Family Safety Plan

June 28, 2010

Family Safety Plan Tuscarawas County Family and Children First Council Service Coordination

Date: ______

Parent/Adult Caregiver Name: ______

Children Included in the Safety Plan

Name Age

1 June 28, 2010

Important Information About Safety Plans

This safety plan is a specific agreement to help ensure your family’s stability as the process of service coordination begins. When children are in an emergency placement outside the home and don’t have prior involvement in the service coordination process, this safety plan is developed in preparation for the children’s return home or to a less restrictive level of care. Your decision to participate in the safety plan is voluntary. Crises are possible in any family and are not signs of failure. The purpose of developing a safety plan is preparation to deal with potential crises before they occur. Through development of this plan, we hope to identify ways to support your child(ren) and family during a crisis. Your signature indicates you were involved in the development of the safety plan for your family.

______Parent/Adult Caregiver Date

______Facilitator Date

2 June 28, 2010

Identify Potential Crises

What has the family, working in conjunction with the service facilitator, identified as potential crises that could arise as the family begins the process of service coordination?

______

Strategies to Support the Child(ren) and Family During Crises

Describe Activity to Keep Family/Child Stable Person Responsible for the Activity

3 June 28, 2010