3590 CJ MOD 3

2-3

JUVENILE NAME ____________________________________ JUVENILE ID _____________________________ JUVENILE DATE OF BIRTH _____/_____/_____ SEX: _____ M _____ F SS# _______ - _______ -________ JUVENILE ACTIVE CASE ID __________________________________ PRESENT OFFENSE CODE (List multiple offenses) ________________ _______________ ______________ DATE REFERRAL RECEIVED _____/______/_____ DATE FORM COMPLETED ______/______/______ COUNTY __________________ CIRCUIT __________ JUVENILE OFFICER ______________________________

THE MISSOURI JUVENILE RISK ASSESSMENT

2017

Age at 1st Referral 16…………………………………….-2 15 ......................................................... 0 14 ......................................................... 0 13 ......................................................... 0 12 and under…………………………..1 Prior Referrals None ..................................................... 0 One or more ......................................... 2 (Actual number of referrals______) Assault Referrals No prior or present referrals for assault ............................................. 0 One or more prior or present referral for misdemeanor assault .......... 1 One or more prior or present referrals for felony assault .................................. 2 (Actual number of referrals______) History of Placement No prior out-of-home placement.......... 0 Prior out-of-home placement ............... 1 Peer Relationships Neutral influence .................................. 0 Negative influence ............................... 1 Strong negative influence .................... 2 History of Child Abuse No history of child abuse/neglect ......... 0 History of child abuse/neglect.............. 1 (Petition filed/DFS finding of probable cause) Substance Abuse No alcohol or drug abuse problem ....... 0 Moderate alcohol and/or drug abuse problem ...................................... 1 Severe alcohol and/or drug abuse/dependence ................................ 2 School Attendance/Disciplinary No or only minor problems…………..-1 Moderate problems .............................. 0 Severe problems ................................... 1

If you did not use a sanction recommended by the matrix, check one of the following reasons why: _____ Nature of the offense _____ Severity of problems associated with one or more risk factors _____ Mitigating or aggravating circumstances _____ Judicial decision

Parental Management Style Effective management style .................. 0 Moderately ineffective management style ...................................................... 1 Severely ineffective management style ...................................................... 2 Parental History of Incarceration No prior incarceration ........................... 0 Prior incarceration ................................ 1

RISK SCORE: RISK LEVEL: 8 & above = High Risk 1 – 7 = Moderate Risk -3 – 0 = Low Risk Motion to dismiss for certification sustained: Check action taken (one): ______ Informal Adjustment ______ Formal Process/Adjudication Check all sanctions you used. A Disposition or Sanction needs to be applied within JIS _____ None _____ Warned/Counseled _____ Restitution _____ Community Service _____ Court Fees & Assessment _____ Supervision _____ Day Treatment _____ Intensive Supervision _____ Court Residential Placement _____ Commitment to DYS _____ Other: _____________________