MISSOURI DEPARTMENT OF SOCIAL SERVICES CHILDREN’S DIVISION Critical Event Case Review – Resource Families
Attach a copy of the CS-23 for the critical event being reviewed.
Complete only for Resource Family. For all other critical events use CD-164.
Name of Child	DCN
Reviewer	Date Review Completed
Resource Family Name:	Length of Time as Resource Home
Current CA/N Incident Number	Current CA/N Incident Date
Critical Event Circuit/County	Foster Care Case Management Agency (if Applicable)
Type of Home: (Check all that apply)
Licensed Relative/Kin	Unlicensed Relative/Kin	Traditional Foster
Medical Foster	Foster Family Group	Respite
Elevated Needs Level A	Elevated Needs Level B	Adoptive
What is the current status of the resource home license? (if applicable)
Summary of Critical Event (please include the most recent information available):
Household Composition: (name, DOB, role)
Answer each of the following questions for the Current Critical Event:
How was safety assured for all children in the home?
Were children removed from home because of the critical event? Yes No Explain:
If applicable, is communication with members of the Family Support Team regarding the critical event documented in the record? Please explain.
Additional Reviewer Comments: