| Visit Date: March 25, 2020 | ID Number: 153255 | ||
| Visit Count: | Children Served: Provider opted out of answer | Children Served: select number | 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: 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: Yes | |||
| 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: Yes | |||
| 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: No | |||
| 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: No | |||
| Resource-Referral Type(s). None Of The Above |
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| Consultation Duration Start Time: 10:30 AM End Time: 11:40 AM Time Period: 60+mins |
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Goals |
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| Goals: Progress made towards goal? | |||
Notes for this Consultation
Client and her son called regarding her gson running away from his mother’s house and calling her. The police were called by both her gson’s mother and the Provider. She was directed to return gson to his mother despite his refusal to go. She feels like she failed him and that he will never trust her again. Talked about some positive pieces -the police will make another CPS report because her gson disclosed additional information about his mom’s abusive behavior. Talked to Provider about the process and how her gson will trust her, as she has always been there for him. Will support Provider in filing a contempt charge on a violation of a No Contact Order the family has against gson’s mother. |
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