| Visit Date: March 20, 2023 | ID Number: | ||
| Visit Count: | Children Served: Provider opted out of answer | Children Served: select number | Community Health Worker: Dahabo M |
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: No | |||
| 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: No | |||
| Childcare Play and Learn and / or outdoor time. Answered: Yes | |||
| 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: No | |||
| 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: Yes | |||
| How to help me cover my HRSN (e.g. food, transportation, housing, medical needs, employment). Answered: Yes | |||
| Coping with stressful situations. Answered: No | |||
| 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: No | |||
| Resource-Referral Type(s). Housing instability, Family and community support, Physical activity |
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| Consultation Duration Start Time: 12:15 PM End Time: Time Period: Under 15 minutes |
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Goals |
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| Goals: Progress made towards goal? | |||
Notes for this Consultation
Today I called mom, to ask how the situation is going. She says she is still with friends and family. I asked if she delivered the package to her manager office and she said yes she delivered to them. The office had spoke with mom and told her that they are currently working on her transfer but it is hard looking for a 4-bedroom unit. They said that they are working hard to get her a home and doing their best. For now, we will have to wait and see. |
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