with provision of adequate child care or supervision. Yes No Yes No Yes No Describe the caretaker’s alleged or observed emotional/mental illness: Caretaker’s/paramour’s If yes, did the caretaker’s Is the caretaker’s/ paramour’s paramour’s developmental likely developmental disabilities interferes developmental disabilities contribute to disabilities to become significant to the with provision of adequate child current report of ongoing safety of the child? care or supervision. maltreatment? Yes No Yes No Yes No Describe the caretaker’s/paramour’s developmental disabilities: Caretaker’s/paramour’s use or If yes, did alleged or observed Is the alleged substance abuse misuse of alcohol and/or drugs substance abuse problem problem likely to become interferes with provision of adequate contribute to current report of significant to the ongoing safety child care or supervision. maltreatment? of the child? Yes No Yes No Yes No Describe the caretaker’s alleged or observed substance abuse problem: In allegations of sexual abuse, the If yes, did the caretaker’s Is the caretaker’s/paramour’s inability to believe and support inability to believe and support caretaker/paramour demonstrate an contribute to likely to become child victim child victim inability to believe and support current report of significant to the ongoing safety child victim of sexual abuse maltreatment? of the child? Yes No Yes No Yes No Describe the caretaker’s/paramour’s level of support to the child victim: Caretaker/paramour has a history of If yes, did the caretaker’s Is the caretaker’s or paramour’s history as a perpetrator of perpetrating sexual or paramour’s history as sexual abuse likely to become perpetrator of sexual abuse significant to the ongoing safety contribute to current report of the child? of maltreatment? Yes No Yes No Yes No Describe the past history of sexual abuse
with provision of adequate child care or supervision. Yes No Yes No Yes No Describe the caretaker’s alleged or observed emotional/mental illness: Caretaker’s/paramour’s developmental disabilities interferes with provision of adequate child care or supervision. Yes No If yes, did the caretaker’s paramour’s developmental disabilities contribute to current report of maltreatment? Yes No Is the caretaker’s/ paramour’s developmental disabilities likely to become significant to the ongoing safety of the child? Yes No Describe the caretaker’s/paramour’s developmental disabilities: Caretaker’s/paramour’s use or misuse of alcohol and/or drugs interferes with provision of adequate child care or supervision. Yes No If yes, did alleged or observed substance abuse problem contribute to current report of maltreatment? Yes No Is the alleged substance abuse problem likely to become significant to the ongoing safety of the child? Yes No Describe the caretaker’s alleged or observed substance abuse problem: In allegations of sexual abuse, the caretaker/paramour demonstrate an inability to believe and support child victim of sexual abuse Yes No If yes, did the caretaker’s inability to believe and support child victim contribute to current report of maltreatment? Yes No Is the caretaker’s/paramour’s inability to believe and support child victim likely to become significant to the ongoing safety of the child? Yes No Describe the caretaker’s/paramour’s level of support to the child victim: Caretaker/paramour has a history of perpetrating sexual Yes No If yes, did the caretaker’s or paramour’s history as perpetrator of sexual abuse contribute to current report of maltreatment? Yes No Is the caretaker’s or paramour’s history as a perpetrator of sexual abuse likely to become significant to the ongoing safety of the child? Yes No Describe the past history of sexual abuse
UPC-Plan-200.1-Risk-Quality-Management-Plan.FY1_.3-15-14.docx