Child Welfare Legal Services Staffing Form - Circuit 10

DEPARTMENT OF CHILDREN & FAMILIES

Child Welfare Legal Services Staffing Form

This form is confidential and contains attorney/client-privileged information. This form should not be released to any party outside of the Department without the consent of CWLS.

ATTORNEY/CLIENT CONFERENCE

DATE OF CONFERENCE: CPI:

SUPERVISOR: ATTORNEY:

MOTHER: DOB:

CHILDREN DOB FATHER(S)

REASON FOR STAFFING: VPS PC Other: DOES COUNSELOR WANT TO FILE A PETITON? YES NO

INFORMATION PROVIDED TO CWLS BY COUNSELOR (provide copies): FAHIS REPORT(S) LAW ENFORCEMENT REPORTS CPT REPORTS was the provider. MEDICAL REPORTS was the provider. PSYCH. EVALS/RECORDS was the provider. PRIOR SERVICES RECORDS was the provider. DRUG & ALCHOHOL SCREEN(S) from , 20 . OTHER .

SUMMARY OF INVESTIGATION RESULTS (to be completed by counselor, you may copy and paste in Cybersecretary or HSn Chronos):

______

COUNSELOR WILL CLOSE OR SUMMARIZE INVESTIGATION AS (if applicable):

Verified for

Some Indicators for

No Indicators because

ISSUES NOT IN THE HSn REPORT WHICH REQURIE FURTHER INVESTIGATION:

ABANDONMENT/ANSENTEE PARENT(S)

SERVICES INVOLVED (IF ANY) & PROVIDERS:

II. BELOW PART TO BE FILLED OUT BY CWLS ATTORNEY

Based upon the information and investigative results provided by CWLS by the counselor(s), there does does not presently exist legal sufficiency to:

File a non-shelter petition for dependency.

Remove the child(ren) from the parent’s custody and file a shelter petition for dependency.

Please respond, in writing, to the following request for additional investigation and information, and provide the additional documentation, in order for CWLS to determine if this case may yet be legally sufficient to sustain the action sought:

2 CWLS RECOMMENDS pursuing additional investigation/provide additional information as follows:

A complete witness list, including names, addresses, phone numbers, and a brief synopsis of relevant testimony. Anyone with knowledge that may prove or disprove the allegations must be included.

Up to date chronos (PI) Up to date chronos (PS) Prior Department files (PI, PS, FC, ARS, VPS/VFS) Child Protection Team reports Medical reports and/or hospital reports FPSS/FAHIS reports, including all priors (family and perpetrator) Expert witness (professionals likely to support significant impairment and/or prospective abuse or neglect) Law enforcement reports (NCIC, FDLE, Sheriff’s Office, local agencies) Criminal court orders, adjudications, injunctions, etc. School/guidance reports, attendance reports, etc. Psychological/psychiatric evaluations, records and/or progress notes Drug/alcohol screens, including record of refusals Substance abuse evaluations and/or treatment progress notes Service provider progress notes and/or termination summaries (e.g. Family Builders, ICCP, Homemakers, Healthy Start, etc.) Audiotapes/videotapes (obtain copies from Child Protection Team, law enforcement, etc.) Photographs (taken by Department, Child Protection Team, law enforcement, etc. Other:

Since there is no legal sufficiency to file a petition, no further action on this case is necessary by CWLS at this time and the case should be considered for closure if no other action is deemed necessary by your supervisor or the POA or OPA.

We will unable to take further action on this case unit we receive further information from you. Please provide the additional information to CWLS no later than , and call this office to schedule a staffing/restaffing.

In order for CWLS to file a petition, please provide the requested information no later than . 3 Other recommendations:

This form is confidential and contains attorney/client-privileged information. This form should not be released to any party outside of the Department without the consent of CWLS.

Dated: ______SIGNATURES: CWLS Print CPI ` CPI NUMBER: 534-7100 SUPERVISOR(S) OTHER cc: