Child Protective Service Report, CFS-2090



Present Danger Threats – Case Application

Directions

The goal of this worksheet is for you to identify present danger threats. This document provides you with a CPS Report and additional information from the reporter. Please read these sections first, and then complete the present danger threat application on page 6. Find a time to meet with your supervisor about your responses and the correct answers.

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CHILD PROTECTIVE SERVICE REPORT

|Case Name |Worker Safety Concerns |Report Number |

|Roger Pugent |X |Yes | |No |xxxxxx |

|Date and Time Report Received |CPS Report Type |County |

|6/27/xxxx 1:25 pm |Primary Caregiver |Any county |

|Name - Worker |Name - Supervisor |

|Allen Access      |Susan Sup |

|I. |Family Information |

| |Name - Family |Telephone Number – Home |

| |Roger Pugent |279-0937 |

| |Address - Street |Apt. No. |City / Town |State |Zip Code |

| |2345 Townline Road |      |Your town |WI |55555 |

| |Primary Language: |English |Interpreter Needed: | |Yes |X |No |

| |Address instructions |

| |West on County JJ, left on Pleasant View (4 miles), right on Townline (2 miles), long driveway on right |

| |A. |Household Members |

| | |Name |Role|Relationship |DOB |Age |Gender |

| | |HM |= |Household Member |B |= |Black |

| | |NM |= |Non-Household Member |I |= |American Indian / Alaskan Native |

| | |PN |= |Parent / Parental Role |P |= |Native Hawaiian / Other Pacific Islander |

| | |RN |= |Report Name |U |= |Unable to Determine |

| | | | | |W |= |White |

| | | |

| | |Information that the and/or family may have American Indian heritage, including names of tribe(s) if known. |

| | |Reporter doesn’t think so; certain no Indian heritage on father’s side |

| |B. |Parent(s) Not in Home / Other Non-Household Members |

| | |Name |

| | |Alleged Victim |Relationship to Victim |A/N Code |Description |F |

| | |Kristiann Pugent |Father |Physical Abuse |Not observed |No |

| | | | | |

| | | F |= |Fatality |

| |D. |Location of Incident |

| | |Address - Street |Apt. No. |City / Town |State |Zip Code |

| | |2345 Townline Road |      |Your town |WI |55555 |

| | |Telephone Number - Home |Telephone Number - Work |Date and Time of Alleged A / N |

| | |279-0937 |      |6/26/xxxx |

| |E. |Contacts / Others with Information About Family |

| | |Harry and Ellen Pugent, Roger’s parents, Mason, Iowa – no contact information |

|II. |Narrative |

| | |Describe alleged maltreatment: current and past; the surrounding circumstances; and the frequency or intervention or services needed for the child. |

| | |Roger appeared at this home Monday night (6/23) with Kristiann and asked to stay. No money, little |

| | |gas, belongings in truck. Had nowhere else to go. Cousin let them stay. Since staying there, Roger hits |

| | |at child, constantly threatens with paddle (old ping pong paddle). Roger hits child on back, buttocks, |

| | |arms or legs with his hand and closed fist to make her do work or keep quiet. Any injuries would be |

| | |under clothing. Hits her hard enough to shove her. Reporter hasn’t witnessed use of the paddle. Orders |

| | |child to do things around the house (clean, make food, care for pets, etc.) and yells until done. Reporter |

| | |doesn’t know about past abuse. Has had very little contact with them in recent years. Last saw Kristiann |

| | |when she was a baby. |

| | |Since yesterday, Kristiann seems to have trouble sitting down, grimace with pain when tried. When |

| | |reporter asked her about it, Roger yelled at reporter and Kristiann. Wouldn’t let child answer. Has kept |

| | |child separate and under constant supervision so she can’t talk to reporter. |

| | | |

| | |Describe the child(ren)’s injury or conditions as a result of the alleged maltreatment or services needed. |

| | |Reporter has not seen injuries. Present concern – child cannot sit without pain. Reporter cannot see |

| | |injury or talk to child about it. |

| | |Child seems to try to avoid Roger. Flinches when he talks. Stays out of arm’s reach when she can. |

| | |Doesn’t make eye contact with Roger or reporter. |

| | | |

| | |Describe the child(ren)’s current location, school/daycare including dismissal time, functioning, including special needs, if any, and highlighting |

| | |current vulnerability. |

| | |Roger and Kristiann have been staying at Roger’s cousin’s house since Monday (6/23) evening. |

| | |Kristiann is very quiet – doesn’t initiate conversation or eye contact. Hard to judge developmental level |

| | |due to little direct contact. Sometimes sits and rocks body. Watches TV. Seems to like the dog – pets it |

| | |and lays head on it. |

| | | |

| | |Document relevant information from CPS history, CCAP and Sex Offender Registry-Reverse Address checks (if no relevant information found, document that |

| | |checks were completed). |

| | |Checks completed; no information found. |

| | | |

| | |Describe when the alleged maltreater will have access to the child. |

| | |Roger is always at the house with Kristiann and will not let anyone talk to her alone. Reporter doesn’t |

| | |know any plans. Wants them out. No sign they are leaving. |

| | | |

| | |Describe any changes in circumstances that may make it difficult to fulfill CPS responsibilities |

| | |Roger may become worried about CPS or law enforcement involvement and leave with Kristiann. |

| | | |

| | |Describe presence of domestic violence, if applicable, including the demonstration of power and control and entitlement within the home environment. |

| | |No domestic violence in current household. Don’t know of history. |

| | | |

| | |Describe how the family may respond to intervention by the agency, including the parental protective capacities. |

| | |Reporter fears how Roger may respond. She wants him to leave the home but is afraid of him. Has hinted for him to leave but he ignores it. Asks her |

| | |if she is turning against him, too. Reporter keeps her son away from the home unless she is there. Fears Roger may be dangerous. Doesn’t know about |

| | |weapons, but the extended family has always hunted a lot and weapons are common. Roger’s current behavior is scary and seems paranoid. Fears he is |

| | |being followed, doesn’t go outside or allow Kristiann to go outside. |

| | | |

| | |DESCRIBE ANY PRESETN DAGNER THREATS , INCLUDING A DESCRIPTION OF POSSIBLE |

| | |OR LIKELY EMERGENCY (EXIGETN) CIRCUMSTANCES |

| | |[You must determine] |

| | | |

| | |THE FOLLOWING SECTION MUST BE COMPLETED FOR ALLEGED MALTREATMENT BY PRIMARY CAREGIVER OR PARENTAL CONTRIBUTION TO THE MALTREATMENT: |

| | |Describe the parents or adults in the parental role: current location, functioning, and parenting practices and views of child(ren). |

| | |Reporter has not seen Roger since she left Iowa fifteen years ago. Showed up with nowhere else to go |

| | |and she couldn’t turn him away. Said he could stay a little while. Reporter doesn’t know how he |

| | |located her. Thought he seemed odd at first but attributed it to long trip, tired, etc. His behavior while |

| | |in the home has become increasingly disturbing. Orders Kristiann around and threatens her. Occasional |

| | |unpredictable outbursts of swearing and yelling. Keeps all windows covered and won’t let anyone open |

| | |them. Peeks out often and makes references to people who may be following them. Reporter doesn’t |

| | |know nature of this – could be someone really is or could be paranoid thinking. Says weird things - |

| | |“You never know when they won’t try to get you.” Many times per day asks Kristiann “Are you with |

| | |me or against me?” and she must answer “I’m with you, Daddy” or he yells and repeats until she |

| | |answers. |

| | |Reporter is afraid of him and wants him out. Afraid of what will happen to Kristiann. |

| | | |

| | |Describe the family functioning, strengths and current stressors. |

| | |Roger never had much to do with extended family. Relationship with cousin because Roger lived with |

| | |their family for about a year when he was about 10 years old. Reporter doesn’t know why but says |

| | |Roger’s family was always “weird”. Doesn’t know where Shawna is. Last reporter knew, she was |

| | |living with Roger, Kristiann and two younger children. When asked about her, Roger ranted about |

| | |disloyalty and called Shawna names. Won’t respond to any further questions. Won’t let reporter talk to |

| | |Kristiann. |

| | |Family lived in Mason, Iowa. Reporter never knew much about the family. They are here with truck |

| | |full of belongings – some furniture, tools, etc. Don’t seem to have many clothes. All still packed in |

| | |truck. Don’t seem to have any money. Won’t talk about plans. |

| | | |

| | |DESCRIBER THE POSSIBLE OR LIKELY IMPENDING THREATS TO CHILD SAFETY |

| | |(Not identified for this exercise.) |

| | | |

| | |Document the name of the alleged maltreater and relationship to child. |

| | |Roger Pugent – Father of Kristiann |

| | | |

|III. |Agency Response |

| |A. |Supervisor Screening Decision |

| | |Decision |Date / Time Decision was Made |

| | |      |      |

| | |Response Time |Reason |

| | |      |      |

| | |Explain |

| | |      |

| |B. | Yes No Law Enforcement Notified |

| | | Yes No After Hours Report |

| | | |

| | | |

|IV. |Signatures |

| | |

| | | | | |

| | SIGNATURE - Worker | |Date Signed | |

| | |

| | | | | |

| |SIGNATURE - Supervisor | |Date Signed | |

Information pertaining to the reporter’s motivation and source of information (if known/possible to obtain)

Reporter is calling today as she is very afraid for Kristiann’s safety. She wants Roger out of her home but is afraid of him. Reporter has witnessed Roger’s behavior firsthand and is very concerned he is dangerous to Kristiann, herself and her son. While reporter wants Roger out of her home, she is concerned about what will happen to Kristiann if Roger leaves with her as she doesn’t think Kristiann is safe alone with him. Reporter thinks Roger needs to be “locked up.”

Reporter seems credible. She is clearly very frightened by his behavior.

When asked about any other information that would be important for CPS to know, the reporter shared that she has a midsize mixed breed dog that has never been dangerous to others. Lives in isolated rural home. Fears Roger may have weapons. Roger talks a lot about people coming to get him and he won’t let that happen.

Present Danger Threats Application

You have had a chance to read both the access report and the information from the reporter.  Take a few moments to list the present danger threats that you can identify.  You may either type them below and then print the document, or print the document first and then write them in. Consult your supervisor about the answers. 

Present danger threats you identify:

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