Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
CPI CASE STAFFING WITH LEGAL Please make sure that you attach pertinent documentation to this staffing form. Documentation including but not limited to photographs, drug/alcohol screens, service provider progress notes, school records, FSFN, Court Orders, CPT Reports, Police Reports. CSA #: Date of Staffing: Child(ren) Name(s) & D.O.B.: Attorney: CPI: CHECK ITEMS APPLICABLE AND COMMENT AS NECESSARY Serious physical injury to child related to DV Caretakers have a history of significant DV Prior reports: Number/Findings Specify: Verified/Some Indicators/No Indicators Priors with same or similar maltreatments Caretaker has a significant documented drug or alcohol problem. Safety Plan: Child seriously neglected resulting in harm Criminal history that poses a threat of harm to child Caretaker not able/willing to protect child from risk, including possible A/P’s access Paramour in the home Services in home – Specify: Referrals/Providers/Dates/Status Is there an open DJJ court case? FACTS/ALLEGATIONS: LIST ALL PRIORS: Services offered/Date of Referral/Follow Up: STAFFING RECOMMENDATION: Direct File Shelter No Judicial Action Needed -Reason: Re-Staff Date: Outcome: FOLLOW UP ITEMS: ANY CHANGE IN CIRCUMSTANCE REGARDING THIS CASE MUST BE PRESENTED AND RESTAFFED WITH CLS AS THAT MAY IMPACT THE RECOMMENDATION MADE. CPI: CLS: Created 7/23/2012