Caretaker Factors Caretaker demonstrates lack of If yes, did the caretaker’s Is this inability to control anger inability to control their anger or impulsivity likely to become impulse and anger control. contribute to current report of significant to the ongoing safety maltreatment? of the child? Yes No Yes No Yes No Describe the caretakers impulsivity/anger control: Paramour has a negative or If yes, did the actions of the Is the paramour’s paramour contribute to presence/actions likely to conflictual relationship with the current report of become significant to the children in the family? maltreatment? ongoing safety of the Yes No N/A Yes No Yes No Describe the paramour’s relationship to other family members: Caretakers lack an adequate If yes, did the caretaker’s lack Is this lack of an adequate of an adequate support system support system likely to support system. contribute to current report of become significant to the maltreatment? ongoing safety of the child? Yes No Yes No Yes No Describe the caretaker’s support system: Caretaker’s/paramour’s physical If yes, did the Is the caretaker’s/paramour’s caretaker’s/paramour’s condition likely to interferes with the physical physical condition contribute to become significant to the provision of adequate child care or current report of ongoing safety of the supervision maltreatment? Yes No Yes No Yes No Describe the caretaker’s/paramour’s physical condition: Caretaker’s/paramour’s If yes, did the alleged or Is the alleged mental illness observed mental illness likely to become significant to emotional/mental health interferes contribute to the current the ongoing safety of the child? report of maltreatment?
Caretaker Factors Caretaker demonstrates lack of impulse and anger control. Yes No If yes, did the caretaker’s inability to control their anger contribute to current report of maltreatment? Yes No Is this inability to control anger or impulsivity likely to become significant to the ongoing safety of the child? Yes No Describe the caretakers impulsivity/anger control: Paramour has a negative or conflictual relationship with the children in the family? Yes No N/A If yes, did the actions of the paramour contribute to current report of maltreatment? Yes No Is the paramour’s presence/actions likely to become significant to the ongoing safety of the Yes No Describe the paramour’s relationship to other family members: Caretakers lack an adequate support system. Yes No If yes, did the caretaker’s lack of an adequate support system contribute to current report of maltreatment? Yes No Is this lack of an adequate support system likely to become significant to the ongoing safety of the child? Yes No Describe the caretaker’s support system: Caretaker’s/paramour’s physical interferes with the provision of adequate child care or supervision Yes No If yes, did the caretaker’s/paramour’s physical condition contribute to current report of maltreatment? Yes No Is the caretaker’s/paramour’s physical condition likely to become significant to the ongoing safety of the Yes No Describe the caretaker’s/paramour’s physical condition: Caretaker’s/paramour’s emotional/mental health interferes If yes, did the alleged or observed mental illness contribute to the current report of maltreatment? Is the alleged mental illness likely to become significant to the ongoing safety of the child?
UPC-Plan-200.1-Risk-Quality-Management-Plan.FY1_.3-15-14.docx