Attachment 4 909A.pdf

Page 1 of 4 Attachment 909A 04-2022

Guidelines for the Pre-Adjudicatory Waiver Evaluation Summary Report of Family and Community Information

INSTRUCTIONS: The County Case Manager will prepare this report and submit it for review to the Consultation and Evaluation Services Administrator within 10 calendar days of the Family Court order for the waiver evaluation.

FAMILY INFORMATION:

1. Brief Family Description:

a. Describe the composition of the immediate family.

b. Note the deaths of immediate family members, if applicable.

c. Describe the extended family (grandparents, aunts, and uncles).

d. List the adults that live in the home and their relationship to the youth.

e. List the children that live in the home and their relationship to the youth. Note each child’s age. Note the jyouth’s birth order within his/her siblings.

f. Document the total number of adults and total number of children living in the home.

2. Brief Description of Parents’ Backgrounds:

a. Note the parent’s ages and birthplaces.

b. Note the educational level and educational background of each parent.

c. Note any unusual family background information.

3. Marital History:

a. Note the date of present marriage and current status.

b. Note the dates of past marriages and the outcomes (dates of divorce, death, etc.)

c. Note the remarriages and dates.

4. Family Unity and Emotional Atmosphere:

a. Describe any tensions in the home.

b. Describe the closeness of the parents to each other.

c. Describe the closeness of parents to the youth.

d. Describe the sense of unity within the family.

e. Describe the supportive atmosphere within the family.

f. Describe the conditions and or specific problems that may be contributing factor to the youth’s present situation.

5. Social Activities

a. Describe the activities in which the parents engage.

b. Describe the activities in which the parents and youth participate and the parents and the family participate.

6. Religious Activities:

SOUTH CAROLINA DEPARTMENT OF JUVENILE JUSTICE

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a. What religion does the family practice/believe?

b. Does the family have membership in a particular church?

c. Does the family attend church as a family unit? How often?

d. Is the youth in a church youth program?

7. Individual Behavior and Adjustment:

a. Describe the parental roles in the home.

b. Who is responsible for ensuring that the youth attends school?

c. What are the methods of discipline used in the home, and by whom?

d. Are the parents well-adjusted?

e. What are the parents’ goals and standards for the youth?

8. Health and Mental Health Information:

a. Note the current general health and serious health problems of the parents.

b. Note the current general mental health and serious mental health problems of the parents.

c. Who is the family doctor? Other doctors currently providing what services?

d. Does the family have health insurance, and if so, who is the provider and is mental health treatment covered under the plan?

e. Obtain a copy of the Immunization Record for the youth. (If the family does not have one, obtain from the youth's school.

9. Economic Practices:

a. Note the current employment (place and position) for each parent.

b. Note the employment background of each parent.

c. Are the finances earned adequate to support the family?

d. What is the estimated social/economic status of the family?

e. Does the family receive support and/or benefits, and if so, from whom and what type?

10. Home and Household Practices

a. Describe the general home, including the number of rooms in the home. Does the youth have his/her own bedroom?

b. Describe the general appearance of the home, including furnishings and cleanliness.

11. Neighborhood Conditions

a. Note the address, location, and directions of the youth's home.

b. Describe the general conditions of the neighborhood, including appearance, economics, and social conditions.

c. What type of relationship does the youth and his/her family have with the neighbors?

d. Describe the neighborhood resources, including recreation facilities, libraries, after-school programs and note if/how often the youth/family utilizes each of these resources.

e. What community groups (religious, mentoring, academic, substance abuse, etc.)

are available to assist the family? Has the family used these resources, and if so, when and how?

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12. Social Agencies Involvement

a. List the social agencies (Department of Social Services, Department of Mental Health, Department of Environmental Control, Department of Special Needs and Disabilities, etc.) that have assisted/are assisting the youth/family.

b. Document the agency, nature of assistance, inclusive dates of services provided, names of case workers, etc.

YOUTH’S HISTORY:

1. Youth's Previous Court History:

a. Document the youth's past contact(s) with the court.

b. Document the services rendered by DJJ to date.

c. Document the youth's past commitments to DJJ and its facilities/contracted facilities.

d. Note if the youth has been or is currently under probation and/or parole supervision.

d. Document siblings’ involvement with the court.

2. Physical Description of the Youth:

a. Document the youth's height, weight, hair color, eye color, and unusual physical characteristics.

b. Describe any tattoos the youth has.

3. Early Developmental History:

a. Did the youth's mother carry him/her the full 9- month term? If not, describe.

b. Was the youth's birth a normal delivery? If not, describe.

c. At what age did the youth talk? Walk?

d. Were there any concerns with the parents/physicians about the youth's early years? If so, what, why and how addressed.

4. Home Adjustment

a. Describe the youth's perception of his/her relationship with his/her parents.

b. Describe the youth's perception of his/her relationship with his/her siblings.

c. According to the youth, to what extent does the juvenile accept parental directions, authority, discipline, and control?

d. According to the youth, is his/her home situation cause or contributing factor in his her present court situation? Describe.

5. Religious Training:

a. Does the youth attend church?

b. Does the youth want/desire to attend church?

c. Does the youth believe religion is important in his/her life?

d. Does the youth attend any other church/religious programs or activities? If so, describe.

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6. Physical and Health History:

a. Describe any past physical defects and/or known special needs and any services provided to address those defects and special needs.

b. Are there current special needs or physical? If yes, describe.

c. Describe the youth's history of serious physical illness.

d. What current medication is the youth taking, why, and how often?

e. Does the youth need any medication?

7. Psychological and Psychiatric Information:

a. Describe any past mental health diagnosis, youth's age, who made the diagnosis, the treatment and services provided, medication, and the youth's current status.

b. Was/is the youth identified as special needs for mental health reasons? If yes, describe.

c. List psychological assessments, evaluations, and in-patient and out-patient services and obtain copies of reports/discharge summaries.

d. When was the youth last evaluated for mental health, and by whom? (Obtain copies).

8. School Information (Obtain from the School Officials):

a. Document the name and address the youth attends.

b. Document the grade the youth is currently assigned to.

c. What is the youth's reading and math level and any other standardized test scores (i.e., MAP, PACT, etc.).

d. Has the youth failed any grades, and if so, which ones and why?

e. What is the youth's school attendance record?

f. What is the youth's behavior record? What types of behavior does the youth exhibit during class?

During non-class school activities?

g. Is the youth identified as special needs or special education? What are the youth's specific disabilities? Does the youth have an AD504 Plan? If so, obtain a photocopy.

h. Are there school situations that appear to lean toward delinquent behavior?

9. Recreational Interests and Activities:

a. Describe the youth's recreational interests.

b. Describe the youth's hobbies.

c. Describe the youth's peer relationships.

d. Do these peer relationships reflect delinquent behavior?

10. Employment, Vocational, and Economic History

a. Describe the youth's past and present employment.

b. Describe the youth's desire and/or ideas about his/her future employment and/or vocation.

c. Describe any skills the youth has developed for employment.