• No child under age 18 (Do not apply in reports of death of the only child[ren] in household where death is suspected to be related to abuse or neglect.) The current referral may allege abuse or neglect, but the alleged victim is 18 years of age or older (including non-minor dependents). Do not apply this item if the report concerns the death of the only child(ren) in the household where death is suspected to be related to abuse or neglect.
• Duplicate referral that contains no new information. The report duplicates an existing referral (this is commonly known as a secondary referral). This report does not contain new allegations from an existing referral.
• Referred to another county. A referral has been received for a child who lives in another county. The caller was both referred to that county and provided with contact information, or the county was notified and the referral was recorded in that county. Refer to local protocol for this type of referral.

The referral concerns a child 72 hours of age or younger whose caregiver has voluntarily surrendered physical custody of the child to any employee on duty at a public or private hospital emergency room or any additional site approved as a Safe Surrender Site. Follow procedures outlined in ACIN I-88-10.

The child has a current or previously unreported injury or impairment AND the caregiver deliberately caused the injury/impairment OR there is a basis to be suspicious that a caregiver caused it and it was non-accidental. Basis for suspicion may include but is not limited to:

• Physician reports that the injury type is consistent with non-accidental injuries;
• Injury to a non-ambulatory child with no plausible alternative explanation;
• Explanation for injury does not match injury;
• Injury is in the shape of an object (e.g., loop marks); or
• Credible disclosure by the child to the reporting party or other adult.

Identify the type of non-accidental or suspicious physical injury.

• Death of a child due to abuse (automatic 24-hour). There was a death of a child in the home; and circumstances are suspicious for abuse, or abuse has been identified as the cause of death in this report or investigation. Select one of the following options:
  • Death of only child or all children in home; no other children reported to be in the home.
  • Other children reported to be in the home.
• Severe (automatic 24-hour). A severe injury is one that, if left untreated, would cause permanent physical disfigurement, permanent physical disability, or death. Include visible injuries and suspected injuries due to symptoms such as loss of consciousness, altered mental status, inability to use an arm, inability to bear weight, etc.
• Other injury (other than very minor unless child is under 1 year old). Any visible or suspected injury that is not severe. Any “other” non-accidental injury to a child under 1 year old should not be considered very minor.
  • Any non-accidental or suspicious injury to a child who is non-ambulatory, including very minor injuries such as welts, scratches, abrasions, swelling, or injuries that cause even brief pain.
  • Injuries caused to a child during a domestic violence incident.
  • “Other” injuries may require assessment/treatment but are not life-threatening and are not likely to result in temporary or permanent disability or disfigurement. These may include bruises, welts, or abrasions in areas of the body that do not pose a threat of serious injury or disfigurement (arms, legs, buttocks).
  • Very minor injuries are defined as those that involve only mild redness or swelling, minor welts/scratches/abrasions, or brief and minor pain.

It is not necessary for a reporter to determine that an injury occurred. Examples of caregiver action that is likely to have caused or will cause injury include but are not limited to the following:

• Shaking or throwing an infant or child under 3 years old.
• Inappropriate physical discipline, such as choking, suffocation, tying child up, locking child in closet/kennel, physical activity exceeding child's ability to perform, etc.
• Hitting a child with enough force or using objects to strike a child that could cause a significant injury, such as a broken bone, concussion, significant bruising or lacerations, or internal injuries.
• Exposing a child to dangerous weather or environmental hazards (e.g., locking child out of the home, confining child to garage with dangerous fumes/exhaust, dropping child off far from home with no resources to get to a safe place).
• Dangerous behavior toward the child or in immediate proximity of the child, including domestic violence incidents that occur while the child is present. Consider combination of child location, type of incident (e.g., pushing, throwing objects, use of a weapon), and child vulnerability.
• Caregiver has made credible threats to cause physical harm to the child that, if carried out, would constitute child abuse, and it is likely that, without intervention, the caregiver will carry out these threats. If threats are clearly for the sole purpose of emotional abuse, select as emotional abuse. If the purpose cannot be discerned, select both this section and “emotional abuse.”

There was a death of a child in the home due to abuse or circumstances were suspicious for abuse prior to the current referral AND there is a new child currently in the care of the identified/suspected perpetrator.

Caregiver action(s), statement(s), or threat(s) have led or are likely to lead to child's emotional damage (e.g., severe anxiety, depression, withdrawal); behavioral concerns (e.g., untoward aggressive behavior toward self or others); and/or adverse impact on the child's emotional development, including but not limited to delayed speech development, abnormal attachment behaviors, and impulse control behaviors. The adverse impact may result from a single event or from a consistent pattern of behavior and may be currently observed and/or predicted as supported by evidence-based practice. Types of emotional maltreatment include but are not limited to the following:

• Rejecting and/or degrading the child.
• Isolating and/or victimizing the child by means of cruel, unusual, or excessive methods of discipline.
• Exposing the child to brutal or intimidating acts or statements, including but not limited to:
  • Harm or threatened harm to animals;
  • Threats of suicide or harm to family members (including the child);
  • Confining the child in places such as closets or animal cages; or
  • Consistently scapegoating the child; consistently berating, belittling, blaming, targeting, or shaming the child.

The adverse impact on the child may or may not be apparent depending on the child's age, cognitive abilities, verbal ability, and developmental level. Adverse impact is not required if the action/inaction is a single incident that demonstrates a serious disregard for the child's welfare.

The child has witnessed, intervened in, or is otherwise aware of physical altercations, serious verbal threats, or intimidation between adults in the home. These incidents may occur on more than one occasion OR on a single occasion that involved weapons, resulted in any injury to an adult, or resulted in arrest/court involvement.

Domestic violence perpetrators, in the context of the child welfare system, are parents and/or caregivers who engage in a pattern of coercive control against one or more intimate partners. This pattern of behavior may continue after the end of a relationship or when the partners no longer live together. The alleged perpetrator's actions often directly involve, target, and impact any children in the family.

If a child has been injured or is threatened with injury, also select “non-accidental or suspicious injury” or “caregiver action that likely caused or will cause injury” under “Physical Abuse.”

• Diagnosed malnutrition (automatic 24-hour). The child has a current diagnosis by a qualified medical professional of severe malnutrition due to inadequate or unbalanced diet, OR a qualified medical professional states that there are indicators of malnutrition but a formal diagnosis has not yet been made.
• Non-organic failure to thrive. The child has a current diagnosis by a qualified medical professional of non-organic failure to thrive, OR a qualified medical professional states that there are indicators of failure to thrive but a formal diagnosis has not yet been made.
• Child's health/safety is endangered. The caregiver has willfully not provided adequate clothing, shelter, supervision, care, or medical care AND there is imminent risk of serious illness or injury, or serious illness or injury has already occurred. Consider child's age, behavior, and vulnerability. For example:
  • The child's clothing is so inappropriate for weather that the child suffered hypothermia or frostbite;
  • Housing conditions result in lead poisoning, severely exacerbated asthma due to smoke exposure, and/or multiple bites from pest infestations;
  • There is methamphetamine production in the home/residence;
  • Medical care has not been provided for an acute or chronic condition and, as a result, the child has required or is likely to require hospitalization or surgery; or the condition may worsen to the extent that unnecessary permanent disability, disfigurement, or death results;
  • Caregiver is willfully not meeting child's mental health needs and child has demonstrated suicidal or homicidal behavior/ideation;
  • Child is not supervised to the extent that the child has been seriously injured, is at risk of being seriously injured, or avoided serious injury only due to intervention by a third party;
  • A young child is left in a motor vehicle during extreme temperature conditions;
  • A caregiver behaves recklessly in proximity to child (e.g., driving under the influence as found by law enforcement, using weapons, etc.); or
  • Caregiver is breastfeeding while using dangerous substances (type of substances and/or amount resulted in or is likely to result in serious injury/illness to child).
• Death of a child due to neglect (automatic 24-hour). There has been a death of a child in the home due to neglect or circumstances that are suspicious for neglect. Select one of the following options.
  • Death of only child or all children in home; no other children reported to be in the home.
  • Other children reported to be in the home.

Consider age/developmental status of children. Minor or no injury or illness has occurred.

• Inadequate food. The caregiver does not provide sufficient food to meet minimal requirements for the child to maintain health and growth. The child experiences unmitigated hunger; lack of food has a negative impact on school performance. Caregiver's use of food stamps and/or food pantries as sources of food should not be considered failure to provide food.
• Inadequate clothing/hygiene. The caregiver has failed to meet the child's basic needs for clothing and/or hygiene to the extent that the child's daily activities are negatively impacted and/or the child develops or suffers a worsening medical condition. Examples include but are not limited to:
  • Sores, infection, or severe diaper rash;
  • Clothing that is inappropriate for the weather and results in health or safety concerns;
  • Inability to attend school due to lack of clean clothing; and/or
  • Experiencing shame or isolation from peers due to poor hygiene/extreme body odor.
• Inadequate/hazardous shelter. The residence is unsanitary and/or contains hazards that have led or could lead to injury or illness of the child if not resolved. Examples include but are not limited to:
  • Housing that is an acute fire hazard or has been condemned;
  • Exposed heaters, gas fumes, or faulty electrical wiring;
  • No utilities (e.g., water, electricity, heat source if needed) AND these are necessary based on current conditions and age/developmental status or special needs of the child;
  • Pervasive and/or chronic presence of rotting food, human/animal waste, or infestations;
  • Presence of poisons, guns, or drugs within reach of child; and/or
  • Lack of safe sleeping arrangements for infant/child.
• Inadequate supervision. Caregiver is present but not attending to the child, or caregiver has made inadequate care arrangements for the child. Injury has occurred due to lack of supervision or been avoided due to third-party intervention. Examples include but are not limited to the following:
  • Caregiver fell asleep in the apartment/house and young child wandered from the home into the hallway/street.
  • Child plays with dangerous objects (e.g., sharp knife, gun, matches).
  • Non-mobile infant left in car seat or carrier for extended periods of time.
  • Caregiver is unable to care for child due to substance use, mental illness, or developmental disability.
• Inadequate medical/mental health care. Child has a mild to moderate condition, and the caregiver is not seeking or following medical treatment; OR the child has a severe, chronic condition and the caregiver's care is partial, but important components of the child's medical needs are unmet.
• Caregiver absence/abandonment.
  • Caregiver is unable to care for the child due to incarceration, hospitalization, or unavoidable absence AND there is no safe adult to care for the child. If the caregiver is incarcerated, hospitalized, or absent and has made a plan of care for the child with a safe adult or is otherwise able to safely mitigate the impact of his/her absence on the child, this item should not be selected.
  • Caregiver has deserted the child with no apparent plans for return. Abandonment may be indicated by quitting jobs, establishing another residence, and taking clothing and other belongings.
  • Child is being discharged from a facility and caregiver refuses to accept child back into his/her home AND has not participated in discharge planning or caregiver cannot be found.
  • Caregiver has kicked child out of the home/refuses child entry to the home and has not provided a safe alternative.
  • Caregiver left child with family or friends who state an intention to discontinue care and caregiver refuses to accept child back or cannot be located.
  • Child is or has been left without an identified caregiver for a period of time inappropriate to the child's age or developmental status. Consider presence of support systems such as relatives and neighbors and child's ability to access support systems by phone or access within immediate walking distance.
• Involving child in criminal activity. The caregiver causes the child to perform or participate in illegal acts that:
  • Create danger of serious physical or emotional harm to the child;
  • Expose the child to being arrested; or
  • Force a child to act against his/her wishes.
• Failure to protect.
  • Caregiver knowingly left child in the care of a person known to neglect or abuse children; a person unknown to the caregiver; or a person known to be violent, use alcohol/drugs, or have serious mental health concerns to the extent that his/her ability to provide care is significantly impaired;
  • Caregiver does not intervene despite knowledge (or reasonable expectation that the caregiver should have knowledge) that the child is being harmed (includes physical, sexual, or emotional abuse or neglect) by another person;
    OR
  • A child has been exploited by a third party, and the person responsible for the child's care has failed in protecting or been unable to protect the child from being commercially sexually exploited and/or sex trafficked. This includes situations where the person responsible for the care of the child has been coerced or otherwise been unable to prevent exploitation.
    • Children and youth aged 17 years old and younger are sexually exploited when they have engaged in, solicited for, or been forced to engage in sexual conduct or performance of sexual acts (e.g., stripping) 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.
    • Commercial sexual exploitation of children/youth/young adults may include prostitution, pornography, trafficking for sexual purposes, and other forms of sexual exploitation. The youth is treated as a sexual object and as a commercial object. The sexual exploitation of the child may profit a much wider range of people than the immediate beneficiary of the transaction.

No event has occurred; however, conditions exist that create a substantial likelihood that the child will be neglected. Caregiver has not demonstrated capacity to meet child's basic needs without external supports and external supports are no longer present.

• Prior failed reunification or severe neglect, and new child in household (in-home only). There is credible information that a current caregiver had one or more children for whom there was:
  • A failed reunification as a result of child abuse or neglect; OR
  • A current caregiver was previously substantiated for severe neglect;
    AND
  • A new child is now living in the home and conditions exist that create a substantial likelihood that the child will be neglected.
• Allowing child to use alcohol or other drugs. Caregiver provides (offers or knowingly allows the child to consume) alcohol, illegal drugs, or inappropriate prescription drugs to a child to the extent that it could endanger the child's physical health or emotional well-being or result in exposure to danger because the child's thinking and/or behavior are impaired. Consider child's age and substance type, including the following:
  • Providing methamphetamine, heroin, cocaine, or similar drugs to a child of any age.
  • Providing enough alcohol to result in intoxication.
  • Providing alcohol over time so that the child is developing a dependency.
  • Providing medications (includes prescription and over-the-counter) that are not prescribed for the child, for the purpose of altering the child's behavior or mood.
  • Providing glue or other inhalants to a child of any age.
  Examples of substance use that should not be included are:
  • Use of small amounts of alcohol for religious ceremonies; and
  • An older child is permitted to try a small amount of alcohol at a family occasion that did not result in intoxication.
• Prior death of a child due to neglect AND there is a new child, of any age, in the home (in-home only). There has been a death of a child in the home due to neglect or circumstances are suspicious for neglect prior to the current referral, AND new children are currently in the care of the identified/suspected perpetrator.

• Prenatal substance use (in-home only). There is a positive toxicology finding for a newborn infant or his/her mother OR other credible information that there was prenatal substance abuse by the mother (e.g., witnessed use, self-admission);
  AND
  There is indication that the mother will continue to use substances, rendering her unable to fulfill the basic needs of the infant upon discharge from the hospital. Indicators may include, but are not limited to, the type of drug (the more addictive the drug, the more likely there will be continued use), pattern of past use, behavior during hospitalization, statements by the mother or others regarding use, AND willingness/ability to care for infant. Willingness/ability to provide care may be indicated by observation of the mother's preparation for care of a newborn, her engagement in prenatal care, appropriate food, lodging, clothing, past safe care of children, engagement in substance abuse treatment services, availability of and willingness to use a support network, etc.

• Other high risk birth (in-home-only). No acts or omissions constituting neglect have yet occurred; however, conditions are present that suggest that the only reasons neglect has not occurred are the external supports of the hospitalization or the limited time since birth. Examples include but are not limited to the following:
  • Sole caregiver or both caregivers have not attended to the newborn in the hospital.
  • Teen mother has no support system, and maturity level suggests she will be unable to meet the newborn's basic needs.
  • A mother of any age with apparent physical, emotional, or cognitive limitations has no support system and may be unable or unwilling to meet the newborn's basic needs.
  • A child was born with medical complications, and sole caregiver's or both caregivers' response suggests caregiver(s) will be unable to meet the child's exceptional needs (e.g., does not participate in medical education to learn necessary care, indicates denial of diagnosis, etc.).

Based on verbal or nonverbal disclosure, medical evidence, or credible witnessed act. If child knows that the alleged perpetrator is not a household member but does not know his/her identity, DO NOT SELECT.

Suspicious indicators include but are not limited to the following:

• Toddler or elementary school-aged child displays highly sexualized aggressive behaviors.
• Pre-adolescent child has initiated sexual acts or activities with caregivers, family members, or peers that are outside age-appropriate exploration or development, and this has led to a concern that he/she is a victim of sexual abuse.
• Child complains of pain in the genital or anal area AND there are other indications of sexual abuse.

Children living in the home engage in sexual behavior that is outside of normal exploration or involves coercion or violence.

Children and 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 (e.g., stripping) 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. Commercial sexual exploitation of children/youth/young adults may include prostitution, pornography, trafficking for sexual purposes, and other forms of sexual exploitation. The youth is treated as a sexual object and as a commercial object. The sexual exploitation of the child may profit a much wider range of people than the immediate beneficiary of the transaction.

• Caregiver actively involved child/youth in acts of exploitation or trafficking. Caregiver involves the child in obscene acts or engages the child in prostitution or pornography. This includes a child being commercially sexually exploited and/or sex trafficked by or with knowledge and consent of caregiver. In this circumstance, an allegation of sexual abuse should be applied to the caregiver AND any third-party perpetrators.
• Child/youth is exploited or trafficked by someone other than a caregiver. Child/youth is being comercially sexually exploited by a person who is not a caregiver. The extent to which a caregiver is involved in or aware of the abuse is addressed in separate screening criteria for both "Sexual Abuse: Sexual exploitation" and "General Neglect: Failure to protect." If this item is selected, an allegation of sexual abuse should be applied to only the alleged perpetrator(s) of the actual exploitation. Do not apply an allegation of sexual abuse to the caregiver.

No sexual act or exploitation has occurred; however, the caregiver behaves in ways that create a substantial likelihood that the child will be sexually abused.

• Known or highly suspected sexual abuse perpetrator lives with child. An individual with a known or suspected record for sexual crimes lives in the same residence as the child.
• Severely inappropriate sexual boundaries. Note: This does not include incidents that are accidental or inadvertent unless the report indicates that the behavior is persistent or frequently occurring.
  • Adults in the home allow children to see sexually explicit material, witness sexual acts, or hear sexual language that is inappropriate to their age/developmental status.

    AND

  • This has resulted in the child exhibiting age-inappropriate sexual behavior OR emotional distress.
  • Adult(s) in the household exhibits behaviors suggesting the purpose is sexual gratification for the adult.

Select this decision if no criteria in Section A are selected, which means that the report does not meet statutory requirements for an in-person response; however, a referral will be opened in the child welfare services case management system (CWS/CMS) for an in-person response due to local protocol. Indicate the type of referral (i.e., courtesy interview at law enforcement's request, residency verification, response required by court order, local protocol, or other).

• Insufficient information to locate child/family. The caller was unable to provide enough information about the child's identity and/or location to enable an in-person response. Select ONLY after following county protocol for attempting to discern identity/location from information provided by caller.
• Another community agency has jurisdiction, AND the report does not allege abuse or neglect in out-of-home care to a dependent or ward child/youth. Local protocol determines that an agency such as law enforcement, probation, or court will be the investigating entity for this issue AND a child welfare response is not required. Cross-report to Community Care Licensing and/or the appropriate agency as required by state regulation.
• Historical information only. Child is at least 10 years old AND the alleged maltreatment occurred more than one year ago, AND there were no reports of abuse or neglect since the alleged incident, AND the conditions that contributed to the alleged incident are no longer present. If reported incident is sexual abuse, all of the above criteria must apply AND the reported perpetrator must be either an unidentifiable non-household member, or deceased.

Select if the child is in out-of-home care and the allegations concern the substitute care provider AND county policy requires a response within 24 hours, making the referral an automatic 24-hour response. If not applicable, proceed to the decision trees.

If a child has already been taken into protective custody, the referral will be an automatic 24-hour response. Workers in differential response counties should proceed to Step IV, Path of Response Decision.

Medical care is immediately necessary and if not provided will seriously and possibly permanently affect the child's health and well-being. This includes treatment and/or evaluation of an injury that is needed or currently in progress. It does not include medical examination completed solely for forensic purposes.

Caregiver acted in brutal or dangerous ways; or the caregiver has made threats (other than empty threats or threats made solely for intimidation) of brutal or dangerous acts toward the child AND absent intervention, it is likely that the child will experience an injury within the next 10 days.

Include concerns of caregiver substance use/abuse or current mental health issues that may increase the risk of physical injury or result in physical injury.

Examples include but are not limited to:

• Hitting with closed fist;
• Hitting child's head, back, or abdomen with substantial force;
• Choking, kicking, or hitting with belt buckle or other dangerous object;
• Using restraints;
• Poisoning; or
• Other actions that could reasonably result in severe injury, such as:
  • Dangling the child from heights;
  • Exposing the child to dangerous temperature extremes; or
  • Throwing objects at the child that could cause severe injury.

The child has not reached his/her second birthday, or a child of any age has the capability of a child younger than 2 years of age due to developmental, physical, or emotional disability.

A nonperpetrating caregiver is aware that physical abuse has been alleged AND demonstrates the ability to prevent the alleged perpetrator from having access to the child. The nonperpetrating caregiver will not pressure the child to change his/her statement and will obtain or has obtained medical treatment for the child as needed.

• A child is vulnerable if, due to age, developmental status, or physical disability, he/she is unable to protect him/herself and/or will not be seen within the next week by other adults who would report concerns (e.g., school personnel).
• The child expresses credible fear of going/remaining home.

There is credible information that there are one or more prior investigations for physical abuse. (Include all investigations assigned for in-person response. If for a differential response county, include Path 2 and Path 3 referrals.)

Credible information includes statements by a reporter, verified information in CWS/CMS, or police reports.

There are physical altercations between the caregiver and another adult living in the home. Include situations where one of the adults does not live in the home but has substantial contact in the home, or has lived in the home but continues to behave in threatening ways.

Examples of behavior that threatens the health or safety of the child or others include but are not limited to the following:

• Attempted or threatened suicide.
• Cutting or other self-harmful behavior.
• Violent behavior toward others involving weapons.
• Threats of violence that involve weapons and there is reason to believe the child will carry out the threat.
• Violence toward very young or vulnerable children.
• Torturing or killing animals.
• Fire-setting behavior.

Examples include but are not limited to the following:

• The caregiver harms him/herself, others, or pets in the child's presence.
• The caregiver threatens to harm him/herself, others, or the child's pet.
• Unusual forms of discipline that rely on humiliation, fear, and intimidation, such as forcing a 10-year-old to wear diapers.
• Extreme rejection of the child, such as not speaking to the child for extended periods, acting as if the child is not present for long periods, or misusing time-out technique by using time limits far beyond what would be appropriate for the child's age/developmental status.
• Domestic violence incidents that involve weapons or result in serious injury to any adult, or during which the child attempts to intervene or is directly in the path of violence.

Medical or mental health care is necessary. If not provided within the next 10 days, the child's health and well-being will be seriously, and possibly permanently, affected. In addition to medical conditions, this includes extreme dental and mental health conditions.

Based on the child's age and developmental status, the child's physical living conditions are hazardous and immediately threatening. Examples include but are not limited to the following:

• Leaking gas from stove or heating unit.
• Substances or objects accessible to the child that may endanger his/her health and/or safety.
• Lack of water or utilities (e.g., heat, plumbing, electricity) and no alternative or safe provisions have been made.
• Open/broken/missing windows.
• Exposed electrical wires.
• Excessive garbage or rotted or spoiled food that threatens the child's health.
• Child has suffered serious illness or significant injury due to living conditions, and these conditions still exist (e.g., lead poisoning, rat bites).
• Evidence of human or animal waste throughout living quarters.
• Guns and other weapons are not locked.
• Illegal drug production in the home.

Based upon local community standards, the child is not receiving appropriate supervision from his/her caregiver, and there is no appropriate alternative plan for supervision within the next 10 days. Examples include:

• Child is currently alone (time period varies with age and developmental stage).
• Caregiver does not attend to the child to the extent that need for care/protection goes unnoticed or unmet (e.g., child being harmed by another person in the home/failure to protect; the caregiver is present, but the child can wander outdoors alone, play with dangerous objects, play on unprotected window ledge, or be exposed to other serious hazards; a child with some suicidal ideation is not closely monitored).
• Child is presently receiving inadequate and/or inappropriate child care arrangements.
• Child has been abandoned and has no caregiver willing and able to provide care for a minimum of 10 days.
• Child/youth is being sexually exploited or trafficked, and information exists that the caregiver is unable or failing to provide supervision that would address immediate safety concerns within the next 10 days.

A newborn who is substance-exposed or otherwise at high risk has been discharged or will be discharged within 10 days, AND the sole caregiver or both caregivers appear unwilling and unable to provide for the child upon discharge OR there is reason to believe the caregiver will remove the child against medical advice. Indicators include the following:

• The caregiver uses substances, such as methamphetamine, heroin, or cocaine, that typically result in severely impaired ability to function.
• The frequency and/or quantity of caregiver substance use suggests a high probability that he/she will be unable to meet the needs of the newborn upon discharge.
• Prior failed reunification.

Disclosure may be verbal or nonverbal (e.g., extreme sexual acting-out behavior). Medical evidence includes medical findings related to sexual abuse and suspicious findings such as sexually transmitted diseases in young children.

A nonperpetrating caregiver is aware that sexual abuse has been alleged, and he/she supports the child's disclosure AND demonstrates the ability to prevent the alleged perpetrator from having access to the child. The nonperpetrating caregiver will not pressure the child to change his/her statement and will obtain or has obtained medical treatment for the child as needed.

Law enforcement requests an immediate response. A law enforcement officer is requesting an immediate child protective services response.

Forensic considerations would be compromised by slower response. Physical evidence necessary for the investigation will be compromised if the investigation does not begin immediately, OR there is reason to believe statements will be altered if interviews do not begin immediately.

There is reason to believe that the family may flee. The family has stated an intent to flee or is acting in ways that suggest an intent to flee, OR there is a history of the family fleeing to avoid investigation.

Child safety requires a strategically slower response. The child's current location is such that initiating contact may create a threat to the child's safety OR the value of coordinating a multi-agency response outweighs the need for immediate response.

The child is in an alternative safe environment. The child is no longer in the same place or no longer with the caregiver who is the alleged perpetrator, and the child is not expected to return within the next 10 days (five days in Los Angeles).

The alleged incident occurred more than six months ago AND no maltreatment is alleged to have occurred in the intervening time period. The incident being reported occurred at least six months prior to the report AND no other maltreatment is alleged to have occurred in the intervening time period.

If reported concerns involve out-of-home care of a dependent or ward child/youth, the county where the approved or licensed facility is geographically located should respond to reports with a 24-hour response priority. Reports with a 10-day response priority should be referred to the placing county as soon as possible.

Credible information shows that there have been prior investigated referrals alleging maltreatment by a current caregiver of the child. (Credible information includes statements by a reporter, verified information in CWS/CMS, or police reports.) Include all allegation types and all dispositions (e.g., substantiated, inconclusive, unfounded). For differential response history, include all Path 2 and Path 3 responses. If prior investigation history is present, indicate the number of prior investigations as either one or two, or three or more.

Credible information shows that a current caregiver of the child has or has had a prior failed reunification for other children in his/her care, or a child in his/her care has died (not due to substantiated abuse or neglect).

Credible information shows that:

• A caregiver has a substance abuse problem.
  • The caregiver is diagnosed with chemical dependency or abuse AND is currently using. Current use does not require that the caregiver be under the influence at the moment of the call, but that the caregiver has used within the past two weeks and has not entered into a formal or informal program to achieve abstinence; OR
  • The caregiver is using illegal drugs; OR
  • The caregiver's alcohol use suggests a probability that dependency or abuse exists, such as blackouts, secrecy, negative effects on job or relationships, identified drinking patterns, etc.
• There are physical altercations between the caregiver and another adult living in the home within the past year, regardless of whether children were present. This includes situations where one of the adults does not live in the home but has substantial contact in the home, or has lived in the home but continues to behave in threatening ways.
• A caregiver has current mental health concerns based on a diagnosis of a major mental illness (e.g., schizophrenia, bipolar disorder, depression) or exhibits symptoms that suggest a probability that such a diagnosis exists, such as hearing voices, paranoid thoughts, severe mood changes, suicidal thoughts or behavior, or extremely depressed affect.

The reporter describes a service or resource need that does not rise to the level of screening threshold but could be addressed through a community agency.

Specify any other information that was used in determining the final path decision for evaluate out.

If conditions alleged by the reporter are true, they would constitute a crime against the child or would constitute the basis for a juvenile court dependency petition.

Current allegation is for sexual abuse.

Credible information shows that there have been prior investigated referrals alleging maltreatment by a current caregiver of the child. (Credible information includes statements by a reporter, verified information in CWS/CMS, or police reports.) Include all allegation types and all dispositions (e.g., substantiated, inconclusive, unfounded). For differential response history, include all Path 2 and Path 3 responses. If prior investigation history is present, indicate the number of prior investigations as either one or two, or three or more.

There has been an open family maintenance, family reunification, or permanency planning case involving any current caregiver; or there have been previous ongoing child protective services in another jurisdiction.

There are four or more children residing in the home who are alleged as victims of abuse or neglect in the current incident. Do not count children alleged to be “at risk” of abuse and/or neglect.

There is credible information that the primary, secondary, or both caregivers have a current mental health concern based on diagnosis of a major mental illness (e.g., schizophrenia, bipolar disorder, depression) or exhibit symptoms suggesting a probability that such a diagnosis exists, such as hearing voices, paranoid thoughts, severe mood changes, suicidal thoughts or behavior, or extremely depressed affect.

There is credible information that the primary caregiver was abused or neglected as a child.

• Mental health/behavioral problems not related to a physical or developmental disability (includes ADHD/ADD). This could be indicated by a Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis, receiving mental health treatment, attendance in a special classroom because of behavioral problems, or currently taking psychoactive medication.
• Developmental or physical disability, defined as a severe, chronic impairment that creates substantial functional limitations in three or more of the following areas of major life activity: self-care, language, learning, mobility, self-direction, potential for independent living, and potential for economic self-sufficiency as an adult.
• Medically fragile or failure to thrive, defined as having a diagnosed medical condition that can become unstable and change abruptly, resulting in a life-threatening situation (e.g., uncontrolled diabetes, required use of monitor, child is non-ambulatory and requires 24-hour care, required nasal gastric or gastronomy tube, tracheotomy) or diagnosis of failure to thrive.
• Positive toxicology screen at birth. Any child had a positive toxicology screen for alcohol or another drug at birth.
• Delinquency history. Any child in the household has been referred to juvenile court for delinquent or status-offense behavior. Status offenses that have not been brought to court attention but have created stress within the household should also be scored, such as children who run away or are habitually truant.

• The family has housing, but the current housing situation is physically unsafe to the extent that it does not meet the health or safety needs of the child (e.g., exposed wiring, inoperable heat or plumbing, roach/rat infestations, human/animal waste on floors, rotting food).
• The family is homeless or was about to be evicted at the time the investigation began. Consider as homeless people who are living in a shelter and those living on a short-term basis with relatives or friends.

There is credible information that a current caregiver injured a child due to abuse or neglect prior to the current allegation.

There were physical altercations between the caregiver and another adult living in the home within the past year, regardless of whether children were present. This includes situations where one of the adults does not live in the home but has substantial contact in the home, or has lived in the home and continues to behave in threatening ways.

• The caregiver is diagnosed with chemical dependency or abuse AND is currently using. Current use does not require that caregiver be under the influence at the moment of the call, but that the caregiver has used within the past two weeks and has not entered into a formal or informal program to achieve abstinence; OR
• The caregiver is using illegal drugs; OR
• The caregiver's alcohol use suggests a probability that dependency or abuse exists, such as blackouts, secrecy, negative effects on job or relationships, identified drinking patterns, etc.

Specify whether this applies to the primary, secondary, or both caregivers.

Specify any other critical risk factor that was used in determining the final path decision for in-person response.