SOCIAL HISTORY FORMAT IN THE JUVENILE COURT OF ______________________________ COUNTY, GEORGIA Childs Name:______________________________ DOB _________________Court Officer:______________________________ I. OFFENSE DATA: A. Prior Offenses Discuss previous contacts with the Juvenile Court in this county as well as any contacts with courts in other counties. B. Current Offense List the current complaint which brings the child before the Court and discuss any relative information which would shed light on the circumstances surrounding the offense. II. FAMILY DATA: Describe the family constellation in which the child is living. Which family members are regularly in the household? A. Father - Absent or present in the home? Is there a stepfather? Explain and define roles. Describe either or both along the following dimensions: (a) role in the home- relationship with spouse, type and consistency of discipline (b) employment - type of job, income, hours worked (c) role in community. Are there any outstanding problems: medical, emotional, drug/alcohol? B. Mother/Stepmother or Other Female Care-taker - Define roles. Describe either or both along the same dimensions as father above. C. Other Significant Adults - Age, sex, relationship to child. D. Siblings - Are any of the siblings positive resources for the child? Have any been involved with court? E. Home Life - Describe housing, neighborhood. Have there been any traumatic experiences (deaths, illness, divorces, etc.)? Describe basic feelings of family members toward each other (caring, hostile, indifferent). Has the family been referred to or involved in, counseling? F. Discuss how the child perceives the present situation and how the court involvement has impacted upon the lives of the family members. Is the child remorseful and willing to face whatever the court decides or is the child hostile and difficult to work with? Will the family resist efforts by the court to help or are they willing to cooperate with the worker? If there has been any prior Court involvement, what was the child and familys reaction to it? Rev. 01/2001 JUV-21>>>> 2III. CHILDS PERSONAL HISTORY AND ADJUSTMENT: A. Physical Health 1. Medical History - Give a general physical description. Discuss in detail any serious illness or handicaps. 2. Drug/Alcohol Involvement - Is the use/abuse of drugs or alcohol involved in the childs offense(s)? B. School - Academic and Vocational Aptitude - Discuss school attendance, achievement, behavior and extra curricular activities. Has the child any career goals, work experience or vocational interests? C. Leisure Time - Has the child any special interest, talents, or activities? D. Treatment Efforts - Has the child been referred to or evaluated by psychologists, mental health clinics, etc.? Has the child been previously placed in a Youth Development Center or other DJJ residential program or non-residential program? What other agencies are now or have been involved with child? IV. RECOMMENDATIONS: These should be well thought-out and reasoned recommendations which include justification for each recommendation. It should contain goals and the recommendations should be the means to achieve those ends. If the recommendation is for probation you should state what your goals are for the child and relate how you intend to help the child reach those goals. If you recommend restitution you should specify how much, to whom it should be paid, how it should be paid and how the victim should receive it. (Should the child be required to deliver it in person or pay it into the clerk of the Court?) Rev. 01/2001 JUV-21>>>> 3 SOCIAL HISTORY FACE SHEET Worker _______________________________________ County ______________________________________ Name ______________________________ Case # _______________________ Date___________ Address _____________________________________________________________________________ Social Security # _______________ Race / Sex ________ DOB ________ Phone # _________________ School __________________________________ Phone # ___________________ Grade ____________ Father Mother Other Male Other FemaleFull Name Address: If different from child Marital Status Occupation Income Highest Grade Siblings Name(s) Age Siblings Address(es) Marital Occupation Highest Status GradeHas a psychological or psychiatric evaluation been done?Date: / / By Whom: ___________________________________ Other agencies involved with family: ______________________________________________________ Current Offense:_______________________________________________________________________ History of Prior Dispositions Informally adjusted Comp. Disposition Date Date or adjudicated offenses Date Disposed DischargedRev. 01/2001 JUV-21