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Instructions for Completing Form DSS-5104

1. Type of Report Definition Abuse An allegation that a juvenile s parent guardian custodian or caretaker inflicts or allows to be inflicted creates or allows to be created a substantial risk of serious physical injury by other than accidental means or uses or allows to be used upon the juvenile cruel or grossly inappropriate procedures or cruel or grossly inappropriate devices to modify or commits permits or encourages the commission of any sexual offense by with or upon the juvenile in violation of the law promotes the prostitution of the juvenile or creates or allows to be created serious emotional damage to the juvenile or encourages directs or approves of delinquent acts involving moral turpitude committed by the juvenile Neglect An allegation that a juvenile does not receive proper care supervision or discipline from the juvenile s parent guardian custodian or caretaker or who has been abandoned or who is not provided necessary medical care or who is not provided necessary remedial care or who lives in an environment injurious to the juvenile s welfare or who has been placed for care or adoption in violation of the law In determining whether to accept a report that a juvenile may be neglected it is relevant whether that juvenile lives in a home where another juvenile has died as a result of abuse or neglect or lives in a home where another juvenile has been subjected to sexual abuse or severe
2. Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 NC Division of Social Services Performance Management Reporting and Evaluation Section Child Welfare Data Management Team 325 N Salisbury Street 2415 Mail Service Center Raleigh NC 27699 2415 Or by fax to 919 334 1052 Appropriate deletion requests include Incorrectly entered each child on a separate DSS 5104 and need to combine into one form Entered children on form that were not a part of the assessment Some child information is incorrect SIS ID birth date misspelled name etc Some perpetrator information is incorrect misspelled name birth date etc RIL code should have been 00 therefore the perpetrator should not have been placed on the RIL and other code was entered by mistake NOTE THAT DELETING THE DSS 5104 IS NOT APPROPRIATE IF THE PERPETRATOR REQUESTED EXPUNCTION THROUGH THE EXPUNCTION PROCESS THIS IS ONLY APPROPRIATE IF THEY WERE ADDED TO THE RIL ORIGINALLY IN ERROR D VICTIM NAME DISPLAY SOUNDEX VICTIM NAME DISPLAY SEARCH 1 VICTIM NAME DISPLAY From the Central Registry Selection Menu key 4 in the selection field and the last first middle initial name in the KEY field Press ENTER When using the victim name display to search the central registry the person s last name and first name must be entered Make sure to separate the victim s last name and first name with a comma and a spa
3. and head start center personnel 03 Educational Personnel This category includes teachers principals school nurses learning aides school librarians or other individuals who report the maltreatment as a result of their involvement in a school setting 04 Law Enforcement or Court Personnel This category includes police courts attorneys parole and probation officers and sheriff s deputies 17 NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Code Definition 05 Medical Personnel This category includes private physicians clinic or hospital physicians dentists emergency room personnel nurses X ray technicians and the staff of a physician in private practice optometrists and paramedics 06 Relative A member of the child and or caretaker s immediate or extended family who is not covered by another category 07 Non Relative A person not related to the child s family or to the child i e friend neighbor and foster parent 08 Human Service Personnel This category includes social workers mental health workers psychiatrist psychologist psychiatric or clinical social workers and the staff of social service agencies and institutions 09 Victim The child who is alleged to be neglected
4. worker s judgment adversely affect the individual s day to day or intermittent functioning 05 Emotionally Disturbed Having mental or emotional problems exhibited in a wide range of important social and personal contexts and causing significant impairment in social educational or occupational functioning 16 NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Code Value Learning Disability Having a disorder in one or more of the basic psychological processes involved in understanding or using language spoken or written that may manifest itself in an imperfect ability to listen think speak read write spell or to use mathematical calculations An example of a learning disability would be dyslexia 07 Medical Condition Having any apparently disabling physical condition other than those listed above which has been diagnosed by a licensed physician and requires medical attention 08 HIV and AIDS Having a syndrome or a disease complex in which the natural immune system is suppressed so significantly those individuals gradually die from vulnerability to a variety of unusual infections and concerns opportunistic infections that would not ordinarily pose a threat to an immunologically healthy person 09 Substa
5. 31 Asian Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 32 N Asian Native Hawaiian or Other Pacific Islander Hispanic or Latino 33 White Black American Indian or Alaskan Native Non Hispanic or Latino 34 LL White Black American Indian or Alaskan Native Hispanic or Latino 35 White Black Asian Non Hispanic or Latino 36 White Black Asian Hispanic or Latino 37 White Black Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 38 White Black Native Hawaiian or Other Pacific Islander Hispanic or Latino White American Indian or Alaskan Native Asian Non Hispanic or Latino 40 White American Indian or Alaskan Native Asian Hispanic or Latino 41 White American Indian or Alaskan Native Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 42 White American Indian or Alaskan Native Native Hawaiian or Other Pacific Islander Hispanic or Latino 43 White Asian Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 44 White Asian Native Hawaiian or Other Pacific Islander Hispanic or Latino 45 Black American Indian or Alaskan Native Asian Non Hispanic or Latino 46 Black American Indian or Alaskan Native Asian Hispanic or Latino 47 Black American Indian or Alaskan Native Native Hawaiian Non Hispanic or Latino 48 Black American Indian or Alaskan Nati
6. CPS In home services service code 215 should be closed on the DSS 5027 the same date it was opened and the appropriate foster care service code opened In all situations the social worker will need to close service code 210 on the DSS 5027 when that service is no longer needed The DSS 5104 is also linked with the DSS 5104a the Responsible Individuals List The Responsible Individuals List is used to identify parent guardians caretakers or custodians who have been identified as perpetrators in all substantiated cases of abuse or serious neglect using the investigative assessment response Information from the Responsible Individuals List is available only to authorized persons for the sole purpose of determining current or prospective employability or fitness to care for children Access to the Central Registry is limited by North Carolina Laws and Administrative Rules and does not change as a result of the Responsible Individuals List At no time shall the Central Registry be used for determining employability Il LOGON AND LOGOFF PROCEDURES A LOGON From the banner screen that shows the message IS CONNECTED TO THE STATE NETWORK key CICSNC16 and press ENTER The next screen will be the CICS sign on screen 199 90 157 13 VIA TCP IP TO THE NOR CUSTOMER SUPPORT CENTER kaa kaa ka 4 TA A e vs kaa kad kad ka kaa THIS IS A GOVERNMEN UTER MAR 2 THE STATE OF NORTH CAROLINA AVE CTATION OF PR u F nits
7. SERVICES CHAPTER VIII PROTECTIVE SERVICES 1426 ATTACHMENT 1 Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Code Value Definition 01 Allegations could At the time of case decision no evidence could be not be proven found to prove allegations occurred 02 Isolated Incident Accidental incident that did not pose a serious physical injury risk of serious physical injury or risk of sever emotional damage 03 Lack of Severity Incident is not of a serious nature to be defined as abuse or neglect 04 No Lack of At the time of case decision incident did not pose any Safety No immediate or future safety protection issues protection issue 05 Cannot Identify At the time of case decision protection of child from Perpetrator the perpetrator was not an issue 06 Perpetrator is not Perpetrator is not a parent guardian or custodian or a caretaker caretaker ENTRY REQUIRED FOR SUBSTANTIATED CASES OF ABUSE NEGLECT OR ABUSE AND NEGLECT ONLY Field 32 Maltreatment Type Found At the conclusion of the CPS assessment if the case is substantiated select the appropriate maltreatment type found Note Do not complete this field if a CPS Family Assessment finding Codes 5 6 7 or 8 is recorded in Field 30 Type Found Do not complete if Dependency Code 4 is recorded in Field 30 Type Found This field allows more than one type of maltreatment to be selected Each maltreat
8. SOUNDEX VICTIM NAME DISPLAY This option is used to search to see if a child has a previous DSS 5104 entered as a result of a prior report For the option the child s last name and first name must be entered This option will display all names that match and are similar to the name entered PERPETRATOR NAME DISPLAY This option is used to search to see if an alleged perpetrator already exists in the Central Registry as a result of a prior report It is also possible to search for a perpetrator using the option See Victim Name Display above ADMINISTRATIVE MENU This option is available only to the State Administrator FATALITIES MENU This option is available only to state staff entering fatalities RIL MENU This option is used to access the RIL menu For more information please see the user s manual for the RIL located in Section 1427 of the Family Services Manual Volume 1 chapter VIII NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 C LOGOFF To logoff press the F3 key twice At the blank screen key in logoff and press enter This will take you back to the main state banner screen ll CENTRAL REGISTRY ENTRY AND FUNCTION A ENTRY AND FUNCTION After a CPS assessment has been completed a DSS 5104 paper form must be completed Onc
9. a juvenile in a child care facility This code is also to be used for any on site administrator found to be responsible for the neglect or abuse of a child 28 Employee of a Child Care Facility Plan Child care is a child care arrangement for a child under 13 years of age ina child care facility or plan as defined in Article 7 of Chapter 110 of the NC General Statutes An employee of a Child Care Facility Plan includes any person who has responsibility for care of a juvenile in a child care arrangement as defined in Article 7 of Chapter 110 of the NC General Statutes or any person who has approval of the care provider to assume responsibility for the juveniles under the care of the care provider This code is to be used also for any owner operator found to be responsible for the neglect or abuse of a child 29 Other Caretaker Any person other than those listed above including an adult member of the juvenile s household 19 NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Field 24 Services Provided ENTRY REQUIRED Enter the two digit code for any services that were referred or provided to the family as a result of the CPS response to reported allegations Report only those services that began on or prior to the report date and continued past the
10. each parent or other caretaker identified as a perpetrator The individual perpetrator s name is entered with the last name at the beginning of the last name block first name at the beginning of the first name block and the middle initial in the middle initial block It is extremely important to be as accurate and complete as possible when entering the name in the event that perpetrators names are placed on the Responsible Individuals List and required by law to be released for such purposes as employment screening 34 NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Field 34 Date of Birth ENTRY REQUIRED FOR CASES SUBSTANTIATED FOR ABUSE AND OR NEGLECT ONLY Enter the month day and year use a leading zero 0 for any month or day less than ten 10 for each perpetrator s date of birth in the format MMDDCCYY It is extremely important to make every effort to obtain the perpetrator s date of birth for identification purposes in the event that perpetrators names are placed on the Responsible Individuals List and required by law to be released for such purposes as employment screening If the exact date of birth is unknown or cannot be obtained leave this field blank and go to Field 35 The Central Registry system will list an estimated date of birth based on the age
11. interpersonal relationships Definition inappropriate types of or feeling under normal circumstances a general pervasive mood of unhappiness or depression or a tendency to develop physical symptoms or fears associated with personal problems The term includes persons who are schizophrenic or autistic The term does not include persons who are socially maladjusted unless it is determined that they are also seriously emotionally disturbed This condition must be clinically diagnosed The diagnosis is based on the Diagnostics and Statistical Manual of Mental Disorders the most recent edition of DSM Visually or Hearing Impaired Caretaker A clinically diagnosed handicapping condition of the principal caretaker s related to visual impairment or permanent or fluctuating hearing or speech impairment that may significantly affect functioning or development Learning Disability Caretaker A disorder of one or more of the principal caretaker s basic psychological processes involved in understanding or using language spoken or written that may manifest itself in an imperfect ability to listen think speak read write spell or to use mathematical calculations This item includes conditions such as perceptual disability brain injury minimal brain dysfunction dyslexia and developmental aphasia This condition must be clinically diagnosed Physically Disabled Caretaker A physical condition tha
12. language spoken or written that may manifest itself in an imperfect ability to listen think speak read write spell or to use mathematical calculations This item includes conditions such as perceptual disability brain injury minimal brain dysfunction dyslexia and developmental aphasia 25 1426 NORTH CAROLINA DIVISION OF SOCIAL SERVICES ATTACHMENT 1 FAMILY SERVICES MANUAL VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES April 2009 Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL Contributory Factor Definition Physically Disabled Child A physical condition that adversely affects the child s day to day motor functioning such as cerebral palsy spinal bifida multiple sclerosis impairments and other physical disabilities Behaviour Problem Child Behaviour in the school and or community that adversely affects socialization learning growth and moral development These may include adjudicated or non adjudicated child behaviour problems This would include the child s running away from home or a placement Other Medical Condition Child A medical condition other than mental retardation visual or hearing impairment physical disability or being emotionally disturbed that significantly affects the functioning or development the child or requires special medical care such as chronic illnesses Included are children diagnosed as HIV positive o
13. or abused 10 Parent The biological adoptive or stepparent of the child Field 21 Petition Filed with Juvenile Court REQUIRED IF APPLICABLE Enter the appropriate two 2 digit code if a petition has been filed in Juvenile Court in relation to the situation of abuse neglect dependency Code Definition 1 Yes 2 No Field 22 Criminal Charges Filed REQUIRED IF APPLICABLE Enter the appropriate two 2 digit code if criminal charges related to the reported abuse or neglect has been filed Code Definition 1 Yes 2 No Field 23 Perpetrator Relationship Code ENTRY REQUIRED SUBSTANTIATED CASES ONLY This field is used to show the sex of the perpetrator and his her relationship to the victim Enter the 2 digit code Although you may enter more than one perpetrator in Field 33 for the purposes of Field 23 you may only enter one Perpetrator Relationship Code If there is more than one perpetrator for the given victim list the perpetrator code that defines the relationship of the perpetrator who had the most responsibility for action causing the greatest harm or risk of harm to the child DO NOT enter more than one DSS 5104 form number for multiple perpetrators 18 NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Codes begin
14. physical abuse by an adult who regularly lives in the home Abuse and Neglect An allegation that both abuse and neglect occurred Dependency An allegation that a juvenile is in need of assistance or placement because he has no parent guardian or custodian responsible for the juvenile s care or supervision or whose parent guardian or custodian due to physical or mental incapacity and the absence of an appropriate alternative child care arrangement is unable to provide for the juvenile s care or supervision Field 29 Maltreatment Type Reported ENTRY REQUIRED IF APPLICABLE At the time that the CPS report was made select what type of maltreatment is alleged by the report source If type reported code is 1 place as many priority codes as apply up to four next to the Abuse selection options If type reported is 2 place as many priority codes as apply up to ten next to the Neglect selection items 27 1426 ATTACHMENT 1 NORTH CAROLINA DIVISION OF SOCIAL SERVICES FAMILY SERVICES MANUAL VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES CENTRAL REGISTRY REPORT USER MANUAL Change 07 2009 April 2009 If type reported code is 3 place as many priority codes as apply up to fourteen next to both the Abuse and Neglect selection items If type reported code is 4 this field may be left blank For the child identified as a safe surrender select safe
15. surrender If there is no alleged maltreatment for this child enter code OO This option is only to be used if there is more than one child If selected Field 28 would be left blank for this child and no other entries are allowed Maltreatment Type Definition Physical Abuse Non accidental serious physical injury or risk of serious physical injury caused or allowed to be caused by the parent guardian custodian or caretaker The parent guardian custodian or caretaker used or allowed the use of cruel or grossly inappropriate procedures or cruel or grossly inappropriate devices to modify behaviour Emotional Abuse Severe emotional damage to the juvenile created or allowed to be created by the parent guardian custodian or caretaker as evidenced by a juvenile s severe anxiety depression withdrawal or aggressive behaviour toward himself or others Sexual Abuse Any sexual act with by or upon a juvenile in violation of the law committed or allowed to be committed by the parent guardian custodian or caretaker This includes prostitution with or by the child Also included are pornographic filming and picture taking Delinquent Acts Involving Moral Delinquent acts committed by the juvenile with the encouragement direction or approval of the parent or Turpitude caretaker Improper The parent guardian custodian or caretaker did not provide Supervision proper supervision
16. the Central Registry Selection Menu key 6 in the selection field and the perpetrator s last name and first name in the Key field Press ENTER Make sure to separate the last name and the first name with a comma anda space or no names will be displayed The search results will only return results that have an exact match To view the record of a name that is displayed key an I next to the name then PF9 to see the perpetrator information of the central registry FATALITIES From the Central Registry Selection menu key 8 in the selection field Press ENTER This menu is available only for state staff RIL MENU From the Central Registry Selection menu key 9 in the selection field Press ENTER DSS 5104 FORM FIELDS AND CODES Field 1 County Name ENTRY REQUIRED Enter the two digit code that identifies the county conducting the CPS assessment In cases where there is a reciprocal county assisting with the CPS assessment the resident county is responsible for completing the DSS 5104 The resident county s two digit county code is to be entered NORTH CAROLINA DIVISION OF SOCIAL SERVICES FAMILY SERVICES MANUAL VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES 1426 ATTACHMENT 1 Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Co Co Name Co Co Name Co Co Name Co Co Name 01 Alama
17. which the safety and risk of harm is so great that the agency cannot ensure the safety of the children without either providing necessary services or monitoring those provided by another agency or provider 30 NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Code Type Found Definition 6 Services Recommended A situation in which a family assessment has been completed on CPS reports of neglect with the exception of abandonment and the special types of reports and dependency and the safety of a child is not an issue and future risk of harm is not an issue but the family has a need for other non safety related services These are cases that the agency could feel comfortable with the safety of the children if the family chose not to agree continue to participate in or otherwise fail to comply with any one or all of the recommendations made by the agency This finding is not appropriate for cases in which the agency feels it needs to monitor compliance with the service recommendation due to safety and future risk of harm It is also not appropriate to make this finding if the agency believes it would become re involved with the family through CPS should information be received that the family had stopped receiving any recommended service 7 Services
18. 1 64 Original Decision Upheld 61 The original decision to place the name on the RIL was upheld at the Director Level 62 The original decision to place the name on the RIL was upheld at the District Attorney Level 63 The original decision to place the name on the RIL was upheld at the Court Level also includes Dismissed petitions and other court actions 64 The original decision to place the name on the RIL was upheld at an Adjudication Hearing Field 40 Military affiliation If the perpetrator is a member of the military enter the two 2 digit code that corresponds to the branch of service Code Definition 00 Not Applicable 01 Army 02 Navy 03 Air Force 04 Marines 05 Coast Guard 06 Reserves Active duty 07 National Guard Active duty 08 Reserves Inactive 09 National Guard Inactive 10 Unknown 39 ATTACHMENT 1 ENTRY REQUIRED IF APPLICABLE NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Field 41 Child Care Group Home Institution Name ENTRY REQUIRED SUBSTANTIATED CASES INVOLVING CHILD CARE GROUP HOME AND INSTITUTION SETTINGS If the perpetrator relationship code in Field 23 is coded as 17 27 18 or 28 enter the day care arrangem
19. AND OR NEGLECT ONLY Enter the appropriate two 2 digit code to indicate the status of the perpetrator on the Responsible Individuals list Code Value 00 The perpetrator s name should not appear on the Responsible Individuals List This code should only be used if Type Found equals code 2 Neglect and the Serious box was not selected for any of the associated Neglect maltreatment types 10 The perpetrator was responsible for committing Abuse and should appear on the Responsible Individuals List This code should only be used if the Type Found equals code 1 Abuse 20 The perpetrator was responsible for committing Serious Neglect and should appear on the Responsible Individuals List This code should only be used if the Type Found equals code 2 Neglect and at least one Serious box was selected 30 The perpetrator was responsible for committing Abuse and Neglect and should appear on the Responsible Individuals List This code should only be used if the Type Found equals code 3 Abuse and Neglect It is not required that a Serious box be selected in order to use this code Below is a list of system generated codes which denotes that a perpetrator has been involved in an expunction review and the disposition of that review Expunctions from the RIL or modifications to the status of the perpetrator on the RIL as a result of the expunction review does not change the ori
20. COMPUT APPLICATION _ From the CICS sign on screen enter in the user id RACE ID bill code and password and press ENTER NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 ELCOME TO CICSNC16 DHR 24 X 7 PRODUCTION REGION ceececccecece TITILLELILLICLIA Cecocceccecec SSSSSSSSSSSSS I ceccce GEEN SSSSSSSSS ecec YAN ssss AAA EEGA ssss CEEE ssss CECEN ssss ecec ssss TITITITITTIIIT coceccecececec SSSSSSSSSSSS IIIIIIIIIIIIITi k PESOS EE EEE EN SSSS fi11 in bill code Cas bbb ddd News North Carolina DHHS region PRODUCTION To be used by authorized users on official business only Help Desk 9 19 855 3200 Press PF2 for more information Mon Mar 16 03 16 0 4 04 47 ys CICSNC16 cpu SYSA USER The next screen will be a blank screen From this blank screen key sy01 and press ENTER The following Central Registry Menu will be displayed _SYO1 CYAOO1LFM DATE 03 16 20 TIME 13 54 STATE OF NORTH CAROLINA DEPARTMENT OF HUMAN RESOURCES CENTRAL REGISTRY SELECTION MENU FUNCTION KEY SELECTIONS DSS 5104 ENTRY DSS 5104 INQUIRY FORM NUMBER DSS 5104 CHANGES FORM NUMBER VICTIM NAME DISPLAY LAST FIRST MI SOUNDEX VICTIM NAME DISPLAY LAST FIRST PERPETRATOR NAME DISPLAY LAST FIRST MI 1 2 3 4 5 6 ADMINIST
21. CPS In Home services is to be opened the social worker updates the existing DSS 5027 to open service code 215 and any other services to be added and to close 210 services If the child does not have a SIS number in the county receiving the report the social worker does not have to complete a DSS 5027 At the conclusion of the CPS assessment the social worker completes the DSS 5104 including items 12 through 19 A DSS 5027 turnaround form will automatically be generated for this new case with service code 210 opened as of the date of the report The DSS 5027 turnaround form will also show service code 215 open as of the date of the case decision for all substantiated cases and all cases found to be services needed unless the perpetrator relationship code indicates day care foster care group homes or institutions NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Any additional services should be added to the DSS 5027 turnaround form as needed For those few cases that are substantiated or found services needed and closed without CPS In Home services the county Department of Social Services staff should indicate on the DSS 5027 turnaround form closure of service code 215 the same date that it was opened If the child was taken into DSS custody without provision of
22. Case Decision Date Services may have either been provided directly by the DSS or by another agency There is space to enter up to three 2 digit codes for Services Provided If more than three services were provided enter the codes for the three most critical services identified to meet the child and family needs If a family was referred to services but those services had not yet been initiated at the time of case decision place code 12 Information and Referral Services No Services Referred or Provided code is used for cases with Type Found of Unsubstantiated Services Recommended or Services Not Recommended Code pe Sete aaao Referred or Provided Adoption Services Services or activities provided to assist in bringing about the adoption of a child 2 Case Management Services Services or activities for the arrangement coordination and monitoring of services to meet the needs of children and their families This would include NC s service code 215 Case Planning Case Management or CPS In Home Services 3 Counselling Services Activities that apply the therapeutic processes to personal family situational or occupational problems in order to bring about a positive resolution of the problem or improved individual or family functioning or circumstances 4 Child Care Services Services or activities provided in a setting that meet applicable standards of State and local law in a center
23. E COUNTY NAME Example SURRENDER SAFE ALAMANCE Oncea legal name has been obtained update the DSS 5027 to update SIS 11 NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Field 12 Child Social Security Number ENTRY REQUIRED If the alleged victim child already exists in the SIS system leave blank this will be populated by information in SIS If the child does not exist in SIS enter the alleged victim child s Social Security Number If the child does not have a Social Security Number or if the number is unknown enter all 0 s Once the victim child s Social Security Number has been attained complete a DSS 5027 to update the Social Security Number in the SIS system Field 13 Date of Birth If the alleged victim child already exists in the SIS system leave blank this will be populated by information in SIS If the child does not exist in SIS enter the alleged victim child s date of birth Enter the month day and year use a leading zero 0 for any month or day less than ten 10 in the format MMDDCCYY Field 14 Sex ENTRY REQUIRED If the alleged victim child already exists in the SIS system leave blank this will be populated by information in SIS If the child does not exist in SIS enter in the appropriate one 1 digit code Code Va
24. Field 19 Special Areas ENTRY REQUIRED IF APPLICABLE If the alleged victim child already exists in the SIS system leave blank this will be populated by information in SIS If the alleged victim child does not exist in SIS enter in the appropriate two digit code You may enter up to three codes per child For more information on this field please view the SIS Manual Code Value 01 Developmental Disabilities Having a severe chronic mental or physical disability resulting in substantial limitations in three or more of the following areas of major life activity self care receptive and expressive language capacity for independent living learning mobility self direction and economic self sufficiency and reflecting the person s need for a combination of special inter disciplinary care or treatment of a lifelong or extended duration manifested before age 22 unless caused by a head injury 02 Blind or Visually Impaired Having visual impairment that in the social worker s judgment may significantly affect day to day functioning 03 Deaf or Hard of Hearing Having a hearing impairment whether permanent or fluctuating which may in the social worker s judgment adversely affect day to day functioning a communication disorder such as stuttering impaired articulator or language impairment that adversely affects functioning 04 Physically Disabled Having a physical condition that may in the social
25. Improper Care The parent guardian custodian or caretaker did not provide proper care Improper Discipline No Physical Injuries The parent guardian custodian or caretaker did not provide proper discipline Improper Discipline Physical Injuries The parent guardian custodian or caretaker providing improper discipline resulting in physical injuries Injurious Environment Lives in an environment injurious to the juvenile s welfare other than substance abuse or domestic violence Injurious Environment Domestic Violence Evidence of Domestic Violence 28 NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL VOLUME CHILDREN S SERVICES ATTACHMENT 1 CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Injurious Maltreatment Type Environment Substance Abuse Definition Evidence of Substance Abuse Abandonment Child has been abandoned by parent guardian custodian or caretaker other than under the Safe Surrender law Safe Surrender Child has been identified as a safe surrender where the age of the child is 7 days or less Improper Medical Care Remedial Care The parent guardian custodian or caretaker did not provide necessary medical care or other remedial care Violation Adoption Law Placed for adoption in violation of law Field 30 Type Fou
26. NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 l GENERAL INFORMATION This User Manual is written for the Social Worker completing the DSS 5104 paper form and or Data Entry staff entering the data from the DSS 5104 paper form into the CPS Central Registry System A Ie CONFIDENTIALITY North Carolina General Statute GS _7B 311 states that information contained in the Central Registry is confidential Any violations of confidentiality are considered a Class 3 misdemeanour County departments of Social Services have the responsibility for ensuring that unauthorized use is prohibited For this reason security procedures have been established Once access to the Central Registry has been secured it is the responsibility of each user to maintain confidentiality SECURITY The Department of Human Resources and the State Computer Center have implemented the Resource Access Control Facility RACF to help protect automated data at the State Information Processing Center SIPS RACE controls overall access to the Divisions automated system which supports programs supervised by the Division of Social Services RACF does not replace security already established for individual systems With RACF each individual user is identified and verified by a unique ID and a self as
27. Not Recommended A situation in which a family assessment has been completed on CPS reports of neglect with the exception of abandonment and the special types of reports and dependency and not only is the safety of a child not an issue and there is no concern for the future risk of harm but also the family has no need for other non safety related services 8 Services Provided Child Protective Services no longer needed A situation in which a family assessment has been completed on CPS reports of neglect with the exception of abandonment and the special types of reports and dependency and the safety of a child and future risk of harm are no longer issues because the agency had been successful in frontloading necessary services during the family assessment These are cases in which continued involuntary CPS supervision is no longer needed to ensure the child s safety This finding is not appropriate for cases in which the agency feels it needs to monitor compliance with th e service recommendation due to safety and future risk of harm Field 31 Findings Reason ENTRY REQUIRED IF APPLICABLE If type found code in Field 30 is unsubstantiated 0 Services Recommended 6 or Services Not Recommended 7 enter in 2 digit reason code for finding For the safe surrender child this field should be left blank 31 NORTH CAROLINA DIVISION OF SOCIAL SERVICES FAMILY SERVICES MANUAL VOLUME CHILDREN S
28. RATIVE MENU FATALITIES MENU RIL MENU J wo SELECTION B THE CENTRAL REGISTRY HAS 9 FUNCTIONS AVAILABLE 1 DSS 5104 ENTRY This is the option that is used when entering in a new DSS 5104 NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 2 Ie gt In ea N 2 e CENTRAL REGISTRY REPORT USER MANUAL April 2009 DSS 5104 INQUIRY This option is used to view a DSS 5104 that has been previously entered DSS 5104 CHANGES This option is used to make changes to an existing DSS 5104 VICTIM NAME DISPLAY This option is used to search to see if a child has had a previous DSS 5104 entered as a result of prior reports For this option the child s last name first name and middle initial can be entered Only exact matches to the name entered will be displayed It is also possible to search for a child using the option To do so key in as many letters of the last name as possible followed by an and then as many letters of the first name as possible followed by an This option allows you to see all children whose names contain the letters keyed For example if searching for John Doe but unsure of the spelling of the name key in Do Jo and all children whose first names begin with Jo and last names begin with Do will be listed
29. TIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Code Value 53 White Black American Indian Asian Non Hispanic or Latino 54 White Black American Indian Asian Hispanic or Latino 55 White Black American Indian Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 56 White Black American Indian Native Hawaiian or Other Pacific Islander Hispanic or Latino 57 White Black Asian Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 58 White Black Asian Native Hawaiian or Other Pacific Islander Hispanic or Latino 59 White American Indian Asian Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 60 White American Indian Asian Native Hawaiian or Other Pacific Islander Hispanic or Latino 61 Black American Indian Asian Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 62 Black American Indian Asian Native Hawaiian or Other Pacific Islander Hispanic or Latino 63 White Black American Indian Asian Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 64 White Black American Indian Asian Native Hawaiian or Other Pacific Islander Hispanic or Latino Field 16 In School ENTRY REQUIRED IF APPLICABLE If the alleged victim child already exists in the SIS system leave blank This will be populated by information in SIS This field may need to be updated with the alleged victim child s current status If s
30. TRY REPORT USER MANUAL April 2009 Code Type Found Definition 2 Neglect Substantiated A situation in which a juvenile does not receive proper care supervision or discipline from the juvenile s parent guardian custodian or caretaker or who has been abandoned or who is not provided necessary medical care or who is not provided necessary remedial care or who lives in an environment injurious to the juvenile s welfare or who has been placed for care or adoption in violation of the law In determining whether a juvenile is a neglected juvenile it is relevant whether that juvenile lives in a home where another juvenile has died as a result of abuse or neglect or lives in a home where another juvenile has been subjected to sexual abuse or severe physical abuse by an adult who regularly lives in the home 3 Abuse and Neglect Substantiated A situation in which both abuse and neglect are found 4 Dependency Substantiated A situation in which a juvenile is in need of assistance or placement because he has no parent guardian or custodian responsible for the juvenile s care or supervision or whose parent guardian or custodian due to physical or mental incapacity and the absence of an appropriate alternative child care arrangement is unable to pr ovide for the juvenile s care or supervision 5 Services Needed involuntary CPS services to ensure the safety of the child These are situations in
31. ay care arrangement or an employee of a group home or institution enter the required information for the specific perpetrator and write the name of that day care arrangement group home or institution in field 41 labelled CHILD CARE GROUP HOME INSTITUTION at the bottom of the DSS 5104 If the case decision is that the owner operator or administrator of a_child care arrangement or of a group home or institution was responsible for the abuse or neglect of a child that individual s name should be listed as a perpetrator If the case decision concludes that there is no specific employee of a child care arrangement or of a group home or institution who can be identified as a perpetrator in the incident being substantiated enter the name of the program administrator as the perpetrator and enter the name of that child care arrangement group home or institution in the field labelled CHILD CARE GROUP HOME INSTITUTION at the bottom of the paper DSS 5104 form If the situation involves a child care home the day care provider s name may be used in this field If a family assessment was conducted or if the case was substantiated for Dependency there is no perpetrator and therefore nothing is entered in the fields 33 through 39 To access the screen to enter perpetrator information on the main frame Central Registry System press F9 To enter each additional perpetrator press F8 to scroll to the next perpetrator screen Enter the name of
32. ce or no names will be displayed The search results will only return results that have an exact match It is also possible to search for a child using the option To do so key in as many letters of the last name as possible followed by an and then as many letters of the first name as possible followed by an This option allows you to see all children whose names contain the letters keyed For example if searching for John Doe but unsure of the spelling of the name key in Do Jo and all children whose first names begin with Jo and last names begin with Do will be listed NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 m m I gt SOUNDEX VICTIM NAME DISPLAY IN From the Central Registry Selection Menu key 5 in the selection field and the last name the first letter of the first name in the KEY field Press ENTER When using the soundex victim name display to search the central registry a last name is required and at least the first letter of the first name is needed The results will return all names that sound similar to the requested name Again make sure to separate the victim s last name and first name with a comma and a space or no names will be displayed PERPETRATOR NAME DISPLAY From
33. ctim child does not exist in SIS enter in the appropriate two digit code Code Value 01 Living Alone An independent living arrangement where the individual resides either alone or with others where the relationship is not characterized by intimacy continuity or commitment as in a rooming house or shared housing 02 Living With Family or Other Significant Individual s A home occupied by two or more people who are related by blood marriage adoption or who have a commitment to care for one another 03 Family Care Home A licensed domiciliary home having a capacity of two to six residents 04 Home for the Aged A licensed domiciliary home has a capacity of seven or more residents 05 Group Home for Developmentally Disabled Adults A licensed DDS group home housing residents with developmental disability regardless of which local state agency has licensing monitoring or certification responsibilities 06 Nursing Combination Home A licensing facility which provides nursing or convalescent care for three or more persons 07 Treatment Rehabilitation Facility Home A 24 hour facility home which provides treatment or rehabilitation services for medical psychosocial or psychiatric needs e g medical or psychiatric hospital State Mental Retardation Center mental health group home for persons with mental illness Not included in this definition are nursing homes maternity homes and gr
34. e completed the information from the form is keyed into the Central Registry System The DSS 5104 has 41 fields Fields 1 9 have general information pertaining to the assessment and must always be completed once per form number Fields 10 32 have information pertaining to the victim The DSS 5104 paper form has space for one victim If the CPS assessment has more than one victim complete fields 10 32 on a DSS 5104c complete as many as needed To enter more than one child select the PF 8 key and proceed to enter the information regarding that child Each victim must have a copy of a completed DSS 5104 paper form in their case record Although there may be multiple DSS 5104 paper forms for one assessment there is only one form number per assessment The Central Registry allows for up to 20 victims and 10 perpetrators per DSS 5104 Do not enter multiple children from the same CPS Assessment under different form numbers for the DSS 5104 Fields 33 40 have information pertaining to the perpetrator The DSS 5104 paper form has space for 2 perpetrators If the assessment has more than 2 perpetrators a DSS 5104p should be used but use the same form number for each sheet To enter more than one perpetrator select the PF 8 key and proceed to enter the information regarding that perpetrator Once the DSS 5104 paper form has been completed and sent to data entry the information is then entered into the Central Registry 1 KEYING INSTRUCTIONS Th
35. e following is a list of function keys that are used The system often displays messages regarding these function keys at the bottom of the screen Read these messages carefully before proceeding to the next screen NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 A m lt FUNCTION m j oO The system edits the screen and displays messages when an error is found or when the form updates successfully 0 TI To exit the screen and return to the Central Registry Selection menu igo TI N To scroll back to the previous screen 0 T 00 To scroll forward to the next screen DSS 5104c and DSS 5104p a T To add update when displayed on the screen you are keying aN oO To cancel data keyed on a current screen IO To enter in information on a new DSS 5104 key in 1 in the selection field and press ENTER The system will not generate a form id number until the entire form has been keyed The next screen will show a blank DSS 5104 and information can be entered and saved DSS 5104 INQUIRY The inquiry function allows users to view previously keyed DSS 5104 s To view the DSS 5104 key 2 as the selection and key in the form number and press enter This will display the DSS 5104 Sinc
36. e this is an inquiry changes will not be allowed DSS 5104 CHANGES When making changes to the DSS 5104 each change and reason should be thoroughly documented along with the appropriate authorization by the county Department of Social Services director or designee indicated in the child s record The corrected paper DSS 5104 form should be placed in the child s record From the Central Registry Selection Menu key 3 as the selection and key the form number of the form being corrected This will display the DSS 5104 screen This screen allows data entry staff to make the appropriate changes There are certain fields that are protected and information can not be keyed These fields are highlighted when this occurs In most cases the cursor does not stop in these fields If information is attempted to be keyed in a protected field the system displays the not allowed symbol in the lower left corner of the screen This symbol is an X next to a stick figure with arrows To remove this error symbol press the ESC key 1 DELETIONS If a DSS 5104 has been entered in error the form must be deleted To request that a DSS 5104 be deleted from the system a written request must be submitted to the Division of Social Services via the DSS 5104d Requests must be submitted to NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES
37. ent group home or institution name involved If the situation involves a child care home the child care provider s name may be used 40
38. eporter is a person who deliberately chooses to remain anonymous 02 Childcare Provider This category includes baby sitters personnel in childcare arrangements Smart Start or Head Start agency personnel 03 Educational Personnel This category includes teachers principals school nurses learning aids school librarians or other individuals who report the maltreatment as a result of their involvement in a school setting 04 Law Enforcement or Court Personnel This category includes police courts attorney parole and probation officers and sheriff s deputies 22 NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Code Definition 05 Medical Personnel This category includes private physicians clinic or hospital physicians dentists emergency room personnel nurses X ray technicians the staff of a physician in private practice optometrists and paramedics 06 Relative A member of the child s and or caretakers immediate or extended family who is not covered by another category 07 Non Relative A person who is not related to the child s family or to the child Example friend neighbor or foster parent 08 Human Service Personnel This is category includes social workers mental health workers psychiatrist psychologist psychiatr
39. ginal maltreatment type found by the agency These are not valid codes for entry on the DSS 5104 Code Value 41 44 Expungements 41 The individual was expunged from the Responsible Individuals List at the Director Level 42 The individual was expunged from the Responsible Individuals List at the District Attorney Level 43 The individual was expunged from the Responsible Individuals List at the Court Level 44 The individual was expunged from the Responsible Individuals List at an Adjudication Hearing 51 59 Modifications 38 NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Code Value 51 RIL Indicator was modified to Abuse at the Director Level 52 RIL Indicator was modified to Serious Neglect at the Director Level 53 RIL Indicator was modified to Abuse and Neglect at the Director Level 54 RIL Indicator was modified to Abuse at the Court Level 55 RIL Indicator was modified to Neglect at the Court Level 56 RIL Indicator was modified to Abuse and Neglect at the Court Level 57 RIL Indicator was modified to Abuse at an Adjudication Hearing 58 RIL Indicator was modified to Serious Neglect at an Adjudication Hearing 59 RIL Indicator was modified to Abuse and Neglect at an Adjudication Hearing 6
40. hild and Household Contributory factors should be prioritized separately The priority must be a two 2 digit number i e 01 for the highest priority Complete this section on the DSS 5104for each child At least one contributory factor from one of these three tables must be identified if the CPS Assessment finding is substantiated or services needed If none of these apply enter 00 if entered no other entries are allowed 23 NORTH CAROLINA DIVISION OF SOCIAL SERVICES FAMILY SERVICES MANUAL VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES 1426 ATTACHMENT 1 Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Caretaker Contributory Factors Contributory Factor Definition Alcohol Abuse Caretaker The principal caretaker s compulsive use of alcohol that is not of a temporary nature Drug Abuse Caretaker The principal caretaker s compulsive use of drugs that is not of a temporary nature Mental Retardation Caretaker Emotionally Disturbed Caretaker Contributory Factor Significant sub average general cognitive and motor functioning existing concurrently with deficits in adaptive that adversely affect socialization and learning This condition must be clinically diagnosed A condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree an inability to build or maintain satisfactory
41. ic or clinical social workers and the staff of social service agencies and institutions 09 Victim The child who alleged to be neglected or abused 10 Parent The biological adoptive or stepparent of the child 11 NA During the course of the CPS assessment there was no failure to report found Field 26 Failure to Report Reason REQUIRED IF Code 01 10 are entered in Field 24 If code 01 10 has been selected for field 24 at least one of the following reasons must be selected Enter an X by the appropriate failure to report reasons Select as many reasons that apply Did not want to get involved family matters religious beliefs e Thought DSS would not respond Fear of retaliation financial distress Did not know how to report Thought someone else would report it better handled by other resources or services Thought it would be a breach of confidentiality e Did not consider actions inappropriate disbelief of possible allegations Other Refused to Say Unknown FIELD 27 CONTRIBUTORY FACTORS REQUIRED IF SUBSTANTIATED OR FOUND SERVICES NEEDED The first two tables for Contributory Factors below are based on the parent and the victim child Select as many factors as applicable based on priority from 01 up to 09 for both the caretaker and the child The third table below is based on household or family unit factor Select as many factors as applicable based on the priority from 01 to 04 Caretaker C
42. ight or for a weekend Not considered by the State to be foster care or other placement Special Services Disabled Activities for persons with developmental physical emotional visual or auditory impairments that are intended to help maximize their potential alleviate the effects of their disabilities and to enable these persons to live in the least restrictive environment possible Special Services Juvenile Delinquent Activities for youth and their families who are or who may become involved with the juvenile justice system Substance Abuse Services Activities designed to deter reduce or eliminate substance abuse or chemical dependency for the child or the child s family as a result of the CPS response to reported allegations or to the child himself 21 NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Code Definition 0 Transportation Services Activities that provide or arrange for travel including travel costs of individuals in order to access services or obtain medical care or employment 1 Other Services Activities that have been provided to the child and or family but which are not included in the services listed above Court Appointed Representative A person appointed by the court to repre
43. il 2009 Code Value 17 White Asian Non Hispanic or Latino 18 White Asian Hispanic or Latino 19 White Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 20 White Native Hawaiian or Other Pacific Islander Hispanic or Latino 21 Black American Indian or Alaskan Native Non Hispanic or Latino 22 Black American Indian or Alaskan Native Hispanic or Latino 23 Black Asian Non Hispanic or Latino 24 Black Asian Hispanic or Latino 25 Black Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 26 Black Native Hawaiian or Other Pacific Islander Hispanic or Latino 27 American Indian or Alaskan Native Asian Non Hispanic or Latino 28 American Indian or Alaskan Native Asian Hispanic or Latino 29 American Indian or Alaskan Native Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 30 American Indian or Alaskan Native Native Hawaiian or Other Pacific Islander Hispanic or Latino 31 Asian Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 32 Asian Native Hawaiian or Other Pacific Islander Hispanic or Latino 33 White Black American Indian or Alaskan Native Non Hispanic or Latino 34 White Black American Indian or Alaskan Native Hispanic or Latino 35 White Black Asian Non Hispanic or Latino 36 White Black Asian Hispanic or Latino 37 White Black Nat
44. ino 14 White Black Hispanic or Latino 35 NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Code Value 15 White American Indian or Alaskan Native Non Hispanic or Latino 16 White American Indian or Alaskan Native Hispanic or Latino 17 White Asian Non Hispanic or Latino 18 White Asian Hispanic or Latino 19 White Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 20 White Native Hawaiian or Other Pacific Islander Hispanic or Latino 21 Black American Indian or Alaskan Native Non Hispanic or Latino 22 Black American Indian or Alaskan Native Hispanic or Latino 23 Black Asian Non Hispanic or Latino 24 Black Asian Hispanic or Latino 25 Black Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 26 Black Native Hawaiian or Other Pacific Islander Hispanic or Latino 27 American Indian or Alaskan Native Asian Non Hispanic or Latino 28 American Indian or Alaskan Native Asian Hispanic or Latino 29 American Indian or Alaskan Native Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 30 American Indian or Alaskan Native Native Hawaiian or Other Pacific Islander Hispanic or Latino
45. ive Hawaiian or Other Pacific Islander Non Hispanic or Latino 38 White Black Native Hawaiian or Other Pacific Islander Hispanic or Latino 39 White American Indian or Alaskan Native Asian Non Hispanic or Latino 40 White American Indian or Alaskan Native Asian Hispanic or Latino 41 White American Indian or Alaskan Native Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 42 White American Indian or Alaskan Native Native Hawaiian or Other Pacific Islander Hispanic or Latino 43 White Asian Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 44 White Asian Native Hawaiian or Other Pacific Islander Hispanic or Latino 45 Black American Indian or Alaskan Native Asian Non Hispanic or Latino 46 Black American Indian or Alaskan Native Asian Hispanic or Latino 47 Black American Indian or Alaskan Native Native Hawaiian Non Hispanic or Latino 48 Black American Indian or Alaskan Native Native Hawaiian Hispanic or Latino 49 Black Asian Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 50 Black Asian Native Hawaiian or Other Pacific Islander Hispanic or Latino 51 American Indian Asian Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 52 American Indian Asian Native Hawaiian or Other Pacific Islander Hispanic or Latino 13 NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTEC
46. ker used or allowed the use of cruel or grossly inappropriate procedures or cruel or grossly inappropriate devices to modify behaviour Emotional Abuse Severe emotional damage to the juvenile created or allowed to be created by the parent guardian custodian or caretaker as evidenced by a juvenile s severe anxiety depression withdrawal or aggressive toward himself or others Sexual Abuse Any sexual act with by or upon a juvenile in violation of the law committed or allowed to be committed by the parent guardian custodian or caretaker This includes prostitution with or by the child Also included are pornographic filming and picture taking Delinquent Acts Involving Moral Turpitude Delinquent acts committed by the juvenile with the encouragement direction or approval of the parent or caretaker Neglect Type Definition Improper Supervision The parent guardian custodian or caretaker did not provide proper supervision Improper Care The parent guardian custodian or caretaker did not provide proper care Improper Discipline No Physical Injuries The parent guardian custodian or caretaker did not provide proper discipline Improper Discipline Physical Injuries The parent guardian custodian or caretaker providing improper discipline resulting in physical injuries Injurious Environment Lives in an environment injurious to the juvenile s welfare o
47. lander Non Hispanic or Latino 62 Black American Indian Asian Native Hawaiian or Other Pacific Islander Hispanic or Latino 63 White Black American Indian Asian Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 64 White Black American Indian Asian Native Hawaiian or Other Pacific Islander Hispanic or Latino Field 37 Sex ENTRY REQUIRED ON CASES SUBSTANTIATED FOR ABUSE AND OR NEGLECT ONLY Enter the appropriate one 1 digit code to indicate the sex of the perpetrator See field codes for codes and definitions Code Value 1 Male 2 Female Field 38 Social Security Number ENTRY REQUIRED ON CASES SUBSTANTIATED FOR ABUSE AND OR NEGLECT ONLY Enter the social security number for the perpetrator Itis extremely important to make every effort to obtain the perpetrators social security number for identification purposes in the event that perpetrator s names are placed on the Responsible Individuals List and required by law to be released for such purposes as employment screening If the social security number is unknown and cannot be obtained enter all O s in this field 37 NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Field 39 Responsible Individuals List Indicator ENTRY REQUIRED ON CASES SUBSTANTIATED FOR ABUSE
48. listed in Field 35 and the date of the report The fact that the date of birth is estimated will be marked in the Central Registry system Field 35 Age ENTRY REQUIRED FOR CASES SUBSTANTIATED FOR ABUSE AND OR NEGLECT ONLY If the perpetrator s date of birth is unknown and cannot be obtained enter the two 2 digit code that indicates the perpetrator s age in years If the exact age is unknown approximate the age Do not code a 99 for unknown Do not complete this Field when the date of birth was entered in Field 34 The Central Registry system will compute the age automatically Field 36 Race Ethnicity ENTRY REQUIRED FOR CASES SUBSTANTIATED FOR ABUSE AND OR NEGLECT ONLY Enter the appropriate two 2 digit code to indicate the primary racial group of which the perpetrator is a member Code Value 01 White Native Non Hispanic or Latino 02 White Hispanic or Latino 03 Black Non Hispanic or Latino 04 Black Hispanic or Latino 05 American Indian or Alaskan Native Non Hispanic or Latino 06 American Indian or Alaskan Native Hispanic or Latino 07 Asian Non Hispanic or Latino 08 Asian Hispanic or Latino 09 Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 10 Native Hawaiian or Other Pacific Islander Hispanic or Latino 11 Unable to Determine Non Hispanic or Latino 12 Unable to Determine Hispanic or Latino 13 White Black Non Hispanic or Lat
49. lue 1 Male 2 Female Field 15 Race Ethnicity ENTRY REQUIRED If the alleged victim child already exists in the SIS system leave blank this will be populated by information in SIS If the alleged victim child does not exist in SIS enter in the appropriate two digit code For the safe surrender child if no parent is available to indicate the race use code 11 or 12 Unable to determine Code Value 01 White Native Non Hispanic or Latino 02 White Hispanic or Latino 03 Black Non Hispanic or Latino 04 Black Hispanic or Latino 05 American Indian or Alaskan Native Non Hispanic or Latino 06 American Indian or Alaskan Native Hispanic or Latino 07 Asian Non Hispanic or Latino 08 Asian Hispanic or Latino 09 Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 10 Native Hawaiian or Other Pacific Islander Hispanic or Latino 11 Unable to Determine Non Hispanic or Latino 12 Unable to Determine Hispanic 13 White Black Non Hispanic or Latino 14 White Black Hispanic or Latino 15 White American Indian or Alaskan Native Non Hispanic or Latino 16 White American Indian or Alaskan Native Hispanic or Latino 12 NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII P Change 07 2009 ROTECTIVE SERVICES CENTRAL REGISTRY REPORT USER MANUAL Apr
50. ment type must be assigned a priority code The priority code is based on what level of priority is given to the maltreatment type with 01 being the highest priority The priority code must be at least 2 digits The maltreatment type is based on the case finding type found in Field 30 If the case finding type found code is 1 then prioritize as many Abuse maltreatment types as apply up to four If the case finding type found code is 2 then prioritize as many Neglect maltreatment types as apply up to ten If the case finding type found code is 3 then prioritize as many Abuse and Neglect maltreatment types as apply up to fourteen If Abandonment is prioritized as a Neglect maltreatment code check the Safe Surrender box if the child was abandoned under the Safe Surrender law the child s date of birth must be within 7 days of report date For all Neglect maltreatment types that are prioritized the Serious box may be selected 32 NORTH CAROLINA DIVISION OF SOCIAL SERVICES FAMILY SERVICES MANUAL VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES 1426 ATTACHMENT 1 Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Abuse Type Definition Physical Abuse Non accidental serious physical injury or risk of serious physical injury caused or allowed to be caused by the parent guardian custodian or caretaker The parent guardian custodian or careta
51. month or day less than ten 10 that the report of abuse neglect dependency was made to the county Department of Social Services in the format of MMDDCCYY If subsequent reports are received before the completion of the CPS assessment enter the date of the first report that led to the opening of the CPS assessment 10 ENTRY REQUIRED ENTRY REQUIRED IF APPLICABLE Entry is not required if a valid county worker ID is entered Otherwise enter the last name first initial and middle initial of the case manager ENTRY REQUIRED ENTRY REQUIRED NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Field 6 Date CPS Assessment Initiated ENTRY REQUIRED Enter the month day and year use a leading zero 0 for any month or day less than ten 10 that the CPS assessment was initiated in the format of MMDDCCYY Field 7 Date Case Decision ENTRY REQUIRED Enter the month day and year use a leading zero 0 for any month or day less than ten 10 that the CPS assessment was completed in the format MMDDCCYY All information gathered during the CPS assessment process shall be incorporated into one case decision and one DSS 5104 Even if there are multiple children multiple perpetrators and or multiple maltreatment types submit the information into the Central Registry unde
52. nce 26 Cumberland 51 Johnston 76 Randolph 02 Alexander 27 Currituck 52 Jones 77 Richmond 03 Alleghany 28 Dare 53 Lee 78 Robeson 04 Anson 29 Davidson 54 Lenoir 79 Rockingham 05 Ashe 30 Davie 55 Lincoln 80 Rowan 06 Avery 31 Duplin 56 Macon 81 Rutherford 07 Beaufort 32 Durham 57 Madison 82 Sampson 08 Bertie 33 Edgecombe 58 Martin 83 Scotland 09 Bladen 34 Forsyth 59 McDowell 84 Stanly 10 Brunswick 35 Franklin 60 Mecklenburg 85 Stokes 11 Buncombe 36 Gaston 61 Mitchell 86 Surry 12 Burke 37 Gates 62 Montgomery 87 Swain 13 Cabarrus 38 Graham 63 Moore 88 Transylvania 14 Caldwell 39 Granville 64 Nash 89 Tyrrell 15 Camden 40 Greene 65 New Hanover 90 Union 16 Carteret 41 Guilford 66 Northampton 91 Vance 17 Caswell 42 Halifax 67 Onslow 92 Wake 18 Catawba 43 Harnett 68 Orange 93 Warren 19 Chatham 44 Haywood 69 Pamlico 94 Washington 20 Cherokee 45 Henderson 70 Pasquotank 95 Watauga 21 Chowan 46 Hertford 71 Pender 96 Wayne 22 Clay 47 Hoke 72 Perquimans 97 Wilkes 23 Cleveland 48 Hyde 73 Person 98 Wilson 24 Columbus 49 Iredell 74 Pitt 99 Yadkin 25 Craven 50 Jackson 75 Polk 00 Yancey Field 2 County Case Number Enter the county s Child Protective Services case number up to 6 numeric digits Field 3 Case Manager Name Field 4 Case Manager Number Enter the county case manager worker ID number up to 9 numeric digits Field 5 Date of Initial Report Enter the month day and year use a leading zero 0 for any
53. nce Abuse Using alcohol or other drugs to a degree which creates a risk of harm to self or others or impairs social educational or occupational functioning 11 Undisciplined Child A child who is an adjudicated undisciplined child under NCGS 7A 517 28 12 Delinquent Child A child who is an adjudicated delinquent child under NCGS 7A 517 12 13 Homeless Person A person who does not have what society defines as a normal place of his her own to live 14 Alzheimer s Disease and Related Dementias Having an organic mental disorder in which intellectual function is progressively impaired in a previously well adult usually accompanied by memory loss disorientation impaired judgment and personality change Field 20 Source of Referral ENTRY REQUIRED Enter the two 2 digit code for the source of referral There are spaces for up to three 3 sources of referral to allow for subsequent reports that may come in during the CPS assessment If more than one source of referral is listed list the initial source first and the subsequent sources in order of receipt All information gathered during the fact finding process shall be incorporated into one case decision and one DSS 5104 Code Definition 01 Anonymous An anonymous reporter is a person who deliberately chooses to remain unknown 02 Child Care Provider This category includes baby sitters personnel in day care arrangements
54. nd ENTRY REQUIRED Enter the one 1 digit code to indicate the findings of the CPS assessment These codes may be different for each alleged victim child in the report Select the appropriate type found for each alleged victim child in the report Expunction Modification decisions do not change the type found The expunction or modification will only be reflected on the RIL Code Type Found Definition 0 Unsubstantiated A situation that abuse neglect or dependency was not found 1 Abuse A situation in which a juvenile s parent guardian Substantiated custodian or caretaker inflicts or allows to be inflicted creates or allows to be created a substantial risk of serious physical injury by other than accidental means or uses or allows to be used upon the juvenile cruel or grossly inappropriate procedures or cruel or grossly inappropriate devices to modify behaviour or commits permits or encourages the commission of any sexual offense by with or upon the juvenile in violation of the law promotes the prostitution of the juvenile or creates or allows to be created serious emotional damage to the juvenile or encourages directs or approves of delinquent acts involving moral turpitude committed by the juvenile 29 NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL VOLUME CHILDREN S SERVICES ATTACHMENT 1 CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGIS
55. ning with one 1 indicate female Codes beginning with two 2 indicate male Female Male Definition 10 20 Natural Parent Biological mother or father of the child 11 21 Adoptive Parent Parent who is not the child s natural parent but who has completed the legal procedures for adoption of the child 22 Stepparent Father s spouse or mother s spouse when the spouse is not the natural parent and when the child has not been adopted by the stepparent 23 Foster Parent An individual who lives in a private residence and who is licensed by the Division of Social Services to provide continuing full time 24 hour foster care or therapeutic care to children 24 Grandparent A parent of the child s mother or father 25 Step Grandparent A parent of the child s stepfather or stepmother 26 Other Relatives A relative other than parents or grandparents aunts uncles cousins nieces siblings nephews etc 27 Employee of an Institution Group Home An institution group home is any public or private agency group organization corporation or partnership employing directing assisting or providing its facilities to persons who as a part of their association with the institution give 24 hour residential care and services to children less than 18 years of age An employee of Institution Group homes includes house parents cottage parents or other persons supervising
56. o update this field in SIS If the alleged victim child does not exist in SIS enter in the appropriate code Code Definition P Yes child is enrolled in a public school R Yes child is enrolled in a private school H Yes child is enrolled in home school N No child is not enrolled in school Field 17 Grade ENTRY REQUIRED IF APPLICABLE If the alleged victim child already exists in the SIS system leave blank This field will be populated by information in SIS This field may need to be updated with the alleged victim child s current status If the alleged victim child does not exist in SIS enter in the appropriate code for highest grade or status 14 NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Code Definition P Preschool 01 20 To identify either the highest grade attained if the individual is no longer in school or the last grade attended or the current grade if the individual is still in school 98 GED Status 99 Unknown Field 18 Living Arrangement ENTRY REQUIRED IF APPLICABLE If the alleged victim child already exists in the SIS system leave blank This will be populated Unknown by information in SIS For the safe surrender child enter code 99 If the alleged vi
57. or in a home for a portion of a 24 hour day 5 Educational and Training Services Activities provided to improve knowledge or daily living skills and to enhance cultural opportunities 6 Employment Services Activities provided to assist individuals in securing employment or acquiring of skills that promote opportunities for employment 7 Family Planning Services Educational medical or social service activities that enable individuals including minors to determine freely the number and spacing of their children and to select the means by which this may be achieved 8 Health Related and Home Health Services Activities provided to attain and maintain a favourable condition of health a a a M pe pe P ee 20 NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Code Definition Home Based Services In home activities provided to individuals or families to assist with household or personal care that improve or maintain family well being Includes in home aides home maintenance and household management services Housing Services Activities designed to assist individuals or families in locating obtaining or retaining suitable housing Independent and Transitional Living Services LINKS Activities designed to help older youth in foste
58. oup homes for developmentally disabled adults 08 Maternity Home A 24 hour residential program whose primary purpose is to provide care support and other services for pregnant females 09 Jail Lockup Detention A local jail or a facility administered by the Department of Corrections or Division of Youth Services 10 Battered Women s Shelter A 24 hour residential program whose primary purpose is to offer protection food shelter support and other services to battered women and their children 11 Shelter for the Homeless An overnight shelter for people without homes 15 NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Code Value 97 Child Placement System DSS 5094 When the client is a child for whom the DSS has custody or placement authority the living arrangement will be tracked through the Child Placement and Payment System This code should remain unchanged in this system for as long as the DSS 5094 record remains open If the client remains a service client after the DSS 5094 record is closed this field will have to be updated on the 5027 to reflect the actual living arrangement 98 Other A living arrangement which is known to the agency but does not fit the above definitions 99 Unknown
59. r care or homeless youth make the transition to independent living N Information and Referral Services Resources or activities designed to provide facts about services made available by public and private providers after a brief assessment of client needs but not a diagnosis and evaluation to facilitate appropriate referral to these community resources o Legal Services Activities provided by a lawyer or other person s under the supervision of a lawyer to assist individuals in seeking or obtaining legal help in civil matters such as housing divorce child support guardianship paternity and legal separation Mental Health Services Activities which aim to overcome issues involving emotional disturbance or maladaptive adversely affecting socialization learning or development Usually provided by public or private mental health agencies and includes both residential and non residential activities o D O A D O a a a a a U Pregnancy Parenting Services for Young Parents Activities for married or unmarried adolescent parents and their families to assist them in coping with social emotional and economic problems related to pregnancy and to plan for the future e gt Respite Care Services Activities involving the temporary care of the children in order to provide relief to the caregiver May involve care of the children outside of the caregiver s own home for a brief period of time such as overn
60. r only one DSS 5104 Form Number Field 8 Risk Assessment Rating ENTRY REQUIRED Enter the one 1 digit code indicating the over all risk rating as determined by the family risk assessment for each case A family risk assessment is not required for a case involving child care group home or institutional settings in which case select N A on the DSS 5104 CODE DEFINITION L Low M Medium H High l Intensive N Not Applicable Field 9 Request for Assistance ENTRY REQUIRED IF APPLICABLE Enter the two 2 digit numeric code that corresponds to the county that provided assistance during the assessment Up to three 3 county codes may be entered Refer to Field 1 for a listing of the county codes Field 10 Child ID ENTRY REQUIRED If the alleged victim child already exists in SIS enter the SIS Client ID on the form If the alleged victim child does not already exist in SIS obtain a new SIS Client ID and enter it on the form Field 11 Child Name ENTRY REQUIRED If the alleged victim child already exists in SIS enter the last name first name and middle initial as it appears in the SIS system This name will be verified at data entry when the SIS Client ID is keyed If the alleged victim child does not already exist in SIS enter the last name first name and middle initial of the alleged victim child For the child involved in a safe surrender enter the last name as SURRENDER the first name as SAF
61. r with AIDS Household Family Unit Contributory Factors Contributory Factor Definition Domestic Violence Incidents of inter spousal physical or emotional abuse perpetrated by one of the spouses or parent figures upon the other spouse or parent figure in the child s home environment Inadequate Housing A risk factor related to substandard overcrowded unsafe or otherwise inadequate housing conditions including homelessness Financial Problem A risk factor related to the family s inability to provide sufficient financial resources to meet minimum needs Public Assistance Any one or combination of the following welfare or social services programs TANF WFFA General Assistance Medicaid SSI Food Stamps etc Field 28 Type Reported ENTRY REQUIRED Enter the one 1 digit code to identify the type of report received For the child where the only allegation is safe surrender type 4 should be selected Note when there are multiple children involved in a CPS assessment and there are no allegations of maltreatment associated with the child this field may be left blank provided that the first child listed has a valid code entered 26 NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 ATTACHMENT 1 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Code
62. sent or advocate for a child in a neglect or abuse proceeding May be an attorney or a court appointed Special Advocate or both and is often referred to as a Guardian ad Litem 3 Family Preservation Services Activities designed to help families alleviate crises that might lead to out of home placement of children maintain the safety of children in their own homes support families preparing to reunify or adopt and assist families in obtaining services and other supports necessary to address their multiple needs in a culturally sensitive manner Family Support Services Community based preventative activities designed to alleviate stress and promote parental competencies and behaviours that will increase the ability of families to successfully nurture their children enable families to use other resources and opportunities available in the community and create supportive networks to enhance child rearing abilities of parents 2 4 A a a i Field 25 Failure to Report Source ENTRY REQUIRED This field is completed when during the course of the CPS assessment sources were found to know of the allegations but failed to report them Use the code that best describes the source If there is more than one source identified that failed to report the allegations please record the first source identified Enter the two 2 digit code for the source of failure to report Code Definition 01 Anonymous An anonymous r
63. signed password Each county security control officer is responsible for assigning generic RACF ID s and password s provided by the Division s security administrators Each user then selects an individual password RACE ID s and passwords are confidential and all users must sign a memorandum of understanding when assigned security clearance All users are instructed that RACE ID s and passwords are for Official Use Only Passwords must begin with an aloha character and must be six to eight characters can be letters numbers or a combination of both A password and RACE ID is revoked if not used in 45 days entered incorrectly five times in a row or not changed within the required time frame 90days Should a user s access be revoked the user must contact the security officer for that county Ifa user forgets a password the county security officer would need to be contacted TERMINAL MESSAGES A CW Listserv has been established to deliver terminal messages via email Terminal messages are used to communicate system related issues updates or changes To receive these messages you must subscribe to the CW Listserv NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 S m a To Subscribe Go to the website http lists ncmail net mailman listinfo cwlis
64. sub average general cognitive and motor functioning existing concurrently with deficits in adaptive behaviour manifested during the developmental period that adversely affect a child s youth s socialization and learning This condition must be clinically diagnosed Emotionally Disturbed Child A condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree an inability to build or maintain satisfactory interpersonal relationships inappropriate types of or feeling under normal circumstances a general pervasive mood of unhappiness or depression or a tendency to develop physical symptoms or fears associated with personal problems The term includes persons who are schizophrenic or autistic The term does not include persons who are socially maladjusted unless it is determined that they are also seriously emotionally disturbed This condition must be clinically diagnosed The diagnosis is based on the Diagnostics and Statistical Manual of Mental Disorders the most recent edition of DSM Visually or Hearing Impaired Child A clinically diagnosed handicapping condition of the child related to visual impairment or permanent or fluctuating hearing or speech impairment that may significantly affect functioning or development Learning Disability Child A disorder in one or more of the child s basic psychological processes involved in understanding or using
65. t adversely affects the caretaker s day to day motor functioning such as cerebral palsy spinal bifida multiple sclerosis impairments and other physical disabilities This condition must be clinically diagnosed 24 NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Other Medical Condition A medical condition other than mental retardation visual or Caretaker hearing impairment physical disability or being emotionally disturbed that significantly affects the functioning or development of the primary caretaker s and their ability to provide a suitable child care environment This condition must be clinically diagnosed Lack of Child Limited knowledge of what can be reasonably expected of a Development child at various stages of development Knowledge Caretaker Child Contributory Factors Contributory Factor Definition Alcohol Problem Child A compulsive use of or need for alcohol This includes infants addicted at birth or who are victims of Fetal Alcohol Syndrome or who may suffer other disabilities due to the use of alcohol during pregnancy Drug Problem Child A compulsive use of or need for narcotics This includes infants addicted at birth Mental Retardation Child Significant
66. ther than substance abuse or domestic violence Injurious Environment Domestic Violence Evidence of Domestic Violence Injurious Environment Substance Abuse Evidence of Substance Abuse Abandonment Child has been abandoned by parent guardian custodian or caretaker Check the Safe Surrender box if the child has been abandoned under the Safe Surrender law the child s date of birth must be within 7 days of report date Improper Medical Care Remedial Care The parent guardian custodian or caretaker did not provide necessary medical care or other remedial care Adoption Law Violation Placed for adoption in violation of law 33 NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Field 33 Perpetrator Name ENTRY REQUIRED FOR CASES SUBSTANTIATED FOR ABUSE AND OR NEGLECT ONLY No perpetrator information is entered when the type found in Field 30 is Dependency 4 or for any of the Family Assessment Findings 5 6 7 or 8 There are sections on the DSS 5104 for up to two perpetrators in the report At data entry there are sections in the system for up to ten perpetrators in the report Therefore if there are more than two perpetrators in a report complete the DSS 5104p If any perpetrator is an employee of a d
67. tserv and complete the registration You will be notified by email when access has been approved IN To Unsubscribe Go to the website http lists ncmail net mailman listinfo cwlistserv and at the bottoms of the page there is an option to unsubscribe TURNAROUNDS For each DSS 5104 keyed and processed in the nightly update a DSS 5104 turnaround is created and mailed to the county LINK TO SIS AND RIL The DSS 5104 is linked with the form DSS 5027 SIS Client Entry Form This linkage eliminates the need for the county Department of Social Services staff to complete a separate DSS 5027 when opening a case for CPS assessment when the alleged victim child does not already have a previously assigned SIS number in that county When a CPS report is accepted on a child the SIS system needs to be checked to see if the child has an existing SIS number in the county receiving the report If the child has an existing SIS number in the county the social worker should update the existing DSS 5027 for that child open service code 210 CPS assessment if not already open and submit it for data entry The social worker will complete the DSS 5104 at the conclusion of the CPS assessment In this situation items 12 through 19 on the DSS 5104 should be left blank as this information is already in the SIS system The social worker submits the DSS 5104 for data entry If the report is substantiated or found services needed and service code 215
68. ve Native Hawaiian Hispanic or Latino 49 Black Asian Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 50 Black Asian Native Hawaiian or Other Pacific Islander Hispanic or Latino 51 American Indian Asian Native Hawaiian or Other Pacific Islander Non 36 NORTH CAROLINA DIVISION OF SOCIAL SERVICES 1426 FAMILY SERVICES MANUAL ATTACHMENT 1 VOLUME CHILDREN S SERVICES CHAPTER VIII PROTECTIVE SERVICES Change 07 2009 CENTRAL REGISTRY REPORT USER MANUAL April 2009 Code Value Hispanic or Latino 52 American Indian Asian Native Hawaiian or Other Pacific Islander Hispanic or Latino 53 White Black American Indian Asian Non Hispanic or Latino 54 White Black American Indian Asian Hispanic or Latino 55 White Black American Indian Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 56 White Black American Indian Native Hawaiian or Other Pacific Islander Hispanic or Latino 57 White Black Asian Native Hawaiian or Other Pacific Islander Non Hispanic or Latino Code Value 58 White Black Asian Native Hawaiian or Other Pacific Islander Hispanic or Latino 59 White American Indian Asian Native Hawaiian or Other Pacific Islander Non Hispanic or Latino 60 White American Indian Asian Native Hawaiian or Other Pacific Islander Hispanic or Latino 61 Black American Indian Asian Native Hawaiian or Other Pacific Is

Instructions for Completing Form DSS-5104

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