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: No | |||
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: 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: 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, Interpersonal safety, Family and community support |
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Consultation Duration Start Time: 10:00 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
Mom called to tell me how worried she was. She had sent her husband to gather her belongings from her home and that’s when the husband met with the neighbor outside while standing by their door smoking. Her husband was shocked for his life. This neighbor is the reason why everything happened in the first place. They were told he was evicted from his house and yet he is still there. Mom fears that if she returns to her home, something terrible will happen. They fear for their lives. |