9. Adjustment to Trauma
What is the worst thing that has happened to you? Have you ever experienced a very stressful situation? This can include a difficult move, loss of a loved one, witness to a violent situation, car accidents, natural disasters, abuse, military deployment/war experiences, etc.
0 – No action needed. I have not experenced any significant trauma or can quickly get over traumatic experiences.
1 – Let’s watch/wait. I experienced past traumatic life events but they no longer have an effect on me; or I am unsure if these events have had an effect on me.
2 – Help is needed. I have some difficulty dealing with my traumatic experiences. I believe I experience one or more of the following: continued stress due to the situation, depression, nightmares, anxiety, anger, difficulty leaving the house, etc., which makes it hard to be a parent.
3 – Help is needed now/immediately. I have great difficulty dealing with my past experiences. I often think or worry about it, and it’s affecting my daily life. I have been diagnosed with PTSD and I am not taking any medications to treat the PTSD. I am having a very difficult time trying to parent at the moment because of my symptoms.
10. Medical/Physical Health
How is your health? Do you have any health problems that make it hard for you to take care of your family? Have you had any recent surgeries or have any upcoming surgeries? Do you experience any chronic health issues
0 – No action needed. I’m pretty healthy.
1 – Let’s watch/wait. I’m recovering from some health problems.
2 – Help is needed. I have some health problems that get in the way of parenting.
3 – Help is needed now/immediately. I have great difficulty taking care of my child because I have some serious health problems.
11. Developmental- (Intellectual Disability)
Has anyone ever told you that you may have developmental problems that makes parenting/caring for your child more difficult? Do you have difficulty understanding what is needed for your child? Do you need help reading medicine labels and school letters? Do you receive Social Security Disability
0 – No action needed. I’m able to function as a parent.
1 – Let’s watch/try to prevent. I have some problems here and there, but I can still take care of my child.
2 – Help is needed. I have some difficulties functioning and I need some help being a better parent.
3 – Help is needed now/immediately. I have some serious difficulties functioning and I am struggling to parent my child.
12. Mental Health
Do you have any mental health needs that make parenting more difficult? Do you need assistance accessing a counselor or medication management for emotional problems? Do you have any mental health diagnoses?
0 – No action needed. I’m emotionally stable and have no mental health diagnoses.
1 – Let’s watch/wait. I’m recovering from some emotional problems and I am not required any medication, or I have been emotionally stable with my current medications for over a year.
2 – Help is needed. I have some emotional problems that sometimes make it difficult to parent. I am not currently on medication. Medication could help me with my emotional/ mental health problems.
3 – Help is needed now/immediately. I am struggling to take care of my child because I am having some serious emotional problems. I am not able to get my needed mental health medication.
13. Substance Use
How often do you use alcohol and drugs? Does your use of alcohol and/or drugs make parenting more difficult? Have you ever received alcohol or drug abuse treatment? Has anyone expressed concern about your alcohol or drug use
0 – No action needed. I don’t use drugs or alcohol.
1 – Let’s watch/wait. I’m in recovery from drugs/alcohol abuse or I may have occasional alcohol and/or drug use.
2 – Help is needed. I use drugs/alcohol and I have difficulty taking care of my child sometimes because of it.
3 – Help is needed now/immediately. I use drugs/alcohol and it can be very challenging trying to parent right now because of it.
14. Criminal Activity
Do you have any current or past criminal activity that led to a misdemeanor or a felony? Do you have any pending charges? Are you currently on probation
0 – No action needed. I am not involved with any criminal activity and have no history of criminal behavior.
1 – Let’s watch/wait. I have a history of criminal activity, but I have not engaged in any illegal activities in the past year or longer.
2 – Help is needed. I have recently been released from jail, I am on house arrest, or I currently participate in activities that could land me in jail.
3 – Help is needed now/immediately. I have pending criminal charges. I actively participate in behaviors that are of the criminal nature. I need a plan quickly so that my child will be taken care of if I go to jail.
15. Supervision
How do you feel about your ability to monitor or keep an eye on your child? Are the children following rules at home? Does your child sneak out or leave home without permission? Do you have difficulty finding someone to watch your children? Do you think you might need some help with these issues?
0 – No action needed. I can monitor my child. I have appropriate childcare.
1 – Let’s watch/wait. For the most part I can monitor my child, but may need occasional help.
2 – Help is needed. I have a lot of trouble monitoring my child or finding appropriate childcare and I need some kind of help.
3 – Help is needed now/immediately. I can’t seem to monitor my child and I have no childcare. I need a lot of help and I’m concerned that she/he may get hurt.
16. Discipline
How do you feel about your ability to discipline your child/children? Do you feel your discipline is fair and effective? Do your discipline techniques prevent the unwanted behavior of your child? What kind of discipline do you use? What techniques do you use to encourage positive behavior? Do you think you might need some help with this?
0 – No action needed. I can discipline my child effectively and safely.
1 – Let’s watch/wait. For the most part I can effectively discipline my child, but may need occasional help with it.
2 – Help is needed. I have a lot of trouble effectively, consistently and/or safely disciplining my child. I need some kind of help.
3 – Help is needed now/immediately. I can’t discipline effectively, and I’m concerned that she/he may get hurt or hurt others.
17. Involvement in Caregiver Functions
How active and involved are you in your child’s daily life? Do you eat meals together, help with homework, play games, etc.? Do you participate in activities out of the home such as attending school meetings, taking your child to the doctor when needed, attending their recreational activities, etc.?0- No action needed. I am fully involved as a parent.
1 – Let’s watch/try to prevent. I am involved with my child as much as I can. There may be times when my job or other things (other responsibilities, lack of transportation, personal activities, stressors) interferes with the time I have with my child, but this does not occur often. I have a history of having little involvement with my child, but it is not a current issue.
2 – Help is needed. I am involved with my children, but I am often distracted by other things that I have going on. I see the children daily, but we both stay busy.
3 – Help needed now/immediately. I am not actively involved with my children. My children go about their business and I go about mine. I do not have daily contact with them. I am unable to have daily interactions due to other responsibilities, stressors, etc.
18. Knowledge of Child and Family Needs
Do you know how to meet your child’s and family’s needs? Are there areas that you feel you would like to know more about to help meet your child’s/ family’s need(s)? Have professionals told you things about your child/family that were confusing to you or you didn’t understand?
0 – No action needed. I know what my child’s/family’s good points are, and I know how to meet the need(s).
1 – Let’s watch/wait. I know a lot about my child/family, but I think that I could use some more information.
2 – Help is needed. I definitely need some more information in order to better care for my child/family.
3 – Help is needed now/immediately. I need help understanding what my child/family needs and how to go about meeting those needs.