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New Jersey Department of Children and Families Policy Manual

 

Manual:

CP&P

Child Protection and Permanency

Effective Date:

Volume:

X

Forms

Chapter:

A

Forms

04-29-2013

Subchapter:

1

Forms

Issuance:

22.6

CP&P Form 22-6, New Jersey Child Safety Assessment (Resource Homes)

 

Click here to view or print the CP&P Form 22-6, New Jersey Child Safety Assessment (Resource Homes).

 

WHEN TO USE IT

 

This form is used to assess child safety in a resource home:

 

      •     Within five (5) work days of placing or moving/re-placing children in the home;

 

      •     On an annual basis, during the resource family reevaluation, and at other times, when assessing child safety is appropriate and necessary;

 

      •     By the Resource Family Support Unit staff in no more than three days before an Area Director-OOL review to determine if an exception to population limits should be authorized;

 

      •     By IAIU Investigators, when conducting a CPS-IAIU investigation;

 

      •     By SPRU Workers;

 

      •     By the Public Defender Conflict Investigation Unit; and

 

      •     By the Resource Family Support Worker when a home is added to his or her caseload.

 

HOW TO USE IT

 

Complete this form in the NJ Spirit application, by accessing it through the Investigation Window > Basic tab > Options Drop-down, or the Resource Maintenance Window > Options Drop-down, or from Create Casework > Assessment.

 

Only complete this template outside of the NJ Spirit application as part of a contingency plan when the application is unavailable.  However, in doing so, you are still required to create the form in NJ Spirit when the application becomes available.

 

Note: Page 4 Part D is completed in the field with the family.  Enter this information into NJ Spirit word for word.

 

TIPS FOR COMPLETING THE FORM

 

Subject Child:  Prefills when launched from an investigation.  Enter the child name(s) any other time.

 

Case ID #:  Prefills when launched from an investigation.  Enter the case ID # any other time.

 

IAIU #:  For IAIU use only.

 

By:  Enter name of the Worker, Nurse Consultant, OOL representative or RFSW if a teamed approach.

 

Name of Child: NJ Spirit will enter (prefill) up to 4 children.  Worker enters any additional children.

 

Name of Adult:  NJ Spirit will enter (prefill) up to 4 adults.  Worker enters any additional adults.

 

The Worker/Investigator, RFSW/Other and Supervisor sign and date the form in the section that designates the safety of the child (safe, unsafe, unsafe: removal/re-placement required).

 

Complete an Out-of-Home Safety Protection Plan as needed.

 

Concerns, Risk, Recommendations, Need for Collaterals, Need for Services: Enter additional information, concerns, intervention by OOL or IAIU, service needs, planning or risks of future incidents in the home, as well as collateral contacts and follow up dates or information.

 

DISTRIBUTION

 

Original                      -           Child's Record (signed paper copy)

 

Copy                           -           Office of Licensing

 

Copy                           -           Contracted Agency, for a Contracted Agency

                                                Home

 

Copy                           -           IAIU (copy of CP&P conducted safety

                                                assessment when appropriate)

 

Electronic Copy        -           NJ Spirit case record