CAFES Case Closure Survey

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Email*

A copy of your responses will be emailed to the address you provided.

CAFES Name*

First Middle Last

CAFES Contact Email

CAFES Contact Phone

Attorney Name:*

Case Name:*

Case #:*

Client Name

First Middle Last

Type of Client:

Parent

Minor

NMD (non-minor dependent)

De Facto Parent

Legal Guardian

Other:

Type of Client:

Case was closed before CAFES able to work with client: (check box and hit submit without completing the rest of the form).

Client did not engage with CAFES

Attorney changed mind and no longer needed CAFES

Other:

Case was closed before CAFES able to work with client: (check box and hit submit without completing the rest of the form).

Start date that client was assigned to CAFES per authorization:

# of months worked with client/s:*

# of months worked with client/s:

Interventions/ Work Done on Case (check all that apply)

PAST Status/ Prior to CAFES involvement for Parents: Housing

1. (Homeless)

2. (In transitional or temporary, housing unaffordable)

3. (In stable housing, but not adequate)

4. (In stable subsidized housing that is safe and adequate)

5. (Unsubsidized household is safe and adequate)

6. Not willing to participate in services

7. NA

Other:

PAST Status/ Prior to CAFES involvement for Parents: Housing

PRESENT Status/Post-CAFES involvement for Parents: Housing

1. (Homeless)

2. (In transitional or temporary, housing unaffordable)

3. (In stable housing, but not adequate)

4. (In stable subsidized housing that is safe and adequate)

5. (Unsubsidized household is safe and adequate)

6. Not willing to participate in services

7. NA

Other:

PRESENT Status/Post-CAFES involvement for Parents: Housing

PAST Status/ Prior to CAFES involvement for Parents/NMD: Employment

1. (No job)

2. (Temporary, part-time, seasonal, not enough to live)

3. (Employed full time, inadequate pay to live, few or no benefits)

4. (Employed full time, enough to pay to live, benefits)

5. (Maintains permanent employment)

6. (On SSI or has other financial support to live)

7. Not willing to participate in services

8. NA

Other:

PAST Status/ Prior to CAFES involvement for Parents/NMD: Employment

PRESENT Status/ Post-CAFES involvement with parents/NMD: Employment

1. (No job)

2. (Temporary, part-time, seasonal, not enough to live)

3. (Employed full time, inadequate pay to live, few or no benefits)

4. (Employed full time, enough to pay to live, benefits)

5. (Maintains permanent employment)

6. (On SSI or has other financial support to live)

7. Not willing to participate in services

8. NA

Other:

PRESENT Status/ Post-CAFES involvement with parents/NMD: Employment

PAST Status/ Prior to CAFES involvement with parents/NMD: Mobility/Transportation

1. (No access to transportation, public or private; may have car that is inoperable)

2. (Unreliable transportation, unpredictable, unaffordable; no car or no license)

3. (Transportation available, reliable, but limited; drivers license/ minimal insurance)

4. (Transportation generally accessible to meet basic travel needs)

5. (Transportation readily available and affordable; car is adequately insured)

6. Not willing to participate in services

7. NA

Other:

PAST Status/ Prior to CAFES involvement with parents/NMD: Mobility/Transportation

PRESENT Status/ Post-CAFES involvement with parents/NMD: Mobility/Transportation

1. (No access to transportation, public or private; may have car that is inoperable)

2. (Unreliable transportation, unpredictable, unaffordable; no car or no license)

3. (Transportation available, reliable, but limited; drivers license/ minimal insurance)

4. (Transportation generally accessible to meet basic travel needs)

5. (Transportation readily available and affordable; car is adequately insured)

6. Not willing to participate in services

7. NA

Other:

PRESENT Status/ Post-CAFES involvement with parents/NMD: Mobility/Transportation

PAST Status/ Prior to CAFES involvement with parents/NMD: Life Skills

1. (Unable to meet basic needs such as: hygiene, food, every day activities)

2. (In need of some assistance for daily activities)

3. (Very minimal, assistance to meet daily activities)

4. (Meets all basic needs of daily living without assistance)

5. (Provides beyond basic needs of daily living for self and family)

6. Not willing to participate in services

7. NA

Other:

PAST Status/ Prior to CAFES involvement with parents/NMD: Life Skills

PRESENT Status/ Post-CAFES involvement with parents/NMD: Life Skills

1. (Unable to meet basic needs such as: hygiene, food, every day activities)

2. (In need of some assistance for daily activities)

3. (Very minimal, assistance to meet daily activities)

4. (Meets all basic needs of daily living without assistance)

5. (Provides beyond basic needs of daily living for self and family)

6. Not willing to participate in services

7. NA

Other:

PRESENT Status/ Post-CAFES involvement with parents/NMD: Life Skills

PAST Status/ Prior to CAFES involvement for parents/NMD/and Minors: Family/Social Relations

1. (Lack of support from family and friends)

2. (Limited support from family friends who also lack ability to help)

3. (Family and friends are learning to support and communicate support)

4. (Strong support from family and friends)

5. (Has healthy and expanding support and good communication)

6. Not willing to participate in services

7. NA

Other:

PAST Status/ Prior to CAFES involvement for parents/NMD/and Minors: Family/Social Relations

PRESENT Status/ Post-CAFES involvement for parents /NMD and Minors: Family/Social Relations

1. (Lack of support from family and friends)

2. (Limited support from family friends who also lack ability to help)

3. (Family and friends are learning to support and communicate support)

4. (Strong support from family and friends)

5. (Has healthy and expanding support and good communication)

6. Not willing to participate in services

7. NA

Other:

PRESENT Status/ Post-CAFES involvement for parents /NMD and Minors: Family/Social Relations

PAST Status/ Prior to CAFES involvement for parents/NMD: Community Involvement

1. (No involvement due to crisis)

2. (Socially isolated, no social skills, lacks motivation to become involved)

3. (Willing to be involved in the community but lacking skills and unaware of opportunities)

4. (Some community involvement, but has barriers: transportation or child care.

5. (Actively involved in community)

6. Not willing to participate in services

7. NA

Other:

PAST Status/ Prior to CAFES involvement for parents/NMD: Community Involvement

PRESENT Status/ Post-CAFES involvement for parents/NMD: Community Involvement

1. (No involvement due to crisis)

2. (Socially isolated, no social skills, lacks motivation to become involved)

3. (Willing to be involved in the community but lacking skills and unaware of opportunities)

4. (Some community involvement, but has barriers: transportation or child care.

5. (Actively involved in community)

6. Not willing to participate in services

7. NA

Other:

PRESENT Status/ Post-CAFES involvement for parents/NMD: Community Involvement

PAST Status/ Prior to CAFES involvement: Parenting Skills

1. (Safety concerns)

2. (Parenting skills are minimal)

3. (Parenting skills evident but continuous growth recommended)

4. (Parenting skills are adequate)

5. (Parenting skills are well developed)

6. Not willing to participate in services

7. NA

Other:

PAST Status/ Prior to CAFES involvement: Parenting Skills

PRESENT Status/ Post-CAFES involvement: Parenting Skills

1. (Safety concerns)

2. (Parenting skills are minimal)

3. (Parenting skills evident but continuous growth recommended)

4. (Parenting skills are adequate)

5. (Parenting skills are well developed)

6. Not willing to participate in services

7. NA

Other:

PRESENT Status/ Post-CAFES involvement: Parenting Skills

PAST Status/ Prior to CAFES involvement for parents/NMD: Legal

1. (Current outstanding tickets or warrants)

2. (Current criminal charges, criminal trial pending, non-compliance with probation or parole.

3. (Fully compliant with probation/parole terms)

4. (Successfully completed probation/ parole within 12 months, no new charges filed)

5. (No active criminal justice involvement in more then 12 months)

6. Not willing to participate in services

7. NA

Other:

PAST Status/ Prior to CAFES involvement for parents/NMD: Legal

PRESENT Status/ Post-CAFES involvement for parents/NMD: Legal

1. (Current outstanding tickets or warrants)

2. (Current criminal charges, criminal trial pending, non-compliance with probation or parole.

3. (Fully compliant with probation/parole terms)

4. (Successfully completed probation/ parole within 12 months, no new charges filed)

5. (No active criminal justice involvement in more then 12 months)

6. Not willing to participate in services

7. NA

Other:

PRESENT Status/ Post-CAFES involvement for parents/NMD: Legal

PAST Status/ Prior to CAFES involvement for parents/NMD and Minors: Substance Abuse

1. (Meets criteria for severe abuse/dependence; needs hospitalization or residential)

2. (Meets criteria for dependence; preoccupation with use/obtaining drugs)

3. (Use within last 6 months, evidence of occupational, emotional or physical issues persist)

4. (Client has used during last six month but no evidence of recurrent dangerous use)

5. (No drug use/alcohol abuse in the last six months)

6. Not willing to participate in services

7. NA

Other:

PAST Status/ Prior to CAFES involvement for parents/NMD and Minors: Substance Abuse

PRESENT Status/ Post-CAFES involvement for parents/NMD and Minors: Substance Abuse

1. (Meets criteria for severe abuse/dependence; needs hospitalization or residential)

2. (Meets criteria for dependence; preoccupation with use/obtaining drugs)

3. (Use within last 6 months, evidence of occupational, emotional or physical issues persist)

4. (Client has used during last six month but no evidence of recurrent dangerous use)

5. (No drug use/alcohol abuse in the last six months)

6. Not willing to participate in services

7. NA

Other:

PRESENT Status/ Post-CAFES involvement for parents/NMD and Minors: Substance Abuse

PAST Status/ Prior to CAFES involvement for Minors: Education

Struggling in school with no support

Has support in school/ IEP or 504 or SST, still struggling

Has adequate support but needs changes to thrive

Doing very well in school with proper supports in place

Other:

PAST Status/ Prior to CAFES involvement for Minors: Education

Present Status/ Post-CAFES involvement for Minors: Education

Struggling in school with no support

Has support in school/ IEP or 504 or SST, still struggling

Has adequate support but needs changes to thrive

Doing very well in school with proper supports in place

Other:

Present Status/ Post-CAFES involvement for Minors: Education

Current visitation for your client BEFORE CAFES involvement:

Therapeutic

Supervised

Monitored

Unsupervised

Current visitation for your client AFTER CAFES involvement:

Therapeutic

Supervised

Monitored

Unsupervised

At least ONE child was removed from home PRIOR to CAFES involvement:*

Yes

*At least one child was returned home or is in the process (less then three months) of returning home AFTER CAFES involvement:*

Yes

If returned home, approximately how long was the child/ren in placement:

Less than a week

1-3 months

3-6 months

6-12 months

12-18 months

2+ years

N/A

BEFORE CAFES involvement:*

Child was at Juvenile Hall

Child was in a restrictive setting (STRTP/Hospital)

Child/ren was in an out of county resource home or FFA

Child/ren was in a SF resource home or FFA

Child was living Independently

Child/ren was with a relative or NRFEM

Child/ren is going to guardianship

Child/ren is being adopted

Child/ren was home

AFTER CAFES involvement:*

Child was at Juvenile Hall

Child was in a restrictive setting (STRTP/Hospital)

Child/ren was in an out of county resource home or FFA

Child/ren was in a SF resource home or FFA

Child was living Independently

Child/ren was with a relative or NRFEM

Child/ren is going to guardianship

Child/ren is being adopted

Child/ren was home

Any comments to share (successes or challenges) re: case?

Date CAFES completed goals/ closed case (court submitted)