Safety Plan w/ DV
DANGER THREAT(S) DESCRIPTION: Domestic violence exists between the mother and father of two young children. There is a threat of serious physical and/or
emotional harm to the child. There have been two known instances of domestic violence occurring in front of the children, both involving an open hand striking
mom’s face. In one instance, the one year old child was dropped by the child’s father as he struck the child’s mother in the face. Another 3 year old daughter was
a witness to both incidents, but not involved directly. It is alleged that domestic violence has been on-going for at least the last 2 years.
A. SAFETY PLAN
Actions to Keep Child Safe
1. No further visitations with Dad will occur
until the visitation plan is created by the
CPI and Case Manager, with input from
Mom, Dad and the PGPs.
Who is Responsible
for Each Task?
PGPs, Mom, Dad,
Begin Date
Today
Resources or
People Who Will
Help
Case Manager
will monitor
compliance
Frequency of
Intervention
Until visitation
plan is approved
Who is Responsible
for Monitoring
PGPs, Mom
Case Manager will
monitor
compliance by
twice weekly
phone call s to
PGPs and Mom
Target/
Follow-up
Date
Within 30
days
2. A visitation plan will be created in
collaboration with PGMs, Mom and Dad
that will include PGPs’ home as the drop
off and pick up point for the children,
eliminating direct contact between Mom
and Dad. The plan will also include terms
of frequency and duration.
Case Manager will
provide a written
copy of the
visitation plan to
Mom, Dad and the
PGPs’.
Mom, Dad and the
PGPs’ are
responsible for
implementation
Within 7
days
CPI, Case
Manager
Weekly
PGPs, Mom, Dad,
Case Manager
Re-evaluate
within 30
days
3. As soon as a mutually agreeable visitation
plan is created, visitation may proceed
following the terms of the plan.
Signatories of the
visitation plan: Case
Manager, Mom,
Dad, PGPs
PGPs’ will
immediately contact
law enforcement if
there is any physical
violence or threat.
Per terms of
approved
visitation
plan
N/A
Weekly
The Mom, Dad, and Re-evaluate
PGPs’ will contact
within 30
the Case Manager
days
immediately if
there are any
violations of the
visitation plan.
The visitation plan
will not be altered
in any way without
Case Manager
involvement and
approval.
If the visitation
plan is violated and
reported to the
Case Manager or
CPI, no further
visitations will be
permitted, pending
a family team
meeting and/or
judicial/LE.
intervention.
4. Local law enforcement will be briefed on
CPI
Immediately
and after
completion
of the
visitation
plan
Mom, Case Manager
Appt.
request
immediately
Mom, DV Center
worker
Mom
the situation and visitation plan
arrangements by the Case Manager.
5. Mom will be taken by the Case Manager
to the local domestic violence service
center to learn about her protection
Local law
enforcement will
recognize DV
history and be
aware of danger
threat and child
vulnerability
DV Center
assigned worker
On-going
Police will notify
Case Manager if
they respond to
any DV related
incidents
On-going
Per DV Center
recommendation
Case Manager and
DV Center
On-going
1st apt.
Case Manager
will receive
weekly DV
center updates
by e-mail
Daily
DV Center worker;
Case Manager
Plan creation
within 7 days
Following
1st appt.
DV Center
Daily
Mom will selfreport personal
protection plan
status to DV Center
and Case Manager.
options and the feasibility of law
enforcement and/or judicial involvement
to better insure her protection
6. Case Manager and the DV Center will
create a personal protection plan with
Mom so she can better protect herself
and her children.
7. Mom will implement the personal
protection plan upon consultation with
DV Center.
Case manager will
observe both
children and mom
once a week. Case
Manager will
maintain phone
contact with mom,
dad and PGPs’
weekly to assess
the safety of all
parties and the
implementation of
the visitation plan.