| Biologic Family Assessment/Intervention Guide |
| |
Factor |
(a) Low
Risk |
(b) Intermediate
Risk |
(c) High
Risk |
C
H
I
L
D |
1. Infant's drug withdrawal symptoms |
Withdrawal symptoms not apparent |
Mild tremors; sleeps at least 3 hrs. after feeding; feeding well; normal stools |
Vomiting: watery stools; fever; sleeps less than 2 hrs. after feeding; marked tremors; poor feeding; high pitched cry; seizures; lethargic; on meds for drug withdrawal |
| 2. Special medical &/or physical problems |
No apparent med. or phys. prob. |
Minor med. or phys. prob. which do not significantly affect infant's vital life functions or physical & intellectual development |
Any pre-term inf. (born at or before 36 wks.) &s;/or phys. or med. prob. which significantly impact vital life functions or phys. & intel. developm. (e.g., cardiac defect, apnea monitor, visual or hearing handicap, seizure disorder) |
| 3. Special care needs of child |
Only routine pediatric care; no special equipment or medication |
Monthly pediatric care visits & no medicine or special equipment |
Requires 2 or more monthly visits for pediatric care &/or special equipment or medication |
P
A
R
E
N
T |
4. Current drug user |
Not currently using any drugs |
Occasional 1-2x wk. or wknd. use |
Use more than 2x wk.; any use of PCP or Crack |
| 5. Drug treatment history |
Entered drug trtmt. early in pregnancy, remains in program & considered compliant |
Entered drug trtmt. early in pregnancy, remains in program, but attendance sporadic &/or continues to use drugs |
Not in drug trtmt. program or entered in 3rd trimester |
| 6. Prenatal care |
Sought early prenatal care and consistent with follow-up |
Sought prenatal care in 2nd trimester but inconsistent w/prenatal follow-up/medical advice |
Did not seek prenatal care until 3rd trimester; no prenatal care |
| 7. Parent's physical, intellectual, or emotional abilities/control |
No intellectual/
physical limitations; realistic expectations of child; in full control of mental faculties |
Mild physical/
emotional handicap; mild intellectual limitations which would not significantly impact ability to care for child |
Mod. to severely handicapped; poor perception of reality; unrealistic expectations/
perceptions of child's behavior; severe intellectual limitations; incapacity due to alcohol/drug intoxication; past criminal/mental illness; poor impulse control (i.e. demonstrated evidence of violence in home) |
| 8. Parent's level of cooperation |
Willingness & ability to work w/agency to resolve problem & protect child |
Overtly compliant w/investigator &/or presence in home of non-drug using adult to assure minimal cooperation w/agency & follow thru w/med. recommend. |
Doesn't believe there is prob.; refuses to cooperate; disinterested or evasive |
| 9. Parent's awareness of impact of drug use on child |
Expresses concern/interest about drugs; effect on child & sought professional advice & counseling |
Displays concern/interest in child but denies symptoms & special needs |
Displays lack of concern/interest for child & denies symptoms |
| 10. Parenting skills & responsiveness to infant |
Parent exhibits appropriate parenting skills & knowledge re: special medical follow-up care and is responsive to infant's needs |
|
Parent may prov. appr. phys. care but is unresponsive to infant's needs (i.e. lack of response to crying of infant.
Poor eye contact, infrequent visits, inappropriate expectations and criticism of child) |
| 11. History of abuse/neglect |
No known history of abuse/neglect |
Prior protective services provided to child or sibs. with that episode resolved & case closed |
Pending child abuse/neglect investigation; previous abuse/neglect of serious nature/prior/
dependency |
E
N
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R
O
N
M
E
N
T
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12. Father or parent substitute (F or PS) in home.
name:______
(Circle F or PS to specify) |
F or PS in home, who is a supportive/
stabilizing influence & available to assist w/caretaking |
Stable F or PS in home, but assumes only minimal caretaker responsibility fo child |
F or PS who resides wi/family & has poor impulse control (i.e. demonstrated evidence of violence in home), &/or is involved in drug activity |
| 13. Strength of family support systems |
Family, neighbors, or friends available & committed to help; membership in church, community, or social group |
Family supportive but not in geographic area; some support from friends & neighbors; limited community services available |
No relatives or friends available/
committed; geographically isolated from community services; no phone; no transportation available |
| 14. Drug use in home |
No member of household suspected to be involved in drug activity (sale, use, and/or mfg.) |
|
Anyone in the household suspected to be involved in drug activity |
| 15. Sibling assessment (use standard Risk Assessment Guide for sibs.) |
Education, medical & environmental needs being met for all sibs. |
Some but not all educ., med., & environ. needs being met for all sibs. |
Few edus., med., & environ. needs being met for all sibs. |
| 16. Environmental condition of home |
Home relatively clean w/no apparent safety or health hazards; utilities operable; no infestation of rodents & vermin. Evidence of preparation for infant's arrival (clothing, furnishings, formula) |
Home rel. clean (see(a)) but no evid. of prep. for infant's arrival... or vice versa |
Home unclean w/safety or health hazards; no evidence of prep. for infant's arrival |
