WPC! \9HY  ,[ M LSazF$W'P*Fǒ x3#{HQ@Pc L^k+*]v8shz5@q/]OS_FҚ:i+OK;4@fCL4l-_ hV~m45 3i@^a~n'Jņ ]U(g2zɚ !⭿HrzdFX-1̌֍kYLH*x DjFq%K $_Iӄ t%z.#7\yU'{aHUW?yh>A`=rp\q S!󔚜AX :8Pw*^Q"DN|%Ilߏ6>sad90-A/2Gm\N%ԯ>c`4"Lj)a-/kc* /"Nk-;<;`9QS[Vv6Cd-j4U%B %  0 0Z 0g D+  0 0=r 0 AQ< # U@V 0#nX3 0rNw4^ #% m-UND'b 0N\  `*Times New RomanTT' COMPLETING THE CFS-3050A, $Shirley Dwyer$0Shirley Dwyer .   h:Default ParaDefault Paragraph Font        `:footnote reffootnote reference         w )XXXXXX   _(e2$ ҇!XXXXXX   'dxd Level 1 Level 2 Level 3 Level 4 Level 5(e2$ ҇!XXXXXX   ($    (e2$ ҇!XXXXXX    C<< cSAVIN 2055DP PCL 60(hH  Z(Times New Roman (e2$ ҇!XXXXXX   3|x\  `*Times New RomanTTC\  P6QP\  `*Times New RomanTTXXP\  P6QXP(J҇$XJXXJXXXJ  _,l顗, U(hH  Z6Times New Roman Regular  'XXXXXX   _    @5(#XXCFS2030FInstructions H Rev.jJ July2001      #XX#   z_      `  _Page of &>$"Small Circle"0  ҇!XXXXXX   _H   &%XX  8-\\dXXd8COMPLETINGTHEFAMILYBASEDASSESSMENTSUMMARY,FORMCFS2030F#XX%&#XX    TheFBASummary,CFS2030Fmustbecompleted,signedanddatedforeverycaseacceptedforfurther  assessmentunlessthereportisa3rdpartyperpetratorortheabusehappenedinalicensedfacility.AFamily V< BasedAssessmentisnotcompleteduntilthisSummary\ServicePlaniscompleted.    Thisformsummarizestheinformationdrawnfromtheassessmentsandtechniquesusedandestablishestheinitial ~ d (possiblytentative)courseofaction.Itistobecompletedattheconclusionoftheassessment. 6  3  3I"0    CASENAME: 󀀀Usethesamenameasonpage1,SectionII,#1offormCFS1000.3Id݌  (#(# Ќ  3  3*"0    CASENUMBER: Usethesamenumberasonpage1offormCFS1001. 3*E݌ (#(# Ќ  3  3"0    EVENTNUMBER: 󀀀Usethesameeventnumberasonpage1offormCFS1001.3݌l (#(# Ќ  3  3"0    ASSIGNEDSOCIALWORKER: EnterthenameoftheassignedworkerfromformCFS1002,page2,   SectionIII. 3݌ (#(# Ќ  3  3"0    ACCEPTANCEDATE: 󀀀EnterthedateofcaseacceptancefromformCFS1002,page1.3݌ (#(# Ќ  SectionI:ASSESSMENTRESULTSANDSUMMARYOFFINDINGS(Abuse/NeglectCasesOnly)  t    F, 0  DocumenttheassessmentconclusionsoftheSafetyDecision,RiskLevel,RiskConclusionandInvestigation  Findings.#XX#XXԀIftherearemultiplefindingdecisionsassociatedwithareport,thehighestleveloffindingshould  beindicatedasthecasefindingintheFBAsummary.#XX ##XXXX; #XXnT(#(#    &  SectionII:SUMMARYOFASSESSMENTCONCLUSION(CINC/NANcasesonly)  x       DocumenttheassessmentconclusionfromtheCINC/NANAssessment . N4 SectionIII:FAMILYPRESERVATIONSCREEN       Reviewanswerquestions1through7.Inordertorefertofamilypreservation,questions1,2and3mustbe .    answered YesANDquestions4through7mustbeanswered Yesor notapplicable(N.A.). ! 0  DecisiontorefertoFamilyPreservation?IndicateDateandTimethedecisionwasreachedtorefertofamily V<# preservation. Referralistobemadetothefamilypreservationcontractorwithin24hoursofthisdecision.  $(#(#  SectionIV:CASEACTION/INITIALSERVICEPLAN ~!d& 0  Forallcaseactionsinwhichcontactismadewithafamily,describeaminimumofonestrength#XXO #XXanda 6"' minimumofoneneedforthatfamily#XX#XX."((#(# 0  Describestrengthsandneedsofthefamilyasidentifiedthroughtheassessmentscompleted.Indicatehowthat ^$D* strengthimpactsagencydecisionregardingSRSserviceaction.Iftheassessmentdoesnotindicateaneedfor %+ services,N/Aor nonebasedonassessmentcanbedocumentedinresponsetothefamilysneeds.%,(#(#   Indicatewhichcaseactionwillbetaken;familyservices,familypreservation,fostercare,adoption,orclosure. >'$!.   IfFamilyServicesorFamilyPreservationarechosen,indicatewhetherasafetyplanisinplace. '!/  Ifcaseisopenedforservices: f)L#1   SummarizethereasonforSRSinvolvement:  *$3 0  Summarizethereasonswhichbroughtthefamilytotheattentionofthedepartmentandthereasonsthecase +t%4 wasacceptedforassessment.Thesummaryshouldreflectthefamilysunderstandingandownershipofthe F,,&5 reason(s)fordepartmentinvolvement.IfaCINC/NANcase,describethereasonableeffortstakentoprevent ,&6 outofhomeplacement. -'7(#(#   n.T(8   InitialPermanencyGoal :Indicatewhichpermanencygoalisindicated;maintenance,reintegration,adoption,    guardianship,orindependentliving.     ChildProtectionObjectives: Indicateatleastoneandnomorethanthreechildprotectionobjectives.Child B(   protectionobjectivesmustrelatetothereasonthechildcametotheattentionoftheagency.     Ifcaseisclosed:  j P   Ifnocaseaction/initialserviceplanisindicated,checkthereason(s)thisistrue.    ̀  SRSservicenotindicated. J 0     Thereisnoevidencetosupportthereport.Thereportisclearlyfalseandnoadditionalservicesrelatedto     thesafetyofthechild(ren)areneeded.       FamilyrefusestocooperatewithFBA,andSRShasnolegalbasistocompelintervention. *   0  ThefamilydoesnotwishtoparticipateinanFBAorrefusestodoso.ThedepartmentmayclosetheFBA,   forthisreasonONLYIFthereare no unaddressedchildsafetyneedsANDthedepartmentdoesnothavethe   legalauthoritytoproceed.Example:Preliminaryinquiry determines poorparentingbutnosubstantiatedabuse R8  orneglect,theparentsareuncooperativeandthedepartmenthasdeterminednorequestforaCINCpetition    isnecessary.  (#(# ̀  Familymovedoutofstate,cannotbelocated.Medicalneedswereunabletobedetermined. 2  0  Thefamilyhasmovedoutofstateorcannotbelocated.Themedicalneedsoftheidentifiedchildrenwere  unabletobedetermined. (#(#   Anothercommunityagencyiscurrentlyprovidingservices.   0  Thefamilyisexperiencingproblemsbutanotheragencyisassessingthefamily'sneedsand/orproviding  services. h(#(#   AssessmentcompletedandSRSserviceplancontinues.   0  Assignedreportisassociatedwithacasealreadyopentotheagencyandthecurrentserviceplanwillcontinue.  #XXl#XX  `     h      p      x  (#(# SectionV:TIMELINESSOFFAMILYBASEDASSESSMENT/INITIALSERVICEPLAN !     p"   IndicateiftheFBAandServicePlanwerecompletedwithintheallowabletimelines.Ifnotcompletedtimely, B(#   documentthereasonwhy. $ 0  DATEFBACOMPLETED/SIGNATURES: EnterthedatetheFBASummary/InitialServicePlanwas j!P& completedandthesignatureofthesocialworkercompletingtheFBA.Thesupervisorwillsignanddateafter ""' reviewing.  Note:#XX#XXThesupervisorsignatureanddateisrequiredinordertocompletetheFBASummaryprocess, "( howeverisnotrequiredtoinitiateareferraltocontractor.#"###XX##