Caretaker’s/paramour’s criminal If yes, did the caretaker’s Is this criminal behavior and criminal behavior and background likely to become behavior or background poses background contribute to significant to the ongoing safety immediate or continuing threat to current report of of the child? child maltreatment? Yes No Yes No Yes No Describe the caretaker’s/perpetrator’s criminal behavior and history (include LEADS results if available): Perpetrator’s access to the child If yes, did the caretaker’s Is the caretaker’s ability to ability to access the child access the likely to become poses immediate or continuing contribute to current report of significant to the ongoing safety threat to the child maltreatment? of the child? Yes No Yes No Yes No Describe the caretaker’s level of access: PARENTING FACTORS Caretaker’s lack of capacity to If yes, did the caretaker’s Is this inability to parent likely inability to parent contribute to become significant to the parent poses immediate or to current report of ongoing safety of the child? continuing threat to child maltreatment? Yes No Yes No Yes No Describe the caretaker’s capacity to parent: Caretaker’s interactions with child If no, did the caretaker’s Is this inability to control inability to control their anger or impulsivity likely to become are negative or conflictual contribute to current report of significant to the ongoing safety maltreatment? of the child? Yes No Yes No Yes No Describe the caretakers level impulsivity/anger control: FAMILY FUNCTIONING History of abuse or neglect in the If yes, did the prior history Is the prior history likely to contribute to an escalated become significant to the family increases risk of harm to level of risk in the current ongoing safety of the child? child report of maltreatment? Yes No Yes No Yes No Describe the history of abuse or neglect in the family:
Caretaker’s/paramour’s criminal behavior or background poses immediate or continuing threat to child Yes No If yes, did the caretaker’s criminal behavior and background contribute to current report of maltreatment? Yes No Is this criminal behavior and background likely to become significant to the ongoing safety of the child? Yes No Describe the caretaker’s/perpetrator’s criminal behavior and history (include LEADS results if available): Perpetrator’s access to the child poses immediate or continuing threat to the child Yes No If yes, did the caretaker’s ability to access the child contribute to current report of maltreatment? Yes No Is the caretaker’s ability to access the likely to become significant to the ongoing safety of the child? Yes No Describe the caretaker’s level of access: PARENTING FACTORS Caretaker’s lack of capacity to parent poses immediate or continuing threat to child Yes No If yes, did the caretaker’s inability to parent contribute to current report of maltreatment? Yes No Is this inability to parent likely to become significant to the ongoing safety of the child? Yes No Describe the caretaker’s capacity to parent: Caretaker’s interactions with child are negative or conflictual Yes No If no, did the caretaker’s inability to control their anger contribute to current report of maltreatment? Yes No Is this inability to control or impulsivity likely to become significant to the ongoing safety of the child? Yes No Describe the caretakers level impulsivity/anger control: FAMILY FUNCTIONING History of abuse or neglect in the family increases risk of harm to child Yes No If yes, did the prior history contribute to an escalated level of risk in the current report of maltreatment? Yes No Is the prior history likely to become significant to the ongoing safety of the child? Yes No Describe the history of abuse or neglect in the family:
UPC-Plan-200.1-Risk-Quality-Management-Plan.FY1_.3-15-14.docx