DELINQUENT YOUTH RISK REASSESSMENT AND PROGRESS SUMMARY NAME

Name - Youth

Court Number(s)

County

     

     

     

Birthdate - Youth

Gender - Youth

Race - Youth

     

     

     

Time Period Covered by This Document

Status

     

DEL JIPS CHIPS VOL

Offense(s)

Score

1.

Age at first referral to juvenile court intake

0 =

15 or older

2 =

Under 15 years of age

2.

Juvenile adjudication / adult conviction for an assaultive offense

0 =

None

1 =

One or more

3.

Prior runaways

0 =

None

1 =

One or more

4.

History of serious emotional problems / diagnosed emotionally disturbed

0 =

No prior emotional problem history and no emotionally disturbed (ED) diagnosis

1 =

Not diagnosed ED, but history of serious emotional problems on file

2 =

Diagnosed ED

5.

Response to supervision

0 =

No significant problems

2 =

Moderate compliance problems / curfew violations, missed appointments, etc.

4 =

Compliance problems / new arrest or delinquent acts

6.

Current school / employment status

0 =

Enrolled in school or working full-time. No problems noted.

1 =

Some problems with school or job such as moderate behavior problems; attendance problems

3 =

Serious problems with behavior, truancy, absenteeism

4 =

Not enrolled in school and unemployed

7.

Substance abuse

0 =

No known use; no problems noted

1 =

Occasional use; some disruption of functioning (school, job, home)

2 =

Serious disruption of functioning

8.

Peer relationships

0 =

Good support and influence

1 =

Negative influence; some companions involved in delinquent behavior or lack of peer relationships

2 =

Strong negative influence; most peers involved in delinquent behavior and / or involved in gangs

9.

Parental / caretaker control

0 =

Generally effective

2 =

Inconsistent and / or ineffective

4 =

Little or no supervision provided

10.

Program response

0 =

Youth participates willingly in programs, cooperates with worker to carry out case plan

1 =

Program response is inconsistent

2 =

Youth not involved / does not actively participate in needed programs

TOTAL RISK SCORE

0 to 8

Low risk

9 to 13

Moderate risk

14 to 24

High risk

Increase

Decrease

No Change

Note: Please complete following progress summary.

PROGRESS SUMMARY

Review of general desired outcomes, goals, and interventions or tasks

GENERAL DESIRED OUTCOME 1:

Goal 1

Comments / Progress

Goal 2

Comments / Progress

Additional goals and progress (if necessary)

GENERAL DESIRED OUTCOME 2:

Goal 1

Comments / Progress

Goal 2

Comments / Progress

Additional goals and progress (if necessary)

GENERAL DESIRED OUTCOME 3:

Goal 1

Comments / Progress

Goal 2

Comments / Progress

Additional goals and progress (if necessary)

GENERAL DESIRED OUTCOME 4:

Goal 1

Comments / Progress

Goal 2

Comments / Progress

Additional goals and progress (if necessary)

GENERAL DESIRED OUTCOME 5:

Goal 1

Comments / Progress

Goal 2

Comments / Progress

Additional goals and progress (if necessary)

ANALYSIS AND RECOMMENDATIONS

1.

Summarize the youth's conduct and compliance with general rules and expectations.

2.

Summarize the youth's clinical progress.

3.

Additional information including changes in resources, case plan, recommendation for extension, revision, placement, transfer or discharge.

SIGNATURES

SIGNATURE - Youth

Date Signed

SIGNATURE - Parent / Guardian

Date Signed

SIGNATURE - Worker

Date Signed

Distribution: Youth, Parent / Guardian

Delinquent Youth Risk Reassessment Definitions

1.

Age at first referral to juvenile court intake: Age referenced to 15^th anniversary of birth date. Juvenile is "Under 15" if first referral occurred prior to 15^th birthday. Only count referrals to juvenile court intake for a delinquent act. "Delinquent" is defined in s. 938.02(3)(m) of the Wisconsin Statutes as "a juvenile who is 10 years of age or older who has violated any state or federal criminal law, except as provided in ss. 938.17, 938.18 and 938.183, or who has committed a contempt of court, as defined in s. 785.01(1), as specified in s. 938.355(6)(g)." (Include JIPS referrals for youth under age 10 who were referred for delinquent behavior.)

2.

Adjudication or adult conviction for an assaultive offense: If present commitment/re-institutionalization arose from an adjudication or conviction for an assaultive offense, the youth automatically scores “14” and is categorized as “high risk”.

3.

Prior runaways: History of previous runaways from home or any placement. Runaways are defined as absconding from home or any placement and not voluntarily returning within 24 hours.

4.

History of serious emotional problems / diagnosed emotionally disturbed: Severely emotionally disturbed individuals are defined in the FY 1997 MH Block Grant Application: 1997 Children's State Plan, Federal Requirement XI (DHFS FY 1997). Refer to original WI Revised Delinquency Risk Assessment.

Rate the following items based on youth's behavior during the time period covered by this document.

5.

Response to supervision

6.

Current school / employment status

7.

Substance abuse

8.

Peer relationships: “Good support and influence” is defined as positive peer relationships.

“Negative influence” is defined as negative peer relationships where some companions are involved in delinquent behavior, or lack of peer relationships.

“Strong negative influence” is defined as strong negative peer relationships where most peers are involved in delinquent behavior such as gang membership.

9.

Parental / caretaker control

10.

Program response