DCBS Number:
DCBS Name:
COMMONWEALTH OF KENTUCKY
CABINET FOR FAMILIES AND CHILDREN
DEPARTMENT FOR COMMUNITY BASED SERVICES
CONTINUOUS QUALITY ASSESSMENT
FAMILIAL - CPS NARRATIVE OUTLINE
Date CQA Approved:
I.
MALTREATMENT/PRESENTING ISSUE:

State original allegation?

What is extent of current maltreatment/presenting issue for each victim?

Who is responsible?

Collateral/witness description of maltreatment/presenting issue.

Ongoing-- summarize past maltreatment/presenting issues, describe current progress.
.
CPS RATING
II.
UNDERLYING CAUSES

How and why did the maltreatment/presenting issue occur?

According to victims, siblings, household members, non-offending caretaker, perpetrator, and collateral.

Ongoing—summarize prior underlying causes and current progress toward prevention of reoccurrence
CPS RATING
III.
FAMILY DEVELOPMENTAL STAGES & TASKS:
 Consider each adult (including biological and/or legal non-custodial and absent parents)

State developmental stages of family.

Describe tasks family struggles with related to maltreatment/presenting issues.

Effectiveness of parenting practices

Discuss strengths and risk—cultural, financial, physical and mental health, substance usage, domestic violence, etc.
which impact family functioning.

Ongoing—summarize prior Family Developmental Stages and Tasks and current progress.
Selected Assessment Factors
1
DCBS Number:
DCBS Name:
Strength: Parent/caregiver in the home is willing to provide basic food, clothing, and shelter for
child/ren.
Strength: Parent/caregiver knows child/ren needs and is concerned about their safety and wellbeing.
Risk: Adult/s unable to or unwilling to protect self and/or child/ren.
Risk: Adults from serial relationships (paramours, self-parents) provide care for children.
Risk: Past/present history of family violence (not necessarily part of current incident)
Risk: Family shows stresses such as poverty, unemployment, chaotic lifestyle, or isolation.
Parent/Caretaker
CPS Rating
Comments
CPS RATING
IV.
FAMILY CHOICE OF DISCIPLINE:

Consider each adult (including biological and/or legal non-custodial and absent parents)

How does family teach children responsibility and appropriate behavior?

What are the disciplinary approaches used by the parents/caretakers?

Is discipline appropriate to child’s developmental stage/age.

What behavior management techniques create risk.

Ongoing—summarize prior Family Choice of Discipline and current progress
Selected Assessment Factors
Strength: Parents provide discipline that is reasonable, predictable, and helps shape positive behavior.
Risk: There is a pattern of unpredictable, escalating, inappropriate or unusual discipline.
Narrative
Parent/Caretaker
CPS Rating
Comments
2
DCBS Number:
DCBS Name:
CPS RATING
V.

INDIVIDUAL ADULT PATTERNS OF BEHAVIOR:
Consider each adult (including biological and/or legal non-custodial and absent parents)

Describe adult’s high-risk behavior and factors that which influence behavior— cultural, financial, physical and mental
health, substance usage, domestic violence, employment, educational, etc. which impact the adult’s functioning. .

Summarize criminal CPS and APS history

Summarize high-risk behavior as reported by family/collaterals.

Describe strengths of the adult.

Ongoing—summarize prior Individual Adult Patterns of Behavior and current progress.
Selected Assessment Factors
Strength: Adults in the home have average intelligence/education, are generally mentally and physically
healthy, and have adequate social skills.
Risk: Individual’s substance abuse endangers the well being of self or other family members.
Risk: There is a documented history, or observable indicators, of domestic violence in the family.
Risk: There is a pattern of serial relationships (paramours, spouses, etc.)
Risk: There is a criminal history of assault, child abuse, domestic violence, alcohol/drug, or other relevant
charges/convictions (AOC Records Check)
Risk: Previous reports in TWIST, etc RUMBA (CA/N DV LINK, APS Registries)
Narrative
Parent/Caretaker
CPS
Rating
CRIMINAL
RECORDS
CHECKED
CA/N
LINK
Comments
CPS RATING
VI.
CHILD/YOUTH DEVELOPMENT:

Address every child in the home.

Is child able to accomplish developmentally appropriate tasks on a daily basis?

Discuss how task results in maltreatment/presenting issue.

Include strengths

Describe child’s cultural, educational, physical/mental health, independent living skills, attachment, permanency needs

Describe high-risk behaviors of the child.

Ongoing—summarize prior Child/Youth Development and current progress.

3
DCBS Number:
DCBS Name:
Selected Assessment Factors
Any child is fearful of home situation.
Any child is 0 through 5 years old and/or older child cannot protect self.
Narrative:
Child/Youth
CPS Rating
Comments
RATING
VII.
FAMILY SYSTEM OF SUPPORT:

Describe how extended family, friends, and community help family protect the children.

Describe potential negative impact of the support system.

Describe community support system for the family.

If child is placed out of the home what placement support is needed.

Ongoing—summarize prior Family System Support and current progress.
Selected Assessment Factors
Strength: Family is able to identify specific sources of family and community support that provide and/or are
willing to provide support.
Narrative
CPS RATING
RATINGS/FINDINGS/DECISIONS/ACTIONS
CPS RATINGS
Maltreatment/Presenting Issue
Underlying Causes
Family Developmental Stages & Tasks
Family Choice of Discipline
Adult Patterns of Behavior
Child Development
Family System of Support
RISK ASSESSMENT CONCLUSION
High Risk ( 20 – 28 )
Significant Risk ( 14 – 19.9 )
Moderate Risk ( 7 – 13.9 )
Low Risk ( 0 – 6.9 )
TOTAL
ASSESSMENT FINDINGS:
Individual
Enter in TWIST Investigation Results Screen
Incident
Program/ SubProgram
Results
4
DCBS Number:
DCBS Name:
ASSESSMENT/INVESTIGATION CONCLUSION:






Describe sequence of Investigation/FINSA
Statement and justification of findings
Identify family and individual needs and service recommendations.
Summarize safety plans/aftercare plans
Summarize court action
Document dates DPP-154, CPS findings notification, 72-hour notification to law enforcement/county attorney, FSOS
consultation
Worker Signature
Supervisor Signature
____________________________________________________
If Applicable
____________________________________________________
Date: ________________
Date: ________________
5