DCFS Help Unit Consultation Request Form Completed Form Examples and Samples

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A completed DCFS Help Unit Consultation Request Form showing extracted household and case data.

Source document used: Caseworker Clinical Narrative Notes

Caseworker Memo: Consultation Request for Case Smith-Jones (ID: 884920-DCFS). Current status indicates the family is working with 'Bright Horizons Family Services' as our primary POS agency. Household composition includes the primary individual, Mary Smith-Jones, and her spouse, John Smith-Jones (DOB: 05/12/1982). They have two children in the home: Marcus Smith-Jones (DOB: 09/14/2010) and Sarah Smith-Jones (DOB: 02/02/2015). We also have a fifth member, grandmother Elena Smith (DOB: 11/30/1955), residing with them. 

Recent reports are deeply concerning. Marcus has been exhibiting significant behavioral volatility, with teachers noting persistent outbursts and failure to engage in educational tasks. Mary has a long history of substance abuse which appears to be surfacing again, causing physical neglect of the household environment. John has been involved in multiple domestic violence incidents reported to local authorities, necessitating this urgent Help Unit consultation. We are worried about the safety of both children, particularly Sarah, given the chaotic environment. We are requesting immediate guidance on potential placement options and additional wraparound support services to mitigate these risks. All records were compiled on February 14, 2026, and submitted for review by the Help Unit today.