WPCv B~51aҦk+s;_8w)8R`_QtDСU:7:55a גR Z% h\oM2)OZo [Uich=Ϙu3©8m<{GB ÛpV|_]U떀Sz8$ϋ'I0%ޔuĶuӛy{*+Q QyhJH"15Vlds'4Y^fҫZ&f1Z(lBe7SH^pk)[煌!pP@+;(#t3t[ۻZc9/uBr?uŀքv=8ȉҤњS3gȄ9kD33Hrh50ۨ3.-}g~t:SUZvm9d7m!qѪ1LC tÝ@m:-m#UBN % 0: fM aO fc ae fy a{ ^ w 4   m f a f a f a f a f3 a5 fI aK f_ aa fu aw f a f a f a f a f a f a f a f% a' f; a= Q NY 1[ 72 1u 72 0c 0w 0 B B<<<<<< BYHP LaserJet 8150 PCL 60(hH  Z6Times New Roman RegularX($USUS.,PTABLE AhTABLE LXbTABLE C0 юr04(Q|Backup3|xUPTABLE DCTABLE EXTABLE FTABLE GTABLE HPTABLE ITABLE JhTABLE NCTABLE KTABLE MTABLE BTABLE OPdTABLE PTABLE QKTABLE RKTABLE SPTABLE T 0|CEKQW]cioAutoList1A.1.1.A.A.A.A.A.5A.3#37=CIQYag1.a.i.(1)(a)(i)1)a)7i)(;3$2#  0  .3  0  (O;$0  2#  a  .3  0` (#(#(b$0  0` (#(#2#   .3  0 ` (#` (# d  d d !USUS.,  _HHh HH,X*ddd Xdd Xdd XH$H$,^ dd , dd , dd +  $ $ XX  StateofKansas d DepartmentofSocialandRehabilitationServices  ChildrenandFamilyServices#X9X # XX9 '5  ' 'd 'x!x!B,$CFS2030F d !!B,$.July2004  !!B,$Page1of2"5 "#X9X y#* dd^ dd ^ dd  dd  H$H$,pdd ,dd +  (nn (@]]&2%XX9 FamilyBasedAssessmentSummary /%g /STATUS: >   IdentifyingInformation 's  '?'>    'HH*ddpdd pdd  %%,tdd ,dd , dd ,dd ,dd ,dd ,dd ,dd ,dd +  $S S $%&2CaseName: )Z"  ) 0&" Z 0FACTSCase#: )Z" ) 4*"Z 4FACTSEvent#: (Z" ( 1'"Z 1SocialWorker: (Z z ( 1' zZ 1DateofAssignment ,Z z , 4* zZ 4 5f$ z 54*(g   f  4#&2%Ъ# *d dtdd tdd dd dd dd dd dd dd dd %%,Cdd ,dd ,dd ,dd ,Sdd ,dd ,dd ,dd ,dd +  (     (0 ` SectionI:AssessmentResultsandSummaryofFindings(Abuse/NeglectCasesOnly) 4* z `$`$  4\%&2SafetyDecision: 'lll{  ' -#{ lll -Safe 'lll{  ' -#{ lll -ConditionallySafe 'lll{  ' -#{ lll -Unsafe '{  ' '{  ' ,"{ ! ,RiskLevel: 'lllk " ' -#k #lll -Low 'lllk $ ' -#k %lll -Moderate 'lllk & ' -#k 'lll -High 'llllk ( ' -#k )llll -Intense ,"k *  ,RiskConclusion: 'llllg + ' -#g ,llll -NoSignificantRisk 'llllg - ' -#g .llll -RiskControlled 'llllg / ' -#g 0llll -RiskPresent 'g 1 ' 'g 2 '\J  +!g 3 +(#&2%\ #%*4    %(*d dCdd Cdd dd dd Sdd Sdd dd dd dd %%,%dd ,B dd ,dd +  (4 ( %&2InvestigationFindingsfromCaseFindingsform(CFS2011):#&2%# *lll{5 *P%&2 -#<6lll -Unsubstantiated '<7 ' 'lll<8 ' -# 9lll -Substantiated ' : ' 'llll ; ' 1'<llll 1Validated(onlyapplicabletofindingspriortoJuly,2004) -lll= - -#}>lll -Unabletolocate '}? ' 5f$}@ 54*(aA  f 4#&2%Ј#Pv*dd%dd %B dd B dd %%,%dd ,!dd +  (LAL (%&20 ` #&2%R#SectionII:SummaryofAssessmentConclusion(_CINC_/NANcasesonly)%&2 4lll!EB`$`$ 4P -#Clll -NoProblemBehaviors 'lllD ' -#Elll -ProblemBehaviorsControlled: 'llllF ' -#yGllll -ProblemBehaviorsPresent:(child/youthisadangertoselforothers) 5f$yH 5#&2%#4*(]I  f 4P[*dd%dd %!dd !%%,8"dd +  $HIH $%&20 ` #&2%##SectionIII:FamilyPreservationScreen%&2 1'AJ`$`$ 1InorderforreferraltoFamilyPreservationtobeappropriatequestions13mustby Yesandquestions47mustbe Yesor K  NANotApplicable.ReferralistobemadetotheFamilyPreservationcontractorwithin24hoursfollowingthe qL determinationofneed."5M  "#&2%Л#*ldd8"dd 8"%%l,rdd ,dd ,Gdd ,4dd ,dd ,4dd ,dd ,4dd ,]dd +  D:)M)  ?1.?D%&21. J@1N  ?1. ? JIsthefamilyatriskforhavingchildrenremoved? *lllO * -#Plll -Yes#&2%2!#%&2 0lllQ 0 6,!Rlll 6No 0lllS 0 6,!Tlll 6NA G=U  @2.@G2. J@1 $V  @2. @ JIsparent/_caregiver_Ԁavailabletoprotectthechild? *lll $W * -# $Xlll - 'lll $Y ' -# $Zlll - 'lll $[ ' -# $\lll - G= $]  @3.@G3. J@1!P ^  @3. @ JIsparent/_caregiver_ԀwillingandabletoparticipateinFamilyPreservation? *lll!P _ * -#!P `lll - 'lll!P a ' -#!P blll - 'lll!P c ' -#!P dlll - G=!P e  @4.@G4. J@1#|!f  @4. @ JHasfamilywithchronicproblemsexperiencedsignificantchangeswhichmakes #|!g themabletoprogress? 򀀀 *llll#"h * 0&#|!illll 0 6llll#!#|!j 6 0&#|!kllll 0 6llll#!#|!l 6 0&#|!mllll 0 6,!#|!n 6 '$@#o ' Explain: #&2%L"#%&2 $@#p  % $@#q % YO$$@#r  @5.@Y5. J@1&l$s  @5. @ JHasparent/_caregiver_Ԁwithmental/emotionalhealthissuesstabilized? *lll&l$t * -#&l$ulll - 'lll&l$v ' -#&l$wlll - 'lll&l$x ' -#&l$ylll - G=&l$z  @6.@G6. J@1-'%{  @6. @ JCanparent/_caregiver_Ԁwithlimitationscareforselfandchildren? *llll-'%| * -#-'%}llll - 'llll-'%~ ' -#-'%llll - 'llll-'% ' -#-'%llll - G=-'%  @7.@G7. 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(X * )' *Xe2 DateDecisionMade: %Zq*( % -#q*(Z -Time: %Zq*( % -#q*(Z -"q*(  "  .l, *!"dddd dd Pdd Pdd dd %%, dd , dd ,i dd +   %&2 $ $#&2% 4# %&2  StateofKansas d DepartmentofSocialandRehabilitationServices  ChildrenandFamilyServices#&2% -5# %&2 '5  ';;5; ' '""D$CFS2030F d ""E$July2004  F"F"C$Page2of2"5 "*#$dd dd dd i dd i !"%%,8"dd +  $nn $@]]&2%  FamilyBasedAssessmentSummary 'g  'STATUS: IdentifyingInformation ">   "*l%&dd8"dd 8"#$%%l,(dd ,dd ,dd ,:dd ,dd ,dd ,dd ,dd +  $  $#&2%%&26#%&2CaseName: )Zr  ) 0&r Z 0FACTSCase#: %Zr  % 4*rZ 4FACTSEvent#: 7Z&$r 7 1'rZ 1SocialWorker: (Z; ( -#;Z -DateofAssignment: )Z; ) 7-;Z 7 Df3$; D8(4*(o   f 4(<3*dd(dd (dd dd :dd :dd dd dd dd %&%%,dd ,dd +  -# 2 2 Q-X=l0 ` #&2%n:#SectionIV:CaseAction/InitialServicePlan%&2 =3$+ `$`$ Q  = 5(|037"93"  932@2|  A  .3  0 `   DescribeonestrengthandoneneedoftheFamily: 932@b@݌   4*| `$`$ 4l>=0 ` Strength: /Z| `` /iAv -#| Z -0 ` Need: /Z  `` /vAv(    Z (vnBE* dddd dd %%,%dd ,V dd ,"dd ,4dd ,hdd ,4dd , dd +  "V V  " "93"  93?D2|  B  .3  0 `   CaseOpenedforservices: 93?DlD݌ 5+%% `$`$ 5Ќ  ":;"  :;=E0 ` 2|  1  .3  0`$`$  InitialServicePlan: :;=EjE݌ +llllY$$ +Ќ  BL -#"llll -FamilyServices '"  '@))\Isasafetyplaninplace? 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