• Reason to know. Information exists at the time of the assessment of a reason to know that the child/youth is an Indian child/youth, including the following:
  • The child/youth, the family, or a person having interest in the child/youth provides direct information that the child/youth is an Indian child/youth.
  • The residence or domicile of the child/youth, the child/youth’s parents, or an Indian custodian is on a reservation or other tribal lands or in an Alaska Native village.
  • Any participant in a court proceeding, an officer of the court, an Indian tribe(s), an Indian organization, or an agency provides information indicating the child/youth is an Indian child/youth.
  • The child/youth’s words or actions reasonably suggest they are an Indian child/youth.
  • The child/youth is or has been a ward of a tribal court.
  • The parent or child/youth possesses an identification card indicating membership or citizenship in an Indian tribe(s).
• Reason to believe. Information exists at the time of the assessment that suggests that either the child/youth or a parent of the child/youth may be eligible for membership in an Indian tribe(s) or may have Indian ancestry. Further inquiry is required.

• Yes. CWS staff included tribal social workers or representatives in the overall assessment of safety. Examples include but are not limited to including tribal social workers or representatives in gathering key facts about the child/youth’s situation, the facility caregiver’s behavior, and impact on the child/youth.
• No. Indicate whether contact with tribe(s) was attempted. Document all efforts in the child welfare services case management system (CWS/CMS).

Identify whether the person alleged to have caused the harm is a facility staff member (including but not limited to administration, volunteers, temporary staff), another child/youth at the facility, parent/guardian/Indian custodian/family of the child/youth, a third party, or unknown.

Note: If only “parent/guardian/Indian custodian/family” is selected, consider whether the safety assessment for caregivers would be more appropriate to complete.

• Child/youth is younger than most other children/youth at the facility. Determine the age of the children/youth the facility serves and whether the child/youth alleged to have been harmed is significantly younger than most of the other children/youth served.
• Child/youth has conditions that impact their ability to protect themself. Child/youth has physical, emotional, or other challenges that will impair their ability to keep themself safe. Check all that apply.
  • Child/youth has diminished mental capacity (e.g., developmental delay, nonverbal). The child/youth has a developmental/cognitive delay that impacts their ability to communicate verbally or to care for themself and protect themself from harm.
  • Child/youth has a medical condition. The child/youth has a diagnosed medical condition that impairs their ability to protect themself from harm. This item can also be selected if a diagnosis is not yet confirmed but preliminary indications are present.
  • Child/youth has a mental health or trauma history that currently impairs ability to protect themself. The child/youth has a diagnosed mental disorder that impairs their ability to protect themself from harm or has a noted history of being physically or emotionally traumatized. This item can also be selected if a diagnosis is not yet confirmed but preliminary indications are present.
  • Child/youth has diminished physical capacity (e.g., non-ambulatory, limited use of limbs). The child/youth has a physical condition or disability that impacts their ability to protect themself from harm.
  • Other Describe any other factor influencing child/youth vulnerability.
• Child/youth has a history of being sexually exploited or sexually trafficked. The child/youth has a history of being sexually exploited or trafficked.
  • Children/youth age 17 years and younger are sexually exploited when they have engaged in, been solicited for, or been forced to engage in sexual conduct or performance of sexual acts in return for a benefit, such as money, food, drugs, shelter, clothing, gifts, or other goods; or for financial or some other gain for a third party. The sexual conduct may include any direct sexual contact or performing any acts, sexual or nonsexual, for the sexual gratification of others. These acts constitute the sexual exploitation of a child/youth regardless of whether they are live, filmed, or photographed.
  • Commercial sexual exploitation of children/youth may include prostitution, pornography, trafficking for sexual purposes, and other forms of sexual exploitation. The child/youth is treated as a sexual object and as a commercial object. The sexual exploitation of the child/youth may profit a much wider range of people than the immediate beneficiary of the transaction.
• Child/youth identifies as LGBTQ+. The child/youth identifies as lesbian, gay, bisexual, transgender, queer, or questioning their sexual orientation, gender identity, or gender expression.
• Child/youth wears distinctive cultural or religious attire or expresses themselves in ways that demonstrate their religion or culture. The child/youth wears attire representing their culture (hajib, yarmulke, etc.) and/or demonstrating their religious expression (long hair, braided hair).
• Child/youth and facility staff experience a language barrier. The child/youth does not speak English as their primary language. Examples could include a child/youth who speaks American Sign Language (ASL) or another language such as Spanish. Consider children/youth who are unable to speak for their needs despite English being their primary language.

These conditions within the facility or their staff may impact child/youth’s ability to protect themselves or affect the facility’s ability to protect the child/youth.

• Facility combines children/youth of different ages.. Facility places any two of these age groups together as part of facility daily activities: preschool–, elementary school–, middle school–, or secondary school–age children/youth. Consider a child/youth’s development level in conjunction with their chronological age.
• Facility does not appear to provide supervision required to meet the child/youth needs. Facility is out of compliance with expected staff to child/youth ratios. Note: This item can still be selected if evidence is not confirmed yet but preliminary indications are present. CCL will make the final determination of whether ratios were truly out of compliance.
• Facility combines children/youth of different gender identities. Facility places children/youth of different gender identities together during activities of daily living, which may increase their real or perceived sense of vulnerability. Activities include but are not limited to sleeping, bathing/showering, or dressing.
• Facility combines children/youth who have different degrees of acuity or disruptive behavior. Facility places children/youth together who have various levels of acuity, acting out, or aggression.
• Facility has a pattern of community care licensing (CCL) complaints or concerns. Facility has experienced a pattern of CCL complaints that could affect the current concerns related to safety. For more information on complaints, see this link: https://www.ccld.dss.ca.gov/carefacilitysearch/
• Facility utilizes physical or hands-on restraints. Facility staff use hands-on, manual restraints to limit the movement of children/youth in their care. Physical restraints may include forced escorts, holding, prone restraints, or other containment techniques.
• Other. Describe any other facility factor influencing child/youth vulnerability.

Facility caregiver took an action that caused one or more of the following or stated they intended to take an action that likely would cause one or more of the following.

• Injury or abuse to the child/youth occurred, other than accidental. The facility caregiver caused a non-accidental injury OR took an action that could have caused non-accidental injury to the child/youth.
• Facility caregiver has threatened to harm or retaliate against the child/youth. The facility caregiver stated or demonstrated that they intended to take an action that would result either in physical harm to the child/youth or that they plan to retaliate against child/youth.
• Facility caregiver fears they will maltreat the child/youth. The facility caregiver has reported credible fears that they will hurt the child/youth in a way that would cause serious injury or harm, and facility administration has not taken adequate actions to mitigate the threat.
• Facility caregiver has used physical discipline or excessive physical force against the child/youth. The facility caregiver used physical methods to discipline the child/youth, OR facility caregiver injured or nearly injured the child/youth by using excessive physical force. Do not select this item in the case of brief, approved physical restraints that facility caregiver used to prevent imminent harm to the child/youth or others.

The child/youth has an injury that requires medical attention, and medical assessment indicates the injury is likely to be the result of abuse; OR has a suspicious injury that did not require medical treatment, but other information about the injury does not match with the explanation that the facility caregiver provided.

Note: Factors to consider include the child/youth’s age, location of injury, exceptional needs of the child/youth, and chronicity of injuries.

Select this item if sexual abuse is occurring or is suspected of occurring and actions taken by facility are not adequately protecting that child/youth.

Sexual abuse is unwanted sexual activity involving applied force, threats, or manipulation.

Note: Select Item 4 when commercial sexual exploitation occurs or is suspected.

Select this item if commercial sexual exploitation is occurring or is suspected of occurring and actions taken by facility are not adequately protecting that child/youth.

Children/youth aged 17 years old and younger are sexually exploited when they have engaged in or been forced to engage in sexual conduct or performance of sexual acts in return for a benefit, such as money, food, drugs, shelter, clothing, gifts, or other goods; or for financial or some other gain for a third party.

The sexual conduct may include any direct sexual contact or performing any acts, sexual or nonsexual, for the sexual gratification of others. These acts constitute sexual exploitation regardless of whether they are live, filmed, or photographed. Force, fraud, and coercion are not required to constitute commercial sexual exploitation.

Note: Children/youth may engage in this sexual conduct in an effort to meet unmet needs or as a means for survival. If actions taken by the facility are not adequately protecting the child/youth, select this item and consider whether any other safety threat may also be relevant in these situations.

Facility caregiver engages in a regular pattern of behavior that impairs the child/youth’s emotional development, self-worth, or self-confidence.

Examples of facility caregiver actions include the following:

• Describing the child/youth in a demeaning or degrading manner (e.g., as evil, stupid, ugly).
• Cursing at or repeatedly putting the child/youth down.
• Scapegoating the child/youth.
• Encouraging other children/youth in the facility to harm the child/youth.
• Blaming the child/youth for a particular incident or for facility problems that child/youth is not responsible for.

The facility caregiver is unable or unwilling to address critical areas among the following, AND the child/youth has been seriously harmed or is in imminent danger of being seriously harmed as a result.

• Food: The child/youth’s basic nutritional or specialized dietary needs are not met, resulting in danger to the child/youth’s health and/or safety, including malnutrition or morbid obesity
• Clothing:: The child/youth is without clothing or shoes needed for their health or safety. Consider the age of the child/youth and whether clothing is the choice of the child/youth or has been provided or withheld by the facility caregiver.
• Medical/dental care: The facility caregiver does not seek treatment for the child/youth’s immediate, chronic, and/or serious medical condition(s), or does not follow prescribed treatment for such conditions, resulting in child/youth declining in health status (e.g., not providing insulin for a child/youth with diabetes, not providing follow-up care for an infected wound, or not providing care for a broken bone). Consider lack of dental care that results in medical concerns.
• Mental health care: The facility caregiver does not seek treatment for the child/youth’s imminent, chronic, and/or serious mental health condition(s); or does not follow prescribed treatment for suicidal ideation, self-harming behavior, or other serious emotional problems.

Facility conditions are causing or have the potential to cause imminent serious harm to child/youth’s health or safety.

Consider situations including but not limited to the following.

• Leaking gas from stove or heating unit.
• Lack of water or utilities (heat, plumbing, electricity) and no alternative or safe provisions.
• Open/broken/missing windows.
• Exposed electrical wires.
• Excessive garbage or rotted or spoiled food that threatens health.
• Evidence of human or animal waste throughout living quarters.

Note: Physical conditions may be suboptimal, or the CWS investigator may have reason to believe they do not meet California licensing standards. If so, contact licensing. This item should be selected only if the “imminent danger” threshold is reached

The facility caregiver does not or cannot protect the child/youth from threatened or actual serious physical or emotional harm by other children/youth. Consider the age and developmental stage of the child/youth and impact on them from the other child/youth’s action.

Examples include but are not limited to the following.

• Physical harm toward a child/youth by a peer.
• Child/youth sexual abuse by a peer.
• A pattern of or a significant threat, act of intimidation, and/or coercion from peers that impacts the child/youth’s safety, emotional development, or self-worth. Consider the use of social media as well.

The facility caregiver does not or cannot protect the child/youth from serious physical harm, emotional harm, or threatened harm by other adults, including family members or other adults who have regular access to the child/youth.

Examples include but are not limited to the following.

• The facility caregiver does not provide supervision necessary to protect the child/youth from harm by an adult who comes to the facility and physically, sexually, or emotionally abuses the child/youth.
• An adult with known violent criminal behavior history or sexual abuse history as a perpetrator has regular, unmonitored access to the child/youth. Include regardless of whether the facility caregiver (1) knew of the history and allowed access; or, (2) upon learning of the history, has not prevented further access.
• A facility caregiver is unable or unwilling to stop a fellow staff member from harming child/youth. Select this and any relevant safety threat above. Note: In situations where the child/youth is being sexually exploited and trafficked by a facility caregiver, select this item AND safety threat 3.

Note: If an adult harms a child/youth after they have run away, consider (1) if the child/youth already had regular access to this adult that the facility caregiver was aware of and/or (2) if safety threat 10 is more applicable.

The facility caregiver cannot or does not take action in order to protect the child/youth when a child/youth demonstrates behavior that can cause them serious harm, OR the facility caregiver takes actions that worsen the situation when a child/youth falls victim to behavior that can cause themself serious harm.

This includes but is not limited to situations where the facility caregiver is unable or unwilling to respond to the following child/youth actions.

• Self-harm: Child/youth physically harms self or threatens to physically harm self, AND the facility caregiver does not respond to protect child/youth (e.g., refuses to take action to support child/youth, refuses to separate them from items they could harm themself with, does not watch child/youth more closely despite evidence they may harm themself).
• Running away/leaving care without permission: Child/youth regularly leaves the facility without permission and without supervision, AND the facility caregiver does not take actions to try to prevent the child/youth from going missing from care (e.g., provide the child/youth with a “go bag” for basic hygiene items, follow the child/youth, attempt to engage with them to build a preventative and safety plan, inform local law enforcement).
• Aggressive/assaultive behavior: Child/youth physically harms a peer or threatens to physically harm a peer, AND the facility caregiver does not take actions to try to deescalate the situation and/or protect child/youth involved.
• Substance use: Child/youth has used/abused legal or illegal substances or alcoholic beverages to the extent of impairment to their control of their actions or abilities; AND the facility caregiver does not take actions to prevent or respond to the substance use, or they actively encourage it.
• Other (describe): Include other child/youth actions that put the child/youth in imminent danger of serious harm where the facility caregiver does not or cannot respond.

Note: If facility caregiver does not seek needed medical or mental health care after a child/youth engages in behavior that can cause them serious harm, select this item AND consider safety threat 5.

Circumstances or conditions pose an imminent threat of serious harm to the child/youth that are not already described in safety threats 1–10.

Child/youth acknowledges the safety threat.

The child/youth can clearly describe and demonstrates an understanding of the issues that led to the current safety threat.

Child/youth is willing and able to participate in a safety plan.

The child/youth has agreed to participate in a plan to imminently address the safety threat AND has the physical and emotional capacity to participate in that plan.

Child/youth has shown in the past that they can take action to protect themself.

The child/youth has demonstrated an ability to take steps to protect themself from harm in the past (e.g., reporting safety concerns to a safe adult, leaving an unsafe situation, asking for help).

Child/youth reports having a trusting relationship with at least one facility staff member.

The child/youth has at least one supportive relationship with someone at the facility whom they confide in.

Child/youth reports having a trusting relationship with at least one family member or support network member, AND they are willing to share the details of the safety threat with them.

The child/youth has at least one supportive relationship with a family member or support network member, AND they are they are willing to disclose at least some details of the threat to that person.

Other (describe)

The child/youth demonstrates other actions and/or coping skills or accesses resources that may help them respond to the safety threat.

Facility staff and leadership acknowledge the safety threat.

Facility leadership AND at least one other facility caregiver who has day-to-day responsibility for the child/youth can clearly describe and demonstrates an understanding of the issues that led to the current safety threat.

Facility staff shared details of the safety threat with all relevant members of the Child and Family Team, including any tribal social worker.

A facility caregiver has described the concerns and actions that led to the safety threat to child/youth’s family, tribal social worker, and lawyer, as well as to any other key members of their Child and Family Team.

Facility leadership and staff are willing and able to participate in a safety plan.

Facility leadership AND at least one facility caregiver who has day-to-day responsibility for the child/youth have agreed to participate in a plan to immediately address the safety threat, AND facility leadership is willing to commit the staff and resources to that plan.

Other (describe)

The facility demonstrates other actions, is accessing resources, and/or is making responses to the concerns that allow them to immediately respond to the safety threat.

Intervention or direct services provided by a CWS worker (do not include fact-finding actions from the investigation itself).

Actions that the investigating worker or other CWS staff take or plan that specifically address one or more safety threats.

Examples include providing information about expected facility actions in response to a child/youth being AWOL or to signs of exploitation, providing information about child/youth development needs, or planning return visits to the facility to check on progress. Does not include the fact-finding activities of the investigation itself or services provided to respond to child/youth needs that do not directly respond to the indicated safety threats.

Use of Child and Family Team members, support network, and/or community agencies as participants on the safety plan.

Family, extended family, or support networks have actionable items on the safety plan.

Examples include but are not limited to the family agreeing to regularly visit the child/youth at the facility, or a close family friend agreeing to regularly meet with the child/youth and ask about the events that led to the safety threat to ensure the safety threat is no longer present. Action steps should include a backup plan of what steps participants will take if the threat is present and not being controlled for.

Use of resources and/or recommendations from tribal representatives as part of the safety plan.

A tribe(s), Indian community, Indian Child Welfare Act (ICWA) program, or other tribal resource has actionable items on the safety plan.

Examples include regular visits from a tribal social worker or representative of that tribe or from a staff member at a community-based agency who is aware of the safety threat and is willing to ask about it to ensure it is no longer happening.

Other tribal resources include but are not limited to:

• Tribal family services from the child/youth’s or caregiver’s tribe(s) or a tribal consortium;
• Indian resource centers;
• Indian health clinics;
• Title VII Indian education programs, which may not be affiliated with a tribe; and
• A county-based dedicated Indian specialist or service unit.

Alleged perpetrator has been arrested, fired, or suspended from facility. (This cannot be the only item on the safety plan.)

Facility leadership has fired, suspended, or removed a facility caregiver who is an alleged perpetrator; and the alleged perpetrator no longer has access to child/youth.

Note: Consider facility plan to ensure the alleged perpetrator does not have access to the child/youth, such as removing their keys, informing CCL, etc. If a facility has taken this action and the final determination of the assessment is “safe with plan,” the safety plan must include other action items in addition to the termination or suspension of the staff.

Examples of other action items include what the child/youth will do if they become triggered by a similar event and what the facility will do to ensure the fired or suspended staff will not have access to the child/youth in the community.

Facility will change staffing levels to address the safety threat.

Facility leadership has added new staff or shifted staff to support the child/youth in a manner that directly responds to the safety threat

Facility will change behavior plan/response to child/youth.

Facility staff have made significant changes to the behavior plan and have new strategies for responding to the child/youth that will directly respond to the safety threat.

Facility will change location of child/youth within the facility and/or separate them from particular peers.

Facility leadership has moved the child/youth or a peer to new part of the facility in a way that will directly respond to the safety threat.

Other

CWS, the child/youth, tribe (if applicable), their family or support network, and/or facility caregivers will take other actions that immediately respond to the safety threat in a manner not captured in the above interventions.

Placement change

One or more safety threats are present. All interventions above have been considered, and none of them will address the safety threat. A placement change is the only intervention possible to address the safety threat for the child/youth. Without the placement change, the child/youth will remain in imminent danger of serious harm. Note: Parents, legal caregivers, and children/youth’s legal representatives must be contacted if a placement change is being made. Additionally, if there is reason to know that the child/youth is an Indian child/youth and a placement change is to be made, the affiliated tribe(s) must be contacted.

County CWS that is responsible for child/youth will transfer the child/youth to a new placement immediately.

The county child welfare or probation office that is responsible for the child/youth’s care will take steps to move the child/youth to a new placement immediately.

Note: If a transfer is not possible immediately, a safety plan must be initiated that controls for the threat while a new placement is sought.

Complete only if the child/youth is or may be an Indian child/youth.

Is the tribe(s) in agreement with the final safety decision?

If it has been indicated that the child/youth may be an Indian child/youth and contact with the tribe(s) has been made, review the safety decision collaboratively with the tribe(s). While agreement with the decision is not required, document efforts to gain agreement and the tribe’s position on the final safety decision.

Facility leadership and staff are willing and able to participate in a safety plan.

Facility leadership AND at least one facility caregiver who has day-to-day responsibility for the child/youth have agreed to participate in a plan to immediately address the safety threat, AND facility leadership is willing to commit the staff and resources to that plan.

If in the course of this safety assessment the CWS staff became aware of other children/youth who are suspected to have been abused or neglected, call the child abuse hotline for the county that placed the child/youth in this facility.

IS LICENSING AWARE OF THE CURRENT INVESTIGATION?

Determine whether a report to licensing has been made; if not, file report.

IS A REPORT TO LAW ENFORCEMENT REQUIRED?

Determine whether a report to law enforcement is required.

Safe

No safety threats were identified at this time. Based on currently available information, child/youth is not in imminent danger of serious harm. CWS staff should complete the investigation and partner with other counties, tribe(s), and CCL as needed. Complete Section 6; then, this assessment is complete.

Safe with plan

One or more safety threats are present; however, the child/youth can safely remain in the facility with a safety plan. Protective interventions have been initiated through a safety plan that CWS, the facility, and the child/youth will be a part of. The child/youth will remain in the facility as long as the interventions continue to mitigate the safety threats. Complete a formal safety plan with intervention details and share it with the facility caregivers, facility leadership, CCL, child/youth, tribe (if applicable), and child/youth’s family/legal guardian.

Note: If a safety plan is implemented, a Child and Family Team Meeting (CFTM) should be convened, and a new safety assessment should be completed within 30 days.

Unsafe

One or more safety threats are present. All interventions above have been considered, and none of them will address the safety threat. A placement change is the only intervention possible to address the safety threat for the child/youth. Without the placement change, the child/youth will remain in imminent danger of serious harm.

Note: Parents, legal caregivers, and children/youth’s legal representatives must be contacted if a placement change is being made. Additionally, if there is reason to know that the child/youth is an Indian child/youth and a placement change is to be made, the affiliated tribe(s) must be contacted.