CAFES Case Closure Survey

"*" indicates required fields

A copy of your responses will be emailed to the address you provided.
CAFES Name*
Client Name
Type of Client:

Case was closed before CAFES able to work with client: (check box and hit submit without completing the rest of the form).

MM slash DD slash YYYY
# of months worked with client/s:*

Interventions/ Work Done on Case (check all that apply)

PAST Status/ Prior to CAFES involvement for Parents: Housing

PRESENT Status/Post-CAFES involvement for Parents: Housing

PAST Status/ Prior to CAFES involvement for Parents/NMD: Employment

PRESENT Status/ Post-CAFES involvement with parents/NMD: Employment

PAST Status/ Prior to CAFES involvement with parents/NMD: Mobility/Transportation

PRESENT Status/ Post-CAFES involvement with parents/NMD: Mobility/Transportation

PAST Status/ Prior to CAFES involvement with parents/NMD: Life Skills

PRESENT Status/ Post-CAFES involvement with parents/NMD: Life Skills

PAST Status/ Prior to CAFES involvement for parents/NMD/and Minors: Family/Social Relations

PRESENT Status/ Post-CAFES involvement for parents /NMD and Minors: Family/Social Relations

PAST Status/ Prior to CAFES involvement for parents/NMD: Community Involvement

PRESENT Status/ Post-CAFES involvement for parents/NMD: Community Involvement

PAST Status/ Prior to CAFES involvement: Parenting Skills

PRESENT Status/ Post-CAFES involvement: Parenting Skills

PAST Status/ Prior to CAFES involvement for parents/NMD: Legal

PRESENT Status/ Post-CAFES involvement for parents/NMD: Legal

PAST Status/ Prior to CAFES involvement for parents/NMD and Minors: Substance Abuse

PRESENT Status/ Post-CAFES involvement for parents/NMD and Minors: Substance Abuse

PAST Status/ Prior to CAFES involvement for Minors: Education

Present Status/ Post-CAFES involvement for Minors: Education

Placement (for Minors only) BEFORE CAFES involvement:

Permanency Planning BEFORE CAFES involvement:

Permanency Planning/ Outcome (after work with CAFES):

MM slash DD slash YYYY