Instructions for Form CD-215 "Children With Problem Sexual Behaviors Safety Plan" - Missouri

This document contains official instructions for Form CD-215, Children With Problem Sexual Behaviors Safety Plan - a form released and collected by the Missouri Department of Social Services. An up-to-date fillable Form CD-215 is available for download through this link.

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Download Instructions for Form CD-215 "Children With Problem Sexual Behaviors Safety Plan" - Missouri

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CHILDREN WITH PROBLEM SEXUAL BEHAVIORS SAFETY PLAN (CD-215)
INSTRUCTIONS
PURPOSE:
The Children with Problem Sexual Behaviors Safety Plan(s) (CD-215) should be completed on
every juvenile report when the following has occurred:
An act of sexual abuse has been witnessed by an adult;
There has been a disclosure from the child victim;
When the child has admitted to problem sexual behavior; and/or
When a parent/caregiver is concerned that their child is exhibiting problem sexual
behavior.
Factors that may contribute to increased risk for future incidents of problem sexual behavior
include:
Younger children reside in the same home;
The child resides with children and/or adults who are vulnerable due to limited
physical, developmental, and/or intellectual capacity, with other children known to
be sexual abuse victims or with other children known to have sexual behavior
problems; or,
The parent/caregiver is unable or unwilling to provide adequate supervision.
The safety plan should be behaviorally specific and should take the following into account:
Each living arrangement of the child; and
All situations in which the child may have access to other children.
The safety plan should be mutually agreed upon between the worker and the family. All
individuals involved in implementing the safety plan must be contacted by the Children’s Service
Worker to ensure they are in agreement to the plan.
NUMBER OF COPIES AND DISTRIBUTION:
The Children’s Service Worker should provide a copy of the safety plan to the child’s
parent(s)/caregiver(s). More than one safety plan may be required to mitigate the threat of
danger to any children involved in the Juvenile Report or to any other child(ren) the child with
problem sexual behaviors may have access to.
1
CD-215 Instructions (REV 10/15)
CHILDREN WITH PROBLEM SEXUAL BEHAVIORS SAFETY PLAN (CD-215)
INSTRUCTIONS
PURPOSE:
The Children with Problem Sexual Behaviors Safety Plan(s) (CD-215) should be completed on
every juvenile report when the following has occurred:
An act of sexual abuse has been witnessed by an adult;
There has been a disclosure from the child victim;
When the child has admitted to problem sexual behavior; and/or
When a parent/caregiver is concerned that their child is exhibiting problem sexual
behavior.
Factors that may contribute to increased risk for future incidents of problem sexual behavior
include:
Younger children reside in the same home;
The child resides with children and/or adults who are vulnerable due to limited
physical, developmental, and/or intellectual capacity, with other children known to
be sexual abuse victims or with other children known to have sexual behavior
problems; or,
The parent/caregiver is unable or unwilling to provide adequate supervision.
The safety plan should be behaviorally specific and should take the following into account:
Each living arrangement of the child; and
All situations in which the child may have access to other children.
The safety plan should be mutually agreed upon between the worker and the family. All
individuals involved in implementing the safety plan must be contacted by the Children’s Service
Worker to ensure they are in agreement to the plan.
NUMBER OF COPIES AND DISTRIBUTION:
The Children’s Service Worker should provide a copy of the safety plan to the child’s
parent(s)/caregiver(s). More than one safety plan may be required to mitigate the threat of
danger to any children involved in the Juvenile Report or to any other child(ren) the child with
problem sexual behaviors may have access to.
1
CD-215 Instructions (REV 10/15)
INSTRUCTIONS FOR COMPLETION:
Report Date: Enter the date the Juvenile Report was received.
Case/Call Number: Enter the incident number of the Juvenile Report.
Date Completed: Enter the date the safety plan was completed.
Adults Involved: Enter the names of all the adults involved in creating the safety plan.
Child(ren) Involved: Enter the names of all the children for which the safety plan is being
created.
What is needed to keep all the children in the home safe?: Place an “x” in the appropriate
box(es):
Close supervision;
Re-arrange bedrooms;
One or more children will be separated; and/or,
Other (explain)
Who will be responsible for supervising the children?: Enter the names of all the individuals
who will be part of the supervision plan of the child with problem behaviors.
Describe the specific steps that will be taken to supervise the children: Explain the plan for
supervision. Things to consider include, but are not limited to:
How will the children be supervised during the night?
How will the children be supervised when the caregiver has to use the bathroom or take
a shower?
How will the children be supervised when the caregiver has to prepare meals?
How will the children be supervised when they play outside?
How will the children be supervised at the bus stop?
How will the children be supervised when the caregiver needs to leave the home?
How will the parent/caregiver get a break from the stress of providing a high level of supervision?
How will the child be supervised at school and/or daycare?
Does the school and/or daycare need to be notified of the concerns?
If bedrooms need to be re-arranged, describe steps that need to be taken: Things to consider
include, but are not limited to:
Does anyone need their own room?
Who should not share a room?
Do the adults need to move to help with supervision needs?
If the children need to be separated, describe the specific steps that need to be taken: Things
to consider include, but are not limited to:
2
CD-215 Instructions (REV 10/15)
Which child(ren) will go stay somewhere else?
Where will they stay?
Are there children in the other home?
What will visits look like?
What needs to occur before the child(ren) can return home?
Describe the specific steps that will be taken to monitor access to media: Things to consider
include, but are not limited to:
What devices in the home have internet access?
Who is allowed on each device?
Where can devices be used?
Do the devices have parental control settings?
How will exposure to adult content on television or movies be handled?
The family agrees to the following house rules: Examples of pertinent house rules are:
Older children will not be responsible for baby-sitting or supervising younger children.
Alarms will be installed on bedroom doors.
Children will not share beds.
Rules will be established regarding who may be allowed in whose bedroom and under
what circumstances. Explain those rules
Only one person will be allowed in the bathroom at a time.
All household members will close the door when using the bathroom.
All household members will knock before opening a closed door.
Children will have no access to adult sexual materials.
All household members will respect each other’s boundaries, including touch, physical
affection, personal space, etc.
Clothing must be worn at bedtime.
No tickling or wrestling.
No computers, phones, tablets, gaming, or other devices with internet access will be
allowed in bedrooms.
Parents/caregivers will model open communication among family members. No secrets
will be allowed.
What additional steps are necessary to ensure the safety of everyone in the home?: Describe
any other safety intervention not captured in the above sections.
Who should notify the
Children’s Service Worker in the event the safety plan fails and another sexual abuse act fails?
What additional services or supports does the family need?: Describe what services the family
requests or would benefit from to help maintain the safety of the children.
Who will be helping to implement the safety plan?: List everyone who will be used to enforce
the safety plan. The Children’s Service Worker should speak to all of the individuals included in
this section to ensure they understand and are in agreement to their role.
How will the parents/caregivers communicate this safety plan with the children in the home?:
Describe the steps necessary to make sure that all the children are aware of the safety plan.
3
CD-215 Instructions (REV 10/15)
Signatures: Everyone involved in the safety plan should sign the CD-215.
INSTRUCTIONS FOR RETENTION:
All Children with Problem Sexual Behaviors Safety Plans should be filed in the family
assessment section.
MEMORANDA HISTORY:
CD15-52
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CD-215 Instructions (REV 10/15)
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