 Complete for cases where all children are in the home. If any child is in placement, complete the Family Reunification Review. R1. Number of Prior Child Abuse and Neglect Assessments (do not count most recent assessment) Score a. None... 0 b. One... 1 c. Two or more... 2 R2. Prior Assessments for Physical, Emotional, or Sexual Abuse (do not count most recent assessment) a. None... 0 b. Physical and/or emotional abuse only... 1 c. Sexual abuse... 2 R3. Number of Children in the Home (at time of most recent assessment) a. Two or fewer... 0 b. Three or more... 1 R4. Current Age of Primary Caregiver a. 30 or older... 0 b. 29 or younger... 1 R5. Caregiver(s) has a Current Substance Abuse Problem a. No... 0 b. Alcohol only... 1 c. Other drug(s) (with or without alcohol)... 2 d. Yes, and refuses treatment... 4 R6. Household is Currently Experiencing Severe Financial Difficulty a. No... 0 b. Yes... 1 R7. Primary or Secondary Caregiver Currently Employs Excessive and/or Inappropriate Discipline a. No... 0 b. Yes... 2 R8. New Founded Determination of child abuse and neglect (Since the Last Family Risk Assessment or Risk Review) a. No referrals or report was unfounded... 0 b. Yes, a report was received and founded... 3 R9. Primary Caregiver(s) Progress Toward Case Plan Goals (since the last Family Risk Assessment or Risk Review) a. Successfully completed all programs recommended or actively participating in programs; pursuing Case Plan objectives; usually demonstrates desired behavior... 0 b. Moderate participation in pursuing Case Plan objectives; occasionally demonstrates desired behavior... 1 c. Minimal participation or refuses involvement; rarely or never demonstrates desired behavior... 3 R10. Secondary Caregiver s Progress toward Case Plan Goals (since the last Family Risk Assessment or Risk Review) a. Not applicable, only one caregiver in the home... 0 b. Successfully completed all programs recommended or actively participating in programs; pursuing Case Plan objectives; usually demonstrates desired behavior... 0 c. Moderate participation in pursuing Case Plan objectives; occasionally demonstrates desired behavior... 1 d. Minimal participation or refuses involvement; rarely or never demonstrates desired behavior... 3 TOTAL SCORE RISK LEVEL: CASE STATUS: Assign the family s risk level based on the following chart: Is case being closed: Yes No 0-3 Low (close unless an override is used) If yes, case closing 4-7 Moderate reason: 1. Low or moderate risk case 8-12 High 2. Satisfactory completion of case plan 13-22 Very High 3. Offender no longer has access to victim 4. Court-ordered OVERRIDES: 5. Child aged out Policy Overrides to Very High (1-4 apply to reviews based on new referral only): 6. Client moved out of state, referral made 1. Sexual Abuse cases where the perpetrator is likely to have access to child victim. 7. Location of clients unknown 2. Cases with non-accidental physical injury to a child under age three years. 8. Death of only child 3. Serious non-accidental physical injury requiring hospitalization or medical treatment. 9. Other: 4. Death (current) of a sibling as a result of abuse or neglect. Discretionary: 5. Explain: FINAL RISK LEVEL: Low Moderate High Very High Supervisor Review/Approval [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 16 / / Date

SECOND REASSESSMENT (quarterly/every 90 days): The plan for the Hernandez family was for the following: 1. Mr. Hernandez will comply with treatment recommendations for alcohol abuse. 2. Mrs. Hernandez has been referred to the Women s Center to address the escalating conflict in her marriage and to develop a safety plan in the event of a domestic abuse situation. 3. Continued family counseling regarding anger management issues and family interaction. After the incident where Mrs. Hernandez called the police on him, Mr. Hernandez agreed to attend the out-patient substance abuse treatment program. He realized that he could lose his marriage and his family over his drinking and anger management issues. Mr. Hernandez has completed a 30-day out-patient treatment program at a Hispanic agency that provides counseling for AODA problems and domestic violence issues, and has abstained from alcohol since beginning his treatment program. He plans to continue attending AA meetings through their church as part of an ongoing support and relapse prevention plan. He has moved back into the family home and his wife has joined him in marital counseling to work on improved conflict resolution skills. Family sessions have been held with the parents and David to address David s issues with his stepfather. Appropriate discipline is being used by both parents with no use of any physical punishment. Their participation in their church has become a source of great support for all family members. Mrs. Hernandez continues to attend a women s support group at the Women s Center and finds it very helpful. The family is very stable at this time and well connected to community and treatment resources. Stop: Complete Risk Review [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 17

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES FAMILY RISK REVIEW Family Case Name: Family Case #: CPS Referral Date: / / County Name: District Office: CPSW: Review Date: / / Review #: 1 2 3 4 Complete for cases where all children are in the home. If any child is in placement, complete the Family Reunification Review. R1. Number of Prior Child Abuse and Neglect Assessments (do not count most recent assessment) Score a. None... 0 b. One... 1 c. Two or more... 2 R2. Prior Assessments for Physical, Emotional, or Sexual Abuse (do not count most recent assessment) a. None... 0 b. Physical and/or emotional abuse only... 1 c. Sexual abuse... 2 R3. Number of Children in the Home (at time of most recent assessment) a. Two or fewer... 0 b. Three or more... 1 R4. Current Age of Primary Caregiver a. 30 or older... 0 b. 29 or younger... 1 R5. Caregiver(s) has a Current Substance Abuse Problem a. No... 0 b. Alcohol only... 1 c. Other drug(s) (with or without alcohol)... 2 d. Yes, and refuses treatment... 4 R6. Household is Currently Experiencing Severe Financial Difficulty a. No... 0 b. Yes... 1 R7. Primary or Secondary Caregiver Currently Employs Excessive and/or Inappropriate Discipline a. No... 0 b. Yes... 2 R8. New Founded Determination of child abuse and neglect (Since the Last Family Risk Assessment or Risk Review) a. No referrals or report was unfounded... 0 b. Yes, a report was received and founded... 3 R9. Primary Caregiver(s) Progress Toward Case Plan Goals (since the last Family Risk Assessment or Risk Review) a. Successfully completed all programs recommended or actively participating in programs; pursuing Case Plan objectives; usually demonstrates desired behavior... 0 b. Moderate participation in pursuing Case Plan objectives; occasionally demonstrates desired behavior... 1 c. Minimal participation or refuses involvement; rarely or never demonstrates desired behavior... 3 R10. Secondary Caregiver s Progress toward Case Plan Goals (since the last Family Risk Assessment or Risk Review) a. Not applicable, only one caregiver in the home... 0 b. Successfully completed all programs recommended or actively participating in programs; pursuing Case Plan objectives; usually demonstrates desired behavior... 0 c. Moderate participation in pursuing Case Plan objectives; occasionally demonstrates desired behavior... 1 d. Minimal participation or refuses involvement; rarely or never demonstrates desired behavior... 3 TOTAL SCORE RISK LEVEL: CASE STATUS: Assign the family s risk level based on the following chart: Is case being closed: Yes No 0-3 4-7 8-12 13-22 Low (close unless an override is used) Moderate High Very High If yes, case closing reason: OVERRIDES: Policy Overrides to Very High (1-4 apply to reviews based on new referral only): 1. Sexual Abuse cases where the perpetrator is likely to have access to child victim. 2. Cases with non-accidental physical injury to a child under age three years. 3. Serious non-accidental physical injury requiring hospitalization or medical treatment. 4. Death (current) of a sibling as a result of abuse or neglect. 1. 2. 3. 4. 5. 6. 7. 8. 9. Low or moderate risk case Satisfactory completion of case plan Offender no longer has access to victim Court-ordered Child aged out Client moved out of state, referral made Location of clients unknown Death of only child Other: Discretionary: 5. Explain: FINAL RISK LEVEL: Low Moderate High Very High Supervisor Review/Approval [T:\DCYF\Group\DOLLOFF\Related Training HOs & powerpoint\sdm\p&p Manual 9-01CRC.doc 18 / / Date

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES FAMILY STRENGTHS AND NEEDS REVIEW Family Case Name: Family Case #: County Name: District Office: CPSW: Date Case Opened to FS: / / Date Completed: / / Initial or Review # 1 2 3 4 SN1. Substance Use or Abuse Score (Substances: alcohol, illegal drugs, inhalants, and prescription or over-the-counter drugs.) a. Teaches and demonstrates healthy understanding of alcohol and drugs...+3 b. Alcohol or prescribed drug use or no use...0 c. Alcohol or drug abuse... -3 d. Alcohol or drug dependency... -5 If C or D, mark all that apply: Alcohol Barbiturates Cocaine or Crack Heroin Inhalants Marijuana or Hashish Methamphetamine Non-Prescription Methadone PCP Tranquilizers (Benzodiazepine) Over-the-Counter drugs Other Amphetamines Other Opiates and Synthetics Other Sedatives or Hypnotics Other Stimulants Other Tranquilizers Other (specify): SN2. SN3. SN4. SN5. SN6. Emotional Stability a. Positive emotional stability...+3 b. No evidence or symptoms of emotional instability...0 c. Mild to moderate emotional instability... -3 d. Chronic or severe emotional instability... -5 Resource Management and Basic Needs a. Resources sufficient to meet basic needs and are adequately managed...+2 b. Resources are limited but are adequately managed...0 c. Resources are insufficient or not well-managed... -2 d. No resources or resources severely limited and/or mismanaged... -4 Parenting Skills a. Strong skills...+2 b. Adequately parents and protects child(ren)...0 c. Inadequately parents and protects child(ren)... -2 d. Destructive or abusive parenting... -4 Household Relationships a. Supportive...+2 b. Minor or occasional discord...0 c. Frequent discord... -2 d. Chronic discord... -3 Caregiver(s) Abuse or Neglect History a. Abuse or neglect as a child, demonstrates good coping ability...+2 b. No abuse or neglect as a child...0 c. Minor problems related to abuse or neglect as a child... -2 d. Serious problems related to abuse or neglect as a child... -3 Primary Caregiver Secondary Caregiver Abuse or neglect as a child In foster care as a child due to abuse or neglect Perpetrator of abuse or neglect in last seven years 19

SN7. Social or Community Support System a. Strong support system...+1 b. Adequate support system...0 c. Limited support system... -1 d. No support system... -3 SN8. SN9. SN10. Child Characteristics a. Age-appropriate and no difficulties...+1 b. Minor difficulties...0 c. One child has severe or chronic difficulties... -1 d. Children have severe or chronic difficulties... -3 Physical Health a. Preventive health care is practiced...+1 b. Health issues do not affect family functioning...0 c. Health concerns or disabilities affect family functioning... -1 d. Serious health concerns or disabilities result in inability to care for child(ren)... -2 Communication Skills a. Strong skills...+1 b. Functional skills...0 c. Limited skills... -1 d. Severely limited skills... -2 PRIORITY NEEDS AND STRENGTHS Enter item number and description of up to three highest priority needs and strengths. Priority Areas of Need Priority Areas of Strength 1. 1. 2. 2. 3. 3. Does family identify areas of needs or strengths that are not included in the categories assessed by this tool? 1. No 2. Yes, describe: Supervisor Review/Approval / / Date 20

Case Example #2 CPS Intake Report Name: Smith, Carol Primary Caregiver: Carol Smith, age 23 Children: Laura Jones, age 7 Jason Brown, age 18 months Other Non-Household Members: Virgil Brown, age 35, incarcerated Paul Jones, age 25 TELEPHONE REFERRAL CALLER: Sgt. White, City Police Department TIME: 8:15 p.m. 5/12/00 Sgt. White is requesting a DCYF assessment worker to meet an officer at Carol Smith s apartment. Police had been called at 7:50 p.m. by an anonymous female, stating two very young children were home alone. No other information was available at the time of the initial call. The responding officer did receive a response at the door. Seven-year old Laura Jones and her 18-month old brother Jason Brown were the only occupants of the apartment. The seven-year old is unaware of where her mother is or when she will be back. The officer also reports that the apartment is in deplorable condition. Sgt. White had no further details. Sgt. White wants DCYF to place the children immediately. Stop: Complete Screen-In Criteria and Response Priority 1

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES CHILD ABUSE AND NEGLECT SCREEN-IN CRITERIA Family Case Name: Referral ID #: CPS Referral Date: / / County Name: District Office: CPSW: Neglect includes a child who has been abandoned by his parents, guardian, or custodian; or who is without proper parental care or control, subsistence, education as required by law, or other care or control necessary for his or her physical, mental, or emotional health, when it is established that his or her health has suffered or is very likely to suffer serious impairment; and the deprivation is not due primarily to the lack of financial means of the parents, guardian, or custodian; or whose parents, guardian or custodian are unable to discharge their responsibilities to and for the child because of incarceration, hospitalization or other physical or mental incapacity. Abandonment: child is without an apparent caregiver, and is without provision for his or her care. Parental Incapacity: caregiver is unable to discharge his or her caretaking responsibilities due to incarceration, hospitalization, mental or physical illness, or alcohol or drug use. Educational: caregiver interferes with the child s mandatory educational requirements, and there is documentation by an education authority. Failure to Protect: child is experiencing any of the abuse or neglect conditions defined in DCYF policy, and the caregiver fails to take actions that would protect the child from this abuse or neglect, or a substantial risk of this abuse or neglect (includes subjecting a child to witnessing domestic violence). Lack of Supervision: child is left alone for any length of time and is developmentally, emotionally, or physically unable to care for himself or herself, and/or for younger siblings. Inadequate Basic Care (food, clothing, hygiene, shelter, medical or dental, mental health): Child s housing conditions, lack of heat or lack of shelter are hazardous to the safety of a child and conditions could lead to injury or illness of the child if not resolved. A caregiver has failed to meet a child s basic needs for hygiene to the extent that it impairs the child s functioning or has medical indications such as sores, infection, or physical illness. Child is without adequate food or is malnourished as a result of commission or omission by a caregiver. Caregiver is failing to seek, obtain or follow through with medical attention for a specific medical or dental injury, illness, or condition for a child, including failure to use prescribed drugs and failure to thrive. Complete the Medical Neglect Response Priority Decision Tree. Caregiver is unable or unwilling to obtain mental health services and intervention for a child in need of treatment or evaluation (includes suicidal threats or attempts, severe emotional disorders, etc.). Complete the Medical Neglect Response Priority Decision Tree. 2

Physical Abuse includes: bone fractures; brain damage or skull fractures; retinal hemorrhage; cerebral hemorrhage; burns or scalding; significant cuts, bruises or welts; human bites; internal injuries; sprains or dislocations; subdural hematoma or skeletal injuries; torture; wounds; tying or close confinement; poisoning or noxious substances; and death (when caregiver has access to other children in his or her custody or control). Psychological abuse includes symptoms of emotional problems generally recognized to result from consistent mistreatment. Non-accidental or suspicious injury to a child by a caregiver or other household member. Old, healed, or healing injuries, which have gone untreated and appear suspicious as reported by a medical professional. Injury or physical contact suffered by a child as a result of domestic violence. Munchausen s Syndrome by Proxy or suspicion of it is reported by a medical or mental health professional and the reporting professional provides written documentation supporting the allegation. Emotional or Psychological: behavior toward a child by a caregiver that has caused emotional maltreatment or impaired functioning to a child, or is generally recognized as leading to mental or psychological injury (i.e., berating, name-calling, domestic violence, etc.). Professional reporters must submit written documentation. Threat of physical abuse or harm toward a child by a caregiver or other household member. Evidence of injuries need not be present. (Examples may include: increased severity and/or frequency of domestic violence, report from medical professional of a drug positive infant, a breast-feeding mother who is using illicit drugs, caregiver states a fear of harming the child, cruel or bizarre treatment of children, etc.) Sexual Abuse means the following activities under circumstances which indicate that the child s health or welfare is harmed or threatened with harm: the employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or having a child assist any other person to engage in, any sexually explicit conduct or any simulation of such conduct for the purpose of producing any visual depiction of such conduct; or the rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children. Sexual contact or exploitation involving a child (under age 18) by a caregiver or other household member. Disclosure by a child of an incident of sexual abuse but specific offender not identified. Physical finding of a suspicion of sexual abuse reported by a medical professional, even without disclosure. Child exhibits behavior beyond normal psychosexual development. Law Enforcement/Court Requests DCYF Assessment (does not include requests for home studies): Neglect Physical Abuse Sexual Abuse Supervisor Review/Signature / / Date 3

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES RESPONSE PRIORITY Family Case Name: Referral ID #: CPS Referral Date: / / County Name: District Office: CPSW: Current Referral (Use All Applicable - Mark Appropriate Answer) PHYSICAL/PSYCHOLOGICAL ABUSE Is physical injury evident or is medical or psychiatric care required? Yes No SEXUAL ABUSE Does alleged offender have access or is child afraid to go home? Yes No Is child under age seven years or limited by disability? Yes Level 1 Yes Level 1 No Will alleged offender have access to child in next 48 hours? No Level 2 Is child under age three years? Will alleged offender have access to child in next 48 hours, or is child afraid to go home? Yes Yes Level 1 Were severe or bizarre disciplinary measures used? No Yes No No Have there been prior assessed reports of abuse involving any child in the household?* Yes No Level 1 Level 2 Level 2 Level 3 Is non-offender caregiver's response appropriate and protective of child? Level 2 Level 1 Level 2 Is caregiver unaware of abuse or is response to abuse unknown? Yes No Yes No Level 3 * If unable to determine prior investigated allegation type, mark yes. NEGLECT Is the home situation immediately dangerous or unhealthy, or is any child currently left unsupervised who is under seven or limited by disability? Yes No MEDICAL/PSYCHIATRIC NEGLECT Does child appear seriously ill or injured; In need of immediate care? Yes No Level 1 Is any child under age eleven years or limited by disability? Level 1 Level 3 Yes No Are AODA or domestic violence issues currently present? Are AODA or domestic violence issues currently present? Yes No Yes No Level 1 Have prior reports of Is child afraid Level 3 neglect been founded? of going home? Yes No Yes No Level 2 Level 3 Level 1 Level 2 Level 1 Immediate/Within 24 hours Level 2 Within 48 hours Level 3 Within 72 hours Recommended Response (mark one): Level 1 Level 2 Level 3 Intake Supervisor Override? Yes No / / Supervisor Initials Date Override Reason: Assigned Response (mark one): Level 1 Level 2 Level 3 Assessment Supervisor Modification? Yes No / / Supervisor Initials Date Reason: Information documented by the District Office that supports the change. Law Enforcement requests specific time frame. New Response (mark one): Level 1 Level 2 Level 3 Other: 4

CPS RECORD CHECKS Carol Smith: Date County Reason Status 1999 Prince Co. Neglect Unable to locate 1998 King Co. Neglect Founded, open family services case, closed 9/98 1997 Queen Co. Abuse Founded, no injury, closed Virgil Brown: Listed as alleged perpetrator in 1997 abuse referral Paul Jones: No record Detail on 1998 referral: Mother had left five-year-old girl alone for two days. Mother had left to attend a party and become severely intoxicated. She may have experienced a black out and did not return home. On the following day she was stopped by police for a traffic violation (DWI). After being in jail for more than three hours she mentioned that someone should check on her daughter. Laura remained in foster care for six months before being returned home. CRIMINAL RECORD CHECKS Carol Smith: 1999 Victim, domestic violence 1998 DWI On probation 1998 Child endangerment On probation 1998 Complainant, domestic violence Virgil Brown: 1999 Battery Incarcerated 1999 Domestic violence Incarcerated 1998 Delivery of controlled substance Probation Paul Jones: No record 5

FIRST FACE-TO-FACE CONTACT DESCRIPTION OF APARTMENT ON ARRIVAL The apartment is a third story walk-up unit in a converted house. It consists of one bedroom, one bathroom, a living room, and a kitchen. There is a mattress on the living room floor which Laura states is where her mother sleeps with her Adaddies.@ Laura states she has lots of daddies and their names are Virgil, Paul, Rock, TJ, and she can t remember the others. Other than a lamp, and coffee table, there is no other furniture in the living room. It is littered with trash, decaying food, empty beer, wine and liquor containers, and drug paraphernalia including a crack pipe. There are many roaches, and visible mouse droppings. The apartment s only window is open, and there is no screen. Laura explains that she opened the window because it was hot. She had gotten cold, and her mother previously showed her how to turn on the oven and open the door if she got cold. Laura indicates she has done this several times before, but this time she got hot and could not remember how to turn off the oven, so she opened the window. The officer advises that the oven was on upon his arrival. The kitchen cabinets contained few dishes, and no food. Empty packages of cookies and chips were seen, but no other empty containers. The refrigerator contained a nearly empty milk container dated to expire one week ago, and a half-full jar of baby food. Additionally, there was a twelve pack of beer. There was one box of Cheerios, half full, on the counter. There were roaches crawling in the cereal. The bathroom included a bathtub that was full of room temperature dirty water, though the drain was open. The toilet had not been flushed all day. Laura said her mother doesn t let her flush when her mother is gone in case it spills again. A large plastic garbage bag was overflowing with used plastic diapers. There was visible mold throughout the bathroom. The bedroom contained another mattress, which lay on the floor. It was soiled extensively and smelled of urine. Laura explained that this was where she and Jason slept. There was a hook and eye closure on the outside of this door. Laura said that her mother used that when she needs private time. There were no toys anywhere. There was a portable television in the bedroom. DESCRIPTION OF CHILDREN Laura appeared physically thin and dirty. She said she went to school sometimes, but sometimes her mom needed her to stay home to help with Jason. She was very cooperative, and seemed eager to please. She seemed proud that she could help her mother so well by taking care of her brother. She readily recites Arules@ such as don=t talk to anybody, don t flush the toilet, and don=t go across the street. She states that she likes it when Paul comes because he=s nice, but he doesn=t come much since the last time they moved. She doesn=t like when Virgil comes because he is mean to them and sometimes hurts them. Laura said that her mommy told her Virgil was in jail now. She doesn=t like when Rock comes over because he is mean too and yells all the time. Rock and TJ come over alot and use the pipe and drink beer. Her mom doesn=t get mean when she drinks beer, but sometimes she goes away or sleeps a lot. Laura says that when she grows up she never will drink or use drugs. She doesn=t know when her mother left because there is no clock. She doesn=t know where her mother is, when her mother will return, or how to reach her. 6

Jason looked very small. He was wearing only a loose diaper, and severe diaper rash was visible at the edges of the diaper. He walks a little, though is quite unsteady on his feet. He tends to crawl rather than walk, though mostly remained still. He did not speak at all. Laura said he does talk sometimes, but she didn=t remember what he said. COLLATERAL INFORMATION While leaving, a neighbor asked to talk to the assessment worker. This neighbor said she=s been about to call DCYF many times, but hesitated thinking she should mind her own business. She said that Laura often goes around to the neighbors and asks for something to eat. That is the only time Laura goes outside. This neighbor has been tempted to offer some of her older girl=s clothing to Laura, because Laura is usually wearing the same dirty shirt and torn pants, both of which barely fit her. The neighbor (who lives below Carol Smith), frequently hears yelling, swearing, and hitting sounds when one or another of the mother=s male friends are over. This neighbor said that she last saw Carol earlier today around 3:30 pm, drinking a six-pack of beer in the parking lot with an unknown female person. Around 4:00, an unknown male came and picked them up in a car and they took off. Stop: Complete Safety Assessment 7

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES SAFETY ASSESSMENT Family Case Name: Referral ID #: County Name: District Office: CPSW: CPS Referral Date: / / Current Date: / / Initial, or Review Part A. Safety Factor Identification Section 1: Safety Assessment Directions: The following list of factors is behaviors or conditions that may be associated with a child being in imminent danger of serious harm. Identify the presence or absence of each factor by marking either "yes" or "no." Note: The vulnerability of each child needs to be considered throughout the assessment. Children under seven years of age cannot protect themselves. For older children, inability to protect themselves could result from diminished physical, emotional, or cognitive capacity or repeated victimization. 1. Yes No Caregiver's or household member s behavior is violent or out of control. 2. Yes No Caregiver or household member describes or acts toward child in predominantly negative terms or has extremely unrealistic expectations. 3. Yes No Caregiver or household member caused serious physical harm to the child or has made a plausible threat to cause serious physical harm. 4. Yes No The caregiver s explanation of an injury to a child is inconsistent with the nature of the injury and/or there are significant discrepancies between explanations given by caregivers, other household members, or collateral contacts. 5. Yes No The family refuses access to the child, or there is reason to believe that the family is about to flee, and/or the child's whereabouts cannot be determined. 6. Yes No Caregiver has not, will not, or is unable to provide supervision necessary to protect child from potentially serious harm. If yes, is the caregiver s or household member s lack of supervision due to: Alcohol or other drug use Hospitalization Physical, emotional or cognitive incapacity Domestic Violence Incarceration Other 7. Yes No Caregiver is unwilling, or is unable, to meet the child's imminent needs for food, clothing, shelter, and/or medical or mental health care. If yes, are the child s basic needs unmet by the caregiver or household member due to: Alcohol or other drug use Incarceration Child s physical, emotional or cognitive incapacity Hospitalization Caregiver s physical, emotional or cognitive incapacity Other 8. Yes No Child is fearful of caregiver(s), other family members, or other people living in or having access to the home. 9. Yes No The child's physical living conditions are hazardous and imminently threatening. 10. Yes No Child sexual abuse is suspected and circumstances suggest that child safety may be an imminent concern. 11. Yes No Other (specify) IF NO SAFETY FACTORS ARE PRESENT, GO TO SECTION 3: SAFETY DECISION IF SAFETY FACTORS ARE PRESENT, PROCEED WITH PART B Part B. Safety Factor Description Directions: For all safety factors which are marked "Yes," note the applicable safety factor number and then briefly describe the specific individuals, behaviors, conditions, and/or circumstances associated with that particular safety factor. 8

Section 2: Safety Response For each condition identified in Section 1, consider the resources available in the family and the community that might help to keep the child safe. Check each response taken to protect the child and explain below. Describe all safety interventions taken or immediately planned by you or anyone else and explain how each intervention protects (or protected) each child. Note: If any child is being removed from the home, mark #8. 1. Direct intervention by CPSW. 2. Use family, neighbors, or other individuals in the community as safety resources. 3. Use community agencies or services as safety resources. 4. Have the alleged offender leave the home, either voluntarily or in response to legal action. 5. Have the non-offending caregiver move to a safe environment with the child. 6. Caregiver(s) places the child outside the home. 7. Other: 8. Legal action must be taken to place the child(ren) outside the home. Note: child(ren) is considered unsafe in the home; it is contrary to the child(ren) s welfare to remain in the home. If DCYF is initiating legal action and placing the child: 1) explain why responses 1-7 could not be used to keep the child(ren) safe; and 2) describe your discussion with the caregiver(s) regarding the placement. Section 3: Safety Decision Directions: Identify your safety decision by checking the appropriate line below. Check one line only. This decision should be based on the assessment of all safety factors as it relates to the most vulnerable child, and any other information known about this case. A. Unsafe: One or more children will be in imminent danger of serious harm. Remove child(ren) from the home. (Note: check this decision if safety intervention #8 above was used.) List all children who are being removed: B. Conditionally Safe: Controlling safety interventions have been taken since the report was received, and those interventions have resolved the unsafe situation for the present time. C. Safe: There are no children likely to be in imminent danger of serious harm. Supervisor Review/Signature / / Date 9

INITIAL ASSESSMENT INFORMATION PRIOR TO INTERVIEW WITH MOTHER: MEDICAL INFORMATION Dr. Reed at Children s Hospital examined both Laura and Jason. He reported that Laura is at the 45 th percentile for height and weight. Birth records and scattered pediatric records show that she has consistently been at the 45 th percentile. She has no other medical problems. Jason is below the 5 th percentile for height, weight, and head circumference. His birth records were located and indicated he was born at the 35 th percentile. He has several clinical markers for severe malnutrition. He has severe diaper rash and dehydration, and Dr. Reed admitted Jason to Children=s Hospital. There, it was observed that he had gastric reflux. A speech and feeding team consult was ordered. PROBATION INFORMATION Probation officer reports that when police contacted him last night, he issued a probation hold. It turned out he had been trying to contact Carol since her last urine screen was positive for cocaine, despite having a strict abstinence requirement for her probation. He has been assigned to her case for about three months. During that time she had one prior dirty urine screen for which he issued a warning. She has generally been uncooperative, and has not followed through with other conditions of her probation including AODA treatment. INITIAL INTERVIEW WITH MOTHER Carol was picked up during the night by the police and taken to jail for probation violation. The assessment worker interviewed Carol the following day at the county jail. Carol was defiant and angry that her children were in foster care and told the assessment worker that she (the worker) would be held responsible if anything happened to her children. She insisted that assessment worker contact Carol s friend Betty and that Betty is the person Carol wanted to take care of her children. However, Carol could not provide Betty s last name or address, but did have a pager number. Carol stated that she had not been gone long, and was just doing what she was supposed to do: Jason ran out of pampers and she went to get some. But she did not have enough money, so she went to a friend to get back money that was owed to her. That friend wasn t there, and so it took time to get someone to give her money to buy pampers. Carol insisted that it was not a problem anyway, because when she left, both children were asleep. Additionally, she trained Laura to not answer the door, and there would have been no problem if the police hadn t shown up. Carol denied health problems with her children. She sates that Laura s father is short and that s why Laura is. She was unaware of any diaper rash on Jason because Laura usually changes Jason s diapers, so Carol hasn t even seen Jason s bottom in months, and Laura has never told her he had a rash. She said she was planning to go to the grocery store today, and denied that the children ask neighbors for food, but rather the neighbors like Laura and give her things. 10

Carol denied using any drugs or alcohol in the past six months. She stated she stopped using. She denied knowledge of the crack pipe. She denies being in a current relationship. She states she has friends over, but is not involved with anyone at this time. She states that Jason s father is in jail and she has had no contact with him since his arrest. Laura s father sends a support check but otherwise is not involved. Carol has no contact with her family and resented questions about them. She states she has her friends, and that is all she needs. She did not provide any names of her friends or suggest ways they could help her at this time. FOLLOWING INTERVIEW WITH MOTHER COLLATERAL CONTACT WITH BETTY Upon calling the pager number Carol provided, the assessment worker identified Betty Clayton as the person Carol wanted to care for her children. However, Betty sounded intoxicated on the phone, and said that she did not know anyone named Carol Smith. A CPS records check revealed that Betty has an open family services case involving five of her six children in foster care placement. CONTACT WITH VIRGIL Virgil is not adjudicated as Jason=s father, and reports that Carol claims he is the father but he doesn=t know. He blames Carol for his current incarceration and wants nothing to do with her or Jason and says she s been nothing but trouble to him. He is in jail for 6 more months. CONTACT WITH PAUL Paul is adjudicated as Laura=s father. He is glad to have contact about Laura--he has been trying to find Carol for several months. He paid child support but a few months ago, Carol moved and left no forwarding address. Paul has a court order for visitation. He currently lives in a small 2-bedroom apartment that he shares with two roommates, so he isn t in a position to have Laura come live with him, but has always wanted to be involved in her life. Paul reports that he met Carol in high school. They dated and Carol became pregnant. He wanted her to have an abortion, but her family, which is devoutly Catholic, would not allow it. Paul did not feel ready to assume responsibility for a child. He agreed to pay child support from his part time job until he graduated from high school, and then he=d go to work full time so he could provide support. Carol dropped out of school and lived at home with her parents after Laura was born. She was working on her GED, and worked part time in a clothing store at the mall. Her home life was pretty bad--she=s hinted that she may have been physically and sexually abused but never came out and said that. During this time, Paul visited Laura regularly, and though he and Carol had arguments about the visits, they were getting along alright. He was beginning to think that maybe they would be able to get married one day, after he was on his feet. 11

But about a couple years ago, Carol got caught up with Virgil, who seemed to offer her a way out of her home situation. She moved in with Virgil. Virgil used drugs and drank a lot, so she started to do the same. She soon became pregnant again. She did not have any other relationships, but Virgil always claimed she did, and he denied he was the father. Virgil was emotionally and physically abusive to Carol. Virgil pressed her to have an abortion, but she refused, so he kicked her out. While Carol lived with Virgil, Paul tried to visit, but Virgil was often threatening Paul, and made such horrible scenes when Paul came to pick Laura up that Paul didn=t go around as much. Carol returned to her parents home. They accepted her under the condition that she stop drinking and using drugs, and get her GED. Carol seemed to be getting back on track. Virgil started coming around again, and Carol began drinking again. Paul told her she had to stop using and stop seeing Virgil. That was the last Paul knew of until being contacted by the assessment worker. His support checks started coming back with no forwarding address. Paul believes Carol could be a decent mother if she stayed away from Virgil and stopped drinking. He believes she has a lot of damage from her childhood that makes her act the way she does. CAROL AODA ASSESSMENT Confirmed severe alcohol and drug dependency. CAROL PSYCHOLOGICAL ASSESSMENT Carol was not found to have major underlying psychological disturbance. She was diagnosed with depression, and disclosed her history of physical and sexual abuse by her father to the examiner. She also talked about how she started drinking and using drugs at a young age to try and forget about her problems. Carol also disclosed her tendency to get involved with abusive men, but swore she would never let anyone lay a hand on her kids. The recommendation was for her to participate in substance abuse treatment, domestic violence support services, and individual counseling. FOLLOW-UP INTERVIEW WITH CAROL (Carol was released from jail after agreeing to enroll in an intensive alcohol treatment program). Carol was much less defiant, having completed a detoxification period. She expressed feelings of failure and stated that she has been messing up all of her life. She asked about her children, and expressed that she just wanted what was best for them, and that she knew she was in no position to care for them right now. She realized that leaving them alone was a really bad decision and even dangerous and told the assessment worker that she will do whatever she has to do to be a good mother. Carol confirmed the information provided by Paul. She described numerous instances of physical abuse by Virgil. It was when he started to go after Laura that she called the police and got him arrested and got a restraining order on him. She only told the police Virgil hurt her...she lied to cover up his going after Laura because she didn=t want him to get in that much trouble. She reasoned that Laura hadn=t actually gotten hurt. 12

Although she denied having a current boyfriend, she says that there are a couple of guys she hangs out with who may not be the nicest guys in the world, but aren t as bad as Virgil. She admitted to being pushed around sometimes by them, but reasoned that all men are like that and she can hold her own when push comes to shove. She says that she doesn t have anything against Paul, but that it just caused too many problems with Virgil whenever Paul would come around to see Laura, so she told him not to come around any more and just never told Paul when she moved. Carol spoke guardedly about her own childhood. She said that she had gotten hit more than once by her father while she was growing up, which was why she wouldn=t let that happen to Laura. She stated that her father crossed the line@ with her in terms of sexual abuse. She described her mother as not being very supportive. She indicates that her parent will help her as long as she lives the life they want for her, which is to go to church every Sunday, and be perfect all the time. Carol resents her parents church because her parents go every week, but that didn=t help them to treat her (Carol) decently. ADDITIONAL INFORMATION ON LAURA Laura=s school was contacted. Laura is enrolled in the second grade. She has missed more than 50% of school this year. When present, she is well behaved, and catches on fairly well, but is hampered by having missed so much. She is currently failing every subject, but the teacher emphasized that if Laura were in school consistently, he thinks she would do fine. She is teased a lot, mostly related to her poor hygiene and clothing that is in poor repair. She has no friends. She often looks sad, but brightens readily when any attention is paid to her. Laura=s psychological assessment suggested average to slightly above average intelligence, and moderate anxiety and depression. Based on projective tests, she maintains a hopeful worldview, and while she expresses some anxiety about whether her mother will protect her, she generally saw other adults, such as her father, her teacher, her grandparents, and the neighbors as being safe. The foster mother reports that Laura doesn=t sleep well, and is often awakened by fearful dreams. She is anxious about her brother when she is not with him. She is eating well, and often hides food in her room. She needed to be taught basic hygiene skills, but has caught on quickly and takes pride in things such as brushing her teeth. She is shy around other children, but has made friends with one other five-year old girl. ADDITIONAL INFORMATION ON JASON Upon release from Children=s Hospital, Jason was diagnosed with failure to thrive. Dr. Reed indicates that there was some organic basis due to the reflux, however, earlier intervention could have reduced the impact on Jason=s growth. The reflux was most likely exacerbated by environmental factors. His speech evaluation found that his expressive language was functional at chronological age of ten months, and receptive language at twelve months. He was referred to the child development clinic for complete evaluation. 13

His developmental assessment concluded that his present delays appear to be non-congenital. In his first weeks of foster care he is already exhibiting some improvement. They provided detailed nutritional instructions and specific activities for the foster family to use with Jason, and recommended enrollment in early childhood classes. Dr. Reed is hopeful that with services, Jason should make good strides in reaching critical developmental milestones. He emphasized that Jason must have consistent follow-up with treatment recommendations if his delays are to be successfully addressed. OBSERVATION OF CAROL WITH CHILDREN A supervised visit was held during which time the assessment worker observed interaction between Carol and her children. Laura was happy to see her mother and began to tell her about things she did at the foster home. Carol seemed unable to focus on the conversation and instead focused on how hard it s been for herself. She hugged Laura at the very beginning of the visit, but did not have any further physical contact with her until the end of the visit, when Carol insisted that Laura kiss her goodbye. Carol picked Jason up at first, but then laid him on a blanket and did not attend to him further. RELATIVE SEARCH: No relatives were located that had in interest in or ability to provide care for the children. Both children remained in their foster home. Stop: Complete Risk Assessment & Family Strengths and Needs Assessment 14

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES FAMILY RISK ASSESSMENT OF ABUSE AND NEGLECT Family Case Name: Referral ID #: County Name: District Office: CPSW: Assigned Date: / / Today s Date: / / Neglect Score Abuse Score N1. Current Assessment is for Neglect A1. Current Assessment is for Physical, Sexual, or Emotional Abuse a. No...0 a. No... 0 b. Yes...1 b. Yes... 1 N2. Number of Prior Assessments a. None...0 b. One...1 c. Two or more...2 N3. Number of Children in the Home a. Two or fewer...0 b. Three or more...1 N4. Number of Adults in Home at Time of Assessment a. Two or more...0 b. One or none...1 N5. Age of Primary Caregiver a. 30 or older...0 b. 29 or younger...1 N6. Characteristics of Primary Caregiver (check & add for score) a. Not applicable...0 b. Parenting skills are a major problem...1 c. Lacks self-esteem...1 d. Apathetic or feeling of hopelessness...1 N7. Primary Caregiver Involved in Harmful Relationships a. No...0 b. Yes, but not a victim of domestic violence...1 c. Yes, as a victim of domestic violence...2 N8. Primary Caregiver Has a Current Substance Abuse Problem a. No...0 b. Alcohol only...1 c. Other drug(s) (with or without alcohol)...3 N9. Household is Experiencing Severe Financial Difficulty a. No...0 b. Yes...1 N10. Primary Caregiver's Motivation to Improve Parenting Skills a. Motivated and realistic...0 b. Unmotivated...1 c. Motivated but unrealistic...2 N11. Caregiver(s) Response to Assessment and Seriousness of Complaint a. Attitude consistent with seriousness of allegation and complied satisfactorily...0 b. Attitude not consistent with seriousness of allegation (minimizes)...1 c. Failed to comply satisfactorily...2 d. Both b and c...3 TOTAL NEGLECT RISK SCORE A2. Prior Abuse Assessments a. None... 0 b. Physical or emotional abuse assessment(s)... 1 c. Sexual abuse assessment(s)... 2 d. Both b and c... 3 A3. Prior DCYF Family Services History a. No... 0 b. Yes... 1 A4. Number of Children in the Home a. One... 0 b. Two or more... 1 A5. Caregiver(s) Abused as Child(ren) a. No... 0 b. Yes... 1 A6. Secondary Caregiver has a Current Substance Abuse Problem a. No, or no secondary caregiver... 0 b. Yes (check all that apply) Alcohol abuse problem Drug abuse problem... 1 A7. Primary or Secondary Caregiver Employs Excessive and/or Inappropriate Discipline a. No... 0 b. Yes... 2 A8. Caregiver(s) has a History of Domestic Violence a. No... 0 b. Yes... 1 A9. Caregiver(s) is an Over-Controlling Parent a. No... 0 b. Yes... 1 A10. Child in the Home has Special Needs or History of Delinquency a. No... 0 b. Yes (check all that apply) Diagnosed special needs History of delinquency or CHINS... 1 A11. Secondary Caregiver Motivated to Improve Parenting Skills a. Yes, or no secondary caregiver in home... 0 b. No... 2 A12. Primary Caregiver s Attitude is Consistent with the Seriousness of the Allegation a. Yes... 0 b. No... 1 TOTAL ABUSE RISK SCORE INITIAL RISK LEVEL Assign the family s risk level based on the highest score on either scale, using the following chart: Neglect Score 0-4 5-7 8-12 13-20 Abuse Score 0-2 3-5 6-9 10-16 Risk Level Low Moderate High Very High 15 OVERRIDES Policy: Override to Very High. Mark the appropriate reason. FINAL RISK LEVEL: Low Moderate High Very High Supervisor s Review/Approval 1. Sexual abuse cases where the offender is likely to have access 2. Cases with non-accidental physical injury to a child under age three years. 3. Serious non-accidental physical injury requiring hospitalization or medical treatment. 4. Death (previous or current) of a sibling as a result of abuse or neglect. Discretionary: Override and increase one level. 5. Explain: / / Date

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES FAMILY STRENGTHS AND NEEDS ASSESSMENT Family Case Name: Family Case #: County Name: District Office: CPSW: Date Case Opened to FS: / / Date Completed: / / Initial or Review # 1 2 3 4 SN1. Substance Use or Abuse Score (Substances: alcohol, illegal drugs, inhalants, and prescription or over-the-counter drugs.) a. Teaches and demonstrates healthy understanding of alcohol and drugs...+3 b. Alcohol or prescribed drug use or no use...0 c. Alcohol or drug abuse...-3 d. Alcohol or drug dependency...-5 If C or D, mark all that apply: Alcohol Barbiturates Cocaine or Crack Heroin Inhalants Marijuana or Hashish Methamphetamine Non-Prescription Methadone PCP Tranquilizers (Benzodiazepine) Over-the-Counter drugs Other Amphetamines Other Opiates and Synthetics Other Sedatives or Hypnotics Other Stimulants Other Tranquilizers Other (specify): SN2. SN3. SN4. SN5. SN6. Emotional Stability a. Positive emotional stability...+3 b. No evidence or symptoms of emotional instability...0 c. Mild to moderate emotional instability...-3 d. Chronic or severe emotional instability...-5 Resource Management and Basic Needs a. Resources sufficient to meet basic needs and are adequately managed...+2 b. Resources are limited but are adequately managed...0 c. Resources are insufficient or not well-managed...-2 d. No resources or resources severely limited and/or mismanaged...-4 Parenting Skills a. Strong skills...+2 b. Adequately parents and protects child(ren)...0 c. Inadequately parents and protects child(ren)...-2 d. Destructive or abusive parenting...-4 Household Relationships a. Supportive...+2 b. Minor or occasional discord...0 c. Frequent discord...-2 d. Chronic discord...-3 Caregiver(s) Abuse or Neglect History a. Abuse or neglect as a child, demonstrates good coping ability...+2 b. No abuse or neglect as a child...0 c. Minor problems related to abuse or neglect as a child...-2 d. Serious problems related to abuse or neglect as a child...-3 Primary Caregiver Secondary Caregiver Abuse or neglect as a child In foster care as a child due to abuse or neglect Perpetrator of abuse or neglect in last seven years 16

SN7. SN8. SN9. SN10. Social or Community Support System a. Strong support system... +1 b. Adequate support system...0 c. Limited support system... -1 d. No support system... -3 Child Characteristics a. Age-appropriate and no difficulties... +1 b. Minor difficulties...0 c. One child has severe or chronic difficulties... -1 d. Children have severe or chronic difficulties... -3 Physical Health a. Preventive health care is practiced... +1 b. Health issues do not affect family functioning...0 c. Health concerns or disabilities affect family functioning... -1 d. Serious health concerns or disabilities result in inability to care for child(ren)... -2 Communication Skills a. Strong skills... +1 b. Functional skills...0 c. Limited skills... -1 d. Severely limited skills... -2 PRIORITY NEEDS AND STRENGTHS Enter item number and description of up to three highest priority needs and strengths. Priority Areas of Need Priority Areas of Strength 1. 1. 2. 2. 3. 3. Does family identify areas of needs or strengths that are not included in the categories assessed by this tool? 1. No 2. Yes, describe: Supervisor Review/Approval / / Date 17

1 st REVIEW (90 days) Carol s initial Case Plan included services to address substance abuse, parenting skills, and domestic violence issues. Carol attended substance abuse treatment sessions according to the case plan. Her counselor advises that Carol seemed to take the sessions seriously. Though present, she rarely participated actively in group sessions. She had one positive urine screen two months ago. In individual work, Carol has worked on some very difficult issues, but has a long way to go toward understanding her addiction and having resources in place to avoid future use. Carol was evicted from her previous residence and is now living with a girlfriend. Their shared apartment is reasonably clean. Carol plans to move on her own again within a few months. She is participating in a work program and will graduate in two months. She hopes to be able to get a job at that time. Her work program coach indicates that she has been showing up for her classes most of the time and does quite well, however, gets angered easily and has trouble taking directions. Carol has only attended about half of her parenting classes. She has otherwise indicated she had no transportation, forgot, or had other Aemergencies@ come up that caused her to miss. Having completed 60 days of sobriety, Carol began participating in a group for victims of domestic violence. She has only been involved a short time, and the leader had not formed an opinion about her progress, though she is attending regularly and is not disruptive. Carol has not become involved in any relationships. No new referrals have been made on Carol during this time. She has had limited contact with her children. Visitation was scheduled for once each week. Her attendance is summarized as follows: Mo. Attendance Comments 1 1 OK, 1 miss, 1 very late, 1 had to leave half-way through No materials brought to engage children. Told Laura about new boyfriend. Promised Laura she=d be home soon. Did not pick up Jason when he cried but asked Laura to check his diaper. 2 2 OK, 2 miss Brought some candy for the children. Did not ask Laura about school. Asked Laura many questions about foster home, implied that foster parents were not to be trusted. 3 4 OK Brought a book and attempted to read it, but became frustrated when Laura wanted to read it herself. Left Laura to the book and cuddled with Jason. Then watched TV for the rest of visit. Stop: Complete Reunification Review 18

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES FAMILY REUNIFICATION REVIEW Family Case Name: Family Case #: CPS Referral Date: / / County Name: District Office: CPSW: Review Date: / / Review #: 1 2 3 4 Complete for cases where any child has been removed from the home and remains in placement. A. FAMILY REUNIFICATION RISK REVIEW R1. Initial CPS Risk Level (after overrides) Score a. Low... 0 b. Moderate... 3 c. High... 4 d. Very High... 5 R2. Household s Progress Toward Treatment Goals a. Successfully met all current Case Plan objectives; continuing cooperation with ongoing programs; significant progress in all of the applicable high need areas (as identified in the Family Strengths & Needs Assessment Initial or Review)... -2 b. Actively participating in programs; pursuing objectives detailed in the Case Plan; continuing progress in all of the applicable high need areas (as identified in the Family Strengths & Needs Assessment Initial or Review)... -1 c. Partial participation in pursuing objectives in the Case Plan; some progress in at least one of the applicable high need areas (as identified in the Family Strengths & Needs Assessment Initial or Review)... 0 d. Minimal level of participation in pursuing objectives of the Case Plan; marginal progress toward reducing needs... 2 e. Refuses involvement in programs; no progress toward reducing needs (as identified in the Family Strengths & Needs Assessment Initial or Review)... 4 R3. Has there been a New Founded Determination (in this household) Since the Last Family Risk Assessment, Risk Review, or Reunification Review? a. No... 0 b. Yes... 6 RISK LEVEL Assign the family s risk level based on the following chart. Score Risk Level -2 to 1 Low 2 to 3 Moderate 4 to 5 High 6 and above Very High OVERRIDES Total Score Policy Overrides: Override to Very High. Mark appropriate reason: 1. Prior sexual abuse; offender has access to child(ren) and has not successfully completed treatment. 2. Cases with non-accidental physical injury to a child under age three years and parent(s) have not successfully completed treatment. 3. Serious non-accidental physical injury requiring hospitalization or medical treatment and parent(s) have not successfully completed treatment. 4. Death (previous or current) of a sibling as a result of abuse or neglect. Discretionary Override: Override up or down one level. 5. Reason: FINAL RISK LEVEL: Low Moderate High Very High 19

B. VISITATION PLAN EVALUATION Check visitation compliance for each child. 1. Compliance with Plan Child # Child # Child # Child # a. No visitation plan, check the reason: 1) Parent(s) incarcerated 2) Parent(s) in treatment facility 3) Court order prohibits 4) Unable to locate 5) Other, specify: STOP. GO TO SECTION D. b. Excellent - parent(s) have met all objectives outlined in the visitation plan, no missed visits. c. Good parent(s) have met most objectives of plan. (Definition: Parent-child interaction positive during the visits. Visits may have been rescheduled in advance by parent with a legitimate reason. If visitation was supervised, visits are now unsupervised.) d. Fair parent(s) have met some objectives of plan. (Definition: Parent-child interaction appropriate or improving during visits but continued improvement required. No more than one missed visit without legitimate explanation or advance notice.) e. Poor parent(s) have met few objectives of plan or visitation has been changed from unsupervised to supervised. (Definition: More than one missed visit without legitimate explanation and/or advance notice and/or parent has demonstrated poor parenting techniques or parent-child interaction during visitation.) f. None parent(s) have failed to visit or visits have been suspended due to parental behavior. C. REUNIFICATION SAFETY REVIEW IF RISK LEVEL IS LOW OR MODERATE AND PARENTS HAVE ATTAINED AT LEAST A FAIR LEVEL OF COMPLIANCE WITH VISITATION PLAN, COMPLETE A REUNIFICATION SAFETY REVIEW. OTHERWISE GO TO SECTION D. Safety Decision (check one): Safe Conditionally Safe Unsafe (do not return home) 20

D. PLACEMENT/PERMANENCY PLAN GUIDELINES Complete for each child in out-of-home care and enter results below in Section E. Is Risk Level Low or Moderate? No Yes Has risk remained high or very high for two consecutive Reunification Reviews? No Yes Have parents maintained a fair or better level of compliance with visitation plan? No Yes Maintain in Out-of-Home Care Change Permanency Plan Goal Has the child been in placement 12 of the last 22 months? No Yes Is the household safe or conditionally safe (with intervention in place)? No Yes Maintain in Out-of-Home Care Change Permanency Plan Goal Has the household been rated unsafe for two consecutive Reunification Reviews? Return to Removal Home No Yes Maintain in Out-of-Home Care Change Permanency Plan Goal E. PERMANENCY PLAN RECOMMENDATION SUMMARY (Record recommendation for each child.) Child s Name (list in same order as in Section B) Date Placed Out of Home Permanency Plan Recommendation from Section D above (check one) Return Child to Removal Home Maintain OHP w/ Goal of Reunification Change Permanency Plan* New Goal (use codes below) Override Y/N (indicate reason below) CPSW s Final Perm Plan Recommendation 1. 2. 3. 4. 5. 6. * If change permanency plan is marked, you must enter the new goal using the codes below: Permanency Plan Goal Codes: A=Adoption C=Planned Permanent Living Arrangement E=Reunification to Other Parent B=Legal Guardianship D=Reunification to Removal Home F=Permanent Relative Placement Override reason: (Note: if a child is recommended for Return to the Removal Home by use of an override, a Reunification Safety Review must be completed.) F. CURRENT CASE STATUS (check one): 1. Case remains open with at least one child out-of-home. (Future Reunification Risk Reviews required.) 2. Case remains open. All children reunited. (CPS services continue and future Risk Reviews required.) 3. Permanency plan approved by the court and/or TPR granted. (No future Family Reunification Reviews required.) 4. Permanency plan approved by the court and case closed. (No future Family Reunification Reviews required.) 5. Other, specify: / / / / CPSW Signature Date Supervisor Review/Approval Date 21

2 nd REVIEW (180 days) Carol has been clean for 5 months. She has been attending her substance abuse treatment and Narcotics Anonymous. Her counselor reports that she has been doing very good work, and is gaining significant insights into the nature of addiction, as well as acquiring skills for relapse prevention. She graduated from her work program and obtained a job as a receptionist at a local manufacturing company. She has been reprimanded for tardiness and for using the phone for personal calls, but otherwise has done well. With help from the department, she found a small twobedroom apartment that is kept up reasonably well. Carol completed a parenting class and the instructor indicates that eventually, Carol seemed to take things seriously, and began to ask good questions. Carol has been learning about the developmental needs of her children, and has worked hard to apply what she has learned when she visits with the children. Carol has attended all of her visits, with the exception of one day that the foster parent canceled, and one that Carol called to indicate she was sick. During the visits, Carol has generally showed increased attentiveness to the needs of her children, and is interacting with them as a parent to a child. She seems to occasionally treat Laura in more adult ways, but recognizes this and has actually corrected herself on occasion when this happens. Carol remains more inclined to yell, and doesn=t always follow through with her efforts at discipline. For the past month, visits have been taking place in Carol=s apartment, and recently, had one extended weekend visit. She has provided nutritious food. The foster mother reports that Laura has trouble sleeping before and after the visits, and Jason is more tearful after visits. Both children tell the worker they like the visits. Carol is not involved in an intimate relationship at this time. She indicates that as a result of work she has done through her domestic violence support group, she has recognized that she has usually been attracted to men that are not good for her. She is hoping to meet someone, but is being more careful about who she dates. Stop: Complete Reunification Review 22

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES FAMILY REUNIFICATION REVIEW Family Case Name: Family Case #: CPS Referral Date: / / County Name: District Office: CPSW: Review Date: / / Review #: 1 2 3 4 Complete for cases where any child has been removed from the home and remains in placement. A. FAMILY REUNIFICATION RISK REVIEW R1. Initial CPS Risk Level (after overrides) Score a. Low... 0 b. Moderate... 3 c. High... 4 d. Very High... 5 R2. Household s Progress Toward Treatment Goals a. Successfully met all current Case Plan objectives; continuing cooperation with ongoing programs; significant progress in all of the applicable high need areas (as identified in the Family Strengths & Needs Assessment Initial or Review)... -2 b. Actively participating in programs; pursuing objectives detailed in the Case Plan; continuing progress in all of the applicable high need areas (as identified in the Family Strengths & Needs Assessment Initial or Review)... -1 c. Partial participation in pursuing objectives in the Case Plan; some progress in at least one of the applicable high need areas (as identified in the Family Strengths & Needs Assessment Initial or Review)... 0 d. Minimal level of participation in pursuing objectives of the Case Plan; marginal progress toward reducing needs... 2 e. Refuses involvement in programs; no progress toward reducing needs (as identified in the Family Strengths & Needs Assessment Initial or Review)... 4 R3. Has there been a New Founded Determination (in this household) Since the Last Family Risk Assessment, Risk Review, or Reunification Review? a. No... 0 b. Yes... 6 RISK LEVEL Assign the family s risk level based on the following chart. Score Risk Level -2 to 1 Low 2 to 3 Moderate 4 to 5 High 6 and above Very High OVERRIDES Total Score Policy Overrides: Override to Very High. Mark appropriate reason: 1. Prior sexual abuse; offender has access to child(ren) and has not successfully completed treatment. 2. Cases with non-accidental physical injury to a child under age three years and parent(s) have not successfully completed treatment. 3. Serious non-accidental physical injury requiring hospitalization or medical treatment and parent(s) have not successfully completed treatment. 4. Death (previous or current) of a sibling as a result of abuse or neglect. Discretionary Override: Override up or down one level. 5. Reason: FINAL RISK LEVEL: Low Moderate High Very High 23

B. VISITATION PLAN EVALUATION Check visitation compliance for each child. 1. Compliance with Plan Child # Child # Child # Child # a. No visitation plan, check the reason: 1) Parent(s) incarcerated 2) Parent(s) in treatment facility 3) Court order prohibits 4) Unable to locate 5) Other, specify: STOP. GO TO SECTION D. b. Excellent - parent(s) have met all objectives outlined in the visitation plan, no missed visits. c. Good parent(s) have met most objectives of plan. (Definition: Parent-child interaction positive during the visits. Visits may have been rescheduled in advance by parent with a legitimate reason. If visitation was supervised, visits are now unsupervised.) d. Fair parent(s) have met some objectives of plan. (Definition: Parent-child interaction appropriate or improving during visits but continued improvement required. No more than one missed visit without legitimate explanation or advance notice.) e. Poor parent(s) have met few objectives of plan or visitation has been changed from unsupervised to supervised. (Definition: More than one missed visit without legitimate explanation and/or advance notice and/or parent has demonstrated poor parenting techniques or parent-child interaction during visitation.) f. None parent(s) have failed to visit or visits have been suspended due to parental behavior. C. REUNIFICATION SAFETY REVIEW IF RISK LEVEL IS LOW OR MODERATE AND PARENTS HAVE ATTAINED AT LEAST A FAIR LEVEL OF COMPLIANCE WITH VISITATION PLAN, COMPLETE A REUNIFICATION SAFETY REVIEW. OTHERWISE GO TO SECTION D. Safety Decision (check one): Safe Conditionally Safe Unsafe (do not return home) 24

D. PLACEMENT/PERMANENCY PLAN GUIDELINES Complete for each child in out-of-home care and enter results below in Section E. Is Risk Level Low or Moderate? No Yes Has risk remained high or very high for two consecutive Reunification Reviews? No Yes Have parents maintained a fair or better level of compliance with visitation plan? No Yes Maintain in Out-of-Home Care Change Permanency Plan Goal Has the child been in placement 12 of the last 22 months? No Yes Is the household safe or conditionally safe (with intervention in place)? No Yes Maintain in Out-of-Home Care Change Permanency Plan Goal Has the household been rated unsafe for two consecutive Reunification Reviews? Return to Removal Home No Yes Maintain in Out-of-Home Care Change Permanency Plan Goal E. PERMANENCY PLAN RECOMMENDATION SUMMARY (Record recommendation for each child.) Child s Name (list in same order as in Section B) Date Placed Out of Home Permanency Plan Recommendation from Section D above (check one) Return Child to Removal Home Maintain OHP w/ Goal of Reunification Change Permanency Plan* New Goal (use codes below) Override Y/N (indicate reason below) CPSW s Final Perm Plan Recommendation 1. 2. 3. 4. 5. 6. * If change permanency plan is marked, you must enter the new goal using the codes below: Permanency Plan Goal Codes: A=Adoption C=Planned Permanent Living Arrangement E=Reunification to Other Parent B=Legal Guardianship D=Reunification to Removal Home F=Permanent Relative Placement Override reason: (Note: if a child is recommended for Return to the Removal Home by use of an override, a Reunification Safety Review must be completed.) F. CURRENT CASE STATUS (check one): 1. Case remains open with at least one child out-of-home. (Future Reunification Risk Reviews required.) 2. Case remains open. All children reunited. (CPS services continue and future Risk Reviews required.) 3. Permanency plan approved by the court and/or TPR granted. (No future Family Reunification Reviews required.) 4. Permanency plan approved by the court and case closed. (No future Family Reunification Reviews required.) / / / / CPSW Signature Date Supervisor Review/Approval Date 25

NEW HAMPSHIRE DIVISION FOR CHILDREN, YOUTH AND FAMILIES REUNIFICATION SAFETY REVIEW Family Case Name: Family Case #: Current Date: / / SECTION 1: Directions: REUNIFICATION SAFETY REVIEW Review the safety factors listed in the initial assessment to determine if any previously identified factors are still present, or if any new factors are currently present. 1. Yes No Caregiver's or household member s behavior is violent or out of control. 2. Yes No Caregiver or household member describes or acts toward child in predominantly negative terms or has extremely unrealistic expectations. 3. Yes No Caregiver or household member caused serious physical harm to the child or has made a plausible threat to cause serious physical harm. 4. Yes No The caregiver s explanation of an injury to a child is inconsistent with the nature of the injury and/or there are significant discrepancies between explanations given by caregivers, other household members, or collateral contacts. 5. Yes No The family refuses access to the child, or there is reason to believe that the family is about to flee, and/or the child's whereabouts cannot be determined. 6. Yes No Caregiver has not, will not, or is unable to provide supervision necessary to protect child from potentially serious harm. If yes, is the caregiver s or household member s lack of supervision due to: Alcohol or other drug use Hospitalization Physical, emotional or cognitive incapacity Domestic Violence Incarceration Other 7. Yes No Caregiver is unwilling, or is unable, to meet the child's imminent needs for food, clothing, shelter, and/or medical or mental health care. If yes, are the child s basic needs unmet by the caregiver or household member due to: Alcohol or other drug use Incarceration Child s physical, emotional or cognitive incapacity Hospitalization Caregiver s physical, emotional or cognitive incapacity Other 8. Yes No Child is fearful of caregiver(s), other family members, or other people living in or having access to the home. 9. Yes No The child's physical living conditions are hazardous and imminently threatening. 10. Yes No Child sexual abuse is suspected and circumstances suggest that child safety may be an imminent concern. 11. Yes No Other (specify) Safety Factors are: (mark one) Safety Decision: (mark one) A. No longer present (complete Section 2). B. Present, no changes needed to current safety plan (sign and date). C. Present, new safety plan or revisions to plan are needed (complete Section 3). A. Safe (No safety factors present for any child) B. Conditionally Safe (All children safe with controlling safety interventions in place) C. Unsafe (One or more children are unsafe) SECTION 2: Directions: SAFETY RESOLUTION DOCUMENTATION If safety factors had previously been identified but are no longer present, document how the safety issues have been resolved. SECTION 3: Directions: REVISED SAFETY PLAN Describe the revisions to the safety plan. If initial safety factors are still present or new safety factors have been identified, note the applicable safety factor number and then briefly describe the issues. / / / / CPSW Signature Date Supervisor Signature Date 26