1. Financial Resources
Do you have the financial resources to take care of your family’s needs? Have you been able to consistently pay your bills? Are you able to access community resources? Are you employed?
0 – No action needed. My family has enough resources to meet all financial needs, pay bills and feed the family.
1 – Let’s watch/Try to prevent. We have some financial resources, but will occasionally fall short.
2 – Help is needed. We have limited financial resources and I frequently need assistance.
3 – Help is needed now/immediately. We have no financial resources and are we unable to financially provide for our needs (rent, food, utilities, clothes, etc.).
2. Residential Stability
Is your current housing situation stable? Do you have any concerns that you might have to move in the near future? Have you lost your housing?
0 – No action needed. I have no intentions of moving anytime soon. I own my home.
1 – Let’s watch/wait. I’ve been living here about 3 months or I may be moving in about 3 months because I’m having some problems.
2 – Help is needed. I’ve moved around a lot in the past year.
3 – Help is needed now/immediately. I’ve been homeless at times during the last 6 months or I am about to be without a home.
3. Physical Condition of the Home
Is your home in need of repairs? Does your home have any safety concerns? Is your home weather-proofed (for the heat, rain or cold)? Are you aware of any housing code violations (such as lead based paint, mold, etc.)? Do you have enough space for all family members?
0 – No action needed. My home needs no repairs and there are no structural concerns. Everyone in my home has enough personal space.
1 – Let’s watch/try to prevent. I have some minor repairs to make, but it’s not much of a concern.
2 – Help is needed. I have repairs that are needed; I have some problems with vermin (mice, roaches, bedbugs, etc.) that I could use some assistance with; there are not enough appropriate places for everyone to sleep.
3 – Help is needed now/immediately. I have major repairs needed or my house is falling apart/being condemned; my home is infested with vermin; my water is unsanitary; I have exposed wires. I don’t have space for my child(ren) to sleep. My home is not safe for my children.
NA – I do not have a home at this time.
4. Home Maintenance
Do you have difficulty organizing your home? Do you keep your medications locked up? Is your home child-proofed? Do you need assistance cleaning?
0 – No action needed. My home is clean and organized. There are no safety concerns for my children. The medicines are safely stored from my children.
1 – Let’s watch/try to prevent. My home is cluttered or dirty from time to time. Meds and poisons are safely put away, but not locked up.
2 – Help is needed. I need help cleaning and/or organizing my home. Our medicines and cleaning supplies are up but within reach of the children. My gas, heat, or electricity does not work at times. I have too many items plugged in electrical outlets.
3 – Help is needed now/immediately. I need help making my house child-proofed. My windows need screens; I don’t have heat and/or air; I have noticed mold in my home; there are medicines and cleaning products out in the open; I am lacking beds and/or refrigerator. My home has an unidentifiable odor.
NA – I do not have a home at this time.
5. Natural Supports
Do you have family members, friends, and/or a religious organization who can help you when you need it? Who can you count on for help/support with your child? Do you have any other non-paid supports?
0 – No action needed. Several of my friends and family help me with the child. This is a strength for my family.
1 – Let’s watch/wait. I have some family/friends natural supports that help me with my child.
2 – Help is needed. I have some family/friends that maybe would help me with my child, but I need to ask. I’m not sure if my friends are very positive for my children.
3 – Help is needed now/immediately. I don’t know anyone appropriate who can help me with my child.
6. Family Conflict
Do all members of your family get along? Are there problems between specific family members? Has there ever been any violence? How is your family getting along right now?
0 – No action needed. Generally, the members of my family ‘get along’ with each other.
1 – Let’s watch, try to prevent. My family is ‘kind of’ getting along with each other; there are a few problems here and there.
2 – Help is needed. Family member(s) is/are not really getting along with others (parents, bros/sis). There is a lot of fighting.
3 – Help is needed now/immediately. Family member(s) is/are not getting along at all with anyone. There is constant arguing and there may be physical/domestic violence.
In the event of a crisis, is your family able to identify and use strengths to support one another? Are family members able to ‘bounce back’ after a stressful situation? What helps you cope with everyday life?
0 – No action needed. We are able to work together to overcome our challenges. This is a strength for my family.
1 – Let’s watch, try to prevent. We are able to identify our strengths, but at times we struggle with our challenges and crises. On occasion one of us used substances (beer, marijuana, pills, etc.) to get through our stress.
2 – Help is needed. We can identify our family strengths, but we have difficulty using them in a time of crisis. We use substances to help us cope with our stress at least on a weekly basis. More often than we wish, frustrations get the best of us. We have to call our counselor/case manager often for help.
3 – Help is needed now/immediately. I/we cannot handle stressful events or crises.
8. Family Safety
Do you feel your home and neighborhood are safe environments for your family? Do you worry about others potentially harming any members of your family? Are your children safe to play outside? Have you ever had past DCS involvement due to safety concerns?
0 – No action needed. My house is safe and secure. My family is not at risk from others.
1 – Let’s watch/wait. My family members are safe at home, but I am concerned about my neighborhood.
2 – Help is needed. A member of my family isn’t 100% safe at home and I am concerned because of another potentially harmful family member, family friend, or neighborhood acquaintance(s) that has access to our house and our family .
3 – Help is needed now/immediately. My child/family member is in immediate danger and I’m scared my child/family member could end up alone with a dangerous and harmful person.