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GEORGIA DEPARTMENT OF HUMAN RESOURCES

RISK ASSESMENT SCALE OF ABUSE/NEGLECT
Complaint Date
Case Name

     
     

Case #      

County      

Case Manager      

Neglect

Score

N1. Current Complaint is for Neglect
a. No
b. Yes
N2. Number of Prior Investigations
(substantiated or unsubstantiated)
a. None
b. One
c. Two or more
N3. Number of children in the home
a. Two or fewer
b. Three or more

0      
1      
0      
1      
2      
0      
1      

N4. Number of adults in home at time of
complaint
a. Two or more
b. One/None

0      
1      

N5. Age of primary caretaker
a. 30 or older
b. 29 or younger

0      
1      

N6. Characteristics of primary caretaker
Check and add for score
a. Not applicable
b. Significantly lacks parenting skills
(inability/unwillingness to care for
children)
c. Significantly lacks self-esteem
(withdrawn, lacks confidence)
d. Apathetic or hopeless (overwhelmed, indifferent, decline in
hygiene)
N7. Primary caretaker involved in harmful
relationships during the investigation
period
a. No
b. Yes, but not a victim of domestic
violence
c. Yes, as a victim of domestic
violence
N8. Primary client has a current substance
abuse problem
a. No
b. Yes
c. Other drugs (with or without alcohol

CPS_457 Risk Assessment

0      

1      
1      

1      

0      
1      
2      

0      
1      
2      

(Revised 09/06)

Date      
CM ID#      
Abuse

Score

A1. Current Complaint is for Abuse
a. No
b. Yes
A2. Prior abuse investigation (substantiated
or unsubstantiated)
a. None
b. Abuse complaints (except sexual abuse)
c. Sexual abuse complaints
d. Both b and c
A3. Prior CPS ongoing services history
a. No
b. Yes, family has received ongoing
services

0      
1      
0      
1      
2      
3      
0      
1      

A4. Number of children in the home
a. One
b. Two or more

0      
1      

A5. Caretaker(s) abused as children
a. No
b. Yes

0      
1      

A6. Secondary caretaker has a current
Substance abuse problem
a. No, or no secondary caretaker
b. Yes (check all that apply)
Alcohol abuse problem
Drug abuse problem

0      
1      

A7. Primary or secondary caretaker employs
excessive and/or inappropriate discipline
a. No
b. Yes

0      
2      

A8. Caretaker (s) has a history or domestic
violence
a. No
b. Yes

0      
1      

A9. Caretaker is a domineering parent (rate
both primary and secondary caretaker)
a. No
b. Yes

0      
1      

A10. Child in the home has a development
disability or history of delinquency
a. No

0      

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N9. Household is experiencing severe
financial difficulty
a. No
b. Yes

0      
2      

N10. Primary caretaker’s motivation to improve
parenting skills
a. Motivated and realistic (agrees with
and follows safety plan)
b. Unmotivated, does not agree with
and/or does not sign safety plan
c. Motivated but unrealistic, agrees
with safety plan, but unable to
follow it
N11. Caretaker response to investigation
(rate both primary and secondary CT)
a. Viewed situation as seriously as
case manager
b. Viewed situation less seriously
than case manager
c. Failed to cooperate
d. Both b and c
TOTAL NEGLECT RISK SCORE

0      

b. Yes
Developmental disability
including emotionally impaired
History of delinquency
A11. Secondary caretaker motivated to improve
parenting skills
a. yes, or no secondary caretaker in
home
b. No

1      

0      
2      

1      
2      

A12. Primary caretaker views incident less
seriously than case manager
a. No
b. Yes, refused to sign safety plan
and/or minimizes incident

0      
1      

0      
2      
2      
3      
     

TOTAL ABUSE RISK SCORE

     

Risk Level: Assign the family’s risk level based on the
Highest score on either scale, using the following chart.
Neglect Score
      0 - 4
      5 -11
      12 - 20

Abuse Score
      0 - 3
      4 - 8
      9 - 16

Assigned Risk Level
      Low
      Moderate
      High

Service Disposition (check one)
1.
2.
3.
4.
5.
6.
7.
8.

Case remains open
Close – Low risk case
Close for CPS and transfer to foster care
Close – Perp no longer has access to child victim(s)
Close – Unsatisfactory family response – court not feasible
Close – CPS services not needed – referred to other program
Close – Clients unavailable for services – location of clients unknown
Other

Supervisor’s Review      

Date      

Policy Override Required (Override to High reason 1-6. Check appropriate reason)
1. Sexual abuse case where the maltreater is likely to have access to a child victim
2. Non-accidental physical injury to an infant or physical injury or threat of physical injury to a child with a disability.
3. Non-accidental physical injury that requires hospitalization or medical treatment.
4. There is medical documentation of abuse
5. Non-accidental injury to a child age four and younger.
6. Death (previous or current) of a sibling as a result of abuse or neglect.
7. Other / Optional. Reason      
Override Risk Level

Low

Supervisor’s Review / Approval of Optional Override      

CPS_457 Risk Assessment

(Revised 09/06)

Moderate

High
Date      

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