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    New Mexico CYFD - Safety Assessment - Rev 2010

    Uploaded by

    Rick Thoma
    This document contains a child safety assessment form used in New Mexico. It includes sections to identify safety threats to a child, assess the protective capacities of up to two caregivers, and make a final safety decision. Safety threats are factors that endanger a child, either currently or in the near future. Protective capacities are the strengths of the caregiver that help ensure a child's safety. The safety decision is determined by weighing the identified safety threats against the protective factors of the caregiver. The assessment is used in various situations, such as investigations, case planning, and placement changes.

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    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    New Mexico CYFD - Safety Assessment - Rev 2010

    Uploaded by

    Rick Thoma
    743 views6 pages
    This document contains a child safety assessment form used in New Mexico. It includes sections to identify safety threats to a child, assess the protective capacities of up to two caregivers, and make a final safety decision. Safety threats are factors that endanger a child, either currently or in the near future. Protective capacities are the strengths of the caregiver that help ensure a child's safety. The safety decision is determined by weighing the identified safety threats against the protective factors of the caregiver. The assessment is used in various situations, such as investigations, case planning, and placement changes.

    Original Description:

    New Mexico Children, Youth and Families Department Risk Assessment checklist with instructions

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    © Attribution Non-Commercial (BY-NC)

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    This document contains a child safety assessment form used in New Mexico. It includes sections to identify safety threats to a child, assess the protective capacities of up to two caregivers, and make a final safety decision. Safety threats are factors that endanger a child, either currently or in the near future. Protective capacities are the strengths of the caregiver that help ensure a child's safety. The safety decision is determined by weighing the identified safety threats against the protective factors of the caregiver. The assessment is used in various situations, such as investigations, case planning, and placement changes.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    743 views6 pages

    New Mexico CYFD - Safety Assessment - Rev 2010

    Uploaded by

    Rick Thoma
    This document contains a child safety assessment form used in New Mexico. It includes sections to identify safety threats to a child, assess the protective capacities of up to two caregivers, and make a final safety decision. Safety threats are factors that endanger a child, either currently or in the near future. Protective capacities are the strengths of the caregiver that help ensure a child's safety. The safety decision is determined by weighing the identified safety threats against the protective factors of the caregiver. The assessment is used in various situations, such as investigations, case planning, and placement changes.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    of 6

    NEW MEXICO CHILD SAFETY ASSESSMENT

    Case Name: _______________________ Case ID: ________________ Date: _____________


    County: ______________ Worker Name: _____________________ Worker ID: ____________
    This safety assessment was completed:

    CPS investigation
    Prior to decision to physically place the child in foster care
    I-HS Monthly
    I-HS Case Closure
    Prior to unsupervised visitation
    Prior to trial home visit
    Prior to permanency hearing or judicial review
    Prior to discharge of custody
    Other _________________________________________________________________

    Part One: Identify Safety Threats


    Safety threats include both present and impending danger of serious harm.
    Present danger: immediate, significant and clearly observable severe harm or threat of severe
    harm is occurring to a child in the present requiring immediate protective services response.
    Impending danger: a child is living in a state of danger or a position of continual danger due to a
    family circumstance. Danger may not exist at a particular moment or be an immediate concern
    (as in present danger), but a state of danger exists. Impending danger to child safety, or this
    state of danger, is not always obvious or occurring at the onset of protective services
    intervention or in a present context. However impending danger can be identified and
    understood upon more fully evaluating individual and family conditions and functioning.
    Directions: Indicate the presence or absence of each of the following safety threats using all
    the information collected and known about a family at the point of this assessment.
    A yes indicates a safety threat exists; it is observable and it can be described. It is a
    conclusion, not a suspicion, and can only be indicated when sufficient credible, reasonable,
    believable information supports the conclusion.
    A no is indicated when a conclusion is reached that the safety threat does not exist, or at the
    time of the safety assessment, the information available did not reveal the safety threat.

    May 12, 2010 Page 1

    Safety Threats:
    Yes No

    1.

    The behavior of any member of the household is violent and/or out of control
    and this behavior places the child in present or impending danger of serious
    harm.

    Yes No

    2.

    Any member of the household has extremely unrealistic expectations of the


    child given the childs age or developmental level and these perceptions
    place the child in present or impending danger of serious harm.

    Yes No

    3.

    There is reasonable cause to suspect that a member of the household


    caused serious physical harm or has made a plausible threat of physical
    harm to the child.

    Yes No

    4.

    There is serious injury for which there is no reasonable or credible


    explanation.

    Yes No

    5.

    There is a current report of serious harm and there is a reasonable basis to


    believe that the family is about to flee, or the family refuses access to the
    child.

    Yes No

    6.

    Caregiver will not provide supervision necessary to protect the child from
    present or impending danger of serious harm.

    Yes No

    7.

    Caregiver leaves the child alone and the child is not competent to care for
    self, or caregiver leaves the child with persons unwilling or unable to provide
    adequate care, placing the child in present or impending danger of serious
    harm.

    Yes No

    8.

    The child is in present or impending danger of serious harm because the


    caregiver is unable or unwilling to meet the childs immediate needs for
    food, clothing, shelter, mental health or medical care.

    Yes No

    9.

    A household member has previously abused or neglected a child, and the


    severity of the maltreatment, or the caregivers response to the prior
    incident, places the child in present or impending danger of serious harm.

    Yes No

    10. The child is fearful of being harmed by people living in or frequenting the
    home.

    Yes No

    11. The household environment or living conditions place the child in present or
    impending danger of serious harm.

    Yes No

    12. Sexual abuse/exploitation is suspected and circumstances suggest that the


    child may be in present or impending danger of serious harm.

    Yes No

    13. Caregivers impairment due to drug or alcohol use seriously affects his/her
    ability to supervise, protect or care for the child placing the child in present
    or impending danger of serious harm.

    Yes No

    14. Behavior(s) of any member of the household is symptomatic of mental or


    physical illness or disability and this condition is uncontrolled and places the
    child in present or impending danger of serious harm.

    Yes No

    15. Acts of domestic violence have occurred which affect the caregivers ability
    to care for and/or protect the child from present or impending danger or
    serious harm.

    Yes No

    16. The caregivers involvement in criminal activity or the criminal activity of any
    other person living in or having access to the home places the child in
    present or impending danger of serious harm.
    May 12, 2010 Page 2

    Part Two: Assess Caregiver Protective Capacities


    Caregiver protective capacities are those assets possessed by the caregiver that help to
    reduce, control or prevent present or impending danger of serious harm. Caregiver protective
    capacity applies specifically to the adult(s) who lives with the child and is (are) responsible for
    the primary care of a child, including the childs safety. Caregiver protective capacities must be
    very specific with respect to how they provide for child safety and contribute to being protective.
    The PS worker must be able to observe and single them out so that he or she can work with
    caregivers to address them.
    Directions: Indicate the presence or absence of each of the following protective capacities using
    all the information collected and known at the point of this assessment. Space is allowed to
    assess protective capacities for two caregivers.
    A yes indicates a protective capacity exists; it is observable and it can be described. It is a
    conclusion, not an assumption, and can only be indicated when sufficient credible, reasonable,
    believable information supports the conclusion.
    A no is indicated when a conclusion is reached that the protective capacity does not exist, or
    at the time of the safety assessment, the information available did not reveal the protective
    capacity.
    Caregiver One (Name __________________________________________)
    Yes No

    1.

    Recognizes threats

    Yes No

    2.

    Can articulate plan sufficient to protect the child

    Yes No

    3.

    Demonstrates protective role and responsibilities; has a history of taking


    action to protect

    Yes No

    4.

    Recognizes the childs needs and holds realistic expectations

    Yes No

    5.

    Expresses empathy and sensitivity for the child

    Yes No

    6.

    Has the cognitive capacity and has adequate knowledge to protect the
    child, including using resources necessary to meet the childs basic needs

    Yes No

    7.

    The caretaker accurately processes the external world without distortion.

    Yes No

    8.

    Has the capacity to learn from an experience and apply it to a new


    situation

    Yes No

    9.

    Is emotionally able to intervene and protect

    Yes No

    10. Is resilient as a caregiver

    Yes No

    11. Is adaptive as a caregiver

    Yes No

    12. Sets aside her/his needs in favor of the child

    Yes No

    13. Demonstrates tolerance

    Yes No

    14. Demonstrates sufficient impulse and emotional control

    Yes No

    15. Is physically able to protect

    Yes No

    16. Caregiver and child have a strong emotional bond and positive attachment
    May 12, 2010 Page 3

    Caregiver Two (Name __________________________________________)


    Yes No

    1.

    Recognizes threats

    Yes No

    2.

    Can articulate a plan sufficient to protect the child

    Yes No

    3.

    Demonstrates protective role and responsibilities; has a history of taking


    action to protect

    Yes No

    4.

    Recognizes the childs needs and holds realistic expectations

    Yes No

    5.

    Expresses empathy and sensitivity for the child

    Yes No

    6.

    Has the cognitive capacity and has adequate knowledge to protect the
    child, including using resources necessary to meet the childs basic needs

    Yes No

    7.

    The caretaker accurately processes the external world without distortion

    Yes No

    8.

    Has the capacity to learn from an experience and apply it to a new


    situation

    Yes No

    9.

    Is emotionally able to intervene and protect

    Yes No

    10. Is resilient as a caregiver

    Yes No

    11. Is adaptive as a caregiver

    Yes No

    12. Sets aside her/his needs in favor of the child

    Yes No

    13. Demonstrates tolerance

    Yes No

    14. Demonstrates sufficient impulse and emotional control

    Yes No

    15. Is physically able to protect

    Yes No

    16. Caregiver and child have a strong emotional bond and positive attachment

    Part Three: Make the Safety Decision


    The safety decision is based on the presence of safety threats and the protective capacities that
    offset, mitigate, and/or control those threats. Safety decisions are safe, conditionally safe, and
    unsafe.
    Directions: In the sections which follow, identify any Safety Threat checked Yes and describe
    the specific persons, behaviors, conditions and circumstances associated with that particular
    safety threat. For each Safety Threat, list and describe all protective capacities, by caregiver,
    that are sufficient to offset, mitigate and/or control the threat of immediate or impending danger
    of serious harm.

    May 12, 2010 Page 4

    Safety Threat: ________________________________________________________________


    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    Protective Capacity(s): _________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________

    Safety Threat: ________________________________________________________________


    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    Protective Capacity(s): _________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________

    Safety Threat: ________________________________________________________________


    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    Protective Capacity(s): _________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________

    Safety Threat: ________________________________________________________________


    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    Protective Capacity(s): _________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________

    (Attach additional pages as necessary)

    May 12, 2010 Page 5

    Safety Decision: Based on your analysis of safety threats and the presence or absence of
    protective capacities that offset, mitigate and/or control the threat of immediate or impending
    danger of serious harm, please indicate whether the child is safe, conditionally safe, or unsafe.
    The child is safe. There are NO safety threats placing the child in immediate or
    impending danger of serious harm. Safety threats do not exist or have been removed.
    No safety plan is required.
    The child is conditionally safe. One or more safety threats placing the child in immediate
    or impending danger of serious harm were identified. However, one or more protective
    capacities have been identified and documented that offset, mitigate, and/or control the
    threat of immediate or impending danger of serious harm. No safety plan required as the
    family is effectively addressing safety threats.
    The child is unsafe. One or more safety threats placing the child in immediate or
    impending danger of serious harm were identified. There are not sufficient protective
    capacities to offset, mitigate and/or control the threat of immediate or impending danger
    of serious harm. Address the specific threat, parents have ability and evidence that they
    practice
    Summarize the information that led to this safety decision:
    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________

    May 12, 2010 Page 6

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