Division of Child and Family Services

Division of Child and Family Services Confirming Safe Environments: Present Danger Assessment

Case Number: Report Number: Case Name: Present Danger Assessment Date: Placement Provider Name: Legal Custody Placement Type: Relative Fictive Kin Foster Home Parental Placement Type: Relative Fictive Kin Child Name: Age: Child Name: Age: Child Name: Age: Child Name: Age:

Identification of Present Danger (check all that apply and describe below):

Placed Child: Kin Provider or Foster Parent: Other: Child is fearful/anxious of Caregiver(s) is acting violent, dangerous, Physical living conditions the placement home and/or out of control of the home are Child has exceptional Caregiver(s) behave or communicate in hazardous and needs or behaviors which ways that suggest that they may fail to immediately threatening caregivers cannot/will not protect from serious harm; allow primary Caregiver(s) refuse meet caregiver access; or fail to comply with access; or indications Child is seen by any PDP responsibilities that family will flee placement caregiver as Caregiver(s) act towards or describe child Domestic violence exists responsible for their in predominantly negative terms; or have or recent history which primary caregivers negative perceptions; or have unrealistic poses threat of serious problems; does not expectations of the placed child. harm believe child; that they Caregiver(s) are unable or unwilling to History or active criminal deserved what happened meet child’s basic needs; including behavior supervision Active CPS case; history Drug or alcohol use may affect ability to of reports; or history of protect CPS involvement Caregiver(s) physical, emotional, or DD affects ability to protect Caregiver(s) are sympathetic towards the placed child’s primary caregivers; not properly aligned with CPS

Describe the immediate, significant, and clearly observable family conditions for Present Danger identified above: Consider the placement context, relationship with the placed child’s caregivers, history and relationship with the placed child, effects generated by the placed child in the placement home and with those living there and therefore requiring consideration of an immediate placement change. ______DCFS CSE Present Danger Assessment 1/28/13 Final Policy: 0205A Attachment: FPO 0205A(3)

of 2 ______

No Present Danger is identified at Initial Contact with Placement Provider; Continue with Placement

Present Danger is identified at Initial Contact with Placement Provider AND

Placement Option is Discontinued

Justification:

Present Danger is identified During a Routine Home Visit with Placement Provider; indicate type of agency response. Check all that apply:

A Safety Plan Determination Meeting will be scheduled to determine the least intrusive and most appropriate safety plan option

Placement Option is Discontinued

If Voluntary Safety Plan, Parent Agrees to Alternate Caregiver

Legal and Physical Removal

 Child(ren) placed with alternate relative/ Fictive Kin

 Child(ren) placed with alternate foster care provider

Placement Option will Continue, Present Danger was able to be immediately mitigated, District Office Manager approval granted for placement.

Justification:

Caseworker Date Supervisor Approval Date District Office Manager (if necessary) Date

DCFS CSE Present Danger Assessment 1/28/13 Final Policy: 0205A Attachment: FPO 0205A(3)