WPC T~EO3DU,+?f9ѳvN6đ{T"Sqa  .# /yǧasg"k¿+QqÆ3.#Uwp^D\$фļ Ӎ#%K_4\15˥yl /CWG2,[}ZsZ8,UoTX#sGYZ1\iml_Es6(([mlp0&B'8OZW7 >by\Bsqj nIJAQMS|.!aRҫG0j`"0PXRZ Gl)ѓCR|/OQ,Cnbjҳ?%IMzщ9?(gť>2-z- ,+C $$MD*C|G@ߏr3ަsKyK-@ kǨβDK'!Rg# U N %# 0Y)LU> UHUH\UHUHw448LUH[UHUHU*HUH-Nu 0uwUHUH4b|w^  m"2222fTaVVVVV B j D5 B* i C D3 i,R i~~~~~fafafaSAVIN 2055DP PCL 60(9 Z 6Times New Roman RegularX(1 $T;cTXXzC:\OFFICE\WPWIN\TEMPLATE\STANDARD.WPT(\  p`&Times New Roman.\' AZ0Univers (W1) Regular.\' AZ0Univers (W1) Regular.\' AZ0Univers (W1) Regular.\' AZ0Univers (W1) Regular_,3|x.\' AZ0Univers (W1) Regular.\' AZ0Univers (W1) Regular 'TGbRXXz  _Xj"j"C%TlRTGbCFS2003Inst.&b AZ0Univers (W1) Regular.\' AZ0Univers (W1) Regular.\' AZ0Univers (W1) Regular(M3$  !TGbRXXz  .&b AZ0Univers (W1) Regular.\' AZ0Univers (W1) RegularPage of & m 'TGbRXXz  _TlRTGb  @* * 9$CFS2003Instructions   @  @`  @  @  @h  @  @  @p  @  @   @x  @ August,1999s, U     TABLE A d****)!dxdx&0 d d+*d6666'dxd*V"TABLE PTABLE AYTABLE BA  !TGbRXXz  _8   TcRRTGbT RTcTRX3'X3' Letter3'Letter3'LetterT8&dd8   :COMPLETINGTHECFS2003,FAMILYBASEDSAFETYPLAN   " "T " " "".#" " ""&#" " ""#4  ""#" " 4Ԁ0  #" " ""m# " " ""# T  " "#CASENAME: T  T cT Usethesamecasenameasonpage1,SectionII,#1offormCFS-1000.# ccR#U%% # T  cq#.4  T " " 4Ԁ0  # " " ""?# " " " "# T  " "^#CASENUMBER:  c T Usethesamecasenumbergivenasonpage1ofform,CFS1001*%% # T  c#.4  T " " 4Ԁ0  # " " ""# " " " "# T  " "#EVENTNUMBER : " " T " " " "Ԁ#4  ""i#d 4# cd#c cUsethesameeventnumbergivenasonpage1ofform,CFS1001 %% # cc## T  c# " " T " " " "  # " " ""#" " " "#T  ""# 8 SectionI   V .4 T " " 4Ԁ0  #4  "" ##T  4 #T T  DATECOMPLETED: EnterthedatetheSafetyPlanwascompletedbyMM\DD\_YYYY_  %% .0  TIMECOMPLETED: EnterthetimetheSafetyPlanwascompleted00:00a.m.p.m.{  %%    8 SectionII" "T " " ""Ԁ  P  #4  "" #" " 4.0  #" " "" ##T  "" # T T FACTORSTOCONSIDER:  %% T T   ThefactorsarelistedtoassureeachisconsideredindecidingwhetherandwhentoconsideraSafetyPlan.Not ;x  allfactorsmaybepresentineverysituation.Otherfactors,notonthelist,mayalsobeconsidered. D zpT l#T zp#" "T 0  #T  ""d#T T Harmtochildcausedbyremovalfromhome:Thisfactorisplacedfirstinthelisttoencourageworkers  tofirstconsiderpossibleunintendedconsequencesoftheremovalofachildfromhisorherfamily, k friends,familiarsurroundings,possessions,andpredictablecircumstances.Therearetimeswhen 7t removalisthebestcourseofactionamongseveralundesirablealternatives.Remember,however,no @ removaliswithoutanemotionalpricetagtothechild.#T T #" "T  %% #T  ""#T l0  #T r#T T Severityofsituation:Notallsituationsareequallydangerous.Assessthepotentialseriousnessofthe { situation.G%% #T T #T #T ů#T l0  #T #T T Child'sorothers'abilitytoprotectchild:Childrenareneverresponsiblefortheirownprotection.Older  children,however,mayhaveagreaterabilitytoavoidharmfulsituationsorcarryoutplanstogethelp.  Theabilityandlikelihoodthattheadultswillprotectthechildisafactorindevelopingasafetyplanor N requestingalternatecoursesofaction.W %% #T T D#T #T O#T l0  #T Œ#T T AllegedPerpetrator'saccesstochild:Accesscanincluderesidinginthehomeandunwillingnessto " leave,courtorderedvisitation,inabilityofotheradultsinthehouseholdtorefuseaccesstochild.#T T #T U #%% #T #T .#4 .e#9 4l#4 9#. 40  #.##T  #Child'sbehavior:Careandprotectionofchildrenisanadultresponsibility.Childrenarenever !% responsibleforhavingbeenabused.Thebehaviorofchildrencan,however,beafactorinthefamily ~"& historyordynamicsorchainofeventswhichisimportanttothecycleofviolence.Acarefuland J#' sympatheticunderstandingofproblemsfacedbyabusingorneglectfulparentsisessentialinmaking $S( shortorlongtermplanstoprotectthechild.$ )%% zpT l#T zp#0  Familyisolation:Familiesmaybeisolatedgeographically(e.g.adistancefromneighborsorsomeone z&!+ fromwhomtoseekhelp)orsocially(e.g.fewfriendsorextendedfamilyorcommunityties).Insome F'", casesafamilymembermaydominateandcontrolcontactsoutsidethefamily.Alloftheseissues, (O#- especiallythelatter,needtobecarefullyassessedwhenconsideringwhetherafamilysafetyplanis ($. feasible.)$/%% T l0  #T *#T T Family'sabilitytoparticipateinplan:Thefamilyshouldbeassessedforstrengths(e.g.strongbonds, B+&1 pride,historyofaccomplishment)whichwouldindicateanabilitytoparticipateinaplan.Negative ,K'2 indicatorsmightincludesevereandchronicimpairmentoffunctioning,longhistoryoffamilyviolence, ,(3 orrigidbeliefsystems(e.gcultlikereligiousbeliefs,extreme_antig__overnment_Ԁfeelings).-(4%% #T T |#T #T #T l0  #T 1 #T T Medicalneedsofchild(ren):Forasafetyplantoworktheremustbeagreementonobtainingcarefor /R*6 anyacutemedicalcondition.Medicalneedswhichcanwaituntillongertermassessmentandplanning /+7  :       occursneednotpreventtheshorttermplan,however.#T T #T .%% #T @"#8T  X + #T ů"# X   SectionIIISAFETYPLAN   4 T " " 4.#" " ""l###T  ""## 0  BEGINDATE: Self-explanatory.Z,%% 4 T " " 4.#" " ""G$##T  ""f$# 0  ENDDATE: Theend-dateisdeterminedbythebeginningdateofthenextactiontobetaken.Ifnext  stepsarenotknown,aSafetyPlanmaynotbeappropriate. %% SafetyPlansareinterimplans.Amaximumtimelimithasnotbeenestablished.Asarule,planswillrange V (  fromafewhourstoafewdays,dependingonthefamily'sassessedabilitytocarryouttheplanand "   availabilityofresources.    4 T " " 4.#" " ""&##T  ""&#0  GOALS: Goalstatementsandactionstatementsshouldbe:X %% 0  0` %%Agreedtobyallpartiesnecessarytogaincompliance. ` %` % 0  0` %%Statedinclear,understandablelanguage.Professionaltermsand"buzzwords"shouldbe   avoided. ` %` % 0  0` %%Statedinbehavioralandmeasurableorobservableterms.T` %` % 4 T " " 4.#" " "")##T  "")#0  ACTIONNEEDEDTOMEETGOALS: Theactionsstatementshouldinclude:%% 0  0` %%Eachmemberofthefamilyabletoparticipate.` %` % 0  0` %%Actionsappropriatetothebehavioral/developmentalleveloftheparticipants.~P` %` % 0  0` %%Abackupplanintheeventtheprimaryplanisnotsufficient.J` %` % **:ddd Xdd Xdd X%%,dd +      cT +PracticeNote: F Example:  0 l GOALS:0 l#l# # # 0 l 0 l#l#Kevin(6montholdinfant)willbecaredforandsupervisedbyaresponsibleadultatalltimes.n@ # # 0 l 0 l#l#Cheryl(18yearoldunmarriedmother)willbesoberandnotondrugswhencaringforKevin.& # # 0 l ACTIONNEEDED:h!l#l# 0 l 0 l#l#CherylagreestoleaveKevininthecareofGina(Cheryl'smother),Kyle(fathernotinhome)orMrs. N " Gustafson(neighbor).KevinwillnotbeleftwithanyoneelseunlessCherylhasOKfromGina.# # # 0 l 0 l#l#Cherylagreesnottohaveanydrugswhichhavecausedthisprobleminherhouseatanytime.$ # # 0 l 0 l#l#IfCherylthinksthereisachanceshewillusedrugsbeforereturninghome,shewillcallGina,Kyle, v H% orMrs.Gustafsonforassistance..!& # # 0 l 0 l#l#CherylagreestoapplyforadmissiontotheMountainTop_rehab_ԀprogrambeforenextMonday !' (date).Kylewillprovidetransportation."p( # # 0 l 0 l#l#GinawillcallCheryltwiceadayordropintoseeifplanisbeingcarriedout.V#() # # 0 l 0 l#l#Cherylmaycallworkerat5551212ifsheneedshelp.$* # # 0 l 0 l#l#GinaorKylearetocallworkerifplanisnotworking.Ifworkerisnotavailable,call5551213and $ + askforBeth.#T c,#" "T 1'%~%P!, # #  1#T  ""x4#" "T  X   #T  ""4# X cT 0  SectionIVSIGNATURES:#T cU5# H'#-%% *k*dddd *%%k,dd +  ($/($  SIGNATURES(allparticipatingindividualsaretosignthisplanandthefamilyistoretaina 0)%0 copy))%1  " "T #T  ""&7#" "T *k*:dddd *%%k,dd +  +'2+'  #T  ""i7#cT >,(3  #T c[8#  -)4 *r$*%:dddd *%%r,dd +  ..  T T   cT +PracticeNote: d Signaturesareimportantbecauseitindicatestheimportanceoftheagreementtothesigner.Itmayalso J  becomeevidencewhichislessopentodisputeiftheplanisnotcarriedoutandmoreintrusivemeasures  areneeded.  Signaturesmustbevoluntary.Ifnot,aSafetyPlanmaynotbeappropriate.'*  '