Page 13 - ODJFS Human Trafficking Response Summary 2017-2018

19. Please indicate child's gender identity.
Male
Female
Transgender Male Transgender Female Other (please specify)
20. Please indicate child's race.
Asian
Black/African American
Native American/Alaskan Native Native Hawaiian/Pacific Islander Other (please specify)
Agender Genderqueer/Pangender/Bigender Unreported
White (Hispanic/Latino or Non-Hispanic/Non- Latino)
Multiple Races Unreported
21. Please indicate if any of the following special classification apply.
Homeless Youth (Age 24 or younger)
Immigrant/Refugee/Asylee or Currently Seeking Asylum
Lesbian/Gay/Bisexual/Transgender/Queer/Pan sexual/Intersex
Other (please specify)
Disability (Cognitive- Behavioral/Neural/Physical)
Disability (Sensory/Blind or Legally Blind/Deaf or Hard of Hearing)
Limited English Proficiency
22. If child has 'Immigrant' status, does the child have legal documentation?
Yes
No Pending Unknown
23. Please indicate child's ethnicity.
Hispanic/Latino Non-Hispanic/Non-Latino Other (please specify)
24. If Child has 'Immigrant' status, does child's guardian have legal documentation?
Yes
No Pending Unknown
25. Did the victim/survivor use any drugs (either by their own will, coercion, threat, or force) in relation to the trafficking/exploitation case?
Yes
No Unreported/Unknown
26. If 'Yes', please provide any additional details regarding type of drugs and circumstance, if possible.
27. Who made the referral to your CAC regarding this particular victim/survivor?
Children Services Juvenile Court
Juvenile Detention Center Law Enforcement
Medical Provider
Anti-Trafficking Coalition
Other (please indicate referent below)
Anti-Trafficking Task Force School/Educator
Family Member
Friend
Care Provider
ICAC (Internet Crimes Against Children)
11
12
9 10
33. What was the location of residence at time of intake?
28. Which of the following services were provided to this victim?
Forensic Interview
Medical Services
Mental Health
Abuse Assessment Substance Abuse Services Housing Referral/Placement
Faith-Based Services Case Management Victim Advocacy Case Tracking Trauma Screening
29. Did you work with your local anti-trafficking coalition or task force on this case?
Yes No
30. In this case, was CPS/JFS/CSB actively involved?
Yes No
31. Which County's CPS/JFS/CSB had involvement in this case?
32. What was the CPS/JFS/CSB Determination?
Administrative Closure
Unable to Determine/Indicated Moved/Relocated
Other (please specify)
Substantiated Unsubstantiated Pending
Home with Non-Offending Caregiver Returned Home
Foster Care
Group Home
Other (please specify)
Respite Placement
Juvenile Detention Center Placement/Kinship Care/Relative Pending
34. Where does the child currently reside after the initial allegation?
Home with Non-Offending Caregiver Returned Home
Foster Care
Group Home
Other (please specify)
Respite Placement
Juvenile Detention Center Placement/Kinship Care/Relative Pending
35. Was a Law Enforcement entity involved in this case? (You may select more than one)
None (No law enforcement involvement) BCI
FBI
Homeland Security
Internet Crimes Against Children Sheriff's Office
Other Local Law Enforcement
36. If Local Law Enforcement was involved in this case, please identify agency below.
37. If a Sheriff's Office was involved in this case, which county are they affiliated with?