<p> June 28, 2010</p><p>Family Safety Plan Tuscarawas County Family and Children First Council Service Coordination</p><p>Date: ______</p><p>Parent/Adult Caregiver Name: ______</p><p>Parent/Adult Caregiver Name: ______</p><p>Children Included in the Safety Plan</p><p>Name Age</p><p>1 June 28, 2010</p><p>Important Information About Safety Plans</p><p>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.</p><p>______Parent/Adult Caregiver Date</p><p>______Parent/Adult Caregiver Date</p><p>______Facilitator Date</p><p>2 June 28, 2010</p><p>Identify Potential Crises</p><p>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?</p><p>______</p><p>Strategies to Support the Child(ren) and Family During Crises</p><p>Describe Activity to Keep Family/Child Stable Person Responsible for the Activity</p><p>3 June 28, 2010</p><p>4</p>