MISSOURI DEPARTMENT OF SOCIAL SERVICES CHILDREN’S DIVISION Critical Event Case Review – Prior CA/N
Incident Case #	Report/Case Type	Open Date	Close Date
Child/Victim Name	Alleged Perpetrator
Reason this prior case is relevant to critical event:
Allegations:
Findings:
Household Composition: (name, age, role)
Family Strengths
As identified in Case File:
As identified by Reviewer:
Family Challenges: (such as history of substance abuse including mom during pregnancy, mental/physical/behavioral issues, including post partum depression, domestic violence, criminal convictions, financial stressors)
As identified in Case File:
As identified by Reviewer:
Was initial contact made according to policy guidelines? Yes No
If no, explain:
Was there a safety assessment?
Yes - Date of completion:
No (If no explain)
Was there a Safety Plan?
Yes - Date of completion:
No (If no explain)
Did the Safety Plan address the needs identified by the family and the worker? Yes No
If no, explain.
Is there a documented consultation with the Chief Investigator/supervisor? Yes No
What was discussed during the consultation with the Chief Investigator/supervisor?
What service needs were identified or offered? (explain)
What services were utilized by the family?
Were collateral/professional provider contacts appropriately used and documented to address the identified issue? Yes No
Provide examples:
Was a written referral made to the Juvenile Court? Yes No
If yes, discuss the request and the outcome.
If no, discuss why not.
Additional Reviewer Comments