Form 1 Further Assessment Swift Track (FAST) Placement Tool

OMB Control No: 0970-XXXX
Expiration date: XX/XX/XXXX

INTAKES PLACEMENT 

TO BE COMPLETED BY INTAKES 

INITIAL PLACEMENT DECISION 
Date of Initial Placement:  

*First Name:

Program Name:  

*Last Name:

.
.

Program Type:  
*A Number:
DOB:

*OVERRIDE?

.

Yes

No

͘ 

Age
*Gender:
Country of 

Male

Female

.

Birth:  
Re‐
Apprehension? 

Yes 

No

Intake Staff 
Name:  

Placement Matrix  
Initial Placement Score:(Sum of scores for questions 1 to 5): 

Initial Placement Score 

Recommended Placement Type  

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) Public reporting burden for this collection of information is estimated to average .50/ hour per
response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not
conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

OMB Control No: 0970-XXXX
Expiration date: XX/XX/XXXX

0‐5  

Shelter  

6‐7  

Staff‐secure FAST  

8‐12  

Staff‐secure  

13+  

Secure ‐ FAST  

Is this a FAST placement?  
Note: If an upward override is used, the 
placement will also 
be treated as a FAST placement, and “Yes” should 
be selected.  

Yes

No

Are additional therapeutic services required?  

Yes

No

Is this an override of the Placement Matrix?  

Yes

No
confirm that DCS supervisor 

I 
If this is an override, fill in the blanks: 

, time: 
Phone Call

approved this override on date: 

in a  
in‐person conversation

email

Justification for Override:  

PART A: DANGER TO OTHERS
In order to establish the appropriate placement, ORR/DCS must assess the risk the UC poses to others.  
Question 1. Delinquency/criminal record 
Take into account a UC’s prior arrests, charges, and adjudications. You should select ONLY the highest score applicable to the UC’s delinquent/criminal record. For 
guidance on scoring specific offenses, see the Program Guidance. Note that dropped charges should be scored differently during Intakes and FAST reviews; see the 
Program Guidance for an explanation.  
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) Public reporting burden for this collection of information is estimated to average .50/ hour per response, including the time
for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a currently valid OMB control number.

OMB Control No: 0970-XXXX
Expiration date: XX/XX/XXXX

Score  Int.  Fac.  FFS 
No indication  

0  

Non‐violent offenses  
One or multiple petty offenses only e.g. disorderly conduct, disturbing the peace, drug possession, DUI, false ID, public intoxication, resisting 
2  
arrest, shoplifting, technical probation violation, vandalism  
Non‐petty offenses (no violence/weapons) e.g. smuggling, breaking and entering, burglary, car theft, drug distribution, fighting, prostitution, statutory rape without 
violence or intimidation, threats  
One incident 3 
More than one incident 6  
Violent/weapons offenses  
Possession of non‐firearms weapons e.g. possession of brass knuckle, possession of a knife 
One incident 7 
More than one incident 10  
Violent offenses e.g. assault, battery, robbery (No weapons involved, but can include use of hands, fists, etc.) 
One incident 8 
More than one incident 13  
"Weapon 1” involved (Weapon 1 = weapons other than knives or guns, including brass knuckles broken bottles, scissors, etc.) e.g. assault, battery or robbery with 
brass knuckles  
One incident 11 
More than one incident 16  
“Weapon 2” involved (Weapon 2 = knives) e.g. assault, battery, or robbery with a knife 
One incident 14 
More than one incident 19  

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) Public reporting burden for this collection of information is estimated to average .50/ hour per response, including the
time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a currently valid OMB control number.

OMB Control No: 0970-XXXX
Expiration date: XX/XX/XXXX

Possession of “Weapon 3” (Weapon 3 = firearms/guns) e.g. possession of firearm (One or multiple incidents)  

17  

Violent offenses involving “Weapon 3" e.g. assault, battery or robbery with a firearm (One or multiple incidents)  

20  

Sexual Assault e.g. attempted rape, child molestation, lascivious acts 
One incident 13 
More than one incident 18  

Very serious violent offenses e.g. abduction, assault involving serious bodily injury, attempted murder, homicide, murder, rape, statutory 
rape with violence (One or multiple incidents)  
Int.  

Fac. 

20  

FFS 

Comments 

Question 2. Violence/threats in government custody
Take into account past violence or threats in any government custody, including local, state, or federal, and previous DCS placements.  
Do not take into account threats or violence for which an arrest, charge, or adjudication was counted above in Question 1.  
Do not take into account any behavior that is not specifically described as a threat or violent act. 
Do not take into account any new incidents occurring during the FAST period. These should be addressed in Question 7 only.  
Additional instructions are provided in the Program Guidance. 
Score  
No indication  

0  

Threats only  

1  

Int.  

Fac.  

FFS  

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) Public reporting burden for this collection of information is estimated to average .50/ hour per response,
including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor,
and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

OMB Control No: 0970-XXXX
Expiration date: XX/XX/XXXX

1 or more incidents of violence without injury  

2  

1‐2 incidents of violence causing injury  

4  

3 or more incidents of violence causing injury  

6  

Question 3. Gang involvement 
Take into account any evidence of the UAC’s gang involvement.  
Select “Suspected” gang membership when there is only a suspicion of gang membership.  
Select “Admitted or Confirmed” gang membership only if there is specific evidence, such as self‐admission, gang‐specific tattoos, a gang moniker, etc. 
Additional instructions are provided in the Program Guidance. 
Score  Int.  Fac.  FFS 
No indication  

0  

Gang membership suspected  

2  

Gang membership admitted or confirmed 4  
Leadership of gang confirmed  
Int.  

10  
Fac. 

FFS 

Comments 

PART B: RISK OF FLIGHT
In order to establish the appropriate placement, ORR/DCS must assess the UC’s risk of flight.  
Question 4. Prior escapes from government custody
Take into account any prior escapes, escape attempts, and serious threats to escape from an actual Program (e.g. a DCS Program, shelter/foster‐care placements, 
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) Public reporting burden for this collection of information is estimated to average .50/ hour per response,
including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and
a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

OMB Control No: 0970-XXXX
Expiration date: XX/XX/XXXX

and detention facilities). Do not take into account attempts to evade law enforcement officials, such as border patrol agents. Additional instructions are provided in 
the Program Guidance.  
Score  
No indication  

0  

Single escape attempt  

1  

Multiple escape attempts  

3  

Single escape from non‐secure setting  

5  

Multiple escapes from non‐secure settings  

7  

Single escape from staff‐secure Program  

8  

Multiple escapes from staff‐secure Program  

9  

Any escape from secure Program  

10  

Int. 

Fac. 

FFS 

Question 5. Other flight risk factors 
Check all factors that apply. If one or more of the following risk factors is checked, select a score of 1. Additional instructions are provided in the Program Guidance. 
Score 

Int. 

Fac. 

FFS  

Final order of removal  
Prior removal(s)/reinstatement(s)  
Within one month of turning 18  
Breach of bond/failure to appear in immigration court  
Total Score(0 or 1): 

0

0

0

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) Public reporting burden for this collection of information is estimated to average .50/ hour per response, including
the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a currently valid OMB control number.

Int.  

Fac. 

OMB Control No: 0970-XXXX
Expiration date: XX/XX/XXXX

FFS 

Comments 

PART C. DANGER TO SELF
In order to establish the appropriate placement, ORR/DCS may consider the UC’s mental health and therapeutic needs.  

INTAKES 
To be completed by ORR/DCS Intakes: Take into account all available information about a child’s mental health and therapeutic needs. For example, prior arrests, 
charges, and adjudication for sexual offenses and/or alcohol or drug‐related offenses may indicate a therapeutic need.  
Yes Consult with DCS Case Management, go to 6.b.
6a. Are there signs of any serious mental health issue or other therapeutic needs?  
No  Stop here
Yes Go to 6.c.
6b. I confirm that case management (or if after hours, with a DCS supervisor) was consulted.  
No  Explain why:
Yes Explain:
6c. Based on conversation with case management, is a placement with therapeutic services required? 
No  Explain why:

FAST 
For FAST Cases:  Indicate whether a therapeutic need has been identified. This determination may be based on any available information, including 
clinical assessments and the DFC Level of Care Placement Tool.  
6a. Has a therapeutic need been identified?  

Fac.  FFS 

Yes, go to 6b 

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) Public reporting burden for this collection of information is estimated to average .50/ hour per response, including the
time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a currently valid OMB control number.

OMB Control No: 0970-XXXX
Expiration date: XX/XX/XXXX

No, stop here 

6b. Does this therapeutic need require a change in placement (i.e. a move to another Program with additional/specialized therapeutic 
services)?  

Int.  

Fac. 

Yes  
No  

FFS 

Comments 

PART D. FAST OVERRIDE CONSIDERATIONS 
Parts D is applicable to FAST Cases Only – To be completed during a FAST review following the initial placement.  

Question 7a. Behavioral adjustment in Program
Take into account the UC’s behavior during the FAST period and whether the UC can be safely housed in a less secure program than the UC’s initial placement 
program. Additional instructions are provided in the Program Guidance.  
Fac. 
Is there evidence from the child’s behavior during the FAST period that s/he could be safely housed in a less secure setting than the current 
setting?  

FFS 

Yes  
No  

Question 7b. Additional youth welfare criteria
Indicate whether there is an imminent legal process or family reunification reason to maintain the UC in the initial placement program. This determination may be 
based on, but need not be limited to, information provided in an attorney letter. No inference should be made if an attorney or Vera legal service provider does not 
provide an attorney letter.  
Fac. 
Is there a reason to maintain the youth in the current program based on:  

FFS 

Yes  

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) Public reporting burden for this collection of information is estimated to average .50/ hour per response, including
the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a currently valid OMB control number.

OMB Control No: 0970-XXXX
Expiration date: XX/XX/XXXX

No  
An imminent legal process? 
No Infomation  
Yes  
An imminent family reunification?  No  
No Infomation  
Attorney Letter Provided?   
If so, please attach the letter and provide Attorney’s Name (and organization, 
if applicable):  

Int.  

Fac. 

Additional instructions about attorney letters are provided in the 
Program Guidance.  

FFS 

Comments 

FINAL PLACEMENT – FAST CASES ONLY  

FFS Name:  
Program Staff Name:  
Placement Matrix 
FAST Placement Score: (Sum of scores for questions 1 to 5)  
FAST Placement Score  
0‐5  

Recommended Placement Type 
Shelter  

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) Public reporting burden for this collection of information is estimated to average .50/ hour per response,
including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and
a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

OMB Control No: 0970-XXXX
Expiration date: XX/XX/XXXX

6‐12  

Staff‐secure  

13+  

Secure  

In light of the responses to Questions 6 and 7, is an override of the Placement Matrix recommended based on: 
Therapeutic needs:  

Yes

No

Child’s behavior in program:  

Yes

No

Imminent legal process:  

Yes

No

Imminent family reunification:  

Yes

No

FINAL PLACEMENT DECISION – to be completed by FFS 
Date of Final Placement:  
Program Name:  
Program Type:  

Is the final placement different from initial placement?  

Yes

No

Is this an override of the Placement Matrix?  

Yes

No

I 

confirm that DCS supervisor 
Phone Call 

in‐person conversation 

approved this override on date: 

, time: 

in a 

email

Justification for Override or Change in Placement: 
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) Public reporting burden for this collection of information is estimated to average .50/ hour per response,
including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

OMB Control No: 0970-XXXX
Expiration date: XX/XX/XXXX

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) Public reporting burden for this collection of information is estimated to average .50/ hour per response,
including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or
sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.