Chrysalis Health - The Center for Child Welfare
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BROWARD SHERIFF’S OFFICE
Child Protective Investigations Section (Circuit 17)
Human Trafficking (HT)
Commercially Sexually Exploited Child (CSEC) / Domestic Minor Sex Trafficking (DMST)
Multi-Disciplinary Safe Harbor Assessment Staffing Report
|For Office Use Only |Youth’s L/N: |Youth’s F/N: |Youth’s M/N: |
|Previous CSEC/HT staffed : Yes No |If Yes dates: |Previous MSST staffed : Yes No |If Yes dates: |
|FSFN # : |Date Report: |Date Staffing: |Fax: 954-327-2764 |
|CPI: |Desk: (954) |Cell #: (954) |Email: @ |
|CPI Sup.: |Desk: (954) |Cell #: (954) |Email: @ |
|1. ALLEGATIONS |
| |
|2. CURRENT RISKS/CONCERNS (Identified by CPI, LE, or other professionals) |
| |
| |
|3. DEMOGRAPHICS |
|Youth’s Last Name: |First Name: |Age: |DOB: |Gender: |Race: |
| | | | | | |
|# of Children in family? |
|(All siblings) |
| |
|In-Home: Yes No |JAC: Yes No |DJJ: Yes No |Youth Shelter: Yes No |
| | |Location: |Location: |
|Short Term Safe House: Yes No |Safe House: Yes No |Group Home: Yes No |Foster Home: Yes No |
|Location: |Location: |Location: | |
|Home address: |City: |Zip Code: |Contact #: |
|School Name/City: |Grade Level: |Tardiness: Yes No |Academic difficulties? |
| |GPA: |Truancies: Yes No |Yes No |
|Family Culture: |Youth’s Primary Language: |Parent’s Primary Language: |
|Parent/Guardian L/F Name: |Local Address: |City: |Zip Code: |Phone#: |
| | | | | |
|Parent/Guardian L/F Name: |Local Address: |City: |Zip Code: |Phone#: |
| | | | | |
|Does case involve person(s) needing communication assistance? Yes No If Yes, who: Youth Mother Father |
|Caregiver/Other Name: Name: |
|Check all applicable: Deaf or hard of hearing Visually impaired Limited English Proficiency |
|5. RUN-A-WAY YOUTH |
|Has the Youth ever run-a-way? |How many incidents? |How long and where to? |Was LE notified: Yes No |
|Yes No | | |How many times: |
|Active Run-a-way |If Yes, missing persons report filed with LE and entered into FCIC/NCIC? |If Dependent run-a-way - Pick-Up Order |
|Yes No |Yes No LE Case #: Entered into FCIC/NCIC: Yes No |issued? Yes No |
|Where did the Youth “run to?” |With whom did the Youth stay with while a runaway? |
|With whom did the Youth runaway? |Name of location where the Youth went, e.g. City, State. |
|6. SERVICES |
|Past Services: |Case Manager Last/First Name: |Phone#: |
| | | |
|Current Services: |Case Manager Last/First Name: |Phone#: |
| | | |
|7. DJJ STATUS |
|Did LE take the youth into custody during this |If Yes, Law Enforcement Agency: |Case Number: |LE Name: |
|investigation? | | | |
|Yes No | | | |
|DJJ Custody? Yes No |Release to Parent/Guardian? Yes No |On House Arrest? |
|Facility: |Location: |Yes No |
|BSO Juvenile Assessment Center (JAC) Shared Hope International INTERVENE Screening Tool: |
|JAC Report to Abuse Hotline attached: Yes No |
|Tier 2 Assessment attached: Yes No |
|Psychosocial Assessment attached: Yes No |
|GAIN-Q (QRRS) attached: Yes No |
|List concerns and recommendations from assessment report: |
|Youth on Probation? |Probation/Court Restrictions? |JPO Last/First Name: |Phone #: |
|Yes No | | | |
|8. DEPENDENCY |
|Adjudicated Dep. Yes |If Yes, court case: |Dependency Case #: |If Open, CA Last/First Name: |CA Phone#: |
|No |Open Closed |Jurisdiction County: | | |
|Current Placement: | Parent | Relative | Non-Relative | Lic. Placement |
|9. PRIOR ABUSE/NEGLECT/ABANDONMENT HISTORY WITH THE YOUTH AND ANY FAMILY MEMBERS CONNECTED WITH THE YOUTH. (Prior Abuse History with YOUTH and any FAMILY members connected|
|with the YOUTH. List Abuse Report #, each maltreatment and its finding, and intervention/services. Identify if the YOUTH (Y) was the V/C of the abuse report and/or If |
|another child (OC) was the V/C of the abuse report. |
|If extensive prior abuse/neglect/abandonment and a separate report is |FSFN# or Other State: |
|completed then attach to the HT- CSEC/DMST Safe Harbor assessment |Maltreatment/Finding, and Intervention/Services: |
|report. |If the YOUTH was the V/C of the report, check Y. |
|If attachment, check box: |If another child was the V/C of the report, check OC. |
|Florida Department of Children and Families | |
|Yes No | |
|Abuse Investigation from another state | |
|Yes No | |
|List state(s): | |
| |FSFN# or Other State: |
| |Maltreatment/Finding, and Intervention/Services: |
| |If the YOUTH was the V/C of the report, check Y. |
| |If another child was the V/C of the report, check OC. |
| |FSFN# or Other State: |
| |Maltreatment/Finding, and Intervention/Services: |
| |If the YOUTH was the V/C of the report, check Y. |
| |If another child was the V/C of the report, check OC. |
| |FSFN# or Other State: |
| |Maltreatment/Finding, and Intervention/Services: |
| |If the YOUTH was the V/C of the report, check Y. |
| |If another child was the V/C of the report, check OC. |
| |FSFN# or Other State: |
| |Maltreatment/Finding, and Intervention/Services: |
| |If the YOUTH was the V/C of the report, check Y. |
| |If another child was the V/C of the report, check OC. |
| |FSFN# or Other State: |
| |Maltreatment/Finding, and Intervention/Services: |
| |If the YOUTH was the V/C of the report, check Y. |
| |If another child was the V/C of the report, check OC. |
| |FSFN# or Other State: |
| |Maltreatment/Finding, and Intervention/Services: |
| |If the YOUTH was the V/C of the report, check Y. |
| |If another child was the V/C of the report, check OC. |
| |FSFN# or Other State: |
| |Maltreatment/Finding, and Intervention/Services: |
| |If the YOUTH was the V/C of the report, check Y. |
| |If another child was the V/C of the report, check OC. |
|Check all maltreatments identified in above section that the YOUTH or | Sexual Abuse | Bone Fracture | Bizarre Punishment |
|any FAMILY member has been investigated. |Physical Injury |Abandonment |Inadequate Supervision |
|This includes out of state prior abuse history, if the youth is |Mental Injury |Asphyxiation |Family Violence TH Child |
|currently in foster care/group home, DJJ facility or has been TPR. |Child-on-Child |Substance Misuse |Malnutrition/Dehydration |
|Additional information: |Medical Neglect |Failure to Thrive |Environmental Hazards |
| |Threaten Harm |Special Conditions |Excessive Corporal – |
| |Burns |Internal Injuries |Punishment |
| |Death |Neglect | |
| |Failure to Protect |Human Trafficking | |
|10. CSEC/DMST IDENTIFYING QUESTIONS |
|For the following sections, please be advised that “no” may also refer to “none reported,” whereas “unknown” is reserved for that information which is not known at the |
|time of this report. |
|10a. Is the youth CURRENTLY experiencing or witnessing any abuse, | Yes No | Physical Abuse | Death Family/Friend |
|neglect, domestic violence and/or other traumatic event? |Unknown |Sexual Abuse |Substance Misuse |
| |If Yes, (Check all |Neglect |Parent’s Separated/Divorce |
| |applicable) |Abandonment | |
| | |Mental Injury | |
| | |Bullying | |
| | |Domestic Violence | |
| | |Human Trafficking | |
| | |Additional information: |
|10b. Is this a vulnerable youth? | Yes No | Throwaway/Abandon | Lock-Out |
| |Unknown |Victim Physical Abuse |Homeless |
| | |Victim Neglect |Delinquent (DJJ) |
| |If Yes, (Check all |Victim Sexual Abuse |Promiscuous |
| |applicable) |Victim Mental Injury |Isolated |
| | |Juvenile Sex Offender |Substance Abuse |
| | |Child on Child | |
| | |Mental Health | |
| | |Runaway | |
| | |Ungovernable | |
| | |Additional information: |
|10c. Does the youth break curfew? | Yes No | Keeping late nights |
| |Unknown |Unusual hours |
| | |Youth does not follow house rules (Family home, youth shelter, or group |
| |If Yes, (Check all |home). |
| |applicable) |Explain: |
|10d. Is the youth secretive? | Yes No | Friends/Acquaintance |
| |Unknown |Unaccounted Time |
| |If Yes, (Check all |Vagueness concerning whereabouts |
| |applicable) |Defensiveness to questions or concerns |
| | |Sneaks out of home |
| | |Explain: |
|10e. Does the youth have social functioning problems? | Yes No | Poor Social Skills | Social Isolation |
|If Yes, (Check all applicable) |Unknown |Poor Peer Relationships | |
|10f. Is or has the youth used any drugs/alcohol/substances? | Yes No | Crack | Marijuana | Scizzurp |
| |Unknown |Ecstasy |Cocaine |Meth/Crystal |
| |If Yes, (Check all |Alcohol |Prescription Meds |Rohypnol |
| |applicable) |PCP |Heroine |Bath Salts |
| | |GHB |Amphetamines | |
| | |K-2 |Xanax | |
| | |Mollies |Spice | |
|10g. Did the youth use any substances with the trafficker or supplied | Yes No | Crack | Marijuana | Scizzurp |
|by the trafficker? |Unknown |Ecstasy |Cocaine |Meth/Crystal |
| |If Yes, (Check all |Alcohol |Prescription Meds |Rohypnol |
| |applicable) |PCP |Heroine |Bath Salts |
| | |GHB |Amphetamines | |
| | |K-2 |Xanax | |
| | |Mollies |Spice | |
|10h. Does the youth have a history of mental health DX or instability?| Yes No | Baker Act | Impulse Control Problems |
| |Unknown |Suicidal Ideation |Uncontrollable anger |
|Additional Information: | |Mood Disorder |Withdrawn/Isolated |
| |If Yes, (Check all |Depression |Reduced Empathy |
| |applicable) |Anxiety |Oppositional Defiant |
| | |Bi-Polar |Criminal behavior |
| | |ADHD |Paranoid |
| | |Hyper vigilance |Youth is fearful |
| | |Lack of eye contact |Inability to trust |
| | |Hyper-sexualization |Self-destructive |
| | |PTSD | |
| | |Cutting/Mutilation | |
| | |Substance Abuse | |
| | |Marchman Act | |
| | |Additional information: |
|10i. Does the youth have any current or prior criminal charges? | Yes No | Domestic Battery | Trespassing |
| |Unknown |Resisting Arrest |Burglary |
| |If Yes, (Check all |Obstruction |Loitering |
| |applicable) |Assault |Shoplifting |
| | |Robbery |Fraud |
| | |Battery |DUI |
| | |Agg. Battery |Drug Possession/Sell |
| | |VOP |Prostitution/Soliciting |
| | |Failure to Appear |Disruption/School Function |
| | |Pick-up Order |Concealed/Possession Weapon |
| | |Open Container | |
| | |Grand Theft | |
| | |Petty Theft | |
| | |Additional information: |
|10j. Does the youth have a history of sexual victimization? Explain: | Yes No | Incest | Stranger |
| |Unknown |Mother’s paramour |Sexually exploited |
| |If Yes, (Check all |Relative | |
| |applicable) |Friend | |
| | |Sibling | |
| | |Acquaintance | |
|10k. Has or is the youth been a victim in the criminal courts? | Yes No | Sexual Abuse | Neglect |
| |Unknown |Physical Abuse |Witness to crime |
| |If Yes, (Check all |Mental Injury | |
| |applicable) |Domestic Battery | |
|10l. Does the youth have a history or current STD’s? | Yes No |If Yes, explain? |
| |Unknown |Is the Youth receiving medical treatment? |
| | |Has the Youth received medical treatment? |
|10m. Is or has the youth been pregnant? | Yes No |If Yes, how many pregnancies? |
| |Unknown |How many abortions: |
| | |Where is the youth’s minor child? |
| | |Is the Department (DCF) involved, explain? |
|10n. Does the youth have a social networking account or advertising | Facebook | MySpace | Skype | black gay chat |
|account? |Backpage |Craigslist |YouTube |myYearbook |
| |Twitter |Meetup |Flickr |my red book |
|Yes No Unknown |Instagram |Tagged |SnapChat |vampire freaks |
|If Yes, (Check all applicable) |Badoo |Ning |Tumblr | |
| |Rentboy |Jack’D |Mobli | |
| |Adam4Adam |Blendr |WhatsApp | |
| |xanga |sipsap |LINE | |
| |MoCo |Orkut |KakaoTalk | |
| |Grindr |myLife |WeChat | |
| |Scruff |Houseboy |BlackPlant | |
| |Social Media Name(s): |
| |Additional information: |
|10o. Has the youth been exploited on the internet, online ads? | Yes No |If Yes, explain: |
| |Unknown | |
|10p. Does the youth have an adult boy/girlfriend? | Yes No |If Yes, describe the relationship: |
| |Unknown |What is the adult boy/girlfriend age? |
|10q. Is the youth a member of a gang? | Yes No |If Yes, name of gang: |
| |Unknown | |
|10r. Does the youth have FRIENDS who are members of a gang? | Yes No |If Yes, name of gang: |
| |Unknown | |
|10s. Has the youth exchanged sexual favors/activity/photos for | Yes No | Shelter | Sexual Favors | Activities |
|necessities and or gifts? |Unknown |Money |Hair/Nails/Clothing | |
| |If Yes, (Check all |Photos |Cell Phone/Electronics | |
| |applicable) |Food |Unexplained gifts | |
| | |Drugs |Social Activities/Clubs | |
|10t. Does the youth have tattoos and or piercings? |Face: |RT Upper Arm: |RT Thigh: |
| |Front Neck: |LT Upper Arm: |LT Thigh: |
|Yes No Unknown |Back Neck: |RT Forearm Arm: |LT Lower Leg: |
|If Yes, describe tattoo and location on the body. (Check all |Inner Lip: |LT Forearm Arm: |RT Lower Leg: |
|applicable) |Chest: |RT Hand: |RT Ankle: |
| |LT Breast: |LT Hand: |LT Ankles: |
| |LT Breast: |RT Buttocks: |LT Foot: |
| |Upper Back: |LT Buttocks: |RT Foot: |
| |Lower Back: |Stomach: |RT Hip: |
| |Other: |Other: |LT Hip: |
| |Other: |Other: |Other: |
|10u. Is the tattoo associated with something or someone? (pimp, | Yes No |Association? |
|trafficker, branded, gang, etc.) |Unknown |Relationship? |
| |If Yes, what is the….? |Name? |
|10v. Does the youth have a cell phone? | Yes No |Cell #: |
| |Unknown |If Yes, who pays for this cell phone number? |
|10w. Does the youth have multiple cell phones? | Yes No |Cell #: |
| |Unknown |If Yes, who pays for the second/third cell phone number? |
|10x. Does the youth come home or to the group home with unexplained | Yes No | Clothes | Nails | |
|clothes, hair, nails, money, gifts, etc.? |Unknown |Shoes |Cell | |
| |If Yes, (Check all |Gifts |Electronics | |
| |applicable) |Hair |Jewelry | |
|10y. Does youth have hotel/motel key cards, business cards, | Yes No | Hotel/Motel Key card(s) | |
|matchbooks, etc.? |Unknown |Business cards | |
| |If Yes, (Check all |Matchbooks | |
| |applicable)) |Taxi/Transportation info | |
| | |Explain: |
|10z. Does the youth have knowledge of advanced sexual practices? |Does the youth know how much to charge for different sex acts? |
| |Yes No Unknown |
| |Does the youth use advance language when talking about sex? |
| |Yes No Unknown |
| |Does the youth speak with confidence when using sexual words/language? |
| |Yes No Unknown |
| |Is the youth familiar with the sex industry (lingerie shows, strip clubs, social media, massage |
| |parlors, where to buy sex toys or pornography)? |
| |Yes No Unknown |
| |(Check all applicable) |
| |Pornography Lingerie shows Social media Gangs |
| |Modeling Strip clubs Dance clubs Parties |
| |Other: |
| |Is the youth comfortable taking her/his clothes off in front of others? |
| |Yes No Unknown |
| |Does the youth lack regard when talking about sex? |
| |Yes No Unknown |
| |Does the youth speak explicitly about sexual acts? |
| |Yes No Unknown |
| |Does the youth use lack of clothing or provocative clothing to attract sexual interest? Yes |
| |No Unknown |
| |What does the youth think about someone who strips or sells her/his body for sex? |
|10aa. Who involved the youth into sex trafficking (CSEC/DMST) or is | Male Female …… Friend |
|grooming the Youth into sex trafficking (CSEC/DMST). |Male Female …... Relative |
| |Male Female …… Stranger |
| |Male Female …… Acquaintance |
| |Male Female …… Acquaintance in Foster/Youth Shelter/Group Home |
| |Male Female …… Advertisement (name): |
| |Male Female …… Social Media (name): |
|10bb. Is the youth controlled by a particular person | Yes No |If Yes, Name/Nickname: |
|(pimp/boyfriend/girlfriend/firend/acquaintance)? |Unknown | |
|10cc. Was the youth moved to different cities/counties while involved | Yes No |If Yes, which cities/counties? |
|in CSEC/DMST or HT? |Unknown | |
|10dd. Was the youth taken to multiple locations? | Yes No |If Yes, which ones and by whom? |
| |Unknown | |
|10ee. Was the youth asked to recruit others? | Yes No |If Yes, explain: |
| |Unknown | |
|10ff. Does the youth’s PARENT(S), CAREGIVER(S), OR SIBLING(S) have a | Yes No | Baker Act | Impulse Control Problems |
|history of mental health DX or instability? |Unknown |Suicidal Ideation |Uncontrollable anger |
| | |Mood Disorder |Withdrawn/Isolated |
|Additional Information: |If Yes, (Check all |Depression |Reduced Empathy |
| |applicable) |Anxiety |Oppositional Defiant |
| | |Bi-Polar |Criminal behavior |
| | |ADHD |Paranoid |
| | |Hyper vigilance |Youth is fearful |
| | |Lack of eye contact |Inability to trust |
| | |Hyper-sexualization |Self-destructive |
| | |PTSD | |
| | |Cutting/Mutilation | |
| | |Substance Abuse | |
| | |Marchman Act | |
|10gg. Does the youth’s PARENT(S), CAREGIVER(S), OR SIBLING(S) have any| Yes No | Battery | Open Container |
|current or prior criminal charges (This includes if the youth is |Unknown |Aggravated Battery |VOP |
|currently in foster care/group home, DJJ facility or has been TPR)? |If Yes, (Check all |Resisting Arrest |Burglary |
| |applicable) |Assault |Loitering |
|Additional information: |Father |Robbery |Grand Theft |
| |Mother |Homicide/Manslaughter |Petty Theft |
| |Caregiver |Obstruction |Shoplifting |
| | |Domestic Battery |Fraud |
| | |Concealed/Possession Weapon Drug |DUI |
| | |Possession/Sell |Traffic |
| | |Prostitution/Soliciting | |
| | |Failure to Appear | |
| | |Child Abuse/Endangerment | |
| | |Trespassing | |
|10hh. Who is the youth closest to in their family? |Community Youth | Mother | PGM | Cousin |
| |Group Home |Father |PGF |GGParent |
| | |MGM |Brother |GodParent |
| | |MGF |Aunt | |
| | |Sister |Uncle | |
|10ii. When there is a problem in the house who resolves it? |Community Youth | Mother | PGM | Cousin |
| | |Father |PGF |GGParent |
| | |MGM |Brother |GodParent |
| | |MGF |Aunt | |
| | |Sister |Uncle | |
|10jj. Who pays for things in the youth’s house? |Community Youth | Mother | PGM | Cousin |
| | |Father |PGF |GGParent |
| | |MGM |Brother |GodParent |
| | |MGF |Aunt | |
| | |Sister |Uncle | |
|10kk. Does youth’s parent/guardian/CA/group home/LE/service provider, | Yes No |If Yes, explain: |
|etc. suspect the youth of being a sexually exploited victim? |Unknown | |
|Florida Safe Harbor Law: Based on the above questions, is it suspected the youth is being |Suspected CSEC/DMST (the youth has two or more high risk indicators |
|groomed for sex trafficking or the youth is/has been sexually exploited (CSEC/DMST) |identified above): |
|(Commercial Sexual Activity; Sexually Explicit Performance; Pornography)? (“Sexually exploited|Yes No |
|Child” means a dependent Child who has suffered sexual exploitation as defined in s. |Youth is being groomed CSEC/DMST: |
|39.01(67)(g) and is ineligible for relief and benefits under the federal Trafficking Victims |Yes No |
|Protection Act, 22 U.S.C. ss. 7101 et seq.) |Youth is a victim of CSEC/DMST: |
| |Yes No |
|How long has the YOUTH been involved in CSEC/DMST (this includes a youth being groomed)? |Years: Months: |
|Additional Information: |
|11. Complete this section ONLY if the victim youth is a Foreign National and Human Trafficking is suspected. |
|Youth is a: | Foreign National |ICE/Border Patrol |Agent Last Name/First Name: |Phone#: |
|(Check all |Migrant Worker |Notified? | | |
|applicable) |Non-Documented Alien |Yes No | | |
|Parent/Guardian L/F Name: |Address: |City/Country: |Phone#: |
| | | | |
|Is the Pimp/Boy-Girlfriend/John/Trafficker a Foreign National? |DHS (ICE) Notified? Yes No |
|Yes No Unknown |Agent L/F Name: |
|If Yes, Country: |Phone #: |
|HUMAN TRAFFICKING IDENTIFYING QUESTIONS |
|For the following sections, please be advised that “no” may also refer to “none reported,” whereas “unknown” is reserved for that information which is not known at the |
|time of this report. |
|Was the youth recruited for one purpose and forced to engage in some other jobs? | Yes No Unknown |
|Is the youth engaged with irrational work that is not age appropriate or works long hours? | Yes No Unknown |
|Does the youth have freedom of movement? | Yes No Unknown |
|Is the youth’s communications restricted or monitored, can the youth speak on own behalf? | Yes No Unknown |
|Does the youth have possession of his/her identification and/or travel documents? | Yes No Unknown |
|NOTE: If checked YES, who has control of these documents? | |
|Is the youth’s salary being garnished to pay off a smuggling fee? | Yes No Unknown |
|NOTE: Paying off a fee for smuggling alone is not considered Human Trafficking. | |
|Has the youth been forced to sell drugs, jewelry, magazines on the street? | Yes No Unknown |
|Is the youth in control of his/her money? | Yes No Unknown |
|Does the youth have an excessive amount of cash? | Yes No Unknown |
|Has the youth or the youth’s family been threatened with harm if the youth attempts to escape? | Yes No Unknown |
|Is the youth fearful of law enforcement, child protective investigator (CPI), or government officials? | Yes No Unknown |
|Was the youth coached on what to say to law enforcement, CPI, or government officials? | Yes No Unknown |
|Has the youth been threaten with deportation or law enforcement actions? | Yes No Unknown |
|Has the youth been harmed, are there signs of physical abuse (bruises, black-eyes, cuts, marks, etc.)? | Yes No Unknown |
|Has the youth been deprived of food, water, sleep, medical care or other life necessities? | Yes No Unknown |
|Is the youth living in unusual or substandard living conditions, sleeping/living separately from the “family” (garage, on the | Yes No Unknown |
|floor in a room, etc.)? | |
|Can the youth freely contact friends or family? | Yes No Unknown |
|Is the youth in school? | Yes No Unknown |
|Does the youth have significant gaps in schooling? | Yes No Unknown |
|Is the youth involved in a controlling or dominating relationship, is the youth allowed to speak? | Yes No Unknown |
|Is the youth loyal to the trafficker? | Yes No Unknown |
|Has the youth engaged/groomed in prostitution or commercial sex acts? | Yes No Unknown |
|(If YES, complete all the CSEC questions below). | |
|Is the YOUTH a victim of Human Trafficking? | Yes No | Sex Trafficking |
| |Unknown |Slavery |
| | |Involuntary Servitude |
| | |Peonage (debt slavery or debt servitude) |
|How long has the YOUTH been involved in HT? |Years: Months: |
|Additional Information: |
|12. FSFN POST INDICATORS (Complete only if the youth is in Out of Home Placement) |
|Removal from Home Reasons: |
|Commercial Sexual Exploitation of Child Human Trafficking – Labor Sexual Abuse-Sexual Exploitation |
|Was the most recent CBHA used for a Safe House Assessment? Yes No |
|If “No,” when was a Safe House Assessment completed? CSEC/HT Staffing date: |
|CSEC Category: Adult Entertainment Prostitution/No Pimp Prostitution/Pimp Recruiter-Prostitution Pimp |
|CSEC Status: Enter in Error Confirmed Involvement No Longer Involved Possible Involvement |
|Method of Confirmation Values: |
|Arrested/Identified by LE Family Disclosure Findings of CPI Self- Disclosed Professional Observation |
|Reason youth was not placed in a “Safe House”: |
|Age of the child required alternative Placement |
|Child has previously been discharged from a “Safe House” facility/placement due to behavioral issues |
|Child placed in an alternative CSEC placement/program |
|Child refused placement in a “Safe House” facility/placement |
|Child’s limited involvement in CSEC required alternative placement |
|Child’s status as a possible CSEC recruiter for prostitution required alternative placement |
|DJJ placement not related to prostitution charges/conviction |
|DJJ placement related to prostitution charges/conviction |
|Language/Cultural considerations required alternative placement |
|Mental health issues required alternative placement |
|No “Safe House” facility/placement available in are for this child’s gender |
|No “Safe House” facility/placement in area |
|No space available in a “Safe House” facility/placement at this time |
|Other |
|Substance abuse issues required alternative placement |
|Commercial Sexual Exploitation Child: | CSEC – General |
| |CSEC – Law Enforcement Interview with Representation |
| |CSEC – Law Enforcement Interview without Representation |
|CSEC/DMST-HT MULTI-DISCIPLINARY ASSESSMENT TEAM OVERALL RECOMMENDATIONS |
|SELF/SCHOOL: |FAMILY: |PEERS: |COMMUNITY: |
|Academic failure |Family management problems |Negative peer affiliation & gang |Lack of involvement in community |
|Lack of commitment to school |Family history of high risk behavior |involvement |Availability of drugs |
|Poor social skills |Family difficulties |Friends who use drugs |Economic deprivation |
|Behavior/frequent suspensions |Parents favorable attitude toward drugs or|Favorable attitude toward criminal | |
|Substance use/abuse |criminal |activity | |
|Behavioral health concerns |activity |Alienation, rebelliousness | |
| |Lack of family involvement |Easily led by others/”Follower” | |
|Previous MSST staffing Yes No |
|Previous CSEC/HT staffing Yes No |
|If Yes, date and recommendations: |
|Mental Health Dx or instability: |
|Current Medications: |
|Previous Medications: |
|Treatment: |
|A. Counseling: |
|B. Health Care: |
|C. Substance Abuse: |
|D. Educational Opportunities: |
|Safe Environment for the Youth: |
|Family (Re-unite families or provide with appropriate guardians): |
|Risk Factors: |
|Other: |
|This assessment report is the result of a Broward Sheriff's Office CPIS trans-disciplinary staffing review focusing on DMST/CSEC and HT minor victims. The resulting |
|information is based on attending parties’ consensus for purposes of safety & service delivery to the CSEC/HT Minor and FAMILY according to January 2013 FSS Safe Harbor |
|Law. |
|CSEC/HT Staffing date: |
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