Chronological age of child:_______________
Developmental age of child:______________
- Severity of allegations/chronicity/degree
Describe:_________________________________________________________
___________________________________________________________
Describe:___________________________________________________________
___________________________________________________________
- Concerns about current case plan/court order
- Special needs/services not offered/implemented____________________________________
- Child's needs not being addressed:_______________________________________________
- Services for parents inadequate or not effectively utilized:____________________________
- Visitation problems:__________________________________________________________
- Unresolved permanency planning issues:__________________________________________
- Other:______________________________________________________________________
___________________________________________________________________________
- Contested issues
- Describe:____________________________________________________________________
___________________________________________________________________________
- Parental history:
- Previous CPS/dependency history:________________________________________________
- Generational child abuse/neglect:_________________________________________________
- Mental health issues:___________________________________________________________
- Substance abuse:_______________________________________________________________
- Incapable of parenting:__________________________________________________________
- Failure to protect:______________________________________________________________
- Domestic violence:_____________________________________________________________
- Other:________________________________________________________________________
- High number of social worker changes:_____________________________________________________
- Noncompliance with court orders
- Describe:______________________________________________________________________
_____________________________________________________________________________
- Other:________________________________________________________________________________
____________________________________________________________________________________
CASA PROGRAM RECOMMENDATION
- APPOINTMENT OF A CASA/GAL IS RECOMMENDED
- APPOINTMENT OF A CASA/GAL IS NOT RECOMMENDED AT THIS TIME
- APPOINTMENT OF INDEPENDENT COUNSEL OR NON-CASA GUARDIAN AD LITEM RECOMMENED
DATE OF RISK ASSESSMENT:_________________ ASSESSED BY:____________________________________
