| Visit Date: April 23, 2021 | ID Number: 153164 | ||
| Visit Count: | Children Served: Provider opted out of answer | Children Served: 1 | Community Health Worker: SIC Other Staff |
Consultation services Delivered |
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| What type of Consultation was it? Phone or virtual consultation session | |||
| Consultation with providers/caregivers on administering ASQ * Answered: No | |||
| Did you make a Child Development Referral (Not Screening) * Answered: No | |||
| How Many Referrals: Answered: select number | |||
| Get information on how to help me cover my basic needs (food – clothing – housing – medical attention) Answered: Yes | |||
Healthy and Safe Environment Concerns |
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| Is your home safe for children? : Answered: No | |||
| Safe Sleep: Answered: Yes | |||
| How to prevent the spread of illness: Answered: No | |||
| First Aid: Answered: No | |||
| Car Seat Safety: Answered: No | |||
| CPR: Answered: No | |||
| Toxic: Answered: No | |||
| Being ready for a natural disaster: Answered: No | |||
Child Development Concerns |
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| How do I incorporate activities from my homeland that will support the healthy development of my children?: Answered: No | |||
| How do I help children that have difficult? behavior (setting limits and sticking to them)?: Answered: No | |||
| How do I know that the children in my care are learning and developing OK? : Answered: No | |||
| Developmental Screening?: Answered: No | |||
| Early Intervention: Answered: No | |||
| How do I help babies brain develop?: Answered: No | |||
| How to help the children in your care get ready for school. Answered: No | |||
| How my relationship with the children can help them feel secure about themselves. Answered: Yes | |||
| Childcare Play and Learn and / or outdoor time. Answered: No | |||
| Referral to early intervention for a special needs child. Answered: No | |||
Healthy Children |
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| Working with children with special healthcare needs. Answered: No | |||
| Immunizations and Well Child Schedules. Answered: No | |||
| Hand-washing – diapering – toileting. Answered: Yes | |||
| Medication Management Children (Non-clinical). Answered: No | |||
| Nutrition (meal planning – allergies – infant Feeding). Answered: No | |||
| Social/Emotional development. Answered: No | |||
| Mental/Behavioral Health Services (Child). Answered: No | |||
Healthy Caregivers |
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| Taking care of yourself (Whole Person). Answered: No | |||
| Getting further training or school or Certification to improve my Health-Related Social Needs (HRSN). Answered: No | |||
| How to help me cover my HRSN (e.g. food, transportation, housing, medical needs, employment). Answered: Yes | |||
| Coping with stressful situations. Answered: Yes | |||
| Mental / Behavior Health Services (Non Clinical). Answered: No | |||
| Medication Management Adult (Non Clinical). Answered: No | |||
| Child Caregiver relationship. Answered: Yes | |||
| Caregiver of Child relationship. Answered: Yes | |||
| Did you make a Community Resource-Referral. Answered: Yes | |||
| Resource-Referral Type(s). Interpersonal safety |
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| Consultation Duration Start Time: 6:38 PM End Time: 6:59 PM Time Period: 30 mins |
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Goals |
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| Goals: Goal attained | |||
Notes for this Consultation
Provider stressed about her younger sister and her mother relationship. Incident regarding “whipping her ass and saying I hate that bi…ch”, after a incident involving her mother ,her sister and baby niece. The provider’s relationship with her mother is becoming increasingly difficult. “Our mother is treating her like s..t”. The way she did me. Talked about concerns about their plan to sale the house, quiting her job, telling provider she can’t handle their relationship…., consultation, find way and place to ensure sister safe, support sister (who she reported had been cutting on herself, and give prover for sister resources to contact crisis line and medical doctor fir sister. Provider will take sister to family members home and setup sister phone and contact information for reaching crisis line and call sister medical doctor to discuss next steps. |
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