Appendix C

National Study of Child Protective Services Systems and Reform Efforts

Blank State CPS Policy Review Form
State: Agency Name:
Date of Review: Manual Reviewed:
Reviewer: Date(s) of Manual(s) Reviewed:
Same Manual Reviewed for unsub ____Yes ____No

A. Administrative Structure
1. Is CPS in this State
____ 1.1 State Administered
____ 1.2 State Supervised/County Administered
____ 1.3 Other (please specify)_____________________________________________________________________________________________________

2. Responsibility for major functions (in each cell write “P” if the agency has primary responsibility, “S” if the responsibility is shared. If the responsibility is shared
please put an “S” in each cell where that agency or office shares responsibility. If the manual does not specify responsibility put an “X” in the Not Specified
column.)

Function State Central Office Regional District County/Local CPS Other (Please Not Section/page/date
Office Office Specify) Specified
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Maintain Hotline 2.1.a 2.1.b 2.1.c 2.1.d 2.1.e 2.1.f

Receive Referrals/reports 2.2.a 2.2.b 2.2.c 2.2.d 2.2.e 2.2.f

Screen/determine need for 2.3.a 2.3.b 2.3.c 2.3.d 2.3.e 2.3.f

response

Conduct Investigation 2.4.a 2.4.b 2.4.c 2.4.d 2.4.e 2.4.f

Conduct Safety/Risk 2.5.a 2.5.b 2.5.c 2.5.d 2.5.e 2.5.f

Assessments
Conduct Additional 2.6.a 2.6.b 2.6.c 2.6.d 2.6.e 2.6.f
Family Functioning
Assessments
Conducts Other CPS 2.7.a 2.7.b 2.7.c 2.7.d 2.7.e 2.7.f
Response (alternative
track)
Assigns cases to response 2.8.a 2.8.b 2.8.c 2.8.d 2.8.e 2.8.f
track

Other (please specify) 2.9.a 2.9.b 2.9.c 2.9.d 2.9.e 2.9.f

 B. Screening
1. Reporters (please check all that apply)
Mandated Accepted Not Specified Section/Page/Date
1.1 Social Services Personnel
1.2 Medical Personnel
1.3 Mental Health Personnel
1.4 Education Personnel
1.5 Legal, law enforcement or criminal justice personnel
1.6 Child day care providers
1.7 Substitute care providers including foster parents
1.8 Alleged victims
1.9 Parents (birth, adoptive, step)
1.10 Other relatives
1.11 Friends and neighbors (includes clergy, youth group, paramours)
1.12 Alleged perpetrators
1.13 Anonymous or unknown
1.14 Other (please specify)

2. Definition of non-mandated reporter Section/Page/Date

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3. Criteria for Commencing Investigation (Screening In)

Short Description of Criterion (Please copy and attach definitions) Section/Page/Date

3.1.a 3.1.b

3.2.a 3.2.b

3.3.a 3.3.b

3.4.a 3.4.b

3.3.a 3.3.b
 4. Exclusions for Commencing Investigation (Screening Out)

Short Description of Criterion (Please copy and attach definitions) Section/Page/Date

4.1.a 4.1.b

4.2.a 4.2.b

4.3.a 4.3.b

4.4.a 4.4.b

4.5.a 4.5.b
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5. Is there 24-hour availability for accepting referrals? Yes No Not Specified Section/Page/Date

6. Is there a required form for documenting all referrals? Yes No Not Specified Section/Page/Date
(IF YES, PLEASE DESCRIBE FORM HERE)

7. What are the required timeframes for accepting a referral and forwarding it for investigation? Section/Page/Date
 8. Results of Screening Section/Page/Date
8.1 Screened out, no further action
8.2 Referral made outside CPS to other part of Child Welfare agency
(Criteria)

8.3 Referral made to another agency

(Criteria)

8.4 Accepted for investigation

(Criteria)

8.5 Accepted for other CPS response

8.6 Information on the allegation shared with another agency
(Criteria)

8.7 Other (please specify)

9. Results of Screening
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Who decides to forward the case for further action? Section/Page/Date

____ 9.1 Worker only 9.2 Which cases?
____ 9.3 Supervisor only 9.4 Which cases?
____ 9.5 Worker decides/supervisor approves 9.6 Which cases?
____ 9.7 Joint worker/supervisor 9.8 Which cases?
____ 9.9 Not specified
____ 9.10 Other
(including special circumstances that cause basic policy to be modified)

10. Who must be notified when calls are screened in? Section/Page/Date
 C. Investigation

1. Definitions of maltreatment recognized by state policy (please paraphrase briefly and attach a copy of definitions to this document). If this manual has been
reviewed for unsub, skip this section.

Item Topic Definition Section/Page/Date

1.1.a Neglect 1.1.b

1.2.a Physical Abuse 1.2.b

1.3.a Sexual Abuse 1.3.b

1.4.a Emotional Abuse 1.4.b

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1.5.a Other (Please specify) 1.5.b

1.6.a Other (Please specify) 1.6.b

1.7.a Other (Please specify) 1.7.b

 2. Disposition Categories (skip if manual previously reviewed)

Disposition Category/Subcategory
(please use outline format to Definition Legal Standard for Section/Page/Date
designate category/subcategory Classification
relationship)
2.1.a 2.1.b 2.1.c 2.1.d

2.1.1.a 2.1.1.b

2.1.2.a
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 3. What is the purpose or definition of investigation provided in policy? Section/Page/Date

4. Does this state share joint investigation authority as explicitly defined in policy? Yes No Section/Page/Date

If Yes:
With what other agency or agencies?
4.1
4.2
4.3 What is the mechanism governing involvement with agency 1?
4.3.a Statute
4.3.b Protocol
4.3.c Cooperative agreement or Memorandum of Understanding
4.3.d Other (please specify)

4.4 What is the mechanism governing involvement with agency 2?

4.4.a Statute
4.4.b Protocol
4.4.c Cooperative agreement or Memorandum of Understanding
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4.4.d Other (please specify)

4.5 Under what circumstances is agency 1 involved in investigation (check all that apply)?
____ 4.5.a Not involved in investigations
4.5.b When emergency removal of child required
____ 4.5.c Conducts joint investigations on sexual abuse reports only
____ 4.5.d Conducts joint investigations on sexual abuse & severe physical abuse reports
____ 4.5.e Not specified
____ 4.5.f Other

4.6 Under what circumstances is agency 2 involved in investigation (check all that apply)?
____ 4.6.a Not involved in investigations
4.6.b When emergency removal of child required
____ 4.6.c Conducts joint investigations on sexual abuse reports only
____ 4.6.d Conducts joint investigations on sexual abuse & severe physical abuse reports
____ 4.6.e Not specified
____ 4.6.f Other

5. Are priority standards for starting an investigation described in policy? Yes No Section/Page/Date
If yes, please briefly describe levels
 6. Is there a requirement to investigate Section/Page/Date
____All children in the family
____Only the child(ren) who are the subject(s) of the allegation(s)
____Other (please specify)

7. Standardized assessments required (is formal instrument used across state) Section/Page/Date

7.1 Is safety assessment required during investigation? Yes No Section/Page/Date

7.2 At what other points is safety assessment required?
7.2.a Before investigation on all reported cases
7.2.b Before investigation on only reports that are screened in
7.2.c After disposition (only substantiated reports)
7.2.d After disposition (including unsubstantiated reports)
7.2.e Other (please specify)

7.3 Is risk assessment required during investigation? Yes No Section/Page/Date

7.4 At what other points is risk assessment required?
7.4.a Before investigation on all reported cases
7.4.b Before investigation on only reports that are screened in
7.4.c After disposition (only substantiated reports)
7.4.d After disposition (including unsubstantiated reports)
7.4.e Other (please specify)
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7.5 Other standardized assessment(s) required (please describe what is required and at what points in the case)

8. Requirements for specialized assessments (by multi-disciplinary teams, clinicians, child advocacy centers, etc.). Section/Page/Date
Please describe including for which cases and by whom.

9. Contact requirements (please describe requirements for contact with child, family, collaterals) Section/Page/Date
 10. What is the timeframe required to complete the investigation and reach disposition?
Section/Page/Date (skip if manual previously reviewed)

11. Results of Investigation Section/Page/Date

____11.1 Referral to services unit (substantiated cases only)
____11.2 Referral to services unit (substantiated or unsubstantiated cases)
____11.3 Case closure (no further action)
____11.4 Services provided as voluntary case
____11.5 Referral to other CPS response track
____11.6 Other (please specify)

12. Who makes the disposition decision? Section/Page/Date

____ 12.1 Worker only 12.2 Which cases?
____ 12.3 Supervisor only 12.4 Which cases?
____ 12.5 Worker decides/supervisor approves 12.6 Which cases?
____ 12.7 Joint worker/supervisor 12.8 Which cases?
____ 12.9 Not specified
____ 12.10 Other
(including special circumstances that cause basic policy to be modified)
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13. After disposition, which of the following must be notified of investigation findings? Section/Page/Date
(check all that apply)
____13.1 Law enforcement
____13.2 The family
____13.3 The perpetrator
____13.4 The reporter
____13.5 Central Registry (The perpetrator’s name must be placed on the Central Registry)
____13.6 Other (please specify)

14. Does the state have a Central Registry? ____Yes ____No Section/Page/Date

15. What are the criteria for placement on the Central Registry?
 16. What is Central Registry information used for?
16.a background checks for school or child care employees
16.b internal administrative purposes
16.c criminal background checks by law enforcement
16.d other (please specify)

17. What are the criteria for expungement? Section/Page/Date

18.a Does a person placed whose name is on the Central Registry have the right to appeal? Yes No

18.b To whom is the appeal made?

18.c What other provisions are made for due process? Section/Page/Date
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19. During investigation are investigative workers required to provide short-term services if needed? ____Yes ____No
Section/Page/Date

20. Is the investigative worker required to do any service planning for on-going services? ____Yes ____No Section/Page/Date

21. What is the purpose (if stated) for providing the services? Section/Page/Date
 D. Other CPS Response

1. Does this state have a dual track/multiple response system explicitly defined in policy? Yes No
Section/Page/Date Other source

If Yes:
2. Implementation
2.1 Statewide
2.2 Local option
2.3 Other (please specify)

3. Please define the tracks (specific terminology and definitions used) Section/Page/Date

4. Purpose of other CPS response (include desired outcome and impetus for reform i.e. Legislation) Section/Page/Date
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5. Cases/allegations that can be referred to other CPS response Section/Page/Date

6. Role of other agencies (include which services provided, for which cases and why) Section/Page/Date

7. Requirements for standardized assessments or monitoring instruments Section/Page/Date

 8. Requirements for specialized assessments (by multi-disciplinary teams, clinicians, child advocacy centers, etc.). Section/Page/Date
Please describe, including for which cases and by whom.

9. Contact requirements (please describe requirements for contact with child, family, collaterals) Section/Page/Date

10. Results of Investigation Section/Page/Date

____10.1 Completed response, referred for voluntary services
____10.2 Completed response, petitioned the court to order mandatory services
____10.3 Completed with no further action
____10.4 Did not complete other CPS response, returned to investigation unit
____10.5 Closed without being completed
____10.6 Other (please specify)
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11. Decision Making

Who decides result of other CPS response? Section/Page/Date
____ 11.1 Worker only 11.2 Which cases?
____ 11.3 Supervisor only 11.4 Which cases?
____ 11.5 Worker decides/supervisor approves 11.6 Which cases?
____ 11.7 Joint worker/supervisor 11.8 Which cases?
____ 11.9 Not specified
____ 11.10 Other
(including special circumstances that cause basic policy to be modified)

Comments (e.g. clarity of manual, etc.):